(A) "Community transition
services" pay
s for non-recurring start-up living expenses for
individuals transitioning from an institutional setting to a home and
community-based services (HCBS) setting that is compliant with rule
5160-44-01 of the Administrative
Code. Community transition
services:
(1)
Include
expenses necessary to enable an individual to establish a basic household.
Examples include:
Community transition includes
the following:
(a)
Expenses necessary to enable an individual to establish
a basic household. Examples include:
(i)
Security deposits
and rental fees needed to obtain a lease on an apartment or home and rental
expenses required to obtain a residential lease;
(ii)
Essential
household items such as furnishings and moving expenses required to occupy and
use a community home, including furniture needed to occupy and maintain
housing, including window coverings, food preparation items, and
linens;
(iii)
Set-up fees and deposits for utility and service
access, including telephone/cellphone, electricity, gas, garbage, and
water;
(iv)
Services necessary for the individual's health and
safety such as pest eradication and one-time cleaning prior to
occupancy;
(v)
Pre-transition transportation necessary to secure
housing and benefits, etc.;
(vi)
Initial cleaning
and household supplies;
(vii)
Activities to arrange for and to procure other
non-recurring set-up expenses; and
(viii)
Essential
personal hygiene and clothing items needed to transition
safely.
(b)
The provider's administrative cost associated with
providing community transition under this rule. Such fees will be included in
the authorization described in paragraph (A)(2)(b) of this rule.
(a) Security deposits and rental
expenses required to obtain a residential lease;
(b) Basic household items required
to occupy and maintain housing, including window coverings, food preparation
items, and linens;
(c) Fees and deposits for utility
and service access, including telephone/cellphone, electricity, gas, garbage,
and water;
(d) Moving expenses;
(e) Pre-transition transportation
necessary to secure housing and benefits, etc.;
(f) Initial cleaning and household
supplies;
(g) Activities to arrange for and to
procure other non-recurring set-up expenses; and
(h) The provider's administrative
cost associated with providing community transition services under this rule.
Such fees shall be included in the authorization described in paragraph
(A)(2)(b) of this rule.
(2)
Are
Is payable only to the extent:
(a) They are determined reasonable and
necessary through the person-centered services planning process described in
rule
5160-44-02 of the Administrative
Code and are clearly identified in an individual's person-centered services
plan; and
(b) They are authorized
by the Ohio department of medicaid (ODM), the Ohio department of aging (ODA) or
their designee in an individual's person-centered services plan, which
shall
will
only occur if no other person, including a landlord, has a legal or contractual
responsibility to fund the expense, and if family, neighbors, friends, or
community resources are unavailable to fund the expense.
(3) May be authorized up to one hundred
eighty consecutive days before an individual's transition from an institutional
setting into an HCBS setting. The date of service for purposes of payment
shall be
is
the date the individual leaves the institutional setting. If the individual
fails to transition to an HCBS setting, the service is still payable if all
other requirements are met.
(4)
Shall be
Is
provided no later than thirty days after the date on which an individual
enrolls on the waiver program.
(B) Community transition
services do
does not include:
(1)
Room and board, ongoing monthly rental, or mortgage expenses;
(2) Grocery expenses;
(3) Ongoing utility or service
expenses;
(4) Ongoing cable or
internet expenses;
(5) Electronic
and other household appliances and items intended to be used for entertainment
or recreational purposes; and
(6) Tobacco products
and
or
alcohol.
;
and
(7)
Furnishing living arrangements that are owned or leased
by a waiver provider where the provision of these items and services are
inherent to the service they are already providing.
(C) Limitations.
(1) Community transition
services shall
will only be used one time per individual per waiver
enrollment.
(2) Community
transition
services shall
will not exceed two thousand dollars per
individual per waiver
program enrollment.
(D) The provider shall involve the
individual and/or caregiver(s) in the selection of items to be purchased on the
individual's behalf.
(E)(D) Providers
shall
will:
(1) Be either:
(a) An ODM-approved or ODA-certified waiver
agency provider;
(b) An
ODM-approved or ODA-certified non-agency provider;
(c) A transition coordination service
provider under contract with ODM that also meets the requirements set forth in
paragraph (E)(1) of this rule; or
(d) An ODA-certified assisted living
waiver service provider.
(2) Comply with the requirements
set forth in rule
5160-44-31 of the Administrative
Code for an ODM-administered waiver program, or Chapter 173-39 of the
Administrative Code for the pre-admission screening system providing options
and resources today (PASSPORT) or assisted living programs.
(3)
The provider will
involve the individual and/or caregiver(s) in the selection of items to be
purchased on the individual's behalf.
(F)(E)
All providers
shall
will maintain a record at their place of business for
each individual served in accordance with the requirements set forth in rule
5160-44-31 of the Administrative
Code, or with the requirements set forth in Chapter 173-39 of the
Administrative Code for the PASSPORT program. For each service provided, the
record
shall
will include:
(1) The
individual's name;
(2) Date of
service;
(3) A detailed description
of each expense;
(4) A receipt for
each expense;
(5) Verification the
individual was involved in the selection of all items; and
(6) The individual's signature to verify
receipt of the service.
If the signature requirement
cannot be met at the time of service, the provider may accept an electronic
signature or standard signature via regular mail from the individual, or
otherwise obtain signature no later than at the next face-to-face visit with
the individual.
(G) ODM and ODA are authorized to
deem any provider approved by ODM or certified by ODA or the Ohio department of
developmental disabilities (DODD) to provide waiver services as having
satisfied the requirements for approval by ODM or certification by ODA for the
same or similar services.
Notes
Ohio Admin. Code
5160-44-26
Effective:
1/1/2024
Five Year Review (FYR) Dates:
9/22/2023 and
01/01/2029
Promulgated
Under: 119.03
Statutory
Authority: 5166.02
Rule
Amplifies: 5162.03,
5166.02,
5164.02
Prior
Effective Dates: 07/01/2019, 02/01/2020, 06/12/2020 (Emer.),
12/10/2020
