5160:1-17-01 The residential state supplement (RSS) program.

 

 

 

TO BE RESCINDED

 

5160:1-17-01               The residential state supplement (RSS) program.

 

 

 

(A)   The purpose of RSS is to provide cash assistance to medicaid-eligible aged, blind, or disabled adults who have increased needs due to a medical condition which is not severe enough to require institutionalization. The RSS cash payment is used together with the individual's personal income to help prevent premature or unnecessary institutionalization, and to deinstitutionalize those aged, blind, or disabled adults who have been inappropriately placed in long term care facilities and who can return to the community through alternative living arrangements.

 

(B)  Definitions.

 

(1)   "Individual," for the purpose of this rule, means a person who is applying for or receiving RSS benefits.

 

(2)   "RSS administrative agency" means the Ohio department of mental health or its designee.

 

(C)  RSS registration and enrollment process.

 

(1)  The RSS application process is initiated upon receipt of:

 

(a)     A completed JFS 07120 "Residential State Supplement Referral" (rev. 3/2003) from the residential state supplement administrative agency verifying that the individual has been selected for placement in the RSS program; and

 

(b)    A medicaid application, if the individual is not currently in receipt of medicaid.

 

(2)    If the individual completes the JFS 07120 at the CDJFS, a copy of the JFS 07120 will be forwarded to the residential state supplement administrative agency to register the individual for the RSS program.

 

(3)   If the individual submits the JFS 07120 to the CDJFS by mail, a copy of the JFS 07120 will be forwarded to the residential state supplement administrative agency to register the individual for the RSS program.

 

(4)   The signature date on the JFS 07120 shall be the RSS application date. In some instances, medicaid retroactive eligibility must be determined in accordance with  Chapter  5101:1-38  of  the  Administrative  Code  to  cover  the  RSS

 

 

protected date.

(D)  County department of job and family services responsibilities.

(1)     The determination of eligibility for RSS shall be coordinated between the CDJFS and the residential state supplement administrative agency.

(a)    The CDJFS is responsible for determining eligibility for medicaid and financial eligibility for RSS.

(b)   The residential state supplement administrative agency is responsible for determining eligibility for RSS placement, appropriate level of care and the subsequent monitoring of the placement to insure that the individual's needs continue to be met.

(c)    The CDJFS shall inform the residential state supplement administrative agency of the individual's eligibility for medicaid and an RSS payment, the type of RSS living arrangement that can be supplemented, and the amount of the RSS payment that can be authorized. Since the RSS financial need standards vary according to the RSS living arrangement, an individual or couple may be eligible for an RSS payment for one type of RSS living arrangement but not another.

(d)       The CDJFS shall also inform the residential state supplement administrative agency of any change in the individual's or couple's medicaid and/or RSS financial eligibility.

(2)   Once the individual has been selected for enrollment, the CDJFS in the county in which the individual resides shall accept and process the JFS 07120 that has been submitted by the residential state supplement administrative agency in accordance with the application procedures outlined in Chapter 5101:1-38 of the Administrative Code. A copy of the JFS 07120 shall be maintained in the assistance group's case record that is located in the CDJFS.

(3)     For an individual who is not already receiving medicaid, the CDJFS shall preview medicaid eligibility and RSS financial eligibility within five working days of receipt of the JFS 07120 and medicaid application from the residential state supplement administrative agency.

(4)     For an individual who is receiving medicaid, the CDJFS shall, within five working days of receipt of the JFS 07120, determine if the individual meets the RSS financial eligibility criteria. The CDJFS must notify the residential

state supplement administrative agency of the results of the preview of RSS and medicaid eligibility.

(5)   The CDJFS shall not delay the determination of eligibility for other assistance programs when RSS eligibility is still pending.

(6)   The CDJFS shall not treat the level of care determination for RSS eligibility as evidence that the limiting physical factor requirement for medicaid eligibility as defined in rule 5101:1-39-03 of the Administrative Code has been met.

(7)   If RSS income or resource eligibility are not met, the CDJFS shall deny the RSS application. The denial notice shall be sent to the applicant and authorized representative, if any. A copy of the denial notice shall also be issued to the residential state supplement administrative agency.

(8)    The CDJFS shall document in the case record that the individual has received an appropriate level of care determination, and shall identify the RSS placement.

(E)  Individual responsibilities.

(1)   The individual shall cooperate with the CDJFS in order to determine eligibility for RSS.

(2)     The individual is responsible for reporting changes within ten days to the CDJFS.

Effective:                                                             01/01/2016

Five Year Review (FYR) Dates:                         10/16/2015

CERTIFIED ELECTRONICALLY

Certification

12/21/2015

Date

Promulgated Under:                           111.15

Statutory Authority:                           5162.03, 5163.02

Rule Amplifies:                                  5162.03, 5163.02, 5119.41

Prior Effective Dates:                         12/1/82, 7/1/83 (temp.), 9/24/83, 9/1/84, 1/1/89

(Emer.), 3/6/89, 10/1/90, 9/12/91 (Emer.), 12/2/91, 11/1/93 (Emer.), 1/30/94, 5/1/94 (Emer.), 7/24/94,

7/1/95 (Emer.), 9/24/95, 4/1/96, 10/1/02, 7/1/11 (Emer.), 9/29/11