173-44-04 Unified waiting list.

 

 

 

173-44-04                    Unified waiting list.

 

 

 

(A)The United States centers for medicare and medicaid services limits the number of slots available for enrollment in the assisted living, choices, and PASSPORT programs which may cause a waiting list. A lack of capacity for serving PACE applicants may also cause a waiting list. ODA has the authority to operate these programs. ODA manages enrollment into those programs, including the ability to establish a waiting list.

 

(B)Waiting list:

 

(1)If the CDJFS determines that an individual meets all the non-financial eligibility criteria for the program to which the individual has applied, but a slot is not available for enrollment in the program, ODA's designee shall place the individual on the unified waiting list established under section 173.404 of the Revised Code according to the latter of the individual's signature date on form JFS02399 (or, for PACE, either form JFS02398 or JFS02399) or the date the individual met all non-financial eligibility criteria for the program to which he or she applied. For the choices program, ODA's designee shall place the individual on the unified waiting list if the individual meets all the eligibility criteria according to the date the individual completed the certification process described in rule 5101:3-32-03 of the Administrative Code. The following rules present the non-financial eligibility criteria:

 

(a) Assisted living: See rule 5101:3:33-03 of the Administrative Code.

 

(b) Choices: See rule 5101:3-32-03 of the Administrative Code.

 

(c) PACE: See rule 173-50-02 of the Administrative Code.

 

(d)PASSPORT: See rule 5101:3-31-03 of the Administrative Code.

 

(2)With the exceptions of the circumstances specified in paragraph (A) or (B)(3) of this rule, ODA's designee shall offer enrollment to any applicant on the unified waiting list for the assisted living, choices, PACE, or PASSPORT programs who meets all of the eligibility criteria for the program to which he or she applied, in compliance with the enrollment rule for the program to which he or she applied, according to the chronological order that ODA's designee placed him or her on the waiting list.

 

(a) The following rules present the eligibility criteria:

 

(i) Assisted living: See rule 5101:3-33-03 of the Administrative Code.

 

(ii) Choices: See rule 5101:3-32-03 of the Administrative Code.

 

(iii) PACE: See rule 173-50-02 of the Administrative Code.

 

 

 

(iv) PASSPORT: See rule 5101:3-31-03 of the Administrative Code.

(b) The following rule present the enrollment process:

(i) Assisted living: See rule 5101:3-33-04 of the Administrative Code.

(ii) Choices: See rule 5101:3-32-06 of the Administrative Code.

(iii) PACE: See rule 173-50-03 of the Administrative Code.

(iv) PASSPORT: See rule 5101:3-31-04 of the Administrative Code.

(3) ODA's designee shall offer an applicant on the waiting list for the assisted living, PACE, or PASSPORT programs who meets all of the eligibility criteria for the program to which he or she has applied in compliance with the applicable enrollment rule according to the chronological order that ODA's designee placed him or her on the waiting list, and before ODA's designee offers enrollment to any other individual on the waiting list if any of the following apply:

(a) The individual is residing in a nursing facility.

(b) A physician has determined and documented in writing that the individual has a medical condition that, unless ODA's designee enrolls the individual in a home and community-based program such as the assisted living, PACE, or PASSPORT programs, the individual will require admission to a nursing facility in less than thirty days after the physician's determination.

(c) The individual has been hospitalized and a physician has determined and documented in writing that, unless ODA's designee enrolls the individual in a home and community-based program such as the assisted living, PACE, or PASSPORT programs, the individual will require a direct transfer of admission from the hospital to the nursing facility.

(d)Both of the following apply:

(i) The individual is the subject of a report made under section 5101.61 of the Revised Code regarding abuse, neglect, or exploitation or such a report referred to adult protective services under section 5126.31 of the Revised Code; or has made a request to adult protective services for protective services, as defined in section 5101.60 of the Revised Code.

(ii) A  county  department  of  job  and  family  services  and  ODA's

designee have jointly documented in writing that, unless ODA's designee enrolls the individual into a home and community-based services such as the assisted living, PACE, or PASSPORT programs, the individual should be admitted to a nursing facility.

(e) For the assisted living program only, the individual has resided in a residential care facility for at least six months immediately before applying for the assisted living program and is at risk of imminent admission to a nursing facility because the costs of residing in the residential care facility have depleted the individual's resources so that the individual is unable to continue to afford the cost of residing in the residential care facility.

(4) If ODA's designee offers enrollment to an applicant from the unified waiting list, but the applicant declines enrollment, the applicant may remain on the unified waiting list and ODA's designee shall offer enrollment to the next applicant on the list according to the order this rule establishes.

(C)Definitions for this rule:

(1) "Assisted living program" ("program") means the home and community-based medicaid waiver program created under section 5111.89 of the Revised Code that provides consumers in the program with the assisted living service under rule 173-39-02.16 of the Administrative Code and, in some cases, the community transition service under rule 173-39-02.17 of the Administrative Code, if the consumers reside in a residential care facility and would otherwise receive services in a nursing facility if the waiver program was not available.

(2) "CDJFS" means "county department of job and family services."

(3) "Choices program" means the program created under section 173.403 of the Revised Code.

(4) "Form   JFS02398"   means   "form   JFS02398   'Request   for   Program   of All-Inclusive Care for the Elderly Services.'"

(5) "Form JFS02399" means "form JFS02399 'Request for Medicaid Home and Community-Based Services (HCBS).'"

(6) "Nursing facility" has the same meaning as in section 5111.20 of the Revised Code.

(7) "ODA" means "the Ohio department of aging."

(8) "ODA's  designee"  has  the  same  meaning  as  "PASSPORT  administrative agency" in section 173.42 of the Revised Code. The current PASSPORT

administrative agencies are the area agencies on aging listed in rule 173-2-04 of the Administrative Code plus "Catholic Social Services of the Miami Valley."

(9) "PACE" means "the program of all-inclusive care for the elderly," which is established by 42 U.S.C. 1396u-4, as amended, and 42 C.F.R. 460.

(10) "PASSPORT  program"  ("PASSPORT")  means  the  program  created  under section 173.40 of the Revised Code.

Replaces:                                                     173-38-03, 173-42-01, 173-50-03

Effective:                                                     03/12/2011

R.C. 119.032 review dates:                         03/12/2016

CERTIFIED ELECTRONICALLY

Certification

03/02/2011

Date

Promulgated Under:                           119.03

Statutory Authority:                           173.02, 173.40, 173.404, 173.50, 5111.89

Rule Amplifies:                                  173.404, 173.401, 173.501, 5111.894

Prior Effective Dates:                         173-38-03: 07/16/2006, 09/18/2009; 173-42-01:

02/22/2001, 01/13/2006/, 01/14/2010; 173-50-03:

03/28/2009, 01/14/2010