Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-46 - Ohio home care waiver › Section 5160-46-02 - Ohio home care waiver program: eligibility and enrollment

Current through all regulations passed and filed through July 1, 2024
(A) To be eligible
			 for enrollment in the Ohio home care waiver program, an individual must meet
			 all of the following requirements:
(1) Be
			 between the ages of birth through age fifty-nine.
(2) Be determined eligible for Ohio medicaid
			 in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative
			 Code.
(3) Participate in an initial
			 assessment to determine if the individual has needs that can be met through the
			 Ohio home care waiver program.
(4)
			 Be determined to have a nursing facility (NF) -based level of care (i.e.,
			 intermediate or skilled) in accordance with rule
			 5160-3-08 of the Administrative
			 Code.
(5) In the absence of the
			 Ohio home care waiver program, require hospitalization or institutionalization
			 in a NF to meet his or her needs.
(6)
									The individual:
(a)
										Has a need for and agrees to receive at least one
			 waiver service monthly that is otherwise unavailable through another source
			 (including, but not limited to, private pay, community resources and/or the
			 medicaid state plan) in an amount sufficient to meet the individual's assessed
			 needs; or
(b)
										Has a need for and agrees to receive all of the
			 following:
(i)
											Medicaid state plan private duty nursing
			 services,
(ii)
											At least monthly monitoring of the individual's health
			 and welfare through a combination of telephonic and in-person contacts with the
			 case manager, and
(iii)
											At least one waiver service
			 annually.
(7) Be able to establish residency in a place
			 that possesses the home and community-based setting characteristics set forth
			 in rule 5160-44-01 of the Administrative
			 Code, and that is not a hospital, NF, intermediate care facility for
			 individuals with an intellectual disability (ICF-IID) or another
			 licensed/certified facility, any facility covered by section 1616(e) of the
			 Social Security Act (42 U.S.C. 1382(e) (January 1, 2024)),
			 residential care facility, adult foster home or another group living
			 arrangement subject to state licensure or certification.
(8) Sign an agreement prior to waiver
			 enrollment confirming that the individual has been informed of service
			 alternatives, choice of qualified providers available in the Ohio home care
			 waiver program and the options of institutional and community-based care, and
			 he or she elects to receive Ohio home care waiver services. If the individual
			 is unable to provide a signature at the time of enrollment, the individual is
			 to submit an electronic signature or standard signature via regular mail, or
			 otherwise in no instance any later than at the next face-to-face visit with the
			 case manager.
(9) Have needs that
			 can be safely met through the Ohio home care waiver in a home or community
			 setting as determined by the Ohio department of medicaid (ODM) or its
			 designee.