Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-33 - Assisted living HCBS waiver program › Section 5160-33-02 - Definitions for the assisted living home and community based services waiver (HCBS) program

Current through all regulations passed and filed through July 1, 2024
(A) The purpose of this rule is to define the
			 terms used in Chapter 5160-33 of the Administrative Code governing the medicaid
			 assisted living HCBS waiver program.
As used in this chapter:
(B)
			 "Assessment" means a face-to-face evaluation used to obtain information about
			 an individual including his or her condition, personal goals and preferences,
			 functional limitations, health status and other factors that are relevant to
			 the authorization and provision of services. Assessment information supports
			 the determination  an individual
			 
								needs waiver services as well as the development of a
			 person-centered services plan.
(C) "
			 Assisted living HCBS waiver
			 program"  means the medicaid-funded component of the assisted living program
			 created under section
			 173.54
			 of the Revised Code and
								 approved by the centers for medicare and
			 medicaid services.
(D) "CDJFS" means a
			 county department of job and family services.
(E) "CMS" means the
			 centers for medicare and medicaid services, a federal agency that is part of
			 the United States department of health and human services, and
			 administers the medicaid program and
			 approves HCBS waivers.
(F)
			 "Certified" or "certification" means 
								a provider's
			 state of being certified by the Ohio department of aging (ODA)
			 
								as an assisted living provider
								 pursuant to Chapter 173-39 of the Administrative Code
			 or the certification ODA gives to a certified assisted
			 living provider.
(G) "HCBS" or "home and
			 community-based services" means services furnished under the provisions set
			 forth in 42 C.F.R. Part 441 Subpart G (October 1,
			 2021)
			 that permit individuals to live in a home setting rather than a nursing
			 facility (NF) or hospital. HCBS waiver services are approved by CMS for
			 specific populations and are not otherwise available under the medicaid state
			 plan.
(H) "Home first" means
			 the component of the assisted living HCBS waiver program that offers priority
			 enrollment in the waiver 
								to certain individuals in accordance with section
			 173.542
			 of the Revised Code.
(I) "Individual" is a
			 person enrolled on the assisted living HCBS waiver.
(J) "Level of care"
			 (LOC) means the designation describing an individual's functional levels and
			 nursing needs pursuant to the criteria set forth in rules
			 5160-3-05,
			 5160-3-06,
			  and 5160-3-08 of the
			 Administrative Code.
(K)
								The Ohio department of aging (ODA) is
			 responsible for the daily operation of the assisted living home and community
			 based services (HCBS) waiver. ODA will operate this waiver pursuant to an
			 interagency agreement with the Ohio department of medicaid (ODM) in accordance
			 with sections
			 5162.35
			 and
			 5166.21
			 of the Revised Code. ODA will establish processes and procedures to enroll
			 individuals on this waiver.
(L) "ODA's designee"
			 has the same meaning as in rule
			 173-39-01
			 of the Administrative Code .
(M)
			 "Residential care facility" means a residential care facility as defined in
			 section
			 3721.01
			 of the Revised Code that is issued a license pursuant to section
			 3721.02
			 of the Revised Code.
(N) "Room and board"
			 means a payment made by an individual enrolled in the assisted living waiver
			 directly to the ODA certified assisted living waiver provider. When paying
			 "room" the individual 
								will not be charged for the same furnishings and
			 other shelter expenses the residential care facility provides at no cost to
			 private pay non-waiver residents pursuant to the facility's resident agreement.
			 The term "board" means three meals a day or any other full nutritional regimen.
Room and board does not include charges for ancillary items,
				services, and/or social activities purchased or paid for by the individual
				including hygiene and supplies not provided through medicaid and reflected on
				the individual's 
									person-centered services plan, recreation and
				activities, and/or other items or services purchased by the individual; however
				ODA certified assisted living providers may, at their own discretion, provide
				ancillary items, services and/or social activities as part of the room and
				board payment.
(O) "
								Person-centered services plan" has the same meaning as
			  in rule
			 5160-44-02
			 of the Administrative Code.