Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-43 - Specialized Recovery Services Program › Section 5160-43-02 - Specialized recovery services program individual eligibility and program enrollment

Current through all regulations passed and filed through July 1, 2024
(A)
								An individual may
			 be eligible for enrollment in the specialized recovery services program
								if they meet all of the following
			 :
(1) Be at least twenty-one years of
			 age;
(2) Be determined eligible for
			 Ohio medicaid in accordance with Chapters 5160:1-1 to 5160:1-5 of the
			 Administrative Code;
(3) Have a
			 behavioral health diagnosis, be active on the solid organ or soft tissue
			 waiting list, or have a diagnosed chronic
			 condition as listed in qualifying diagnosis appendix which is
			 available on the ODM website at
https://medicaid.ohio.gov/resources-for-providers/special-programs-and-initiatives/srs
;
(4) Participate in an initial assessment
			 using the "Adult Needs and Strengths Assessment (ANSA)"
			 (8/2021) and obtain a qualifying score of either:
(a) Two or greater on at least one item in
			 the "behavioral/ emotional needs" or "risk behaviors"
			 sections; or
(b) Three on at least
			 one item in the "life  functioning"
			 section.
(5) Demonstrate
			 needs related to the management of his or her behavioral health or diagnosed
			 chronic condition as documented in the "ANSA" (8/2021);
(6) Have at least one of the following risk
			 factors prior to enrollment in the program:
(a) One or more psychiatric inpatient
			 admissions at an inpatient psychiatric hospital; or
(b) A discharge from a correctional facility
			 with a history of inpatient or outpatient behavioral health treatment while
			 residing in that correctional facility; or
(c) Two or more emergency department visits
			 with a psychiatric diagnosis or diagnosed chronic
			 condition; or
(d) A history
			 of treatment in an intensive outpatient rehabilitation program for greater than
			 ninety days; or
(e) One or more
			 hospital inpatient admissions due to a diagnosed chronic condition as listed in
			 the qualifying diagnosis appendix available at
https://medicaid.ohio.gov/resources-for-providers/special-programs-and-initiatives/srs
.
(7) Meet at least one of the following:
(a) Currently have a need for one or more of
			 the specialized recovery services to maintain stability, improve functioning,
			 prevent relapse, maintain residency in the community, and be assessed and found
			 that, if not for the provision of home and community-based services (HCBS) for
			 stabilization and maintenance purposes, he or she would decline to prior levels
			 of need (i.e., subsequent medically necessary services and coordination of care
			 for stabilization and maintenance is needed to prevent decline to previous
			 needs-based functioning); or
(b)
			 Previously have met the needs-based criteria described in paragraph (A) (6) of
			 this rule within two years of the date of initial
			 assessment, and be assessed and found that, but for the provision of HCBS
			 for stabilization and maintenance purposes, he or she would decline to prior
			 levels of need (i.e., subsequent medically necessary services and coordination
			 of care for stabilization and maintenance is needed to prevent decline to
			 previous needs-based functioning).
(8) Reside in an HCBS setting;
(9) Demonstrate a need for specialized
			 recovery services, and not otherwise receive those services;
(10) Have needs that can be safely met
			 through the program in an HCBS setting as determined by the Ohio department of
			 medicaid (ODM) or its designee; and
(11) Participate in the development of a
			 person-centered service plan.