5111.971 Request to HHS for waiver regarding health care services.
5111.971 Request to HHS for waiver regarding health care services.
(A) As used in this section, “long-term care medicaid waiver component” means any of the following:
(1) The PASSPORT program created under section 173.40 of the Revised Code;
(2) The choices program created under section 173.403 of the Revised Code;
(3) A medicaid waiver component that the department of job and family services administers.
(B) The director of job and family services shall submit a request to the United States secretary of health and human services for a waiver of federal medicaid requirements that would be otherwise violated in the creation of a pilot program under which not more than two hundred individuals who meet the pilot program’s eligibility requirements specified in division (D) of this section receive a spending authorization to pay for the cost of medically necessary home and community-based services that the pilot program covers. The spending authorization shall be in an amount not exceeding seventy per cent of the average cost under the medicaid program for providing nursing facility services to an individual. An individual participating in the pilot program shall also receive necessary support services, including fiscal intermediary and other case management services, that the pilot program covers.
(C) If the United States secretary of health and human services approves the waiver submitted under division (B) of this section, the department of job and family services shall enter into a contract with the department of aging under section 5111.91 of the Revised Code that provides for the department of aging to administer the pilot program that the waiver authorizes.
(D) To be eligible to participate in the pilot program created under division (B) of this section, an individual must meet all of the following requirements:
(1) Need an intermediate level of care as determined under rule 5101:3-3-06 of the Administrative Code or a skilled level of care as determined under rule 5101:3-3-05 of the Administrative Code;
(2) At the time the individual applies to participate in the pilot program, be one of the following:
(a) A nursing facility resident who would remain in a nursing facility if not for the pilot program;
(b) A participant of any long-term care medicaid waiver component who would move to a nursing facility if not for the pilot program.
(3) Meet all other eligibility requirements for the pilot program established in rules adopted under section 5111.85 of the Revised Code.
(E) The director of job and family services may adopt rules under section 5111.85 of the Revised Code as the director considers necessary to implement the pilot program created under division (B) of this section. The director of aging may adopt rules under Chapter 119. of the Revised Code as the director considers necessary for the pilot program’s implementation. The rules may establish a list of medicaid-covered services not covered by the pilot program that an individual participating in the pilot program may not receive if the individual also receives medicaid-covered services outside of the pilot program.
Amended by 128th General Assembly File No. 9, HB 1, § 101.01, eff. 10/16/2009.
Effective Date: 09-29-2005