5111.85 Medicaid waiver components. - Ohio Statutes

5111.85 Medicaid waiver components.

(A) As used in this section and sections 5111.851 to 5111.856 of the Revised Code:

“Home and community-based services medicaid waiver component” means a medicaid waiver component under which home and community-based services are provided as an alternative to hospital, nursing facility, or intermediate care facility for the mentally retarded services.

“Hospital” has the same meaning as in section 3727.01 of the Revised Code.

“Intermediate care facility for the mentally retarded” has the same meaning as in section 5111.20 of the Revised Code.

“Medicaid waiver component” means a component of the medicaid program authorized by a waiver granted by the United States department of health and human services under section 1115 or 1915 of the “Social Security Act,” 49 Stat. 620 (1935), 42 U.S.C.A. 1315 or1396n. “Medicaid waiver component” does not include a care management system established under section 5111.16 of the Revised Code.

“Nursing facility” has the same meaning as in section 5111.20 of the Revised Code.

(B) The director of job and family services may adopt rules under Chapter 119. of the Revised Code governing medicaid waiver components that establish all of the following:

(1) Eligibility requirements for the medicaid waiver components;

(2) The type, amount, duration, and scope of services the medicaid waiver components provide;

(3) The conditions under which the medicaid waiver components cover services;

(4) The amount the medicaid waiver components pay for services or the method by which the amount is determined;

(5) The manner in which the medicaid waiver components pay for services;

(6) Safeguards for the health and welfare of medicaid recipients receiving services under a medicaid waiver component;

(7) Procedures for both of the following:

(a)Identifying individuals who meet all of the following requirements: (i) Are eligible for a home and community-based services medicaid waiver component and on a waiting list for the component;

(ii) Are receiving inpatient hospital services or residing in an intermediate care facility for the mentally retarded or nursing facility (as appropriate for the component);

(iii) Choose to be enrolled in the component.

(b) Approving the enrollment of individuals identified under the procedures established under division (B)(7)(a) of this section into the home and community-based services medicaid waiver component.

(8)Procedures for enforcing the rules, including establishing corrective action plans for, and imposing financial and administrative sanctions on, persons and government entities that violate the rules. Sanctions shall include terminating medicaid provider agreements. The procedures shall include due process protections.

(9) Other policies necessary for the efficient administration of the medicaid waiver components.

(C) The director of job and family services may adopt different rules for the different medicaid waiver components. The rules shall be consistent with the terms of the waiver authorizing the medicaid waiver component.

(D)Any procedures established under division (B)(7) of this section for the PASSPORT program shall be consistent with section 173.401 of the Revised Code. Any procedures established under division (B)(7) of this section for the assisted living program shall be consistent with section 5111.894 of the Revised Code.

Amended by 128th General Assembly File No. 9, HB 1, § 101.01, eff. 10/16/2009.

Effective Date: 06-26-2003; 10-01-2005