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(4) The individual is under sixty years of age, lives in the community and is at imminent risk of institutionalization due to the documented loss of a primary caregiver.In such instances, there must be written evidence (such as a doctor's order, a death certificate, or documentation that the primary caregiver is institutionalized or relocated out of the area) that substantiates the primary caregiver is unavailable to provide care and support, and without Ohio home care waiver services, the individual will require care in an inpatient hospital setting or a nursing facility (NF).(2) The individual is at least twenty-one but less than sixty years of age and received inpatient hospital services for at least fourteen consecutive days immediately preceding the date of application.
Effective: 7/1/2016Five Year Review (FYR) Dates: 04/15/2016 and 07/01/2021Promulgated Under: 119.03 Statutory Authority: 5166.02 Rule Amplifies: 5164.02, 5162.03, 5166.121 Prior Effective Dates: 4/4/77, 12/21/77, 6/1/80, 5/1/87, 4/1/88, 5/15/89, 3/1/92 (Emer), 6/1/92, 7/31/92 (Emer), 10/30/92, 4/30/93 (Emer), 7/30/93, 7/1/98, 9/29/00, 8/1/01, 3/1/02 (Emer), 5/30/02, 7/1/06, 2/8/09, 12/1/14 This rule sets forth the definitions of the services covered by the Ohio home care waiver.(B) Subject to paragraph (H) of this rule, to be enrolled and maintain enrollment in the Ohio home care waiver program, an individual must be determined by ODM or its designee to meet all of the following requirements:(1) Be determined eligible for the Ohio home care waiver program in accordance with paragraph (A) of this rule; (2) Reside in a setting that possesses the home and community-based setting characteristics set forth in rule 5160-44-01 of the Administrative Code, and 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. (3) Have his or her health and welfare assured while enrolled on the waiver; (4) Participate in the development and implementation of a person-centered services plan in accordance with the process and requirements set forth in rule 5160-44-02 of the Administrative Code, and consent to the plan by signing and dating it; (5) Agree to and receive case management services from ODM or its designee including, but not limited to:(a) Annual and other assessments, as needed, (b) Home safety evaluations, (c) Contact with the case manager and/or the individual's team members, including, but not limited to telephone communications, and face-to-face and in-home visits; and (6) Agree to and participate in quality assurance and participant satisfaction activities during his or her enrollment on the Ohio home care waiver program including, but not limited to, face-to-face visits.(C) An individual shall be given priority for assessment to determine eligibility for enrollment in the Ohio home care waiver when ODM is made aware that he or she meets the criteria for any of the priority categories set forth in paragraphs (C)(1) to (C)(6) of this rule.(1) The individual is under twenty-one years of age, and at the time of application,:(a) Received inpatient hospital services for at least fourteen consecutive days; or (b) Had at least three inpatient hospital stays during the preceding twelve months.If the reassessment determines the individual no longer meets the requirements set forth in paragraph (A) and/or paragraph (B) of this rule, he or she shall be disenrolled from the Ohio home care waiver program.(F) If, at any other time, it is determined that an individual enrolled on the Ohio home care waiver program no longer meets the requirements set forth in paragraph (A) and/or paragraph (B) of this rule, he or she shall be disenrolled from the Ohio home care waiver program.(c) Be employed by a medicare-certified, or otherwise-accredited home health agency, or be a non-agency home care nurse provider.(d) Not be the individual's legally responsible family member, as that term is defined in rule 5160-45-01 of the Administrative Code, unless the legally responsible family member is employed by a medicare-certified, or otherwise-accredited home health agency. (f) Be identified as the provider and have specified on the individual's all services plan, that is prior-approved by the Ohio department of medicaid (ODM) or its designee, the number of hours the provider is authorized to furnish waiver nursing services to the individual.At Elite we simplify socializing and make it easy to get to know people you click with totally free!So take a break from the bar scene, crowded clubs, expensive dating services, and embarrassing blind dates.Reassessment pursuant to paragraph (E) is not required to make this determination.(G) If an individual is denied enrollment in the Ohio home care waiver program pursuant to paragraph (D) of this rule, or is disenrolled from the waiver pursuant to paragraph (E) or (F) of this rule, the individual shall be afforded notice and hearing rights in accordance with division 5101:6 of the Administrative Code.