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Assisted Living Overview
General Information
Beginning 7/1/06, the Assisted Living Program will
be available statewide under a CMS Home and
Community-Based Services Waiver.
Up to 1,800 participants will be enrolled during the
first year of operation (state fiscal year 2007).
The waiver program will pay only for two services:
assisted living services and community transition
services.
The Community Transition service is a one-time
payment of up to $1500 for costs associated with
establishing a residence for individuals
transitioning from a nursing facility.
A three tier model will be used to establish
participant's service needs and provider
reimbursement rate. ($49/98/day, $60.00/day, and
$69.98/day).
Maintenance Needs Allowance has been set at $603.00
(Room and Board Payment: $553 Discretionary
Spending: $50.00 per month.)
Total Provider Reimbursement for each level of
service: Tier 1: $2052.40 Tier 2: $2353.00 and Tier
3: $2652.40.
An independent evaluation of the waiver will be
conducted during the initial program year.
Participant Information
Participant eligibility and enrollment is managed by
the Area Agencies on Aging. Interested consumers
will contact the AAA that serves their county of
residence after 7/1/06 to request an Assisted Living
Waiver assessment.
Participation is limited to nursing facility
residents and existing Medicaid waiver consumers
(i.e., PASSPORT, Ohio Home Care, or Choices
participants) would otherwise permanently
remain/enter a nursing facility.
Participants must be 21 years old.
Participants must be financially eligible for
Medicaid and determined to need a "nursing facility
level of care.
Participants will select from any ODA certified
assisted living provider.
Participants are responsible for making Room and
Board payment to the provider.
If the participant's monthly income exceeds $603,
the participant is responsible for contributing
toward the cost of services. This contribution is
referred to as a client liability payment. The
payment is made directly to the provider.
Eligible Provider Information
Provider must be licensed by the Ohio Department of
Health as a residential care facility.
Provider must be certified as an Assisted Living
provider by the Ohio Department of Aging for the
waiver.
An interested facility may contact the Area Agency
on Aging that serves the county the facility is
located in to request an Assisted Living Provider
application packet.
There will be no minimum or maximum number of
participants a facility can serve.
Provider is responsible for collecting the Room and
Board payment and the client liability payment, if
applicable, from the participant.
For more
information:
Ohio Department
of Aging
5/16/06
Assisted Living Waiver Provider Required
Documentation
The
following documentation should be included with the
application:
• Table of Organization for the residential care
facility
• Facility plan designating the living units that
meet the living space requirements
• Evidence of current liability insurance and
insurance coverage for consumer loss due to theft or
damage
• Description of the procedure for consumers to use
in filing a claim against loss due to theft or
damage
• Procedure for documenting incidents and notifying
the PAA
• Written statement supporting compliance with
non-discrimination laws in hiring, service delivery,
federal wage and hour
• Evidence of current worker compensation insurance
• Identify which if any, Assisted Living services
outlined in 137-39-02.16 A are provided through the
use of a sub-contractor.
• Description of how the service delivery
documentation requirements will be met
The applicant must maintain evidence of compliance
with the following program requirements:
Consumer Records
• PAA notification of significant changes that may
affect the consumer's needs
• Consumer and PAA notification prior to termination
of service
Facility Staff and Volunteers Records
• Use of volunteers only with staff supervision
• Facility staff under the age of 18 years of age
may not assist with medication administration or
supervision, provide transportation, or deliver
hands-on assistance with bathing, toileting, or
transferring without on-site supervision
• Facility staff delivering waiver services
described on the care plan may not be the waiver
consumer's parent, stepparent, or spouse
• Annual continuing education requirement
• Facility staff orientation process and personnel
records must document the following:
• Principles of assisted living aging process
• Interventions with cognitive/behaviorally impaired
consumers
• Confidentiality
• Service plan process and risk assessment process
• Employee code of ethics
• Instruction in the following areas:
• Reporting requirements of suspected abuse,
neglect, exploitation, confidentiality, volunteer
supervision, limitations on tasks provided by staff
under 18 years of age, limitations of facility staff
delivering services to a parent, stepparent or
spouse.
• BCII documentation
5/3/06
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