Ohio Administrative Code|Rule 5160-33-07 | Assisted living home and community based services (HCBS) waiver rate setting.

                                                
(A) The purpose of this rule is to describe the methods used to
		  determine provider rates for the assisted living HCBS waiver as set forth in
		  appendix A to rule 5160-1-06.5 of the Administrative Code.
(B)  Provider rates are determined for the following
		  categories:
(1)  Per-job bid rate or deposit
			 made.
(2)  Unit rate.
(C) A per-job bid rate or deposit made shall be determined on a
		  per-job basis for the community transition service as set forth in rule
		  173-39-02.17 of the Administrative Code. The cost per job shall be paid at a
		  per-job bid rate that is negotiated and approved by Ohio department of
		  aging's (ODA) designee and accepted by the individual. The per-job bid
		  rate includes the items and supports set forth in rule 173-39-02.17 of the
		  Administrative Code and authorized on the person-centered services
		  plan.
(D) A unit rate shall be based on a three-tiered model, and shall
		  not exceed the amounts in appendix A to rule 5160-1-06.5 of the Administrative
		  Code. These rates are used for assisted living services as set forth in rule
		  173-39-02.16 of the Administrative Code.
(1)  The rate for assisted living
			 services for each individual shall be determined by the ODA's designee
			 through an assessment of the individual's service needs in four
			 areas:
(a) Cognitive impairments,
(b) Medication administration,
(c) Nursing services, and
(d) Functional impairments.
(2) The ODA-certified assisted living
			 provider must agree to provide the services in the individual's
			 person-centered service plan at the rate determined by the
			 assessment.
(E) ODA certified assisted living providers shall only be paid
		  for assisted living services authorized by ODA's designee and reflected on
		  the individual's person-centered service plan.
(F) Assisted living service payment constitutes payment in full
		  and may not be construed as a partial payment when the payment amount is less
		  than the provider's charge. The provider may not bill an individual
		  enrolled in the assisted living program for any difference between the medicaid
		  payment and the provider's charge or request that the individual share in
		  the cost through a co-payment or other similar charge.
(G) The assisted living service payment is for assisted living
		  services as defined in rule 173-39-02.16 of the Administrative Code and does
		  not include payment for room and board as calculated pursuant to rule
		  5160-33-03 of the Administrative Code, which is the responsibility of the
		  individual.