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To amend section 5111.851 and to enact section | 1 |
173.405 of the Revised Code to provide that a | 2 |
terminally ill individual with an anticipated life | 3 |
expectancy of five years or less who is on a | 4 |
waiting list for the PACE program or a Medicaid | 5 |
waiver program providing home and community-based | 6 |
services is to have priority over other | 7 |
individuals on such a waiting list. | 8 |
Section 1. That section 5111.851 be amended and section | 9 |
173.405 of the Revised Code be enacted to read as follows: | 10 |
Sec. 173.405. An individual diagnosed as terminally ill with | 11 |
an anticipated life expectancy of five years or less who is on the | 12 |
unified waiting list established under section 173.404 of the | 13 |
Revised Code shall have priority for enrollment in the PACE | 14 |
program over other individuals on the waiting list. | 15 |
Sec. 5111.851. (A) As used in sections 5111.851 to 5111.855 | 16 |
of the Revised Code: | 17 |
"Administrative agency" means, with respect to a home and | 18 |
community-based services medicaid waiver component, the department | 19 |
of job and family services or, if a state agency or political | 20 |
subdivision contracts with the department under section 5111.91 of | 21 |
the Revised Code to administer the component, that state agency or | 22 |
political subdivision. | 23 |
"Level of care determination" means a determination of | 24 |
whether an individual needs the level of care provided by a | 25 |
hospital, nursing facility, or intermediate care facility for the | 26 |
mentally retarded and whether the individual, if determined to | 27 |
need that level of care, would receive hospital, nursing facility, | 28 |
or intermediate care facility for the mentally retarded services | 29 |
if not for a home and community-based services medicaid waiver | 30 |
component. | 31 |
"Medicaid buy-in for workers with disabilities program" means | 32 |
the component of the medicaid program established under sections | 33 |
5111.70 to 5111.7011 of the Revised Code. | 34 |
"Skilled nursing facility" means a facility certified as a | 35 |
skilled nursing facility under Title XVIII of the "Social Security | 36 |
Act," 79 Stat. 286 (1965), 42 U.S.C. 1395, as amended. | 37 |
(B) The following requirements apply to each home and | 38 |
community-based services medicaid waiver component: | 39 |
(1) Only an individual who qualifies for a component shall | 40 |
receive that component's services. | 41 |
(2) A level of care determination shall be made as part of | 42 |
the process of determining whether an individual qualifies for a | 43 |
component and shall be made each year after the initial | 44 |
determination if, during such a subsequent year, the | 45 |
administrative agency determines there is a reasonable indication | 46 |
that the individual's needs have changed. | 47 |
(3) A written plan of care or individual service plan based | 48 |
on an individual assessment of the services that an individual | 49 |
needs to avoid needing admission to a hospital, nursing facility, | 50 |
or intermediate care facility for the mentally retarded shall be | 51 |
created for each individual determined eligible for a component. | 52 |
(4) Each individual determined eligible for a component shall | 53 |
receive that component's services in accordance with the | 54 |
individual's level of care determination and written plan of care | 55 |
or individual service plan. | 56 |
(5) No individual may receive services under a component | 57 |
while the individual is a hospital inpatient or resident of a | 58 |
skilled nursing facility, nursing facility, or intermediate care | 59 |
facility for the mentally retarded. | 60 |
(6) No individual may receive prevocational, educational, or | 61 |
supported employment services under a component if the individual | 62 |
is eligible for such services that are funded with federal funds | 63 |
provided under 29 U.S.C. 730 or the "Individuals with Disabilities | 64 |
Education Act," 111 Stat. 37 (1997), 20 U.S.C. 1400, as amended. | 65 |
(7) Safeguards shall be taken to protect the health and | 66 |
welfare of individuals receiving services under a component, | 67 |
including safeguards established in rules adopted under section | 68 |
5111.85 of the Revised Code and safeguards established by | 69 |
licensing and certification requirements that are applicable to | 70 |
the providers of that component's services. | 71 |
(8) No services may be provided under a component by a | 72 |
provider that is subject to standards that 42 U.S.C. 1382e(e)(1) | 73 |
requires be established if the provider fails to comply with the | 74 |
standards applicable to the provider. | 75 |
(9) Individuals determined to be eligible for a component, or | 76 |
such individuals' representatives, shall be informed of that | 77 |
component's services, including any choices that the individual or | 78 |
representative may make regarding the component's services, and | 79 |
given the choice of either receiving services under that component | 80 |
or, as appropriate, hospital, nursing facility, or intermediate | 81 |
care facility for the mentally retarded services. | 82 |
(10) No individual shall lose eligibility for services under | 83 |
a component, or have the services reduced or otherwise disrupted, | 84 |
on the basis that the individual also receives services under the | 85 |
medicaid buy-in for workers with disabilities program. | 86 |
(11) No individual shall lose eligibility for services under | 87 |
a component, or have the services reduced or otherwise disrupted, | 88 |
on the basis that the individual's income or resources increase to | 89 |
an amount above the eligibility limit for the component if the | 90 |
individual is participating in the medicaid buy-in for workers | 91 |
with disabilities program and the amount of the individual's | 92 |
income or resources does not exceed the eligibility limit for the | 93 |
medicaid buy-in for workers with disabilities program. | 94 |
(12) No individual receiving services under a component shall | 95 |
be required to pay any cost sharing expenses for the services for | 96 |
any period during which the individual also participates in the | 97 |
medicaid buy-in for workers with disabilities program. | 98 |
(13) An individual diagnosed as terminally ill with an | 99 |
anticipated life expectancy of five years or less who is on a | 100 |
waiting list for a home and community-based services medicaid | 101 |
waiver component shall have priority for enrollment in the | 102 |
component over other individuals on the waiting list. | 103 |
Section 2. That existing section 5111.851 of the Revised Code | 104 |
is hereby repealed. | 105 |