Ohio Admin. Code 5160:1-5-07 - Medicaid: specialized recovery services (SRS) program
(A)
This rule sets forth the eligibility criteria for a state plan home and
community-based services (HCBS) benefit authorized under section 1915(i) of the
Social Security Act (as in effect on
October 1, 2017
2024). Section 1915(i) of
the act allows states the flexibility to provide HCBS to individuals
who require less than an institutional level of care (LOC) and who would,
therefore, not be eligible for HCBS under the more restrictive criteria of
section 1915(c) waivers. The specialized recovery services (SRS) program
provides targeted services to the following individuals described in rule
5160-43-02 of the Administrative
Code:
(1) Individuals with severe and
persistent mental illness (SPMI); or
(2)
Individuals who are active on the solid organ or soft tissue waiting list;
or
(3) Individuals with certain
diagnosed chronic conditions.
(B) Eligibility for the SRS program state
plan HCBS benefit. An individual shall meet all of the following criteria to be
eligible for the SRS program state plan HCBS benefit:
(1) Be at least twenty-one years of
age.
(2) Have been determined to
meet the definition of disability used by the social security administration
(SSA) for purposes of supplemental security income (SSI) or social security
disability insurance (SSDI) benefits.
(a) A
disability determination is not required for individuals over
the age of sixty-five years
old
of age who
are active on the solid organ or soft tissue waiting list, or who have certain
diagnosed chronic conditions.
(b) A
disability determination is not required for individuals under
age sixty-five years
old
of age who
are enrolled in the medicare
diagnosed with end-stage renal disease
program
(ESRD).
(3) Meet the clinical diagnostic, needs
assessment, and risk criteria described in rule
5160-43-02 of the Administrative
Code.
(4) Reside in a home and
community-based setting consistent with the qualities identified in
42 C.F.R.
441.710 (as in effect
on October 1, 2017
2024).
(5) Meet the financial and nonfinancial
eligibility requirements of one of the following groups:
(a) Group one.
(i) Be in receipt of medical assistance, as
described in Chapters 5160:1-1 to 5160:1-5 of the Administrative Code;
and
(ii) Have countable income that
does not exceed one hundred fifty per cent of the federal poverty level (FPL),
as determined using the same rules used for determining the individual's
medical assistance eligibility.
(b) Group two.
(ii) Not be otherwise eligible for medical
assistance; and
(iii) For the
purpose of determining whether an individual is income eligible for the SRS
program, the administrative agency shall compare the individual's countable
income to one hundred fifty per cent of the FPL, as determined in accordance
with Chapter 5160:1-3 of the Administrative Code.
(a)
If
When the
individual's countable income exceeds one hundred fifty per cent of the FPL,
apply additional disregards in the following order:
(i) Twenty dollar personal needs disregard;
then
(ii) Disregard income in the
amount of the difference between one hundred fifty per cent of the FPL for an
individual and three hundred per cent of the current supplemental security
income (SSI) federal benefit rate (FBR) for an individual.
(b)
If
When the amount
determined in paragraph (B)(5)(b)(iii) of this rule is no more than one hundred
fifty per cent of the FPL, the individual meets the income eligibility
requirement for the SRS program.
(iv) There is no resource limit for
individuals described in paragraph (B)(5)(b) of this rule.
(C) There is no
retroactive eligibility for the SRS program state plan HCBS benefit. Coverage
under this rule cannot begin prior to the first day of the month in which all
financial, nonfinancial, and programmatic criteria are met.
(D) An individual who is receiving the state
plan HCBS benefit cannot be concurrently enrolled in another HCBS authority,
such as a section 1915(c) waiver. Subject to the individual's choice, he or she
will be enrolled in the HCBS authority best meeting the totality of his or her
needs regardless of the order in which the individual applied for or became
eligible for HCBS.
(E) Eligibility for this program
shall be determined for applications for medical assistance filed on or after
the effective date of this rule.
Notes
Promulgated Under: 111.15
Statutory Authority: 5162.03, 5163.02
Rule Amplifies: 5162.03, 5163.02
Prior Effective Dates: 08/01/2016, 09/11/2017, 07/01/2018
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