2006 Ohio Revised Code - 173.42. Long-term care consultation program.

§ 173.42. Long-term care consultation program.
 

(A)  As used in this section: 

(1) "Area agency on aging" means a public or private nonprofit entity designated under section 173.011 [173.01.1] of the Revised Code to administer programs on behalf of the department of aging. 

(2) "Long-term care consultation" means the process used to provide services under the long-term care consultation program established pursuant to this section, including, but not limited to, such services as the provision of information about long-term care options and costs, the assessment of an individual's functional capabilities, and the conduct of all or part of the reviews, assessments, and determinations specified in sections 5111.202 [5111.20.2], 5111.204 [5111.20.4], 5119.061 [5119.06.1], and 5123.021 [5123.02.1] of the Revised Code and the rules adopted under those sections. 

(3) "Medicaid" means the medical assistance program established under Chapter 5111. of the Revised Code. 

(4) "Nursing facility" has the same meaning as in section 5111.20 of the Revised Code. 

(5) "Representative" means a person acting on behalf of an individual seeking a long-term care consultation, applying for admission to a nursing facility, or residing in a nursing facility. A representative may be a family member, attorney, hospital social worker, or any other person chosen to act on behalf of the individual. 

(B)  The department of aging shall develop a long-term care consultation program whereby individuals or their representatives are provided with long-term care consultations and receive through these professional consultations information about options available to meet long-term care needs and information about factors to consider in making long-term care decisions. The long-term care consultations provided under the program may be provided at any appropriate time, as permitted or required under this section and the rules adopted under it, including either prior to or after the individual who is the subject of a consultation has been admitted to a nursing facility. 

(C)  The long-term care consultation program shall be administered by the department of aging, except that the department may enter into a contract with an area agency on aging or other entity selected by the department under which the program for a particular area is administered by the area agency on aging or other entity pursuant to the contract. 

(D)  The long-term care consultations provided for purposes of the program shall be provided by individuals certified by the department under section 173.43 of the Revised Code. 

(E)  The information provided through a long-term care consultation shall be appropriate to the individual's needs and situation and shall address all of the following: 

(1) The availability of any long-term care options open to the individual; 

(2) Sources and methods of both public and private payment for long-term care services; 

(3) Factors to consider when choosing among the available programs, services, and benefits; 

(4) Opportunities and methods for maximizing independence and self-reliance, including support services provided by the individual's family, friends, and community. 

(F)  An individual's long-term care consultation may include an assessment of the individual's functional capabilities. The consultation may incorporate portions of the determinations required under sections 5111.202 [5111.20.2], 5119.061 [5119.06.1], and 5123.021 [5123.02.1] of the Revised Code and may be provided concurrently with the assessment required under section 5111.204 [5111.20.4] of the Revised Code. 

(G) (1)  Unless an exemption specified in division (I) of this section is applicable, each individual in the following categories shall be provided with a long-term care consultation: 

(a) Individuals who apply or indicate an intention to apply for admission to a nursing facility, regardless of the source of payment to be used for their care in a nursing facility; 

(b) Nursing facility residents who apply or indicate an intention to apply for medicaid; 

(c) Nursing facility residents who are likely to spend down their resources within six months after admission to a nursing facility to a level at which they are financially eligible for medicaid; 

(d) Individuals who request a long-term care consultation. 

(2) In addition to the individuals included in the categories specified in division (G)(1) of this section, long-term care consultations may be provided to nursing facility residents who have not applied and have not indicated an intention to apply for medicaid. The purpose of the consultations provided to these individuals shall be to determine continued need for nursing facility services, to provide information on alternative services, and to make referrals to alternative services. 

(H) (1)  When a long-term care consultation is required to be provided pursuant to division (G)(1) of this section, the consultation shall be provided as follows or pursuant to division (H)(2) or (3) of this section: 

(a) If the individual for whom the consultation is being provided has applied for medicaid and the consultation is being provided concurrently with the assessment required under section 5111.204 [5111.20.4] of the Revised Code, the consultation shall be completed in accordance with the applicable time frames specified in that section for providing a level of care determination based on the assessment. 

(b) In all other cases, the consultation shall be provided not later than five calendar days after the department or the program administrator under contract with the department receives notice of the reason for which the consultation is required to be provided pursuant to division (G)(1) of this section. 

(2) An individual or the individual's representative may request that a long-term care consultation be provided on a date that is later than the date required under division (H)(1)(a) or (b) of this section. 

(3) If a long-term care consultation cannot be completed within the number of days required by division (H)(1) or (2) of this section, the department or the program administrator under contract with the department may do any of the following: 

(a) Exempt the individual from the consultation pursuant to rules that may be adopted under division (L) of this section; 

(b) In the case of an applicant for admission to a nursing facility, provide the consultation after the individual is admitted to the nursing facility; 

(c) In the case of a resident of a nursing facility, provide the consultation as soon as practicable. 

(I)  An individual is not required to be provided a long-term care consultation under this section if any of the following apply: 

(1) The individual or the individual's representative chooses to forego participation in the consultation pursuant to criteria specified in rules adopted under division (L) of this section; 

(2) The individual is to receive care in a nursing facility under a contract for continuing care as defined in section 173.13 of the Revised Code; 

(3) The individual has a contractual right to admission to a nursing facility operated as part of a system of continuing care in conjunction with one or more facilities that provide a less intensive level of services, including a residential care facility licensed under Chapter 3721. of the Revised Code, an adult care facility licensed under Chapter 3722. of the Revised Code, or an independent living arrangement; 

(4) The individual is to receive continual care in a home for the aged exempt from taxation under section 5701.13 of the Revised Code; 

(5) The individual is seeking admission to a facility that is not a nursing facility with a provider agreement under section 5111.22 of the Revised Code; 

(6) The individual is to be transferred from another nursing facility; 

(7) The individual is to be readmitted to a nursing facility following a period of hospitalization; 

(8) The individual is exempted from the long-term care consultation requirement by the department or the program administrator pursuant to rules that may be adopted under division (L) of this section. 

(J)  At the conclusion of an individual's long-term care consultation, the department or the program administrator under contract with the department shall provide the individual or individual's representative with a written summary of options and resources available to meet the individual's needs. Even though the summary may specify that a source of long-term care other than care in a nursing facility is appropriate and available, the individual is not required to seek an alternative source of long-term care and may be admitted to or continue to reside in a nursing facility. 

(K)  No nursing facility for which an operator has a provider agreement under section 5111.22 of the Revised Code shall admit or retain any individual as a resident, unless the nursing facility has received evidence that a long-term care consultation has been completed for the individual or division (I) of this section is applicable to the individual. 

(L)  The director of aging may adopt any rules the director considers necessary for the implementation and administration of this section. The rules shall be adopted in accordance with Chapter 119. of the Revised Code and may specify any or all of the following: 

(1) Procedures for providing long-term care consultations pursuant to this section; 

(2) Information to be provided through long-term care consultations regarding long-term care services that are available; 

(3) Criteria under which an individual or the individual's representative may choose to forego participation in a long-term care consultation; 

(4) Criteria for exempting individuals from the long-term care consultation requirement; 

(5) Circumstances under which it may be appropriate to provide an individual's long-term care consultation after the individual's admission to a nursing facility rather than before admission; 

(6) Criteria for identifying nursing facility residents who would benefit from the provision of a long-term care consultation. 

(M)  The director of aging may fine a nursing facility an amount determined by rules the director shall adopt in accordance with Chapter 119. of the Revised Code 
 

if the nursing facility admits or retains an individual, without evidence that a long-term care consultation has been provided, as required by this section. 
 

In accordance with section 5111.62 of the Revised Code, all fines collected under this division shall be deposited into the state treasury to the credit of the residents protection fund. 
 

HISTORY: 145 v H 152 (Eff 7-1-93); 145 v H 715 (Eff 7-22-94); 146 v H 117 (Eff 9-29-95); 148 v H 471. Eff 7-1-2000; 150 v H 95, § 1, eff. 6-26-03; 151 v H 66, § 101.01, eff. 9-29-05.
 

The provisions of § 203.21.03 of 151 v H 66 read as follows: 

SECTION 203.21.03. PRE-ADMISSION REVIEW FOR NURSING FACILITY ADMISSION. 

Pursuant to an interagency agreement, the Department of Job and Family Services shall designate the Department of Aging to perform assessments under sections 173.42 and 5111.204 of the Revised Code. Of the foregoing appropriation item 490-403, PASSPORT, the Department of Aging may use not more than $2,586,648 in fiscal year 2006 and $2,651,315 in fiscal year 2007 to perform the assessments for persons not eligible for Medicaid under the department's interagency agreement with the Department of Job and Family Services and to assist individuals in planning for their long-term health care needs. 

The effective date is set by § 612.03 of 151 v H 66. 

The effective date is set by section 182 of H.B. 95 (150 v  - ). 
 

Å References to "division (I)" of this section as enrolled by 150 v H 95. 

 

Effect of Amendments

151 v H 66, effective September 29, 2005, rewrote the section. 

H.B. 95, Acts 2003, effective June 26, 2003, substituted "for which an operator has" for "with" in (H).