Chapter 173-43 | Long Term Care Consultation Program

Rule 173-43-01 | Long-term care consultation program: introduction and definitions.

• Effective: February 1, 2023
• Promulgated Under: 119.03

(A) The long-term care consultation program provides information to individuals and their representatives about options available to meet their long-term care needs and factors to consider when making long-term care decisions in accordance with section 173.42 of the Revised Code.

(B) Definitions for this chapter:

(1) "Individual" means a person who may qualify to receive a long-term care consultation.

(2) "Level of care" means the review and determination process under rule 5160-3-14 of the Administrative Code.

(3) "Long-term care consultation" and "consultation" have the same meanings as in section 173.42 of the Revised Code.

(4) "Nursing facility" has the same meaning as in section 5165.01 of the Revised Code.

(5) "ODA" means the Ohio department of aging.

(6) "Pre-admission screening and resident review" has the same meaning as in rules 5160-3-15.1 and 5160-3-15.2 of the Administrative Code.

(7) "Program administrator" has the same meaning as in section 173.42 of the Revised Code.

(8) "Representative" has the same meaning as in section 173.42 of the Revised Code.

Last updated February 1, 2023 at 8:47 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.42
Amplifies: 173.42
Five Year Review Date: 2/1/2028
Prior Effective Dates: 12/19/2013

Rule 173-43-02 | Long-term care consultation program: general standards for providing consultations.

• Effective: February 1, 2023
• Promulgated Under: 119.03

(A) The program administrator may provide a consultation in person or by telephone or video conference.

(B) The program administrator shall offer a consultation to any individual who contacts the program administrator to seek information about options available to meet long-term care needs.

(C) On application for admission to a nursing facility or on seeking medicaid payment for a continued stay in a nursing facility, the following apply:

(1) The nursing facility shall notify the program administrator of any individual that was admitted to the nursing facility under a a categorical determination in accordance with rule 5160-3-15.1, 5122-21-03, or 5123-14-01 of the Administrative Code, but has since been found to need a stay in a nursing facility that will exceed the time limits identified in those rules. The nursing facility shall notify the program administrator no later than seventy-two hours after the expiration of the time limit, unless rule 173-43-03 of the Administrative Code indicates that the program administrator is not required to provide a consultation to the individual. On being notified, the program administrator shall determine if a consultation is required.

(2) If the program administrator is not required to provide a consultation to an individual under rule 173-43-03 of the Administrative Code, then the nursing facility shall specify the reason why the program administrator is not required to provide a consultation in the individual's record.

(3) The program administrator shall provide a consultation at a time agreed to by the program administrator and the individual, whether before or after admission to a nursing facility.

(4) The nursing facility shall not deny or limit access to the facility or a resident of the facility to any person who is attempting to provide a consultation.

(5) The program administrator may obtain information about an individual who is applying to a nursing facility or seeking medicaid payment for a continued stay in a nursing facility from the individual, the nursing facility to which admission is being sought, the pre-admission screening and resident review under rules 5160-3-15.1 and 5160-3-15.2 of the Administrative Code, or through the resident assessment instrument as defined in rule 5160-3-43.1 of the Administrative Code.

(6) A nursing facility that has a provider agreement with the department of medicaid may admit an individual as a resident only if the nursing facility has evidence of all of the following:

(a) The nursing facility complied with this rule.

(b) The nursing facility complied with rule 173-43-03 of the Administrative Code.

(c) The program administrator provided a consultation to the individual, unless rule 173-43-03 of the Administrative Code exempted the individual.

(D) Concurrent assessments: The program administrator may incorporate either of the following assessments into a consultation:

(1) The level-of-care assessment under rule 5160-3-14 of the Administrative Code.

(2) The pre-admission screening and resident review under rules 5160-3-15.1 and 5160-3-15.2 of the Administrative Code.

(E) Components of each consultation: When providing a consultation, the program administrator shall focus on the individual's needs, circumstances, and values and provide the individual with information about options available to meet the individual's needs, including all of the following information:

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

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

(3) Factors to consider when choosing among the available program, 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.

(5) If the individual is a veteran, as defined in section 5901.01 of the Revised Code, or the spouse, surviving spouse, or representative of the veteran, the following additional information:

(a) The availability of health care or financial benefits through the United States department of veterans affairs.

(b) Information about congressionally-chartered veterans service organizations or the county veterans service office that can assist with investigating and applying for benefits through the United States department of veterans affairs.

(6) Support for the individual as the individual explores the range of options available, makes decisions about the appropriate services to meet the individual's needs, and creates a plan of care.

(F) At the conclusion of the consultation, the program administrator shall provide the individual (or the individual's representative) with a written or electronic summary of the options and resources discussed. The information the program administrator provides to an individual during a consultation is not binding. The individual may choose the long-term services and supports that best meet the individual's needs.

Last updated February 1, 2023 at 8:47 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.42
Amplifies: 173.42; 42 U.S.C. 3002, 3012, 3025, 3032
Five Year Review Date: 2/1/2028
Prior Effective Dates: 12/19/2013

Rule 173-43-03 | Long-term care consultation program: required consultations and exemptions.

• Effective: February 1, 2023
• Promulgated Under: 119.03

(A) The program administrator shall provide a consultation to an individual satisfying one or more of the following categories, unless paragraph (B) of this rule exempts the individual:

(1) An individual who applies, or indicates an intention to apply, for admission to a nursing facility.

(2) A nursing facility resident who was admitted under a categorical determination under rule 5160-3-15.1, 5122-21-03, or 5123-14-01 of the Administrative Code, but has since been found to need a stay in a nursing facility that will exceed the time limits in those rules.

(3) An individual who contacts the program administrator to seek information about options available to meet long-term care needs.

(4) Any individual that ODA or the program administrator identifies as being likely to benefit from a consultation.

(B) The program administrator is not required to provide a consultation to an individual if any of the following is the case:

(1) The program administrator has attempted to provide the consultation, but the individual or the individual's representative refuses to cooperate.

(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 providing a less-intensive level of services, including a residential care facility licensed under Chapter 3721. of the Revised Code; a residential facility licensed under section 5119.34 of the Revised Code providing accommodations, supervision, and personal care services for three to sixteen unrelated adults; or an independent living arrangement.

(4) The individual is to receive continual care in a home for the aged that is 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 5165.07, 5165.511, or 5165.512 of the Revised Code.

(6) The individual is exempt from the requirement for a face-to-face level-of-care determination under rule 5160-3-14 of the Administrative Code.

(7) The individual is being admitted to a nursing facility directly from a hospital and the program administrator expects the individual to have a stay of thirty days or less based upon factors such as medical condition, probable need for long-term care services, history of hospitalizations, availability of informal supports, and awareness of options available to determine the appropriateness of the consultation.

(8) The program administrator determines that the individual has care needs clearly exceeding the services available to the individual in an alternative setting to the nursing facility based upon the availability of existing formal and informal support systems, the availability of potential formal and informal support systems, the functional abilities and limitations of the individual, the individual's diagnosis, the individual's prognosis, and the individual's plan of treatment, placing special emphasis on end-of-life treatment, because such a treatment is most likely an indicator that the individual will not benefit from a consultation.

(9) The individual has been admitted to a nursing facility under a categorical determination or hospital discharge exemption under rule 5160-3-15 of the Administrative Code.

(10) The individual received a consultation from the program administrator within the previous one hundred twenty days.

(C) The source of payment for an individual's care in a nursing facility is not a factor in determining whether the program administrator may provide a consultation to an individual who resides in a nursing facility.

Last updated February 1, 2023 at 8:47 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.42
Amplifies: 173.42; 42 U.S.C. 3002, 3012, 3025, 3032
Five Year Review Date: 2/1/2028
Prior Effective Dates: 8/1/2018

Rule 173-43-04 | Long-term care consultation program: deadlines.

• Effective: February 1, 2023
• Promulgated Under: 119.03

(A) The program administrator shall complete every consultation no later than ten days after it receives a request for the consultation, unless an exception under paragraph (B) of this rule applies.

(B) Exceptions to the deadline in paragraph (A) of this rule:

(1) If the deadline in paragraph (A) of this rule falls on a Saturday, Sunday, or a legal holiday listed in section 1.14 for the Revised Code, the deadline is the next day that is not a Saturday, Sunday, or legal holiday rather than the deadline in paragraph (A) of this rule.

(2) If an individual or the individual's representative requests a consultation after the deadline in paragraph (A) of this rule, the program administrator shall provide the consultation at a time that is mutually agreed to between the individual, or the individual's representative, and the program administrator and retain a record on the reason why the program administrator was not able to provide the consultation before the deadline.

(3) If the program administrator cannot complete the consultation before the deadline in paragraph (A) of this rule, the program administrator shall provide the long-term care consultation as soon as is practicable and retain a record on the reason why the program administrator was not able to provide the consultation before the deadline.

Last updated February 1, 2023 at 8:47 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.42
Amplifies: 173.42; 42 U.S.C. 3002, 3012, 3025, 3032
Five Year Review Date: 2/1/2028
Prior Effective Dates: 7/5/2012, 12/31/2020

Rule 173-43-05 | Long-term care consultation program: staff certification.

• Effective: October 1, 2024
• Promulgated Under: 119.03

(A) Section 173.42 of the Revised Code permits a person to provide a consultation only if ODA certifies the person.

(B) Qualifications for certification: ODA may certify a person to provide consultations only if the person meets all of the following qualifications, unless paragraph (C) of this rule applies:

(1) The person is an employee of the program administrator.

(2) The person meets at least one of the following qualifications:

(a) The person has a current, valid license to practice as a registered nurse (RN) or licensed practical nurse (LPN) under Chapter 4723. of the Revised Code, including an RN or LPN with a "multistate license" from another state with "multistate licensure privilege," as those terms are defined in section 4723.11 of the Revised Code.

(b) The person has a current, valid license under Chapter 4757. of the Revised Code as a licensed independent social worker (LISW), licensed social worker (LSW), an LISW or LSW from a member state with an unencumbered multistate license under section 4757.52 of the Revised Code, or a current, valid license to practice in a related profession upon approval by ODA.

(c) The person has a current, valid registration as a social worker trainee, as defined in rule 4757-3-01 of the Administrative Code.

(d) The person has a bachelor of arts degree or a bachelor of science degree and also possesses at least one year of experience in one or both of the following:

(i) Providing individuals with information about options available to meet long-term care needs or providing individuals with related information such as that which is provided through information and referral, information and assistance.

(ii) Managed care experience or other such healthcare experience related to individuals' long-term care needs.

(e) The person has at least three years of experience in one or both of the following:

(i) Providing individuals with information about options available to meet long-term care needs or providing individuals with related information such as that which is provided through information and referral, information and assistance.

(ii) Managed care experience or other such healthcare experience related to individuals' long-term care needs.

(3) The person is not an employee of a provider of long-term services and supports.

(4) The person is not disqualified for a paid direct-care position under Chapter 173-9 of the Administrative Code.

(C) Consultants moving to Ohio from other states: Section 173.422 of the Revised Code establishes a requirement for ODA to certify an applicant from the uniformed services or another state according to Chapter 4796. of the Revised Code if the applicant meets all the following conditions:

(1) The applicant is an employee of the program administrator.

(2) The applicant is not disqualified from a paid direct-care position under Chapter 173-9 of the Administrative Code or section 173.38 of the Revised Code.

(3) The applicant meets the qualifications in section 4796.03, 4796.04, or 4796,05 of the Revised Code.

(D) General standards regarding certification:

(1) ODA shall notify the program administrator of the date that it certifies a person to provide long-term care consultations.

(2) If, at any time, a certified person no longer qualifies for certification under paragraph (B) or (C) this rule, the person shall not provide another long-term care consultation until the person qualifies under this rule.

(3) Training:

(a) The program administrator shall train and orient each certified person on the following topics:

(i) Local availability of publicly-financed and privately-financed long-term care options, programs, services, and benefits.

(ii) Factors to consider when choosing among available options.

(iii) Opportunities and methods for individuals to maximize independence and self-reliance.

(iv) The availability of health care or financial benefits through the United States department of veterans affairs.

(v) How to refer an individual to a congressionally-chartered veterans service organization or the county veterans service office.

(b) Each certified person shall successfully complete fifteen clock hours of professional development every two years after the date ODA certified the person on topics relevant to the duties involved in providing a consultation. This requirement does not apply to any person who qualified to be a consultant under paragraph (B)(2)(a) or (B)(2)(b) of this rule.

(4) For each certified person, the program administrator shall retain records demonstrating compliance with this rule.

Last updated October 1, 2024 at 9:42 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.42, 173.422
Amplifies: 173.422
Five Year Review Date: 10/1/2029
Prior Effective Dates: 6/30/2007, 8/1/2018, 6/11/2020 (Emer.)