07/19/2017

NEW Level of Care Rules

The Ohio Department of Medicaid is revising the NF Level of Care (LOC) rules. The LOC rules are being revised to incorporate the new assessment tools (Adult Comprehensive Assessment Tool “ACAT” and Child Comprehensive Assessment Tool “CCAT”) as well as additional changes. Click here for Business Impact Analysis.

OAC 5160-3-10 (New)

This proposed new rule identifies the process by which a level of care for a child is determined.

In addition, this rule will mandate the use of, either the ODM 10126 “Child Comprehensive Assessment Tool” (CCAT) for children who seek waiver services or ODM 10128 “Child Level of Care Questionnaire” for children who seek Medicaid payment for a nursing facility stay.

 

OAC 5160-3-14 (Rescinded/New)

This rule establishes a process for determining level of care. Proposed changes to the rule are outlined below.

Changes to rule 5160-3-14 include:

• State agency name references, form numbers, and rule number references were updated to reflect statutory and Administrative Code changes.

• Clarifies that this rule is specific to the adult population.
  
  
• Removes unnecessary references to ICF-MR level of care.
  
  
• Adds the use of an ODM approved assessment instrument to determine the need for less than twenty-four (24) hour support in order to prevent harm due to a cognitive impairment, when diagnosed by a physician.
  
  
• Adds the need for a face to face level of care assessment when an individual seeking anursing facility-based level of care appears to meet solely on the basis of a need for twenty-four (24) hour support in order to prevent harm due to a cognitive impairment.
  
  
• Replaced the usage of the JFS 03697, “Level of Care Assessment” or alternative form to determine level of care with the ODM 10125 “Adult Comprehensive Assessment Tool” (ACAT) or ODM 10127 “Adult Level of Care Questionnaire.”