Ohio Department of Aging
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The following are answers to basic questions about provider certification for the Assisted Living Waiver Program. If you have a question that is not answered here, please contact us.
What is the first step in the process of becoming an ODA-certified Assisted Living provider?
Contact the Area Agency on Aging that serves the county where the residential care facility is located to request a provider application packet.
Who is eligible to obtain ODA-certification as an Assisted Living provider?
An eligible provider is a licensed residential care facility that can provide private occupancy living units that include a full bath (sink, toilet, and tub or shower).
Will there be a limited number of providers that can participate?
No. Enrollment is open to any provider that demonstrates the capacity to meet the program guidelines.
My facility already has a Medicaid provider number. Do I still need to complete the Ohio Health Plans Provider Enrollment Application?
Yes. This application will be used to assign a new provider type and category of service.
Is my facility required to carry general commercial liability insurance?
Yes. Rule 173-39-02 (E1e) of the OAC (Conditions of Participation) state the provider must provide evidence of commercial liability insurance. Is my facility required to carry general commercial liability insurance?
Is my facility responsible for a waiver consumer's property loss?
Yes. The provider must provide evidence of insurance coverage for a consumer's loss resulting from the action or inaction of facility staff.
Where do I submit a completed application packet?
The completed application packet is returned to the Area Agency on Aging that serves the county the facility is located in.
What happens after I submit the application?
The Ohio Department of Health will conduct an on-site visit and report findings to the appropriate Area Agency on Aging, which will make the final recommendation for certification to the Ohio Department of Aging.
What if my facility doesn't meet all the requirements at the time of the on-site visit?
The Area Agency on Aging will provide written notification to the applicant specifying the areas of non-compliance. The applicant will have 20 business days from the date of notification to demonstrate full compliance with all requirements. The Area Agency on Aging will provide technical assistance to the provider applicant to resolve, when possible, the identified issues.
Where can I find the Assisted Living program rules?
The program rules (173-39-02.16 and 173-39-02.17 of the OAC) are included in the application packet and can also be obtained through the Ohio Department of Aging Web site.
Is my facility required to have nursing services round the clock?
No, the expectation is the provider will have the capacity to provide nursing services when ordered on the consumer's care plan.
How is the term "care plan" defined in this program?
The care plan is a description of the type and amount of services that have been determined to meet an individual’s needs. The care plan identifies who is responsible for providing the services. The plan is developed by the consumer, the Area Agency on Aging case manager and the facility.
How will my facility receive referrals for the program?
Referrals to the facility will be made by the Area Agencies on Aging.
Am I obligated to accept a referral if I have a vacant living unit that meets the space requirement?
No. The provider has the right to decline any referral.
What is the reimbursement for the waiver?
The reimbursement includes the room and board payment made by the consumer ($587.00/month) and a daily rate for services based on the level of service a consumer needs.
| Level of Service | Daily Rate | Room & Board Payment | Total Reimbursement* |
|---|---|---|---|
| Tier 1 | $49.98 | $573.00 | $2,122.38 |
| Tier 2 | $60.00 | $573.00 | $2,433.00 |
| Tier 3 | $69.98 | $573.00 | $2,742.38 |
* daily rate + room and board payment; based on a 31 day month
How is the level of service determined?
The initial level of service is determined by the case manager following a comprehensive in-person assessment. The first re-assessment of the level of service is completed 30 days after the consumer is enrolled. After that, a change in the level of service is determined by the consumer’s needs.
How is the facility paid?
The Assisted Living provider will receive two payments: one from the Consumer for room and board ($587.00/ month) and one from the Area Agency on Aging based on the service tier assignment.
What if the consumer is hospitalized? Are "bed hold" days paid?
"Bed hold" day reimbursement does not apply in the assisted living waiver. Reimbursement for the waiver services is not available when services are not delivered. The consumer is responsible for continuation of the room and board payment.
Do all of the living units in my facility have to meet the space requirements in order to participate?
No. In many cases, a residential facility community will offer a variety of living space configurations. We expect the provider applicant will identify those units that meet the living space requirements for the waiver.
Is there a minimum/maximum number of living units required to participate in the program?
No. Facilities are advised, but not required, to certify all living units that meet the requirements. This gives maximum flexibility when considering admissions waiver consumers.
The living units in the facility are studio apartments with the bedroom furnishings in full view. Will this meet the space requirements?
Yes, as long as the room configuration is large enough to allow for a separate area for socialization. There is no requirement for a physically divided bedroom space.
The facility only has double occupancy rooms and/or no private bathrooms. Can the space requirements be waived?
No. The living space requirements are a provision of CMS approval of the waiver and in accordance with OAC Rule 173-39-16-02.
Can I use the living units that meet the waiver space requirements for other consumers?
Yes. ODA certification as an assisted living provider does not require the provider to reserve living units.
At the time of application, is the facility required to have vacant living units that meet the space requirements?
No.
Ohio Department of Aging