Chapter 3701-44 Ryan White Program

3701-44-01 Definitions.

As used in this chapter:

(A) "AIDS" means acquired immune deficiency syndrome.

(B) "Department" means the Ohio department of health.

(C) "Director" means the director of health or the director of health's designee.

(D) "Family" means a group of individuals who are related by blood, marriage, or adoption.

(E) "HIV" means human immunodeficiency virus.

(F) "Ryan White part B program" means the program established by the Ryan White HIV/AIDS Treatment Modernization Act, 42 U.S.C. 300ff et seq. (as in effect on January 1, 2009), and administered by the director of health under division (D) of section 3701.241 of the Revised Code.

Replaces: 3701-44-01

Five Year Review (FYR) Dates: 1/28/2019 and 01/28/2024
Promulgated Under: 119.03
Statutory Authority: 3701.241
Rule Amplifies: 3701.241
Prior Effective Dates: 9/23/1991 (Emer.), 12/22/91, 5/20/99, 7/20/01, 12/18/06, 8/2/09, 11/4/11

3701-44-02 [Rescinded] HIV medical case management.

(A) The department may provide HIV medical case management services or delegate the authority to provide medical case management services to another entity through the department's grant process.

(B) HIV medical case management services shall be provided in accordance with the Ryan White part B program, sections 3701.24 to 3701.249 of the Revised Code, chapter 3701-44 of the Administrative Code and guidelines established by the director.

Replaces: 3701-44-03

Effective: 4/1/2019
Five Year Review (FYR) Dates: 11/19/2018
Promulgated Under: 119.03
Statutory Authority: 3701.241
Rule Amplifies: 3701.241
Prior Effective Dates: 9/23/1991 (Emer.), 12/22/91, 5/20/99, 8/2/09, 11/4/11

3701-44-03 Eligibility for benefits under the Ryan White part B program.

(A) To be eligible for benefits under the Ryan White part B program, an individual shall meet all of the following requirements:

(1) The individual must be an Ohio resident;

(2) The individual must have a verified HIV infection ; and

(3) Applicants to the Ryan White part B programs must meet the following financial guidelines to be eligible:.

(a) The individual or individual's family gross income must be equal to or less than five hundred per cent of the federal poverty level (FPL) published in the federal register on or before the first of April of each calendar year. When possible, these income calculations may be made using modified adjusted gross income (MAGI);

(b) The calculations shall exclude taxes and any mandatory retirement deduction.

(B) The director may deny an individual's application, or terminate an individual's program enrollment, or deny an individual's access to specific services, if the director determines:

(1) There are insufficient funds;

(2) With consideration given to the continuity of care, the individual does not meet the eligibility guidelines set forth in paragraph (A) of this rule;

(3) The individual submitted false or misleading information;

(4) The individual abused or misused an approved benefit; or

(5) The individual failed to apply for or use or disclose other available resources to which the individual has access to pay for services otherwise paid for by Ryan White part B .

(C) Pursuant to 42 U.S.C. 300ff-21 (2009) and 42 U.S.C. 300ff-22 (2009), the Ryan White part B program funds are federal grants. If, at any time, there is insufficient funding to sustain the current Ryan White part B programs, the director, pursuant to division (D) of section 3701.241 of the Revised Code, as necessary for the effective administration of available funds to the Ryan White part B programs, may, upon thirty-day notice to affected clients, restrict, reduce, or eliminate existing programs. If the director restricts or reduces existing programs by changing the maximum income threshold set forth in paragraph (A)(3)(a) of this rule, the director shall not set the maximum income threshold below three hundred per cent of the federal poverty level.

(D) An individual may seek reconsideration of a decision that is based on other than the insufficiency of program funds pertaining to the Ryan White part B programs .

(1) An individual seeking reconsideration of a decision listed in paragraphs (B)(2) to (B)(5) of this rule shall file a written request for reconsideration with the department. The request for reconsideration must be received within thirty days from the date the individual received a decision . The request for reconsideration must contain a statement of the reasons that the individual believes that the decision is incorrect or inconsistent with the Ryan White part B program guidelines, and may include any written documentation, arguments, or other materials that the affected party wishes to submit for the purposes of the reconsideration.

(2) Upon receiving a timely request for reconsideration, the director shall:

(a) Review the information submitted within thirty days of receipt of the request. The director may request additional information which extends the review time. Except for good cause, additional information shall be submitted to the director within forty-five days of receiving a request for additional information.

(b) Render a written decision to the requestor of the reconsideration within thirty days of the receipt of the request for reconsideration or receipt of additional information, whichever is later. The written decision shall include the reasons for the decision. The decision of the director is final and there is no further review.

(E) The Ryan White part B program is the payer of last resort.

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Effective: 4/1/2019
Five Year Review (FYR) Dates: 11/19/2018 and 01/28/2024
Promulgated Under: 119.03
Statutory Authority: 3701.241
Rule Amplifies: 3701.241
Prior Effective Dates: 9/23/1991 (Emer.), 12/22/91, 5/20/99, 7/20/01, 12/20/01, 8/2/09, 11/4/11, 8/30/12

3701-44-04 Waiver.

(A) Upon request from an applicant, client, or the HIV-treating physician or nurse practitioner, or authorized representative of an applicant or client, the director may waive any part of this chapter. A request for a waiver shall be accompanied by documentation supporting the request. The director may request additional documentation prior to making a decision. Waiver requests are subject to paragraph (B) of this rule.

(B) The director may not grant a waiver request if the approval of the request is contrary to any of the following:

(1) The established standard of care for the treatment of HIV;

(2) The public interest;

(3) Federal or state law;

(4) The federal requirements for the Ryan White part B funding; or

(5) There are insufficient funds to support a waiver request.

(C) The director's decision pursuant to a waiver request is final and not subject to further review.

Replaces: 3701-44-04

Effective: 4/1/2019
Five Year Review (FYR) Dates: 01/28/2024
Promulgated Under: 119.03
Statutory Authority: 3701.241
Rule Amplifies: 3701.241
Prior Effective Dates: 9/23/1991 (Emer.), 12/22/91, 5/20/99, 7/20/01, 8/2/09, 11/4/11

3701-44-05 [Rescinded] Eligibility for benefits under the Ryan White part B program.

Effective: 11/04/2011
R.C. 119.032 review dates: 04/20/2011
Promulgated Under: 119.03
Statutory Authority: 3701.241
Rule Amplifies: 3701.241
Prior Effective Dates: 9/23/91 (Emer.), 12/22/91, 5/20/99, 12/20/01, 8/2/09

3701-44-06 [Rescinded] Provider eligibility for core medical services.

Effective: 11/04/2011
R.C. 119.032 review dates: 04/20/2011
Promulgated Under: 119.03
Statutory Authority: 3701.241
Rule Amplifies: 3701.241
Prior Effective Dates: 9/23/1991 (Emer.), 12/22/91, 5/20/99, 7/20/ 01, 8/2/09

3701-44-07 [Rescinded] Reconsideration process for denial or termination of eligibility.

Effective: 11/04/2011
R.C. 119.032 review dates: 04/20/2011
Promulgated Under: 119.03
Statutory Authority: 3701.241
Rule Amplifies: 3701.241
Prior Effective Dates: 9/23/1991 (Emer.), 12/22/91, 5/20/99, 7/20/01, 8/2/09

3701-44-08 [Rescinded] Ohio HIV drug assistance program eligibility requirements.

Effective: 11/04/2011
R.C. 119.032 review dates: 04/20/2011
Promulgated Under: 119.03
Statutory Authority: 3701.241
Rule Amplifies: 3701.241
Prior Effective Dates: 7/20/2001, 12/18/06, 8/2/09

3701-44-09 Operation of home health program; establishment of list of services covered by the home health program.[Rescinded].

Rescinded eff 8-2-09

3701-44-10 Payment for services under the Ryan White home health program.[Rescinded].

Rescinded eff 8-2-09

3701-44-11 Eligibility for benefits under the Ryan White home health program.[Rescinded].

Rescinded eff 8-2-09

3701-44-12 Eligibility of providers for Ryan White home health program.[Rescinded].

Rescinded eff 8-2-09

3701-44-13 Reconsideration of eligibility and authorization decisions.[Rescinded].

Rescinded eff 8-2-09