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Ohio Laws and Rules
(A) An individual or entity that wishes to receive payments for services under the Ryan White program shall meet the eligibility criteria specified in this rule.
(B) The provider shall possess any license or other regulatory approval required by law to practice in Ohio.
(C) If the provider is not required to have a license or other regulatory approval to practice in Ohio, the provider shall have a current federal tax identification number, except as otherwise provided in this paragraph. A community-based HIV case manager may authorize payment for services provided by an individual or entity In such a case, the agency that employs the community-based HIV case manager shall pay the individual or entity. That agency shall enter into a provider agreement with the director under paragraph (D) of this rule and shall bill the third-party administrator for reimbursement, under rule 3701-44-04 of the Administrative Code, for payments made under this paragraph.
(D) The provider shall execute an agreement with the consortium which includes, but is not limited to, the following provisions:
(1) A requirement that the provider accept as payment in full for the service the following applicable payment, as determined under paragraph (C) of rule 3701-44-04 of the Administrative Code;
(a) Usual, customary, and reasonable charges, as determined by the thirdparty administrator for the service in question; or
(b) The payment rate established by the applicable HIV care consortium or the director for the service.
The provider shall not bill the recipient of services or any other person for any services for which payment is made under the Ryan White program and for which an outstanding balance remains. Ryan White program funds constitute payment in full; and
(2) A requirement that the provider comply with all applicable provisions of state and federal law regarding confidentiality of information about individuals with HIV infection.
(E) The consortium serving the geographic area where the provider provides services shall determine the provider’s eligibility. Once a provider has been determined to be eligible, the provider shall be eligible to provide services to individuals and families residing in any geographic area in the state unless the director has terminated the provider’s eligibility under paragraph (F) of this rule.
(F) The director may terminate a provider’s eligibility upon determining that the provider no longer meets the eligibility requirements specified by this rule or has violated the provider agreement required by paragraph (D) of this rule.
(G) The consortium or the director, as applicable, shall provide written notification of any decision regarding eligibility of a provider. If the consortium or director denies or terminates eligibility, he or she shall state in the notice the reasons for denial or termination and the process for reconsideration under rule 3701-44-07 of the Administrative Code.
R.C. 119.032 review dates: 04/30/2004 and 04/30/2009
Promulgated Under: 119.03
Statutory Authority: 3701.241
Rule Amplifies: 3701.241
Prior Effective Dates: 5/20/1999