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

(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 to practice in Ohio.

(C) The provider shall execute an agreement with the director 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 third-party administrator, for the service in question; or

(b) The payment rate established by the ohio department of health Ryan White home health coordinator or the director for the service;

(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.

(D) The consortium or the consortia program coordinator 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 service to individuals and families residing in any geographic area in the state unless the director has terminated the provider’s eligibility pursuant to paragraph (C) of this rule.

(E) 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 (C) of this rule.

(F) The community based HIV case manager or the director, as applicable, shall provide written notification of any decision regarding eligibility of a provider. If the case manager or director denies or terminates eligibility, he or she shall state in the notice the reason(s) for denial or termination and the process for reconsideration under rule 3701-44-24 of the Administrative Code.

R.C. 119.032 review dates: 06/29/2006 and 06/29/2011

Promulgated Under: 119.03

Statutory Authority: 3701.241

Rule Amplifies: 3701.241

Prior Effective Dates: 7/20/2001