5101:2-25-07 Title XX reimbursement dependent upon correct determination of recipient eligibility.

(A) Child care services provided under Title XX are excluded from the requirements contained in this rule and the county department of job and family services (CDJFS) shall follow child care requirements contained in Chapter 5101:2-16 of the Administrative Code.

(B) Reimbursement under Title XX for expenditures for services delivered to individuals is contingent upon the following:

(1) Service is included in the "Comprehensive Title XX Social Services Plan" (CTXXSSP).

(2) The individual who receives the service is a member of one of the eligibility categories to which the service is available in the county of residence. Availability of services to eligibility categories is shown in the county data section of the CTXXSSP.

(3) The individual receiving the service(s) correctly met the eligibility factors which are applicable to the service(s) received by the individual and the individual's eligibility category.

(C) When the CDJFS provides Title XX social services for free or for a fee, it shall establish eligibility standards or a fee schedule based on income level guidelines. The CDJFS shall formalize these eligibility standards and fee schedules in a written document which the CDJFS shall make available at all times for public review.

(D) Categories of eligibility under the Title XX program are as follows:

(1) Income eligible

(a) Services for free, as determined by the CDJFS.

(b) Services for a fee, as determined by the CDJFS.

(i) Services for a fee is the amount charged by the CDJFS or provider agency under contract with the CDJFS.

(ii) The CDJFS may offer any service(s) identified in their current CTXXSSP in the "Service for a Fee" category with the exception of information and referral services, protective services for adults and protective services for children.

(iii) Only those services to which fees are applicable are counted in determining the amount of the fee. Services that are available to consumers without regard to income would therefore not be counted.

(2) Without regard to income, as determined by the CDJFS.

(a) A written application is not required where service is deemed without regard to income.

(b) Protective services for adults and children and information and referral may be provided without regard to income.

(E) Eligibility determinations and redeterminations may be conducted by the agency providing the service; however the CDJFS may make eligibility determinations if it concludes that doing so would benefit consumers or result in more efficient operation of the Title XX social services program in the county, or if it concludes that a provider is making unsatisfactory eligibility determinations. The CDJFS will determine the frequency of redeterminations, based upon the service plan.

(F) Proper and improper determination and redetermination of eligibility, under the Title XX program are as follows:

(1) Reimbursement is available for services provided during the period of proper eligibility determination and until the end of the month in which the individual is subsequently determined to be ineligible for services.

(2) A proper determination of eligibility is based on a correct assessment of all necessary information available to the CDJFS or provider agency at the time of such determination. The determination must be made within thirty calendar days of the date of the initial application or request for services, or prior to the due date of a redetermination.

(3) Written notification of approval or denial of an application or request for Title XX social services, shall be made within fifteen calendar days of the date of determination. Paragraph (H) of this rule shall apply.

(4) If a consumer is found to have been improperly determined eligible for services, reimbursement is not available for the services provided during the period of improper determination.

(5) Reimbursement from the Ohio department of job and family services (ODJFS) to the CDJFS or from the CDJFS to the provider agency is not available prior to the date of the initial application or request for services.

(G) The CDJFS or the agency under contract make eligibility determinations and redeterminations for Title XX social services shall:

(1) Accept consumer applications and requests for services.

(2) Complete a social service plan.

(3) Determine eligibility.

(4) Authorize requested services, if appropriate.

(5) Fulfill all applicable responsibilities relative to state hearings in accordance with division 5101:6 of the Administrative Code.

(H) When Title XX eligibility determination and redetermination are conducted by the purchased service provider under contract, the CDJFS must assure that the provider agency will explain to the consumer the following rights and responsibilities:

(1) The consumer has the right:

(a) To apply for services and have eligibility determined within thirty calendar days of the receipt of the application.

(b) To receive any needed service listed in the county's profile as provided in the consumer's eligibility category in the consumers' county provided all eligibility factors are met and sufficient funds are available to provide the services.

(c) To a state hearing as described in division 5101:6 of the Administrative Code.

(d) To be advised of the eligibility requirements for social services.

(e) To the safeguarding of information reported by or about the consumer, to the extent permitted by law.

(2) The consumer has the responsibility:

(a) To report, within ten calendar days, any information that may affect eligibility.

(b) To provide documentation to substantiate eligibility.

(c) To cooperate with subsequent efforts to assess any error rate made in the eligibility process.

Effective: 05/31/2012
R.C. 119.032 review dates: 02/02/2012 and 05/01/2017
Promulgated Under: 119.03
Statutory Authority: 5101.46
Rule Amplifies: 5101.46
Prior Effective Dates: 10/01/82, 10/01/90, 08/15/91, 11/01/91 (Emer.), 1/10/92, 8/1/98, 1/1/04, 1/12/07