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Ohio Laws and Rules
(A) Prior notice of enrollment
(1) When the recipient monitoring and review section, ODJFS, intends to enroll an individual in the primary alternative care and treatment (PACT) program, the individual and authorized representative shall be provided prior written notice of the proposed enrollment, with a copy to the local agency.
(2) The notice shall be mailed or personally delivered no less than fifteen calendar days prior to the effective date of enrollment.
(3) The notice shall contain a clear and understandable statement of the proposed action and the reasons for it, cite the applicable regulations, explain the individual’s right to and the method of obtaining a state hearing, explain the circumstances under which a timely hearing request will result in continued unrestricted benefits, and contain the name and telephone number of the PACT representative to contact for more information and a telephone number to call about free legal services.
(4) The notice shall explain the method of and the deadline for selecting a designated physician and/or pharmacy, and that the recipient monitoring and review section will select a physician and/or pharmacy if a selection is not received by the deadline.
(5) The “Prior Notice of PACT Program Enrollment,” JFS 04028 (rev. 4/2003), or its computer-generated equivalent, shall be used.
(B) Notice of continued enrollment
(1) When the recipient monitoring and review section determines, at the end of the individual’s PACT program enrollment period, that the enrollment should be continued, the individual and authorized representative shall be provided written notice of that determination, with a copy to the local agency.
(2) The notice shall contain a clear and understandable statement of the determination and the reasons for it, cite the applicable regulations, explain the individual’s right to and the method of obtaining a state hearing, and contain the name and telephone number of the PACT representative to contact for more information and a telephone number to call about free legal services.
(3) “Notice of Continued Enrollment in the PACT Program,” JFS 04030 (rev. 4/2003), or its computer-generated equivalent, shall be used.
(C) Notice of denial of a designated provider change.
(1) When the recipient monitoring and review section denies a PACT individual’s request for a change of designated medical assistance provider, the individual and authorized representative shall be provided written notice of the denial, with a copy to the local agency.
(2) The notice shall contain a clear and understandable statement of the denial and the reasons for it, cite the applicable regulations, explain the individual’s right to and the method of obtaining a state hearing, and contain the name and telephone number of the PACT representative to contact for more information and a telephone number to call about free legal services.
(3) “Notice of Denial of Designated Provider Change,” JFS 04029 (rev. 3/2003), or its computer-generated equivalent, shall be used.
Effective: 09/01/2008
R.C. 119.032 review dates: 05/30/2008 and 09/01/2013
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35
Prior Effective Dates: 9/1/76, 4/1/80, 10/1/81, 5/1/82, 7/1/82, 4/1/83, 9/24/83, 11/1/83 (Temp), 12/1/83, 1/1/84, 3/1/84 (Temp), 6/1/84, 10/3/84 (Emer), 12/22/84, 4/1/86, 4/1/87, 9/1/87, 7/1/88 (Emer), 9/25/88, 2/1/90, 6/1/93, 6/1/03