5101:1-5-20 Disability financial assistance: the determination of a disability.

(A) What is the definition of disability?

"Disability" for purposes of the disability financial assistance (DFA) program is defined in section 5115.01 of the Revised Code. "Disability" applies to an individual who is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or that has lasted or can be expected to last for a continuous period of not less than nine months.

(B) How is an individual determined to be disabled?

(1) For all individuals who applied for DFA prior to the effective date of this rule, the disability determination shall be made in accordance with this rule as it was in effect on that date.

(2) For all individuals who apply, reapply or require a continuing disability review (CDR) on or after the effective date of this rule, the determination shall be based on a current medical statement. For purposes of division 5101:1 of the Administrative Code, "current medical statement" means a JFS 07302 "Basic Medical" (10/2016) signed by a physician; and/or the JFS 07308 "Mental Functional Capacity Assessment" (10/2016) signed by a licensed physician, psychiatrist or licensed psychologist; and:

(a) The form indicates that the individual is unable to do any substantial or gainful activity by reason of a medically determinable physical or mental impairment that can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than nine months; and

(b) The form is dated:

(i) For DFA applicants, no sooner than thirty days from the date of application and no later than ninety days from the date it was requested by the county agency; or

(ii) For DFA recipients undergoing a CDR, no sooner than thirty days from the CDR date and no later than ninety days from the date it was requested by the county agency.

(3) A county agency does not make a determination of disability.

(C) For how long shall a determination of disability remain in effect?

(1) Each individual determined to be disabled in accordance with paragraph (B) of this rule shall be assigned a CDR date.

(a) For individuals determined disabled under paragraph (B)(1) of this rule, the CDR date shall be determined according to this rule as it was in effect prior to the effective date of this rule.

(b) For individuals determined to be disabled under paragraph (B)(2) of this rule, the CDR date shall be ninety days prior to the DFA reapplication date established in accordance with paragraph (B) of rule 5101:1-2-10 of the Administrative Code.

(2) A determination of disability shall remain in effect until:

(a) A CDR is completed in accordance with paragraph (E) of this rule;

(b) The social security administration (SSA) has denied the individual's supplemental security income (SSI) or social security disability insurance (SSDI) application; or

(c) A DFA recipient is no longer eligible for DFA.

(D) What is the responsibility of the county agency in the disability determination process?

(1) The county agency shall ensure the applicant was provided the JFS 07302 and/or the JFS 07308 in accordance with rule 5101:1-2-01 of the Administrative Code.

(2) Upon request, the county agency shall assist the individual in receiving an eye examination or medical/psychological examination (which may include scheduling appointments) in order to obtain a current medical statement. When the cost of obtaining the examination is not covered by medicaid and/or a third-party, the county agency shall utilize administrative funds to assist the applicant in obtaining a current medical statement.

(3) The county agency shall maintain case records in accordance with rule 5101:9-9-21 of the Administrative Code.

(E) What is a CDR and when is it conducted?

A CDR is the process for verifying a DFA recipient continues to meet the disability requirement in paragraph (A) of this rule.

(1) When shall the CDR be conducted?

(a) When there are more than ninety days between the CDR date and the reapplication date, the CDR shall be rescheduled and conducted ninety days prior to the reapplication date.

(b) When the CDR date is less than or equal to ninety days from the reapplication date, the CDR shall be conducted on the CDR date.

(2) What is the responsibility of the county agency in conducting a CDR?

The county agency shall:

(a) Provide the DFA recipient with the JFS 07302 and/or the JFS 07308 and notify the recipient that the form(s) must be completed and received by the county agency within ninety days;

(b) Upon request, assist the recipient in accordance with paragraph (D)(2) of this rule; and

(c) Terminate DFA when a current medical statement has not been returned on or before the ninetieth day from the date it is requested, or the current medical statement does not meet the requirements described in paragraph (B)(2) of this rule. The adverse action shall be taken in accordance with Chapter 5101:6 of the Administrative Code.

Replaces: 5101:1-5-20

Effective: 10/1/2016
Five Year Review (FYR) Dates: 10/01/2021
Promulgated Under: 111.15
Statutory Authority: 5115.03
Rule Amplifies: 5115.01, 5115.03
Prior Effective Dates: 9/3/77, 1/1/81, 6/1/84, 9/6/84, 8/1/85, 7/1/87 (Emer.), 8/3/87, 1/1/88, 3/28/88, 4/1/89 (Emer.), 4/24/89, 4/1/90, 10/1/90, 10/1/91 (Emer.), 12/20/91, 4/1/92 (Emer.), 6/30/92, 12/22/92 (Emer.), 3/20/93, 10/30/95, 7/1/98, 7/1/03, 1/1/05, 4/1/10, 1/1/16