Chapter 5160-54 Metrohealth Care Plus

5160-54-01 Medicaid expansion demonstration programs: metrohealth care plus.

(A) "Metrohealth care plus" is Ohio's medicaid waiver demonstration in Cuyahoga county, authorized under Section 1115 of the Social Security Act , and approved by the centers for medicare and medicaid services.

(B) Notwithstanding other provisions in divisions 5101:1, 5101:3, and 5101:6 of the Adminstrative Code, the following provisons apply to the metrohealth care plus program:

(1) Eligibilty standards, including verfication of income, residency, and citzenship, as described in appendix A to this rule.

(2) Covered benefits and providers, as described in appendix B to this rule. Non-covered services are also described in appendix B to this rule.

(C) Eligible individuals must exhaust the internal grievance protocols established by metrohealth and described in appendix C to this rule prior to accessing the state's fair hearing system for redress of grievances as outlined in division 5101:6 of the Administrative Code.

(1) For purposes of this waiver, metrohealth is a "local agency" as that term is defined in rule 5101:6-1-01 of the Administrative Code.

(2) Nothing in this section will limit or interfere with a recipient's freedom to ultimately request a hearing from the state.

(D) Services, coverage, and eligibilty are authorized, only to the extent that they are expressly approved in the 1115 waiver found at http://jfs.ohio.gov/ohp/index.stm.

(E) Metrohealth care plus services are not eligible for coverage under this rule if the aggregate annual funding limit established for metrohealth care plus has been reached.

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Effective: 02/05/2013
R.C. 119.032 review dates: 02/01/2018
Promulgated Under: 119.03
Statutory Authority: 5111.01 , 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5101.35