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

(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