5160:1-2-06 Medicaid: outstationing workers at disproportionate share hospitals and federally qualified health centers.

(A) This rule describes the administrative agency's role in facilitating outreach services for low-income children and pregnant women through the process of outstationing workers at disproportionate share hospitals and federally qualified health centers.

(B) Responsibilities of the administrative agency.

(1) Locations. The administrative agency:

(a) Must establish and staff outstation locations at each disproportionate share hospital and each federally-qualified health center participating in the medicaid program and providing services to medicaid-eligible children and pregnant women.

(b) May establish additional outstation locations at any other site where potentially eligible children or pregnant women receive services. These additional sites may include additional sites other than the main outstation location of federally-qualified health centers or disproportionate share hospitals.

(2) Hours.

(a) Workers must be available at each outstation location during the administrative agency's regular office operating hours to accept applications and to assist applicants with the application process (b) If the administrative agency determines that an outstation site is infrequently used and does not require a full-time outstationed worker, a notice must be displayed:

(i) Containing the following information:

(A) The hours when an outstationed worker will be available; and

(B) The telephone number of the administrative agency that individuals may call for assistance.

(ii) Providing adequate notice to persons who are blind or deaf or who are unable to read or understand the English language.

(3) Workers and assistance.

(a) The agency may use county employees, provider or contractor employees, or volunteers who have been properly trained to staff outstation locations under the following conditions:

(i) County outstation intake workers may perform all eligibility processing functions, including the eligibility determination, if the worker is authorized to do so at the regular intake office.

(ii) Provider or contractor employees and volunteers may perform only initial processing functions. Provider and contractor employees and volunteers are subject to:

(A) The confidentiality of information rules specified in 42 C.F.R.part 431, subpart F (as in effect on December 1, 2015);

(B) The requirements of 42 C.F.R. section 447.10 (as in effect on December 1, 2015), which prohibit medicaid payments to anyone other than a provider or recipient except under specific circumstances; and

(C) All other Ohio or federal laws concerning conflicts of interest.

(b) The outstationed worker must:

(i) Complete the initial processing of the application for medical assistance.

(A) When authorized by the administrative agency, the outstationed worker may also determine medicaid eligibility.

(B) If the outstationed worker is only performing initial processing duties, the outstationed worker must forward the application to the administrative agency in accordance with Chapter 5160:1-1 and Chapter 5160:1-2 of the Administrative Code.

(ii) Accept and refer applications for other public assistance programs to the administrative agency for processing.

Replaces: 5160:1-1- 51.4

Effective: 8/1/2016
Five Year Review (FYR) Dates: 08/01/2021
Promulgated Under: 111.15
Statutory Authority: 5162.031, 5163.02
Rule Amplifies: 5163.02, 5163.10, 5163.101
Prior Effective Dates: 5/1/95, 7/1/00, 1/1/06, 1/1/14