Rule 5101:2-25-07 | Title XX reimbursementdependent upon correct determination of recipient eligibility.
(A) Child care services provided under Title XX are excluded from the requirements contained in this rule and the county department of job and family services (CDJFS) shall follow child care requirements contained in Chapter 5101:2-16 of the Administrative Code.
(B) Reimbursement under Title XX for expenditures for services delivered to individuals is contingent upon the following:
(1) Service is defined in the "Comprehensive Title XX Social Services Plan" (CTXXSSP) and specifically included in the county's "Title XX County Profile," maintained in the federal reporting SSBG Title XX system.
(2) The individual who receives the service is a member of one of the eligibility categories to which the service is available in the county of residence. Eligibility information will be documented in accordance with paragraphs (D) and (E) of this rule.
(3) The individual receiving the service(s) correctly met the eligibility factors which are applicable to the service(s) received by the individual and the individual's eligibility category.
(C) Eligibility categories under the Title XX program are as follows:
(1) Income eligible
(a) Services for free.
(i) Under services for free, no cost is paid by the client to either the CDJFS or the provider.
(ii) Income eligibility will be determined in accordance with the agency's defined policy, utilizing an application or other means to document the income for the assistance group.
(b) Services for a fee.
(i) Services for a fee is the amount charged to the client by the CDJFS or provider agency under agreement with the CDJFS.
(ii) Only those services to which fees are applicable are counted in determining the amount of the fee. Services that are available to consumers without regard to income would therefore not be counted.
(2) Without regard to income.
(a) Any service category can be designated as without regard to income; however, the following categories are typically provided without regard to income:
(i) Protective services for adults.
(ii) Protective services for children.
(iii) Information and referral.
(b) A written application is not needed where service is deemed without regard to income.
(D) When the CDJFS has determined that any Title XX service will be provided as services for free or services for a fee, the CDJFS will establish a written policy to document the established income eligibility criteria applicable to each service. If different eligibility criteria are established for different services, the policy will clearly define the eligibility criteria applicable for each individual service. The written policy should identify the types of income that will be counted or not counted in the eligibility determination. Additionally, the policy should establish the length of time the eligibility determination is considered valid, and the frequency of any eligibility redeterminations. This written policy will be available at all times for public review.
(E) When the CDJFS has determined any Title XX service will be provided a service for a fee the CDJFS will establish a fee schedule for the individual services. Any such fee schedule will be documented in a written policy, available at all times for public review.
(F) Eligibility determinations and redeterminations may be conducted by the agency providing the service; however the CDJFS may make eligibility determinations if it concludes that doing so would benefit consumers or result in more efficient operation of the Title XX social services program in the county, or if it concludes that a provider is making unsatisfactory eligibility determinations.
(G) Proper and improper determination and redetermination of eligibility, under the Title XX program are as follows:
(1) Reimbursement is available for services provided during the period of proper eligibility determination and until the end of the month in which the individual is subsequently determined to be ineligible for services or in which the eligibility determination has expired.
(2) A proper determination of eligibility is based on a correct assessment of all necessary information available to the CDJFS or provider agency at the time of such determination. The determination must be made within thirty calendar days of the date of the initial application or request for services, or prior to the due date of a redetermination.
(3) Written notification of approval or denial of an application or request for Title XX social services shall be made within fifteen calendar days of the date of determination. Paragraph (H) of this rule shall apply.
(4) If a consumer is found to have been improperly determined eligible for services, reimbursement is not available for the services provided during the period of improper determination.
(5) Reimbursement from the Ohio department of job and family services (ODJFS) to the CDJFS or from the CDJFS to the provider agency is not available prior to the date of the initial application or request for services.
(H) The CDJFS or the provider under agreement that makes eligibility determinations and redeterminations for Title XX social services shall:
(1) Accept consumer applications and requests for services.
(2) Complete a social service plan.
(3) Determine eligibility.
(4) Authorize requested services, if appropriate.
(5) Fulfill all applicable responsibilities relative to state hearings in accordance with division 5101:6 of the Administrative Code.
(I) When Title XX eligibility determination and redetermination are conducted by the provider under the agreement, the CDJFS must assure that the provider will explain to the consumer the following rights and responsibilities:
(1) The consumer has the right:
(a) To apply for services and have eligibility determined within thirty calendar days of the receipt of the application.
(b) To receive any needed services listed in the county's"Title XX County Profile," maintained in the federal reporting SSBG Title XX system, provided all eligibility factors are met and sufficient funds are available to provide the services.
(c) To a state hearing as described in division 5101:6 of the Administrative Code.
(d) To be advised of the eligibility requirements for social services.
(e) To the safeguarding of information reported by or about the consumer, to the extent permitted by law.
(2) The consumer has the responsibility:
(a) To report, within ten calendar days, any information that may affect eligibility.
(b) To provide documentation to substantiate eligibility.
(c) To cooperate with subsequent efforts to assess any error rate made in the eligibility process.
Last updated February 7, 2022 at 12:39 PM
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