Rule 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, federally qualified health centers, and other designated locations where potentially eligible children and pregnant women receive services.
(B) Definitions.
(1) "Administrative agency," for the purpose of this rule, means the Ohio department of medicaid (ODM) and/or an agent of ODM authorized to determine eligibility for a medical assistance program.
(2) "Individual," for the purpose of this rule, means a person who is applying for medical assistance benefits at a disproportionate share hospital, federally qualified health center, or another designated outstation location.
(3) "Outstationing" refers to the federal requirement that administrative agencies must provide opportunities for low-income children and pregnant women to apply for medical assistance at locations other than the local county department of job and family services (CDJFS) office.
(C) 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 that participates in the medicaid program and provides services to children and pregnant women who are eligible for medical assistance.
(b) May establish additional outstation locations at other sites where potentially eligible children or pregnant women receive services. These additional locations may include sites independent from the main outstation locations 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 individuals with the application process.
(b) When the administrative agency determines that an outstation site is infrequently used and does not require a full-time outstationed worker, the following must occur:
(i) A notice must be displayed 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) Adequate notice must be provided to individuals with visual or hearing impairments or who are unable to read or understand the English language.
(3) Workers and assistance.
(a) The administrative 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, when the worker is authorized to determine medical assistance eligibility at a 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 2 (as in effect October 1, 2023) and 42 C.F.R. part 431, subpart F (as in effect October 1, 2023); and
(b) The requirements of 42 C.F.R. section 447.10 (as in effect October 1, 2023), 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) Provide for the receipt and initial processing of medical assistance applications at each outstation location.
(a) When authorized by the administrative agency, the outstationed worker may evaluate an application for medical assistance and make a determination of eligibility.
(b) When the outstationed worker is only performing initial processing duties, the outstationed worker must forward the application to the administrative agency in accordance with Chapters 5160:1-1 and 5160:1-2 of the Administrative Code.
(ii) Accept and refer applications for other public assistance programs to the administrative agency or appropriate program office for processing. Assist individuals with connecting to appropriate agencies, organizations, providers and other community supports as requested.
Last updated January 2, 2024 at 9:33 AM
Supplemental Information