Ohio Administrative Code Search

...erification program outlined in section 1940 of the Social Security Act (as in effect October 1, 2023), requiring state agencies that administer medical assistance to implement a system by which the agency will obtain financial records from financial institutions with respect to an individual, his or her spouse, or any other such person, as applicable, whose assets are required to be evaluated whe...

...(A) This rule describes section 1903(r)(3) of the Social Security Act (as in effect October 1, 2019) and paragraph (d) of 42 C.F.R 435.945 (as in effect October 1, 2019), that each medicaid state agency have an eligibility determination system which provides for data matching through the public assistance reporting information system (PARIS). (B) Definition. "PARIS" is a system for matching d...

...(A) This rule describes section 1903(r)(3) of the Social Security Act (as in effect October 1, 2024) and paragraph (d) of 42 C.F.R 435.945 (as in effect October 1, 2024), that each medicaid state agency have an eligibility determination system which provides for data matching through the public assistance reporting information system (PARIS). (B) Definition. "PARIS" is a system for matching d...

...change, shall be computed as follows: (1) When counting the number of days in a specified time period, the initial day is excluded from the computation and the last day is included. (2) When the last day of the time period falls on a Saturday, Sunday, or legal holiday, the time period shall end on the next business day. (C) Effective date of applications, reported information, or requests for a...

...change, shall be computed as follows: (1) When counting the number of days in a specified time period, the initial day is excluded from the computation and the last day is included. (2) When the last day of the time period falls on a Saturday, Sunday, or legal holiday, the time period shall end on the next business day. (C) Effective date of applications, reported information, or requests for a...

...t group. Unless otherwise stated: (1) If living in the same household, income and resources of a spouse are considered available to the other spouse, and income and resources of a parent are considered available to children under age twenty-one. (2) The income of a minor's parent, living in the same home as the minor and the minor's dependent child, shall be counted as income to the covered ...

...t group. Unless otherwise stated: (1) If living in the same household, income and resources of a spouse are considered available to the other spouse, and income and resources of a parent are considered available to children under age twenty-one. (2) The income of a minor's parent, living in the same home as the minor and the minor's dependent child, shall be counted as income to the covered ...

...s (HCBS) waiver, as described in rules 5123:2-9-01, 5160-31-03, 5160-33-03, 5160-40-01, 5160-41-17, 5160-42-01, 5160-46-02, 5160-58-02.2, and 5160-59-04 of the Administrative Code. (B) Eligibility for an HCBS waiver. To receive services under an HCBS waiver, the individual shall: (1) Be eligible for medical assistance, as described in Chapters 5160:1-1 to 5160:1-6 of the Administrative Code; and (2) Be in need of ...

...CBS) waiver, as described in rules 5123:2-9-01, 5160-31-03, 5160-33-03, 5160-40-01, 5160-41-17, 5160-42-01, 5160-46-02, and 5160-58-02.2 of the Administrative Code. (B) Eligibility for an HCBS waiver. To receive services under an HCBS waiver, the individual shall: (1) Be eligible for medical assistance, as described in Chapters 5160:1-1 to 5160:1-6 of the Administrative Code; and (2) Be in ...

...CBS) waiver, as described in rules 5123:2-9-01, 5160-31-03, 5160-33-03, 5160-40-01, 5160-41-17, 5160-42-01, 5160-46-02, 5160-58-02.2, and 5160-59-04 of the Administrative Code. (B) Eligibility for an HCBS waiver. To receive services under an HCBS waiver, the individual shall: (1) Be eligible for medical assistance, as described in Chapters 5160:1-1 to 5160:1-6 of the Administrative Code; and...

...gation in accordance with 42 C.F.R. 455.14 (as in effect on November 1,2015 ) to determine if there is sufficient basis to warrant a full investigation. (1) If the preliminary investigation finds that a full investigation is warranted in accordance with 42 C.F.R. 455.15 (as in effect on November 1, 2015): (a) And there is reason to believe that a beneficiary has defrauded the medicaid program as...

...on in accordance with 42 C.F.R. 455.14 (as in effect October 1, 2023) to determine whether there is sufficient basis to warrant a full investigation. (1) When the preliminary investigation finds that a full investigation is warranted in accordance with 42 C.F.R. 455.15 (as in effect October 1, 2023): (a) And there is reason to believe that a beneficiary has defrauded the medicaid program as desc...

...e Portability and Accountability Act of 1996 (HIPAA) is a federal law requiring the administrative agency to issue a notice of privacy practices. (B) The administrative agency shall: (1) Ensure appropriate safeguards are taken in accordance with rule 5160-1-32 of the Administrative Code. (2) Issue all individuals eligible through the medical assistance programs a notice of privacy practices, as described in 45 C.F...

...rtability and Accountability Act of 1996 (HIPAA) is a federal law requiring the administrative agency to issue a notice of privacy practices. (B) The administrative agency shall: (1) Ensure appropriate safeguards are taken in accordance with rule 5160-1-32 of the Administrative Code. (2) Issue a notice of privacy practices to all individuals eligible for medical assistance, as described...

...ies 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...

...n 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 quali...

...equest process. (B) Definitions. (1) "Estate" includes both of the following: (a) All real and personal property and other assets to be administered under Title XXI of the Revised Code and property that would be administered under that title if not for section 2113.03 or 2113.031 of the Revised Code; and (b) Any other real and personal property and other assets in which an individual had a...

... (B) Individual responsibilities. (1) When applying for or receiving any medical assistance, an individual must: (a) Sign, under penalty of perjury, and submit an application for medical assistance. The individual's signature may be written (original or a copy), electronic, or telephonic. (b) Cooperate with the administrative agency in any eligibility determination for initial or continuing cov...

... (B) Individual responsibilities. (1) When applying for or receiving any medical assistance, an individual must: (a) Sign, under penalty of perjury, and submit an application for medical assistance in accordance with rule 5160:1-2-01 of the Administrative Code. (b) Cooperate with the administrative agency in any eligibility determination for initial or continuing coverage, audit, and quality co...

... assistance, an individual shall: (1) Provide a social security number (SSN) in accordance with 42 C.F.R. 435.910 (as in effect October 1, 2020). (a) The individual's self-declaration of SSN meets this condition unless contradictory information is provided to or maintained by the administrative agency. (b) An individual is not required to provide an SSN when the individual: (i) Is applying...

... assistance, an individual shall: (1) Provide a social security number (SSN) in accordance with 42 C.F.R. 435.910 (as in effect October 1, 2024). (a) The individual's self-declaration of SSN meets this condition unless contradictory information is provided to or maintained by the administrative agency. (b) An individual is not required to provide an SSN when the individual: (i) Is applying...

...42 C.F.R. 435.407 (as in effect October 1, 2019). (1) After an individual's U.S. citizenship or nationality is verified by the administrative agency, the administrative agency shall not require the individual to re-verify citizenship. (2) The following individuals are not required to verify their U.S. citizenship: (a) An individual applying for medical assistance only for other individuals....

...42 C.F.R. 435.407 (as in effect October 1, 2022). (1) After an individual's U.S. citizenship or nationality is verified by the administrative agency, the administrative agency shall not require the individual to re-verify citizenship. (2) The following individuals are not required to verify their U.S. citizenship: (a) An individual applying for medical assistance only for other individuals....

...(A) This rule sets forth: (1) Medical assistance eligibility criteria for an individual who is not a U.S. citizen or national; and (2) Acceptable documentary evidence of qualified non-citizen status; and (3) The circumstances under which an individual who declares qualified non-citizen status, under penalty of perjury, may be given a reasonable opportunity to verify that status. (B) Defin...

...riteria for presumptive coverage. (1) Except as set forth in paragraph (B)(2) of this rule, an individual is eligible for presumptive coverage if the individual: (a) Is a resident of the state of Ohio; and (b) Is a U.S. citizen or has an immigration status as defined in rule 5160:1-2-12 of the Administrative Code that allows for medicaid eligibility; and (c) Meets the non-financial eligibility...