Ohio Administrative Code Search

...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...

...riteria for presumptive coverage. (1) Except as set forth in paragraph (B)(2) of this rule, an individual is eligible for presumptive coverage when 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 eligibili...

...nth period, as described in section 1902(e)(12) of the Social Security Act (as in effect October 1, 2019). (B) Eligibility criteria. A child remains eligible for coverage despite changes in the child's circumstances for a period of twelve months if the child was found to be eligible for a category of medical assistance other than: (1) Presumptive eligibility as described in Chapter 5160:1-1 ...

...nth period, as described in section 1902(e)(12) of the Social Security Act (as in effect October 1, 2023). (B) Eligibility criteria. A child remains eligible for coverage despite changes in the child's circumstances for a period of twelve months when the child was found to be eligible for a category of medical assistance other than: (1) Presumptive eligibility as described in rule 5160:1-2-1...

...ng terms have the following meanings: (1) "Healthchek" is Ohio's early and periodic screening, diagnostic and treatment benefit for all medicaid eligible individuals under twenty-one years of age. (2) "Healthchek coordinator" is the CDJFS employee who is responsible for the implementation of healthchek services. (3) "Healthchek services" are periodic screening services (including a comprehensiv...

... of age who is enrolled in medicaid. (1) The healthchek benefit provides comprehensive preventative, diagnostic, and treatment services for an eligible individual as specified in Section 1905(r) of the Social Security Act (as in effect October 1, 2024). (2) There is no separate enrollment for healthchek. When an individual is eligible for medical assistance and is under twenty-one years of age,...

...comes in accordance with 42 C.F.R. 440.210 (as in effect January 1, 2014). (B) Definitions. (1) "Individual" for the purpose of this rule, means a medicaid-eligible individual who is pregnant, as verified by either self-declaration or medical verification, including the sixty days post-partum period. (2) ODM 03515 "Pregnancy Related Services Implementation Plan" (PRSIP) (rev. 1/2015) means the document submitted b...

...comes in accordance with 42 C.F.R. 440.210 (as in effect October 1, 2023). (B) Definitions. (1) "Administrative agency," for the purpose of this rule, means the county department of job and family services (CDJFS). (2) "Individual" for the purpose of this rule, means a pregnant woman eligible for medical assistance, as verified by either self-declaration or medical verification, including d...

...sability status as set forth in section 1902 of the Social Security Act (as in effect on February 1, 2016). The provisions of Chapter 5160:1-3 of the Administrative Code establish eligibility criteria, standards, and procedures that apply to individuals enrolling in an aged, blind or disability categorical coverage group. (B) The rules of this chapter are organized as follows: (1) Rules under pr...

... requirements as set forth in section 1902 of the Social Security Act (as in effect October 1, 2022). The provisions of Chapter 5160:1-3 of the Administrative Code establish eligibility criteria, standards, and procedures that apply to individuals enrolling in an aged, blind, or disabled categorical coverage group. (B) The rules of this chapter are organized as follows: (1) Rules under princip...