Ohio Administrative Code Search

...d party. When the third party is an insurance company, the appellant or the appellant's authorized representative or attorney shall also provide the names and addresses of the beneficiaries of the issuance policy. Upon a showing of good cause, or upon the hearing examiner's own initiative, this thirty day period may be increased or decreased. (E) Subpoenas (1) The depository agent shall issu...

...r medical assistance. (10) "Creditable insurance" or "creditable coverage" means health insurance coverage as defined in 42 U.S.C. 300gg-3(c) (as in effect October 1, 2016). (a) This includes: (i) A group health plan. (ii) Health insurance coverage. (iii) Medicare part A, as set forth in 42 U.S.C. 1395c to 1395i-5 (as in effect October 1, 2016) or part B, as set forth in 42 U.S.C. 1395j to 1395w-4 (as in effec...

...r a transfer from another agency or insurance affordability program in accordance with 42 C.F.R. 435.4 (as in effect October 1, 2021). (5) "Approve" or "approval" means a determination by the administrative agency that an individual is eligible for one or more categories of medical assistance applied for by the individual or on behalf of the individual by his or her authorized representative....

...r a transfer from another agency or insurance affordability program in accordance with 42 C.F.R. 435.4 (as in effect October 1, 2022). (5) "Approve" or "approval" means a determination by the administrative agency that an individual is eligible for one or more categories of medical assistance applied for by the individual or on behalf of the individual by his or her authorized representative....

... agency to report: (a) Possible health insurance coverage of an individual. A separate report shall be made for each possible health insurance policy. (b) Potential TPL due to an injury, disability, or court order. (2) At renewal, or upon any reported change, the administrative agency shall compare the individual's current information to the information on the most recent ODM 06612 "Health ...

... agency to report: (a) Possible health insurance coverage of an individual. A separate report shall be made for each possible health insurance policy. (b) Potential TPL due to an injury, disability, or court order. (2) At renewal, or upon any reported or identified change, the administrative agency shall compare the individual's current information to the information on the most recent ODM ...

...(A) The Health Insurance 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,...

...(A) The Health Insurance 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 a notice of privacy practices to all individuals eligible for medical a...

... (a) New coverage under a health insurance policy, no matter who is paying for the coverage; (b) A change in health insurers; (c) Loss or ending of other health insurance coverage; (d) A court order requiring a person or entity to pay some or all of the individual's medical expenses; or (e) Any accident or injury for which another person or entity may be responsible, such as a...

... (a) New coverage under a health insurance policy, regardless of who is paying for the coverage; or (b) A change in health insurers; or (c) Loss or ending of other health insurance coverage; or (d) A court order requiring a person or entity to pay some or all of the individual's medical expenses; or (e) Any accident or injury for which another person or entity may be res...

...enefits, social security disability insurance (SSDI), railroad retirement, and unemployment compensation. (c) When eligibility or ineligibility for other benefits cannot be verified electronically, an official letter from the paying entity or financial institution is sufficient to verify the benefit. (5) In accordance with 42 C.F.R. 435.610 (as in effect October 1, 2020) and section 5160.38 of t...

...ndividual shall provide the name of the insurance company, billing address, subscriber identification number, group number, name of policy holder, and a list of covered individuals. In addition, the individual shall cooperate with requests: (a) From a third-party insurance company to provide additional information that is required to authorize coverage or obtain benefits through the third-party i...

...eiving social security disability insurance (SSDI); or (iv) Receiving adoption or foster care assistance under Title IV-E of the Social Security Act (as in effect October 1, 2019); or (v) In foster care and receiving child welfare services under Title IV-B of the Social Security Act (as in effect October 1, 2019). (d) Other individuals on such other basis as the secretary of the d...

...eiving social security disability insurance (SSDI); or (iv) Receiving adoption or foster care assistance under Title IV-E of the Social Security Act (as in effect October 1, 2022); or (v) In foster care and receiving child welfare services under Title IV-B of the Social Security Act (as in effect October 1, 2022); or (vi) Receiving federal kinship guardianship assistance program...

...i) Receiving social security disability insurance (SSDI); (iv) Receiving adoption or foster care assistance under Title IV-E of the Social Security Act (as in effect October 1, 2025); (v) In foster care and receiving child welfare services under Title IV-B of the Social Security Act (as in effect October 1, 2025); or (vi) Receiving federal kinship guardianship assistance program (KGAP) payments under Title IV-E of...

...n that is compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The ODM 03397 "Authorization for the Release or Use of Protected Health Information (PHI)" shall be used when the CDJFS needs additional medical information from the individual or the individual's provider. (5) Provider recruitment. The CDJFS is required to take steps to recruit and maintain a networ...

... days of a change. (8) Obtain a Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant signed authorization for release of information, ODM 03397 "Authorization for the Release or Use of Protected Health Information", when additional medical information is needed from the individual. (9) Maintain a listing of fee-for-service providers who have expressed a willingness to fu...

...y medicare part B (supplemental medical insurance) premiums for certain medicaid-eligible individuals even if those individuals are not eligible for a medicare premium assistance program (MPAP) set out in rule 5160:1-3-02.1 of the Administrative Code; and (2) The beginning date of payment of medicare part B (part B) benefits under this rule; and (3) The date and effect of termination of benefits...

...ODM to pay part B (supplemental medical insurance) premiums for certain individuals even when those individuals are not eligible for a medicare premium assistance program (MPAP) set forth in rule 5160:1-3-02.1 of the Administrative Code; and (2) The beginning date of payment of part B benefits under this rule; and (3) The date and effect of termination of benefits under part B buy-in. (4) The p...

...in retirement, survivors and disability insurance (RSDI) as described in 42 C.F.R. 435.134 (as in effect October 1, 2019): individuals eligible despite the October 1972 twenty per cent general increase: (i) An individual who would currently be eligible for SSI or cash assistance except for the amount of increased income resulting from the October 1972 twenty per cent general increase in RSD...

...n retirement, survivors, and disability insurance (RSDI) as described in 42 C.F.R. 435.134 (as in effect October 1, 2024): individuals eligible despite the October 1972 twenty per cent general increase: (i) An individual who would currently be eligible for SSI or cash assistance except for the amount of increased income resulting from the October 1972 twenty per cent general increase in RSD...

...) Retirement, survivors, disability insurance (RSDI); (2) Prouty benefits; (3) Railroad retirement; (4) Veterans benefits; (5) Other public/private retirement benefits; (E) The following items are not considered income, in accordance with 20 C.F.R. 416.1103 (as in effect October 1, 2019). This list is not all inclusive: (1) A personal service performed for an individual is not in...

...) Retirement, survivors, disability insurance (RSDI); or (2) Prouty benefits; or (3) Railroad retirement; or (4) Veterans benefits; or (5) Other public/private retirement benefits. (E) The following items are not considered income, in accordance with 20 C.F.R. 416.1103 (as in effect October 1, 2023). This list is not all-inclusive: (1) A personal service performed for an individu...

...served in Vietnam. (q) Austrian social insurance payments based, in whole or in part, on wage credits received under the provisions of the Austrian General Social Insurance Act, paragraphs 500 to 506 (as in effect October 1, 2020). These payments are to be documented and identifiable from countable insurance. (r) Payments made to Native Americans as listed in section IV of 20 C.F.R. 416 subpart ...

..., jewelry, household goods, tools, life insurance policies, automobiles, promissory notes, etc. (6) "Real property" means land, including buildings or immovable objects, attached permanently to the land. (7) "Resources" is defined in rule 5160:1-1-01 of the Administrative Code. (8) "Resource limit" means the maximum combined value of all resources an individual can have an ownership interest in and still qualify f...