Ohio Administrative Code Search

...(A) Medicaid will not pay for services provided under the conditions set out in paragraph (C) of this rule, even when an individual has been found eligible for a medical assistance category and is enrolled in medicaid. (B) Definitions. (1) "Inmate" means an individual who is serving time for a criminal offense or who is confined in a state or federal prison, jail, detention facility, or other pe...

...(A) Medicaid will not pay for services provided under the conditions set out in paragraph (C) of this rule, even when an individual has been found eligible for a medical assistance category and is enrolled in medicaid. (B) Definitions. For the purposes of this rule: (1) "Eligible juvenile" means: (a) An individual under the age of twenty-one; or (b) A former foster care child up to the age...

...(A) This rule describes the requirements in section 1137 of the Social Security Act (as in effect October 1, 2020) and in section 42 C.F.R. 435.945 (as in effect October 1, 2020), requiring state agencies administering certain federally funded public assistance programs to establish procedures for obtaining, using, and verifying information relevant to determinations of eligibility. The Ohio depar...

...(A) This rule describes the asset verification program outlined in section 1940 of the Social Security Act (as in effect on October 1, 2016), 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 t...

...(A) This rule describes the asset verification 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 asse...

...(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...

...(A) This rule describes the responsibilities of the administrative agency. (B) Calculation of time periods for eligibility determinations. All calculations of time periods used in the determination of eligibility, including an annual renewal or a redetermination as a result of a reported change, shall be computed as follows: (1) When counting the number of days in a specified time period, the in...

...(A) This rule describes the responsibilities of the administrative agency. (B) Calculation of time periods for eligibility determinations. All calculations of time periods used in the determination of eligibility, including an annual renewal or a redetermination as a result of a reported change, shall be computed as follows: (1) When counting the number of days in a specified time period, the in...

...(A) This rule sets forth general income guidelines, calculations, and exclusions used in determining eligibility for medical assistance. Income guidelines, calculations, or exclusions that apply to a specific covered group will be addressed in the eligibility rules for that group. Unless otherwise stated: (1) If living in the same household, income and resources of a spouse are considered availab...

...(A) This rule sets forth general income guidelines, calculations, and exclusions used in determining eligibility for medical assistance. Income guidelines, calculations, or exclusions that apply to a specific covered group will be addressed in the eligibility rules for that group. Unless otherwise stated: (1) If living in the same household, income and resources of a spouse are considered availab...

...(A) This rule sets forth the process for determining whether an individual is eligible for medical assistance payments for services under a home and community-based services (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 H...

...(A) This rule sets forth the process for determining whether an individual is eligible for medical assistance payments for services under a home and community-based services (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, and 5160-58-02.2 of the Administrative Code. (B) Eligibility for an HCBS waiver. To receive service...

...(A) This rule sets forth the process for determining whether an individual is eligible for medical assistance payments for services under a home and community-based services (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 rec...

...(A) This rule sets out requirements for the administrative agency to identify and refer consumer fraud and erroneous payments made on behalf of an individual by medicaid. (B) Investigation of complaints. Upon notification of a complaint of medicaid fraud, abuse or questionable practices, the administrative agency must conduct a preliminary investigation in accordance with 42 C.F.R. 455.14 (as in ...

...(A) This rule sets out requirements for the administrative agency with regard to identifying and referring consumer fraud and recouping medicaid payments from an individual. (B) Investigation of complaints. Upon notification of a complaint of medicaid fraud, abuse, or questionable practices, the administrative agency must conduct a preliminary investigation in accordance with 42 C.F.R. 455.14 (as...

...(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) 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 and federally qualified health centers. (B) Responsibilities of the administrative agency. (1) Locations. The administrative agency: (a) Must establish and staff outstation locat...

...(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 a...

...(A) This rule describes Ohio's medicaid estate recovery program and the undue hardship waiver request 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 Co...

...(A) This rule describes the responsibilities of an individual, or someone acting on his or her behalf, who is applying for or receiving medical assistance. (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 (...

...(A) This rule describes the responsibilities of an individual, or someone acting on an individual's behalf, who is applying for or receiving medical assistance. (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 ...

...(A) This rule describes eligibility criteria that apply to all medical assistance programs, how eligibility criteria will be verified by the administrative agency, and when an individual will be asked to provide manual verification. Eligibility conditions that are specific to a certain eligibility group are addressed in the eligibility rule for that group. (B) To be determined eligible for medica...

...(A) This rule describes eligibility criteria that apply to all medical assistance programs, how eligibility criteria will be verified by the administrative agency, and when an individual will be asked to provide manual verification. Eligibility conditions that are specific to a certain eligibility group are addressed in the eligibility rule for that group. (B) To be determined eligible for medica...