Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-16.1 - Adult hemophilia insurance premium payment program

Current through all regulations passed and filed through July 1, 2024
(A) As used in this
			 rule:
(1) "Adjusted family income" means a
			 balance after credits for child care expenses or educational expenses not
			 reimbursed by a third party, estimated annual expenditures for health insurance
			 not reimbursed by a third party, and service level are subtracted from family
			 income.
(2) "Assistance" means
			 reimbursement to the eligible participant or legal representative for premiums
			 paid by the eligible participant or legal representative for health insurance
			 coverage for the eligible participant. Assistance may include payments for
			 premiums for an eligible participant's single coverage under a health insurance
			 plan or payments for premiums for the dependent portion of an insurance plan
			 when the eligible participant is one of a group of dependents who is covered
			 under a health insurance plan.
(3)
			 "Eligible participant" means a person twenty-one years of age or older with
			 hemophilia or a related bleeding disorder, who is under the care of a BCMH
			 approved hemophilia treatment center, and who also meets the conditions for
			 eligibility for insurance premium payment assistance set forth in paragraph (B)
			 or (C) of this rule.
(4)
			 "Estimated annual expenditure for health insurance" means the estimated amount
			 for which a family unit spends on insurance premiums.
(5) "Family income" means the current year's
			 projected adjusted gross earnings based on current gross earnings as reported
			 on pay stubs and/or the sum of the annual adjusted gross incomes, as reported
			 to the United States internal revenue service for federal income tax purposes
			 for the previous year, of the eligible participant.
Family income shall not include educational scholarships,
				loans, and grants; amounts spent by the family unit for child care expenses;
				amounts spent by the family unit for respite care (with appropriate
				verification from a qualified respite care provider); and lump-sum death
				benefits.
(6) "Family
			 unit" means the group consisting of the following persons:
(a) The eligible participant;
(b) The eligible participant's spouse, if
			 married;
(c) The eligible
			 participant's parents, if participant is considered a dependent by parents for
			 federal income tax purposes;
(d)
			 Other persons who, for federal income tax purposes are considered dependents of
			 the eligible participant.
(7) "Service level" means a credit against
			 the family income as determined by the director based upon the eligible
			 participant's need for treatment services. Service level credits are the
			 following:
(a) Service level one is based on
			 the eligible participant's need for routine physician visits or routine
			 outpatient hospital care. The service level credit for this service level is
			 five hundred dollars.
(b) Service
			 level two is based on the eligible participant's need for brief
			 hospitalizations, minor surgical procedures, medications, durable equipment, or
			 medical supplies. The service level credit for this service level is one
			 thousand dollars.
(c) Service
			 level three is based on the eligible participant's documented need for
			 medication and supplies costing more than five hundred dollars per month. The
			 service level credit for this service is two thousand dollars.