reglab/statecodes huggingface dataset:
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-5 - Medicaid for Other Covered Groups › Section 5160:1-5-07 - Medicaid: specialized recovery services (SRS) program

Current through all regulations passed and filed through July 1, 2024
(A) This rule sets
			 forth the eligibility criteria for a state plan home and community-based
			 services (HCBS) benefit authorized under section 1915(i) of the Social Security
			 Act (as in effect on October 1, 2017). Section 1915(i) of the act allows states the
			 flexibility to provide HCBS to individuals who require less than an
			 institutional level of care (LOC) and who would, therefore, not be eligible for
			 HCBS under the more restrictive criteria of section 1915(c) waivers. The
			 specialized recovery services (SRS) program provides targeted services to the
			 following individuals described in rule
			 5160-43-02
			 of the Administrative Code:
(1) Individuals
			 with severe and persistent mental illness (SPMI); or
(2) Individuals who are active on the solid
			 organ or soft tissue waiting list; or
(3) Individuals with certain diagnosed
			 chronic conditions.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-5 - Medicaid for Other Covered Groups › Section 5160:1-5-08 - Medicaid: state-funded medical assistance for non-citizen victims of trafficking

Current through all regulations passed and filed through July 1, 2024
(A) This rule describes the eligibility
			 requirements for state-funded medical assistance for a non-citizen victim of a
			 severe form of human trafficking.
(B) For purposes of this rule the following
			 definitions apply unless otherwise stated.
(1) "Labor trafficking" means recruiting,
			 harboring, transporting, or obtaining of a person for labor or services through
			 the use of force, fraud, or intimidation for the purpose of involuntary
			 servitude, debt bondage, or slavery.
(2) "Severe form of human trafficking" means
			 sex trafficking or labor trafficking.
(3) "Sex trafficking" means recruiting,
			 harboring, transporting, or obtaining of a person for the purpose of a
			 commercial sex act where the commercial sex act is induced by force, fraud, or
			 intimidation, or the person being induced to perform such act is under eighteen
			 years of age.
(4) "T
			 non-immigration status" is also known as the T Visa and provides immigration
			 protection to victims of a severe form of human trafficking.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-01 - Medicaid: eligibility for medicaid payment for long-term care (LTC) services

Current through all regulations passed and filed through July 1, 2024
(A) This rule describes how an individual is
			 determined eligible for medicaid payment for long-term care (LTC)
			 services.
(B)
								In order to receive medicaid payment for LTC services,
			 the individual must:
(1) Be eligible for
			 medical assistance in accordance with Chapter 5160:1-3, 5160:1-4, 5160:1-5, or
			 5160:1-6, as applicable; and
(2)
			 Meet any non-financial eligibility requirements  for the type of LTC services requested;
			 and
(3) Not be subject to a
			 restricted medicaid coverage period, in accordance with rule
			 5160:1-6-06.5 of the
			 Administrative Code.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-02 - Medicaid: special resource rules when an individual is requesting or receiving medicaid payment for long-term care (LTC) services

Current through all regulations passed and filed through July 1, 2024
(A)
								This rule describes the application of resource rules
			 only when an individual is requesting or receiving medicaid payment for
			 long-term care (LTC) services.
(B)
								Individuals
			 requesting or receiving medicaid payment for LTC services are subject to the
			 following resource rules:
(1)
									The home equity limit as described in rule
			 5160:1-6-02.1 of the Administrative Code.
(2)
									Evaluation of any
			 qualified long-term care insurance policy as described in rule 5160:1-6-02.2 of
			 the Administrative Code.
(3)
									Evaluation of any entrance fee when the individual is
			 residing in a continuing care retirement community, life care community, or a
			 philanthropic long-term care facility as described in rule 5160:1-6-02.3 of the
			 Administrative Code.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-02.1 - Medicaid: home equity limit for individuals requesting or receiving medicaid payment for long-term care (LTC) services

Current through all regulations passed and filed through July 1, 2024
(A) This rule
			 describes the treatment of the home equity limit for an
								individual requesting or receiving medicaid payment
			 for long-term care (LTC) services.
(B) Definition. "Home equity limit" means the maximum
			 amount of equity which an individual could have in the home
			 and become or remain eligible for LTC services. The home equity limit of five
			 hundred sixty thousand dollars will increase annually by the percentage
			 increase in the consumer price index for all urban consumers (CPI-U) in
			 accordance with section
			 5163.32 of the Revised
			 Code.
(C) An individual shall not
			 be eligible for LTC services when the individual's equity interest in
			 the
			 home, as defined in rule
			 5160:1-3-05.13 of the
			 Administrative Code, exceeds the home equity limit.
(D) The home equity limit does not apply to
			 an individual when any of the following persons are lawfully
			 residing in the individual's home:
(1) The
			 individual's spouse; or
(2) The
			 individual's child who is under  age
			 twenty-one; or
(3) The individual's
			 child who is age twenty-one or over and is blind or disabled as defined in
			 Chapter 5160:1-3 of the Administrative Code.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-02.2 - Medicaid: treatment of qualified long-term care insurance policies

Current through all regulations passed and filed through July 1, 2024
(A) This rule
			 describes the qualified long-term care partnership (QLTCP) program.
(B) Definitions.
(1) "Estate recovery" means the program set
			 forth in rule
			 5160:1-2-07 of the
			 Administrative Code.
(2) "Qualified
			 long-term care partnership" (QLTCP) means the program established under section
			 5164.86 of the Revised Code,
			 under which an individual's assets or resources are disregarded in eligibility
			 determinations and at estate recovery in the amount of insurance benefit
			 payments made to or on behalf of the individual who is a beneficiary of a QLTCP
			 policy.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-02.3 - Medicaid: continuing care retirement communities, life care communities, and philanthropic long-term care facilities

Current through all regulations passed and filed through July 1, 2024
(A)
								The purpose of this rule is to describe the eligibility
			 requirements for individuals residing in a continuing care retirement community
			 (CCRC), life care community, or a philanthropic long-term care facility
			 (PLTCF).
(B)
								Definitions.
(1)
									"CCRCs" and "life care communities" mean housing
			 communities that provide different categories of care based on each resident's
			 need over time. CCRCs and life care communities may range from independent
			 living in an apartment, to assisted living, to full-time care in a nursing
			 facility. Residents may move from one setting to another, based on their needs,
			 but continue to live as part of the community. Generally, CCRCs require a
			 written contract and an entrance fee, in addition to monthly fees. CCRCs and
			 life care communities may also be PLTCFs.
(2)
									"Entrance fee"
			 means a payment generally required for admission to a CCRC, life care
			 community, or PLTCF and may vary in amount based on the type of housing
			 accommodations and/or category of care.
(3)
									"PLTCF" means a
			 not-for-profit long-term care facility.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-03 - Medicaid: special income rules that may apply when an individual is requesting medicaid payment for long-term care services

Current through all regulations passed and filed through July 1, 2024
(A)
								The following
			 income rules only apply when an individual, regardless of age, is seeking
			 medicaid payment for long-term care services.
(1)
									An individual
			 ineligible for base eligibility due to excess income shall have his or her
			 income eligibility determined using the special income level (SIL), in
			 accordance with rule 5160:1-6-03.1 of the Administrative Code.
(2)
									If an
			 individual's countable income is greater than the SIL, as determined in rule
			 5160:1-6-03.1 of the Administrative Code, the individual may establish a
			 qualified income trust (QIT), in accordance with rule 5160:1-6-03.2 of the
			 Administrative Code to become income eligible for medical
			 assistance.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-03.2 - Medicaid: use of qualified income trusts (QIT)

Current through all regulations passed and filed through July 1, 2024
(A) This rule sets forth the requirements
			 that must be met in order to establish and use a qualified income trust (QIT)
			 (also referred to as a Miller trust) to become eligible for medicaid payment of
			 long-term care services.
(B)
			 Definitions
(1) "Beneficiary" is defined in
			 rule 5160:1-3-05.2 of the
			 Administrative Code.
(2) "Grantor"
			 is defined in rule
			 5160:1-3-05.2 of the
			 Administrative Code.
(3)
			 "Individual" is defined in rule
			 5160:1-6-01.1 of the
			 Administrative Code.
(4)
			 "Irrevocable trust" is defined in rule
			 5160:1-3-05.2 of the
			 Administrative Code.
(5) "Primary
			 beneficiary" means the "individual" as defined in paragraph (B)(3) of this
			 rule.
(6) "Qualified Income Trust"
			 (QIT) means a trust that allows an individual whose income is over the special
			 income level (SIL), as described in rule
			 5160:1-6-03.1 of the
			 Administrative Code, to have some or all of his or her income not be counted
			 when determining medicaid eligibility by placing income in the trust.
(7) "QIT account" means the account that
			 holds the income placed into a QIT.
(8) "Trustee" is defined in rule
			 5160:1-3-05.2 of the
			 Administrative Code.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-04 - Medicaid: treatment of income and resources for an institutionalized spouse with a spouse in the community

Current through all regulations passed and filed through July 1, 2024
(A) This rule describes how to treat the
			 income and resources of the institutionalized spouse (IS) and the community
			 spouse (CS) for purposes of determining eligibility of the IS. When determining
			 eligibility under this rule, the income and resources deeming provisions in
			 Chapter 5160:1-3 of the Administrative Code do not apply.
(B) This rule only applies to the financial
			 eligibility determination of the IS, who is:
(1) Requesting long-term care (LTC) payment
			 of services, as described in rule 5160:1-6-01 of the Administrative Code, in a medical
			 institution,  home and community-based
			 services (HCBS) waiver, or program of all-inclusive care for the elderly
			 (PACE), for a continuous period of institutionalization as defined in rule
			 5160:1-6-01.1 of the
			 Administrative Code; and
(2)
			 Married to someone who is not in a medical institution, eligible for an HCBS
			 waiver, or receiving PACE services. This spouse is called the CS.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-05 - Medicaid: treatment of income and resources for spouses who are both seeking medicaid payment for long-term care (LTC) services

Current through all regulations passed and filed through July 1, 2024
(A) This rule
			 describes the treatment of income and resources for spouses who are both
			 seeking medicaid payment for LTC services.
(B)
								When both spouses
			 are expected to receive LTC services for less than thirty consecutive days,
			 each spouse's eligibility must be determined in accordance with Chapter
			 5160:1-3 or 5160:1-4 of the Administrative Code and the rules in Chapter
			 5160:1-6 of the Administrative Code do not apply.
(C)
								When both spouses
			 are likely to receive LTC services for more than thirty consecutive days, the
			 following rules apply:
(1)
									When the
			 spouses are no longer living together (for example, one spouse is residing in
			 a medical
			 institution and the other spouse is requesting enrollment in a home and
			 community-based services (HCBS) waiver), determine each spouse's eligibility
			 independently as follows:
(a) Determine
			 whether one
			 or both spouses have base eligibility under
			 Chapter 5160:1-4 of the Administrative Code.
(b)
										When a spouse
			 does not have base eligibility under Chapter 5160:1-4
			 of the Administrative Code, beginning the first month following the month the
			 couple ceased to live together, treat the spouse as an individual and compare
			 his or her income and resources to the individual income and resource standards
			 in accordance with Chapter 5160:1-3 of the Administrative Code.
(c)
										When a spouse's
			 income exceeds the individual income standard, then, when applicable,
			 determine each spouse's eligibility under the special income level (SIL) as
			 described in rule
			 5160:1-6-03.1 of the
			 Administrative Code.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-06 - Medicaid: transfer of assets

Current through all regulations passed and filed through July 1, 2024
(A)
								This rule
			 implements section 1917 of the Social Security Act (as in effect on October 1,
			 2016) and describes the treatment of transfers of assets when an
			 institutionalized individual, as defined in rule 5160:1-6-01.1 of the
			 Administrative Code, is seeking medicaid payment for long-term care (LTC)
			 services. This rule, and rules 5160:1-6-06.1 to 5160:1-6- 06.8 of the
			 Administrative Code, only apply to institutionalized
			 individuals.
(B)
								If the institutionalized individual (or his or her
			 spouse) disposes of assets for less than fair market value on or after the
			 look-back date specified in paragraph (C) of this rule, any such transfer will
			 be presumed an improper transfer and will result in a restricted medicaid
			 coverage period (RMCP) in accordance with rule 5160:1-6-06.5 of the
			 Administrative Code.
(C)
								The look-back date is sixty months (five years) before
			 the individual's baseline date, as defined in rule 5160:1-6-01.1 of the
			 Administrative Code.
(1)
									If the individual is already eligible for medical
			 assistance when he or she first became an institutionalized individual, the
			 baseline date is the first day of institutionalization.
(2)
									If the individual
			 is requesting enrollment in home and community-based (HCBS) waiver, the
			 baseline date is the first date that the individual has both applied for
			 medical assistance and requested enrollment on an HCBS waiver. These transfer
			 of asset provisions only apply if the individual is eligible for medical
			 assistance using the special income level (SIL).
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-06.1 - Medicaid: treatment of annuity purchases and transactions

Current through all regulations passed and filed through July 1, 2024
(A) This rule
			 describes the treatment of annuity purchases and transactions when an
			 institutionalized individual is requesting medicaid payment for long-term care
			 (LTC) services.
(B) The
			 institutionalized individual, or his or her spouse, must disclose any interest
			 that he or she has in an annuity, regardless of whether the annuity is
			 irrevocable or is treated as an asset to the institutionalized individual or
			 his or her spouse.
(C) Failure to
			 comply with paragraph (B) of this rule will result in a denial
			 or discontinuance  of medical assistance for
			 failure to cooperate as required by rule
			 5160:1-2-10 of the
			 Administrative Code.
(D) Treatment
			 of annuity purchases or transactions on or after February 8, 2006.
(1) Any purchase or annuity transaction,
			 including annuities purchased by a spouse, shall be treated as an improper
			 transfer subject to a restricted medicaid coverage period (RMCP) in accordance
			 with rule
			 5160:1-6-06.5 of the
			 Administrative Code unless:
(a) The state of
			 Ohio is named as the remainder beneficiary in the first position for the total
			 amount of medical assistance furnished to the institutionalized individual;
			 or
(b) The state of Ohio is named
			 as such a beneficiary in the second position for the total amount of medical
			 assistance furnished to the institutionalized individual after the community
			 spouse or minor or disabled child, or is named in the first position for the
			 total amount of medical assistance furnished to the institutionalized
			 individual when such spouse or a representative of such child
			 disposes of any such remainder for less than fair market value.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-06.2 - Medicaid: treatment of transfers involving a trust

Current through all regulations passed and filed through July 1, 2024
(A)
								This rule describes when transfers, by an
			 institutionalized individual or his or her spouse, involving a trust are
			 considered improper and subject to a restricted medicaid coverage period (RMCP)
			 in accordance with rule 5160:1-6-06.5 of the Administrative
			 Code.
(B)
								This rule does not affect whether the contents of the
			 trust or payments or distributions from a trust are considered resources or
			 income to the institutionalized individual for purposes of determining base
			 eligibility under Chapters 5160:1-3, 5160:1-4, and 5160:1-5 of the
			 Administrative Code.
(C)
								This rule applies to any revocable or irrevocable
			 trust, as defined in rule 5160:1-3-05.2 of the Administrative Code, that
			 contains assets of the institutionalized individual or his or her spouse, that
			 was established (other than by will) on or after the look-back date by:
(1)
									The
			 institutionalized individual; or
(2)
									The
			 institutionalized individual's spouse; or
(3)
									A person,
			 including a court or administrative body, with legal authority to act in place
			 of or on behalf of the institutionalized individual or his or her spouse;
			 or
(4)
									A person, including any court or administrative body,
			 acting at the direction or upon the request of the institutionalized individual
			 or his or her spouse.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-06.3 - Medicaid: transfers involving life estates

Current through all regulations passed and filed through July 1, 2024
(A)
								This rule
			 describes the treatment of transfers involving life estates when an
			 institutionalized individual is requesting medicaid payment for long-term care
			 services.
(B)
								The following steps must be taken to determine whether
			 a transfer involving a life estate, as defined in rule 5160:1-3-05.17 of the
			 Administrative Code, was an improper transfer in accordance with rule
			 5160:1-6-06
			 of the Administrative Code:
(1)
									Review the life estate instrument to determine the
			 nature of the life estate and the rights, responsibilities, and/or restrictions
			 placed on the life estate owner and/ or the remainderman, as defined in rule
			 5160:1-3-05.17 of the Administrative Code.
(2)
									Determine the
			 effective date of the creation of a life estate in accordance with rule
			 5160:1-3-05.17 of the Administrative Code.
(3)
									Calculate the
			 fair market value of a life estate in accordance with rule 5160:1-3-05.17 of
			 the Administrative Code.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-06.4 - Medicaid: transfers involving promissory notes, property agreements, and loans

Current through all regulations passed and filed through July 1, 2024
(A)
								This rule
			 describes how to treat transfers involving promissory notes, property
			 agreements, and loans held by an institutionalized individuals, or his or her
			 spouse, when the institutionalized individual is requesting medicaid payment
			 for long-term care (LTC) services.
(B)
								Assets used to
			 purchase or obtain a promissory note, property agreement, or loan are
			 considered to be improperly transferred unless the the purchase of the note,
			 agreement or loan was for fair market value and the terms of the promissory
			 note, property agreement, or loan:
(1)
									Have a repayment term that is actuarially sound as
			 determined in accordance with actuarial publications of the office of the chief
			 actuary in
			 26
			 C.F.R. 20.2031-7 (as in effect on October 1,
			 2016);
(2)
									Provide for payments to be made in equal amounts during
			 the term of the promissory note, property agreement, or loan, with no deferral
			 and no balloon payments made; and
(3)
									Prohibit
			 cancellation of the balance upon the lender's death; and
(4)
									Allow for the
			 transfer or sale of the note, agreement, or loan.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-06.5 - Medicaid: restricted medicaid coverage period

Current through all regulations passed and filed through July 1, 2024
(A) This rule describes how to calculate and
			 apply a restricted medicaid coverage period (RMCP), which is the period of time
			 that long-term care (LTC) services will not be paid for by medicaid because the
			 institutionalized individual improperly transferred an asset.
(B) RMCP calculation.
(1) Total the value of all improperly
			 transferred assets.
(2) When the
			 first month of requested payment of LTC services is less than a full calendar
			 month, an initial pro-rated period of restricted coverage (IPPRC) shall be
			 calculated as follows and is considered the first month of the RMCP:
(a) Determine the daily average private pay
			 rate (APPR) for nursing facility services in Ohio by dividing the monthly APPR
			 by the number of days in the month for which the first month of RMCP is being
			 calculated. Round the result to the second decimal place.
(b) Multiply the daily APPR by the number of
			 days from the first day of eligibility for requested LTC services through the
			 last day of the month in which the institutionalized individual is eligible for
			 medical assistance and would otherwise be receiving LTC services paid for by
			 the medicaid program.
(3) Determine full months of RMCP as follows:
(a) Subtract the IPPRC from the total value
			 of all improperly transferred assets, if applicable; then
(b) Divide by the monthly APPR.
(c) The resulting whole number is the number
			 of full months of RMCP.
(d)
										
										When there
			 is a remaining fractional amount, calculate a partial month of restricted
			 coverage.
(4) To
			 determine the partial month of restricted coverage (PMRC):
(a) Multiply the APPR by the number of full
			 months of restricted coverage; then
(b) Subtract that amount from the total value
			 of the improperly transferred assets; then
(c) Subtract the IPPRC determined in
			 paragraph (B)(2) of this rule; then
(d) The remainder is the amount of the
			 PMRC.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-06.6 - Medicaid: undue hardship exemption

Current through all regulations passed and filed through July 1, 2024
(A) This rule describes an undue hardship
			 exemption for institutionalized individuals who are subject to a restricted
			 medicaid coverage period (RMCP) described in rule
			 5160:1-6-06.5 of the
			 Administrative Code.
(B) The
			 institutionalized individual will not be subject to 
								an RMCP
			 
								when the
			 imposition of the RMCP would cause an undue hardship.
(C) An undue hardship exists
			 
								when the
			 imposition of the RMCP would deprive the institutionalized individual of:
(1) Medical care such that the
			 institutionalized individual's health or life would be endangered; or
(2) Food, clothing, shelter, or other
			 necessities of life.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-06.7 - Medicaid: allegations of asset transfers by the social security administration

Current through all regulations passed and filed through July 1, 2024
(A) This rule describes the social security
			 administration's (SSA) reporting requirements to the Ohio department medicaid
			 (ODM) regarding alleged transfer of assets by supplemental
			 security income (SSI) applicants.
(B) When an individual applies for SSI
			 benefits, the SSA requests information from the applicant
			 regarding any asset transfers and reports the
			 information to ODM. The SSA notifies ODM of any
			 resource transfer, regardless of when the transfer occurred.
(C) ODM forwards the information to the
			  department of job and family
			 services (DJFS) for the county in which the individual resides to determine whether any such
			 transfers were improper in accordance with rule
			 5160:1-6-06 of the
			 Administrative Code.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-06.8 - Medicaid: disposal of assets of individuals receiving services from the Ohio department of developmental disabilities and/or Ohio department of mental health and addiction services

Current through all regulations passed and filed through July 1, 2024
(A) This rule describes the disposal of
			 assets of individuals who are receiving services
			 from the Ohio department of developmental disabilities (DODD) and/or
			 the Ohio department of mental health and
			 addiction services (OhioMHAS)
			 and who are in receipt of medical
			 assistance.
(B) Individuals in
			 receipt of medical assistance may have received or continue to receive services
			 from  DODD and/or
			 OhioMHAS.
(1) DODD
			 and OhioMHAS provide for any and all personal needs, e.g.,
			 recreational activities and services necessary to assure a better quality of
			 life for individuals under their care. Many of these services are not covered
			 by medicaid and exceed the individual's available personal income.
(2) DODD and OhioMHAS
			 maintain records and documentation of expenses incurred on an individual's
			 behalf that fall outside of the scope of coverage for medical assistance and
			 exceed the individual's available income.
(3) When an individual receives a lump-sum
			 payment or available assets are identified, DODD and OhioMHAS seek
			 reimbursement for appropriately incurred expenses.
Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-07.1 - Medicaid: post-eligibility treatment of income for individuals receiving services through a home and community-based services (HCBS) waiver or the program of all-inclusive care for the elderly (PACE)

Current through all regulations passed and filed through July 1, 2024
(A) This rule describes the process for
			 calculating an individual's post-eligibility treatment of income (PETI),
			 commonly referred to as patient liability or share of cost, when the individual is not living in a medical
			 institution. This rule only applies to an individual who is both eligible for
			 medical assistance under the special income level (SIL) as described in rule
			 5160:1-6-03.1 of the Administrative Code
			 and who is receiving HCBS waiver or PACE
			 services.
(B) The administrative
			 agency will reduce its payment to the HCBS waiver or PACE providers
			 
			 for services provided to the individual by the amount of the individual's
			 patient liability calculated in accordance with this rule.
(C) The individual must pay the patient
			 liability amount to his or her providers identified by the HCBS waiver or PACE
			 administrative agency.
(D)
								Providers are to collect the full patient liability
			 amount or up to the cost of care, whichever is less.
(E)
			 Patient liability must be recalculated when there is a change in circumstances
			 that affects the patient liability amount.
(F)
								A patient
			 liability calculated for a child younger than age nineteen shall not increase
			 during the child's continuous eligibility period as described in rule
			 5160:1-2-14 of the
			 Administrative Code. Any decrease in a child's patient liability results in a
			 new maximum amount, which will not increase for the remainder of the child's
			 continuous eligibility period.
(G) Providers are
			 required to refund to the individual any overpayments of patient liability paid
			 by the individual, such as when retroactive patient liability adjustments are
			 made.
(H) For purposes of
			 this rule, the following definitions apply:
(1) "Assisted living waiver maintenance needs
			 allowance (ALMNA)" is an amount equal to the current supplemental security
			 income (SSI) federal benefit rate (FBR).
(2) "Special individual maintenance needs
			 allowance (SIMNA)" is sixty-five per cent of the special income
			 level.
Ohio Administrative Code › Title 5501 - Department of Transportation - Administration and Director › Chapter 5501-1 - Rule-making Procedure › Section 5501-1-01 - Notice of hearing to adopt or change rules

Current through all regulations passed and filed through July 1, 2024
(A) The director of the department of
			 transportation shall give notice of the intention of the department to conduct
			 a public hearing on a proposal to adopt, amend, or rescind a rule, when
			 required by section
			  119.03 
			 of the Revised Code. The public notice shall be published in the register of
			 Ohio at least thirty days prior to the date set for the hearing. The public
			 notice shall include all the following:
(1) A
			 statement of the department's intention to consider adopting, amending, or
			 rescinding a rule.
(2) A general
			 statement of the subject matter to which the proposed rule, amendment, or
			 recission relates.
(3) A statement
			 of the reason or purpose for adopting, amending, or rescinding the rule.
(4) The date, time, and place of
			 the public hearing on the proposed action, which shall not be earlier than the
			 thirty-first or later than the fortieth day after the proposed rule, amendment
			 or rescission is filed.
Ohio Administrative Code › Title 5501 - Department of Transportation - Administration and Director › Chapter 5501-2 - Business Plan › Section 5501-2-02 - Disciplinary appeals

Current through all regulations passed and filed through July 1, 2024
(A) An employee in the career professional
			 service may appeal a demotion or a suspension of more than three days only as
			 provided in this rule.
Parties to the appeal shall be the employee, acting as
				appellant, and a management representative, acting as appellee.
(B) The employee may appeal if,
			 within ten days after being notified in writing that the demotion or suspension
			 will be imposed, the employee submits a written request for an appeal to the
			 deputy director having supervision over that employee or the deputy director's
			 designee. An employee who does not submit a timely written request for an
			 appeal waives any right to an appeal.
Upon timely submission of a written request for an appeal, the
				employee shall have a right to a hearing before the director or the director's
				designee, who shall act as the hearing officer. No person shall act as hearing
				officer who also participated in the employee's predisciplinary hearing on the
				demotion or suspension being appealed.
(C) The hearing officer shall schedule a
			 hearing within fifteen days, but not earlier than seven days, of the date
			 employee submits the written request for an appeal. Immediately upon scheduling
			 the hearing, the hearing officer shall send written notice to the parties of
			 the date, time and place of the hearing.
Each party, upon request, shall receive one continuance of up
				to three days. The hearing officer may grant further continuances within the
				hearing officer's discretion.
Each party, not less than five days prior to the date of the
				hearing, shall submit to the hearing officer and the other party a list of
				witnesses the party expects to call. The hearing officer has the right to limit
				witnesses on the basis of redundancy and relevance.
(D) Prior to calling the hearing to order,
			 the hearing officer shall inform the employee that the employee is permitted to
			 have counsel present. The hearing officer then shall call the hearing to order,
			 make introductions, and distribute a sign-in sheet. If the employee is
			 accompanied by counsel, the hearing officer shall inform the employee that
			 counsel's participation is limited to protecting the rights of the employee
			 when the employee is called as a witness, but that counsel shall not examine or
			 cross examine any witnesses, including the employee.
(1) The hearing officer shall review the
			 following:
(a) The purpose of the hearing;
(b) The charges giving rise to the
			 demotion or suspension;
(c)
			 Documentation supporting the demotion or suspension.
Ohio Administrative Code › Title 5501 - Department of Transportation - Administration and Director › Chapter 5501-2 - Business Plan › Section 5501-2-03 - Career professional service classification

Current through all regulations passed and filed through July 1, 2024
Positions within the Ohio department of transportation, which
				are listed in the attached appendix to this rule are to be included in the
				career professional service classification created under section  5501.20  of the
				Revised Code.
Click
				to view Appendix
Ohio Administrative Code › Title 5501 - Department of Transportation - Administration and Director › Chapter 5501-4 - Accessing Confidential Personal Information › Section 5501-4-02 - Procedures for accessing confidential personal information

Current through all regulations passed and filed through July 1, 2024
For personal information systems, whether manual or computer
				systems, that contain confidential personal information, the department shall
				do the following:
(A) Criteria for
			 accessing confidential personal information. Personal information systems of
			 the department are managed on a "need-to-know" basis whereby the information
			 owner determines the level of access required for an employee of the department
			 to fulfill his/her job duties. The determination of access to confidential
			 personal information shall be approved by the employee's supervisor and the
			 information owner prior to providing the employee with access to confidential
			 personal information within a personal information system. The department shall
			 establish procedures for determining a revision to an employee's access to
			 confidential personal information upon a change to that employee's job duties
			 including, but not limited to, transfer or termination. Whenever an employee's
			 job duties no longer require access to confidential personal information in a
			 personal information system, the employee's access to confidential personal
			 information shall be removed.
(B)
			 Individual's request for a list of confidential personal information. Upon the
			 signed written request of any individual for a list of confidential personal
			 information about the individual maintained by the department, the department
			 shall do all of the following:
(1) Verify the
			 identity of the individual by a method that provides safeguards commensurate
			 with the risk associated with the confidential personal information;
(2) Provide to the individual the list of
			 confidential personal information that does not relate to an investigation
			 about the individual or is otherwise not excluded from the scope of Chapter
			 1347. of the Revised Code; and
(3)
			 If all information relates to an investigation about that individual, inform
			 the individual that the department has no confidential personal information
			 about the individual that is responsive to the individual's request.
Ohio Administrative Code › Title 5501 - Department of Transportation - Administration and Director › Chapter 5501-4 - Accessing Confidential Personal Information › Section 5501-4-03 - Valid reasons for accessing confidential personal information

Current through all regulations passed and filed through July 1, 2024
(A) Pursuant to the
			 requirement of division (B)(2) of section
			  1347.15 
			 of the Revised Code, this rule contains a list of valid reasons, directly
			 related to the department's exercise of its powers or duties, for which only
			 employees of the department may access confidential personal information (CPI)
			 regardless of whether the personal information system is a manual system or
			 computer system:
(B) Performing
			 the following functions constitute valid reasons for authorized employees of
			 the department to access confidential personal information:
(1) Responding to a public records
			 request;
(2) Responding to a
			 request from an individual for the list of CPI that the department maintains on
			 that individual;
(3) Administering
			 a constitutional provision or duty;
(4) Administering a statutory provision or
			 duty;
(5) Administering an
			 administrative rule provision or duty;
(6) Complying with any state or federal
			 program requirements;
(7)
			 Processing or payment of claims or otherwise administering a program with
			 individual participants or beneficiaries
(8) Auditing purposes;
(9) Permit, certification, eligibility,
			 registration, or filing processes;
(10) Investigation or law enforcement
			 purposes;
(11) Administrative
			 hearings;
(12) Litigation,
			 complying with an order of the court, or subpoena;
(13) Human resource matters (e.g., hiring,
			 promotion, demotion, discharge, salary/compensation issues, leave
			 requests/issues, time card approvals/issues);
(14) Complying with an executive order or
			 policy;
(15) Complying with a
			 department policy or a state administrative policy issued by the department of
			 administrative services, the office of budget and management or other similar
			 state agency; or
(16) Complying
			 with a collective bargaining agreement provision.
Ohio Administrative Code › Title 5501 - Department of Transportation - Administration and Director › Chapter 5501-4 - Accessing Confidential Personal Information › Section 5501-4-04 - Confidentiality statutes

Current through all regulations passed and filed through July 1, 2024
The following federal statutes or regulations or state statutes
				and administrative rules make personal information maintained by the department
				confidential and identify the confidential personal information within the
				scope of rules promulgated by the department in accordance with section
				 1347.15 
				of the Revised Code.
(A) Social
			 security numbers:
			  5 U.S.C. 552a, unless the individual was told that the
			 number would be disclosed.
(B)
			 Certification information:
			  49 C.F.R. 26.109, personal information submitted
			 in relation to qualification as a possible disadvantaged business
			 enterprise.
(C) Medical records:
			 division (A)(1)(a) of section
			  149.43 
			 of the Revised Code, any documents and/or information relating to
			 hospitalization, treatment or diagnosis generated from medical
			 treatment.
(D) Investigation
			 reports: section
			  5501.55 
			 of the Revised Code, personal information related to the investigations of
			 accidents involving rail fixed guideway systems.
(E) Bidding information: section
			  5525.04 
			 of the Revised Code, information related to bidder qualification.
(F) Trial preparation records: division
			 (A)(1)(g) of section
			  149.43 
			 of the Revised Code, any record that contains information that is specifically
			 compiled in reasonable anticipation of, or in defense of, a civil or criminal
			 action or proceeding, including the independent thought processes and personal
			 trial preparation of an attorney.
(G) Confidential law enforcement
			 investigatory records: division (A)(1)(h) of section
			  149.43 
			 of the Revised Code, any record pertaining to a law enforcement matter of a
			 criminal, quasi-criminal, civil, or administrative nature, but only to the
			 extent that the release of the record would create a high probability of
			 disclosure of personal identifying information.
Effective:
				12/7/2017
Five Year Review (FYR) Dates:
				9/8/2017 and
				12/07/2022
Promulgated
				Under:
				 119.03
Statutory Authority:
				 1347.15
Rule Amplifies:
				 1347.15
Prior Effective Dates:
				07/31/2011
Ohio Administrative Code › Title 5501:1 - Division of Aviation › Chapter 5501:1-1 - Certification of Commercial Airports, Heliports, Seaplane Landing Sites, Landing Fields, and Landing Areas › Section 5501:1-1-01 - Definitions

Current through all regulations passed and filed through July 1, 2024
(A) "Commercial
  purposes" means airports, heliports, except for medical
  use heliports, and seaplane bases landing
  sites having repeated or successive flights for compensation, student training
  for hire, or offering to the general public any other services pertaining to
  aircraft or aviation for compensation.
(B) "Non-commercial purposes" means all
  airports, heliports, except for medical use
  heliports, seaplane landing sites, landing fields and landing areas that
  at all times are used exclusively by the owner of the airport and by persons
  the owner authorizes. No specifications or restrictions apply except that the
  owner shall be required to register the airport with the office of aviation
  biennially on the forms provided.
(C)
								Federal navigable
  waterways are specifically exempted from inspection, approval and certification
  requirements.
(D)
								"Aircraft operations area"
  (AOA) means all areas where aircraft can operate, either under their own power
  while in tow. The AOA includes runways, taxiways and apron areas. Federal
  navigable waterways are specifically exempted from inspection, approval and
  certification .
(E)
								"Medical use
  heliports" means all heliports used exclusively for emergency and medical
  purposes and located at, on or near hospitals, clinics or other medical
  facilities regardless of any compensation charged or paid for such
  use.
Ohio Administrative Code › Title 5501:1 - Division of Aviation › Chapter 5501:1-1 - Certification of Commercial Airports, Heliports, Seaplane Landing Sites, Landing Fields, and Landing Areas › Section 5501:1-1-02 - Commercial operating certificate

Current through all regulations passed and filed through July 1, 2024
In accordance with section
	 4561.11 of the Revised Code, all
	 public and private airports, heliports, seaplane landing sites, landing fields,
	 landing areas and bodies of water shall first be approved and issued an
	 operating certificate by the office of aviation before being used for
	 commercial purposes and renewed every three years
	 thereafter
based upon the requirements listed within this chapter and as required
	 by the FAA.
(A) Airports, heliports,
  seaplane landing sites, landing fields and landing areas constructed or
  established after January 1, 1998 must meet the requirements set forth in 14
  CFR part 77, as amended, and federal aviation administration design advisory
  circulars.
(B) Airports, heliports,
  seaplane landing sites, landing fields and landing areas constructed or
  established before January 1, 1998 will be certificated in accordance with the
  standards set forth during original construction; however, these airports,
  heliports, seaplane landing sites, landing fields and landing areas must comply
  with the requirements of certification in rule
  5501:1-2-01for airports and landing fields, rule
  5501:1-5-01 for heliports and
  rule 5501:1-4-01 for seaplane
  landing sites of the Administrative Code, as amended.
(C) Conditional approval may be given where
  the office of aviation determines that additional requirements need to be met
  before final approval can be issued. Such conditional approval
  will be issued in writing listing
								 the
  requirements to be met before such approval will be given and provide a
  reasonable time in which to satisfy such requirements.
(D) Airports that have a current
  certification from the FAA under 14 CFR part 139, as amended, are exempt from
  state inspection and certification.
(E) If a certification is denied or a
  conditional approval is not granted, this decision shall be sent by certified
  mail, return receipt requested 
								informing the airport, heliport,
  seaplane landing site, landing field, or landing
  area of their right to request a hearing. Any request for a hearing must be
  filed with the administrator within thirty days of the receipt of written
  notice. If a hearing is requested, it shall be conducted in accordance with
  Chapter 119. of the Revised Code.
Ohio Administrative Code › Title 5501:1 - Division of Aviation › Chapter 5501:1-1 - Certification of Commercial Airports, Heliports, Seaplane Landing Sites, Landing Fields, and Landing Areas › Section 5501:1-1-03 - Temporary commercial operating certificate for special events

Current through all regulations passed and filed through July 1, 2024
(A) During
  short-term special events such as fairs, exhibitions, fly-ins, splash-ins etc.
  a temporary commercial operating permit may be issued
  to the owner or entity that has legal control of the property for a specific
  period of time not to exceed twenty-one consecutive calendar days.
(B)
								In addition to those requirements contained in the
  division of aviation rules under rules
  5501:1-1-04 to
  5501:1-5-01 of the
  Administrative Code,
								
								adequate ground personnel and appropriate means
  of crowd control, including temporary markings and boundaries such as buoys or
  barricades, shall be present to 
								ensure that the complete aircraft landing area
  and approach-departure path will be free and clear of all equipment, vehicles,
  watercraft, and pedestrians.