reglab/statecodes huggingface dataset:
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-42 - WIC Program › Section 3701-42-10 - Pharmacy vendor authorization

Current through all regulations passed and filed through July 1, 2024
(A)
								 To apply for a
			 contract, a pharmacy applicant shall complete an application packet on forms
			 prescribed by the director. The director shall determine a pharmacy applicant
			 to be authorized by entering into a contract with the pharmacy applicant that
			 meets the criteria set forth in rule
			 3701-42-03
			 of the Administrative Code, as applicable, to provide prescribed infant formula
			 to participants. The contract shall be for a term of no more than three years.
			 Unless otherwise provided in this rule, the contract beginning date shall be
			 consistent with the dates set forth in paragraph (C) of rule
			 3701-42-03
			 of the Administrative Code.
(B)
								 A pharmacy
			 applicant is not required to have food assistance program
			 authorization.
(C)
								 A pharmacy shall only provide prescribed infant
			 formula in exchange for the benefits on the WIC nutrition card unless the
			 director determines it is in the best interest of the program to permit the
			 location to also provide contract formula. The prescribed formula must be
			 provided to the participant within twenty-four hours of
			 request.
(D)
								 A pharmacy shall comply with the requirements of rules
			 3701-42-04,
			 3701-42-06,
			 and
			 3701-42-07
			 of the Administrative Code, where applicable.
(E)
								 The director
			 shall sanction a pharmacy that abuses the WIC program in accordance with rule
			 3701-42-08
			 of the Administrative Code.
(F)
								 A pharmacy or
			 pharmacy applicant subject to an adverse action under rule
			 3701-42-08
			 of the Administrative Code shall have the right to an administrative or
			 abbreviated review in accordance with rule
			 3701-42-09
			 of the Administrative Code.
Effective: 9/16/2016
Five Year Review
				(FYR) Dates: 09/15/2021
Promulgated Under:
				119.03
Statutory
				Authority: 3701.132
Rule
				Amplifies: 3701.132
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-01 - Definitions

Current through all regulations passed and filed through July 1, 2024
As used in this chapter of the Administrative Code:
(A) "Adult with cystic fibrosis" means an
			 Ohio resident who is twenty-one or more years of age, who is diagnosed with
			 cystic fibrosis and who meets the financial eligibility requirements
			 established by rule
			 3701-43-16
			 of the Administrative Code.
(B)
			 "Advanced practice nurse" means a certified registered nurse anesthetist,
			 clinical nurse specialist, certified nurse-midwife, or certified nurse
			 practitioner who has met the requirements of section
			 4723.41 of the Revised Code and
			 who holds a current valid certificate of authority issued by the board of
			 nursing pursuant to section
			 4723.42 of the Revised
			 Code.
(C) "Applicant" means an
			 individual for whom application has been made for eligibility for payment for
			 diagnostic, service coordination or treatment services or goods by the program
			 for medically handicapped children.
(D) "Diagnostic services" means services
			 necessary to determine whether an Ohio resident under twenty-one years of age
			 has a medically handicapping or potentially medically handicapping condition.
			 Diagnostic services include:
(1) Services
			 needed to establish or rule out a diagnosis that would allow the Ohio resident
			 to meet the medical eligibility requirements for payment for treatment goods
			 and services; and
(2) Services
			 needed to develop a plan of care for an individual.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-02 - Standards and procedures for determining eligibility of providers

Current through all regulations passed and filed through July 1, 2024
(A) The director
			 shall apply the standards and procedures prescribed by this rule and by rules
			 3701-43-03
			 to
			 3701-43-08
			 and
			 3701-43-13
			 of the Administrative Code for the purposes of reviewing the applications of
			 provider applicants and for making determinations as to whether these
			 applicants are eligible providers.
(1) For
			 the purposes of this chapter "provider applicant" means a health care
			 professional, hospital, medical equipment supplier or other individual, group
			 or agency that makes application to become a provider, as defined in paragraph
			 (P) of rule
			 3701-43-01 of the
			 Administrative Code.
(2) Subject
			 to the termination provisions prescribed by rule
			 3701-43-10
			 of the Administrative Code, anyone who is a provider for the program for
			 medically handicapped children or adults with cystic fibrosis on the effective
			 date of this rule is not required to apply for approval under this rule and
			 shall be considered a provider for the purposes of this chapter.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-03 - Standards and procedures for determining eligibility of physician providers

Current through all regulations passed and filed through July 1, 2024
(A) The director shall apply the standards
			 and procedures prescribed by this rule in reviewing and making determinations
			 concerning applications by physicians to be providers for the program for
			 medically handicapped children.
(B)
			 To be approved as a provider, a physician shall:
(1) Be licensed to practice allopathic
			 medicine or osteopathic medicine in the state of Ohio or the state in which the
			 physician's practice is located, if the physician will be providing services
			 outside Ohio;
(2) Meet the
			 following certification requirements:
(a) All
			 physicians shall be certified by a certifying board of the "American Board of
			 Medical Specialities" or a certifying board of the "American Osteopathic
			 Association";
(b) To be designated
			 as a subspecialist, a physician shall be certified in the relevant subspecialty
			 by a certifying board of the "American Board of Medical Specialties" or a
			 certifying board of the "American Osteopathic Association." If the applicable
			 board does not certify physicians in the relevant subspecialty, the director
			 may designate a physician as a subspecialist based upon significant advanced
			 postgraduate training in the area. The director may consult with one or more
			 members of the medical advisory council or with other individuals with
			 expertise in the area in determining whether a physician has significant
			 advanced postgraduate training;
(3) Meet the following practice requirements:
(a) Possession of skill and experience in the
			 treatment of children or adolescents with handicapping conditions, as
			 determined by the director. In making this determination, the director may
			 consult with one or more members of the medical advisory council or with other
			 individuals with expertise in the area; and
(b) Actively providing at the time of
			 application, treatment to children with medically eligible conditions or adults
			 with cystic fibrosis; and
(4) Maintain privileges on the staff of a
			 hospital that is approved under rule
			 3701-43-04
			 of the Administrative Code; or have arrangements with physicians who are
			 approved under this chapter to admit children needing inpatient care to a
			 hospital that is approved under rule
			 3701-43-04
			 of the Administrative Code for inpatient care.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-04 - Health care facilities

Current through all regulations passed and filed through July 1, 2024
(A) Hospitals:
(1) Must be approved by joint commission,
									 American osteopathic
			 association, or healthcare facilities accreditation
			 program (HFAP);
(2) Must be
			 licensed or registered in the state in which they are located;
(3) For inpatient services and outpatient
			 surgery, must have:
(a) Physical facilities
			 appropriate for the care of pediatric patients;
(b) Trained and qualified staff to care for
			 pediatric patients; and
(c)
			 Anesthesia providers approved under rule
			 3701-43-03
			 of the Administrative Code.
(4) Must meet national standards of care for
			 children with special health care needs including, but not limited to the
			 American academy of pediatrics. The department may establish approval criteria
			 and policies for specialized services with no national standards of care.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-05 - Medical equipment suppliers

Current through all regulations passed and filed through July 1, 2024
(A) To be approved as a medical equipment
			 supplier of orthotics, prosthetics, or wheelchairs, a provider shall meet the
			 requirements of rule
			 3701-43-02
			 of the Administrative Code and the following.
(B) If the provider is:
(1) A prosthetist or orthotist, he or she
			 shall:
(a) Hold a current, valid license
			 issued in accordance with Chapter 4779. of the Revised Code; and
(b) Be capable of maintaining and repairing
			 the wheelchairs on the provider's premises if he or she is providing
			 wheelchairs; or
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-06 - Dentists

Current through all regulations passed and filed through July 1, 2024
(A) To be approved
			 for general dental services, a dentist must be a graduate of an approved dental school and
			 licensed as such by the state of Ohio or in the state in which the dentist's
			 practice is located;
(B) A dental
			 specialist shall:
(1)
									Meet the
			 requirement in paragraph (A) of this rule;
(2) Submit verification of having had a
			 minimum of two years of graduate training in the specialty; and
(3) Document his or her primary area of
			 practice.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-07 - Health professionals and other providers

Current through all regulations passed and filed through July 1, 2024
(A)
								 To be eligible
			 for consideration as a provider, the following applicants must be licensed,
			 registered, or certified in accordance with the following:
(1)
									 Advanced
			 practice nurses in accordance with Chapter 4723. of the Revised Code;
(2)
									
			 Ambulances in accordance with Chapter 4766. of the Revised Code;
(3)
									
			 Audiologists in accordance with Chapter 4753. of the Revised Code;
(4)
									
			 Dietitians in accordance with Chapter 4759. of the Revised Code;
(5)
									
			 Hearing aid dealers in accordance with Chapter 4747. of the Revised Code;
(6)
									
			 Occupational therapists in accordance with Chapter 4755. of the Revised
			 Code;
(7)
									 Optometrists in accordance with Chapter 4725. of the
			 Revised Code;
(8)
									 Pedorthists in accordance with Chapter 4779. of the
			 Revised Code;
(9)
									 Pharmacies in accordance with Chapter 4729. of the
			 Revised Code;
(10)
									 Pharmacists in accordance with Chapter 4729. of the
			 Revised Code;
(11)
									 Physical therapists in accordance with Chapter 4755.
			 of the Revised Code;
(12)
									 Podiatrists in accordance with Chapter 4731. of the
			 Revised Code;
(13)
									 Psychologists in accordance with Chapter 4732. of the
			 Revised Code; and
(14)
									 Speech language pathologists in accordance with
			 Chapter 4753. of the Revised Code.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-08 - Local health departments

Current through all regulations passed and filed through July 1, 2024
(A) Local health department applicants:
(1) Must meet the definition of a "local
			 health department" as defined under paragraph (F) of rule
			 3701-43-01 of the
			 Administrative Code; and
(2) Must
			 meet provider requirements of rule
			 3701-43-02
			 of the Administrative Code.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-10 - Termination of provider services

Current through all regulations passed and filed through July 1, 2024
A provider of services approved under rules
				3701-43-02
				to
				3701-43-08and 3701-43-13 of the Administrative Code may have his
				or her approval terminated if he or she:
(A) Voluntarily terminates his or her
			 medicaid provider agreement or the provider's medicaid provider agreement is
			 terminated by the Ohio department of job and family services;
(B) Is deceitful or fraudulent in connection
			 with obtaining approval or in providing services;
(C) Violates any provision of sections
			 3701.021 to
			 3701.028 of the Revised Code or
			 Chapter 3701-43 of the Administrative Code;
(D)
								
								Reports in writing that he or
			 she no longer wishes to participate in the program;
(E)
								Is deceased;
(F) Is unable to be located by the program;
(G) Is required to have a license
			 or certification and the license or certification have been revoked or
			 suspended due to legal action; or
(H) Is not providing services:
(1) In accordance with
			  applicable federal or state standards
			 
									relevant to care of children with handicapping
			 conditions;
(2) Which are in the
			 best interest of a child; or
(3)
			 In accordance with standards prescribed by the program
			 or a
			 national professional 
									organization for the care of children with
			 handicapping conditions such as the American academy of pediatrics.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-11 - Application and eligibility for provision of diagnostic services

Current through all regulations passed and filed through July 1, 2024
(A) Application for
			 provision of diagnostic services as defined in paragraph (D) rule
			 3701-43-01 of the
			 Administrative Code requires the following:
(1) The applicant, parent, guardian or other
			 legal representative of the child for whom services are being requested shall
			 submit to the director a signed consent form allowing the program to release
			 information to persons or agencies who may participate in or facilitate the
			 delivery of authorized services to the child; and
(2) The managing physician shall sign and
			 submit to the director a medical application on a form prescribed by the
			 director. The form shall be completed in full and shall include an individual
			 plan for diagnostic services describing the medical and nonmedical procedures
			 needed for diagnosing or confirming a medical condition of the applicant. The
			 completed medical application inclusive of signed consent forms shall be
			 received by the director within sixty days of the initial examination.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-12 - Authorization for payment of diagnostic services

Current through all regulations passed and filed through July 1, 2024
(A) Subject to paragraphs (B) and (C) of this
			 rule, diagnostic services shall be authorized for applicants determined to be
			 eligible for diagnostic services pursuant to paragraph (B) of rule
			 3701-43-11
			 of the Administrative Code if all of the following apply:
(1) The services are included in the
			 applicant's medical application submitted by the managing physician in
			 accordance with paragraph (A)(2) of rule
			 3701-43-11
			 of the Administrative Code, or additional services have been requested by the
			 applicant's managing physician or other BCMH provider on forms prescribed by
			 the director;
(2) The services are
			 furnished by providers, as defined in paragraph (P) of rule
			 3701-43-01 of the
			 Administrative Code, who are approved under applicable provisions of this
			 chapter to provide the specific services requested and the services are
			 furnished within the period of eligibility for diagnostic services;
(3) The services are deemed necessary by the
			 director for an assessment of the eligible applicant's condition in accordance
			 with medical policies and the applicable standards of care as defined in
			 paragraph (U) of rule
			 3701-43-01 of the
			 Administrative Code;
(4) The
			 managing physician and any provider shall furnish to the director upon request
			 medical reports and progress records verifying completion of the diagnostic
			 services and indicating whether the child has a handicapping condition;
(5) The services are rendered in
			 Ohio. The director may waive this requirement if comparable services are not
			 available in Ohio or if the director determines that travel to obtain
			 comparable services in Ohio would present an undue hardship for the applicant;
			 and
(6) Request for authorization
			 of services must be received within eleven months from date of service to
			 enable payment for those services to occur in accordance with this chapter.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-13 - Application and eligibility for provision of service coordination

Current through all regulations passed and filed through July 1, 2024
(A) An applicant
			 who wishes to be approved as a service coordinator shall:
(1) Have a bachelor's degree or higher in
			 nursing or social work and is licensed, registered, or certified in the
			 profession, as applicable, by the state of Ohio;
(2) Be employed through a hospital-based
			 interdisciplinary specialty team or physician provider office team approved by
			 the program for the delivery of service coordination services; and
(3) Submit a service coordinator provider
			 application as required in rule
			 3701-43-02
			 of the Administrative Code, and include a copy of applicant's resume and
			 current position description that describes how the service coordinator will
			 function within the team.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-14 - Authorization for payment of service coordination services

Current through all regulations passed and filed through July 1, 2024
(A) Service
			 coordination services shall be authorized for eligible applicants pursuant to
			 rule
			 3701-43-13
			 of the Administrative Code if all of the following apply:
(1) Application for service coordination has
			 been received in accordance with rule
			 3701-43-13
			 of the Administrative Code;
(2)
			 Service coordination services are furnished by providers, who are approved
			 under applicable provisions of this chapter to provide the specific services
			 requested and the services are furnished within the period of eligibility for
			 service coordination;
(3) The
			 service coordination services are deemed necessary by the director for the
			 applicant's medically handicapping condition in accordance with medical
			 policies and the applicable standards of care as defined in paragraph (U) of
			 rule
			 3701-43-01 of the
			 Administrative Code;
(4) The
			 service coordinator shall furnish to the director a comprehensive service plan
			 in accordance with medical policies verifying progress in the coordination of
			 services for the child.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-15 - Application and review procedures for eligibility for payment for treatment

Current through all regulations passed and filed through July 1, 2024
(A) This rule
			 prescribes the procedures for applying for a determination by the director as
			 to whether the applicant is eligible for payment for treatment services and
			 goods by the program because the applicant:
(1) Meets the definition of medically
			 handicapped child established by paragraph (K) of rule
			 3701-43-01 of the
			 Administrative Code; or
(2) Meets
			 the definition of adult with cystic fibrosis established by paragraph (A) of
			 rule
			 3701-43-01 of the
			 Administrative Code.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-16.2 - Financial eligibility requirements for payment for treatment for adults with cystic fibrosis

Current through all regulations passed and filed through July 1, 2024
(A) As used in this rule:
(1) "Income guidelines" means the guidelines,
			 as established by the director on April first of each year, for use in
			 determining financial eligibility for payment for treatment. The income
			 guidelines shall be equal to one hundred eighty-five per cent of the poverty
			 income for each size family, as reported in the "Federal Register" by the
			 United States department of health an human services, rounded up to the nearest
			 five hundred dollars.
(2) A
			 "family unit" means the group consisting of the following persons:
(a) The applicant or recipient;
(b) The applicant's or recipient's spouse;
(c) Other persons who, for federal
			 income tax purposes, are considered dependents of the individual who claims the
			 applicant or recipient as a dependent or who are considered dependents of the
			 applicant or recipient, except for a spouse who is not the biological parent. A
			 family unit consists only of the applicant or recipient if the applicant or
			 recipient is self-supporting and has no spouse or dependents.
(3) "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 each member of the family unit.
			 For the purposes of this rule, 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.
(4) "Maximum
			 ability to pay for medical care" means the difference between the amount a
			 family unit spends, including payroll deductions, for health-related insurance
			 coverage and the sum of the following amounts:
(a) Ten per cent of the first fifteen
			 thousand dollars by which the family income exceeds the applicable income
			 guidelines, as defined in paragraph (A)(1) of this rule;
(b) Twenty-five per cent of the next
			 twenty-five thousand dollars by which the family income exceeds the applicable
			 income guideline, as defined in paragraph (A)(1) of this rule; and
(c) Thirty-seven and one half per cent of the
			 remaining amount by which the family income exceeds the applicable income
			 guideline, as defined in paragraph (A)(1) of this rule.
(5) "Service level credit" means a credit of
			 two thousand dollars.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-17 - Medical eligibility requirements for payment for treatment

Current through all regulations passed and filed through July 1, 2024
(A) The director
			 shall apply the requirements prescribed by this rule in determining whether an
			 applicant or recipient is medically eligible for payment for treatment services
			 and goods by the program for medically handicapped children. An applicant or
			 recipient is medically eligible if he or she has been diagnosed as having a
			 medically eligible condition. In determining whether an applicant's or
			 recipient's condition is a medically eligible condition under paragraphs (B)
			 and (C) of this rule, the director may consult with one or more members of the
			 medical advisory council or with other individuals with expertise in the area.
(B) A condition is a medically
			 eligible condition if:
(1) The condition is a
			 "chronic, physically handicapping condition," defined, for purposes of this
			 chapter as a condition which has a degree of severity that restricts physical
			 development and is expected to impair health functioning for a period of one
			 year or more or at frequently recurring intervals;
(2) The condition is amenable to treatment
			 through treatment services or goods, as defined in paragraph (X) of rule
			 3701-43-01 of the
			 Administrative Code;
(3) The
			 condition either is a neoplasm or a congenital anomaly or affects one or more
			 of the following:
(a) Endocrine system;
(b) Immune system;
(c) Nervous system;
(d) Integumentary system;
(e) Cardiovascular system;
(f) Respiratory system;
(g) Digestive system;
(h) Genitourinary system;
(i) Musculoskeletal system;
(j) Sensory organs;
(k) Metabolic diseases;
(l) Diseases of the blood.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-19 - Third-party payments

Current through all regulations passed and filed through July 1, 2024
Notwithstanding any contract provision to the contrary, any
				bureau payments for costs of treatment, supportive services, accessories and
				their upkeep, shall be in excess of and secondary to payments of any
				third-party payor, and therefore any bureau payments for costs shall be made
				after all third-party payment sources are exhausted.
Effective:
				09/06/2008
R.C. 119.032 review dates: 05/23/2008 and 09/01/2013
Promulgated Under: 119.03
Statutory Authority:
				3701.021
Rule Amplifies: 3701.021, 3701.022,
				3701.023
Prior Effective Dates: 11/16/1978, 12/1/01
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-20 - Providing assistance with health insurance premiums

Current through all regulations passed and filed through July 1, 2024
(A) As used in this
			 rule:
(1) "Eligible participant" means a
			 recipient who also meets the conditions for eligibility for insurance premium
			 payment assistance set forth in paragraph (B) of this rule.
(2) "Cost-effective" means that the total
			 cost to the program for uncovered services provided to an eligible participant
			 plus the cost for health insurance premiums paid by the program on behalf of
			 the eligible participant plus the associated administrative costs to the
			 program is less than the total anticipated annual costs to the program for
			 authorized services provided to an eligible participant.
(3) "Assistance" means:
(a) The payment of health insurance premiums
			 by the program to a third party or an employer for purposes of providing health
			 insurance coverage for an eligible participant; or
(b) Reimbursement to the eligible participant
			 or the eligible participant's parent, guardian or other legal representative
			 for premiums paid by the eligible participant or the eligible participant's
			 parent, guardian or other 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.
(4) "Uncovered services" means authorized
			 services provided to an eligible participant that are not covered benefits of
			 the eligible participant's health insurance plan.
(5) "Total anticipated annual costs" means
			 the estimated costs to the department for authorized services if the eligible
			 participant had no health insurance coverage.
(6) "Recipient" has the same meaning as set
			 forth in rule
			 3701-43-01 of the
			 Administrative Code.
(7) "Family
			 unit" has the same meaning as set forth in rule
			 3701-43-16
			 of the Administrative Code.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-21 - Providing assistance with medicaid spenddown payments

Current through all regulations passed and filed through July 1, 2024
(A) As used in this
			 rule:
(1) "Eligible participant" means a
			 recipient who also meets the conditions for eligibility for medicaid spenddown
			 payment assistance as set forth in paragraphs (B) to (F) of this rule.
(2) "Cost-effective" means the
			 total cost to the department for uncovered services provided to an eligible
			 participant plus the cost for medicaid spenddown payments paid by the program
			 on behalf of the eligible participant plus the associated administrative costs
			 to the program is less than the total anticipated annual costs to the program
			 for authorized services provided to an eligible participant.
(3) "Assistance" means the payment of
			 medicaid spenddown liability by the program to a county job and family services
			 agency for the purpose of providing continued medicaid coverage or obtaining
			 medicaid coverage.
(4) "Uncovered
			 services" means authorized services provided to an eligible participant that
			 are not covered benefits of the eligible participant's medicaid health plan.
(5) "Total anticipated annual
			 costs" means the estimated costs to the program for authorized services if the
			 eligible participant had no health insurance coverage.
(6) "Primary source of payment" mean the
			 payment source with primary responsibility for payment.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-22 - Waiver

Current through all regulations passed and filed through July 1, 2024
(A) Upon request
			 from an applicant, recipient, provider or legal representative of applicant,
			 recipient, or provider, the director may waive any of the requirements in this
			 chapter unless the requirement is specified in statute.
(B) The director may not grant a waiver
			 request if the approval of the request is contrary to public interest or there
			 are not sufficient funds to support a waiver request.
(C) The director's decision pursuant to a
			 waiver request is not appealable. The director is not required to provide an
			 opportunity for a hearing if the wavier request is denied.
Effective:
				09/01/2008
R.C. 119.032 review dates: 05/23/2008 and 09/01/2013
Promulgated Under: 119.03
Statutory Authority:
				3701.021
Rule Amplifies: 3701.023
Prior Effective Dates:
				12/1/2001
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-23 - Appeal procedures for decisions concerning the program for medically handicapped children

Current through all regulations passed and filed through July 1, 2024
(A) This rule prescribes the procedures for
			 appealing proposed decisions of the director concerning the program for
			 medically handicapped children that are subject to division (H) of section
			 3701.023 of the Revised Code.
			 These proposed decisions include:
(1) A
			 proposed determination under rules
			 3701-43-15
			 and
			 3701-43-11
			 of the Administrative Code that an applicant or recipient, as defined in
			 paragraphs (C) and (R) of rule
			 3701-43-01 of the
			 Administrative Code, does not meet the requirements for financial or medical
			 eligibility for payment for treatment or diagnostic services prescribed by
			 rules
			 3701-43-11,
			 3701-43-16,
			 and
			 3701-43-17
			 of the Administrative Code;
(2) A
			 proposed determination under rule
			 3701-43-15
			 of the Administrative Code that an adult cystic fibrosis applicant or
			 recipient, as defined in paragraphs (A), (C), and (R) of rule
			 3701-43-01 of the
			 Administrative Code, does not meet the financial eligibility requirements under
			 rule 
									3701-43-16 of the Administrative Code or the medical
			 eligibility requirements for payment for treatment services under rule
			 3701-43-17
			 of the Administrative Code;
(3) A
			 proposed determination under rule
			 3701-43-13
			 of the Administrative Code that an applicant for or recipient of service
			 coordination, as defined in paragraph (S) of rule
			 3701-43-01 of the
			 Administrative Code, does not meet the requirements for eligibility for service
			 coordination;
(4) A proposed denial
			 of a request for authorization of provision of treatment services or goods
			 under rule
			 3701-43-18
			 of the Administrative Code or provision of diagnostic services under rule
			 3701-43-12
			 of the Administrative Code;
(5) A
			 proposed termination of approval under rule
			 3701-43-10
			 of the Administrative Code of a provider, as defined in paragraph (P) of rule
			 3701-43-01 of the
			 Administrative Code; and
(6) A
			 proposed decision to pay an amount less than the charges for authorized goods
			 or services under rule
			 3701-43-09
			 of the Administrative Code.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-24 - Medically handicapped children's medical advisory council

Current through all regulations passed and filed through July 1, 2024
(A) The medically
			 handicapped children's medical advisory council, created by section
			 3701.025 of the Revised Code,
			 shall consist of twenty-one members appointed by the director for terms set by
			 paragraph (B) of this rule. The director shall appoint members based upon the
			 following criteria:
(1) All members shall be
			 licensed physicians, surgeons, dentists and other professionals in the field of
			 medicine;
(2) All members shall be
			 providers; and
(3) The members
			 shall be representative of the various disciplines, geographic areas of Ohio
			 and types of treatment facilities, such as hospitals, private and public health
			 clinics and private physicians' offices, involved in the treatment of children
			 with medically handicapping conditions.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-25 - County financial participation

Current through all regulations passed and filed through July 1, 2024
For the purposes of division (F) of section
				3701.023 of the Revised Code,
				the board of county commissioners of each county shall annually appropriate to
				the credit of the medically handicapped children's county assessment fund
				established pursuant to section
				3701.024 of the Revised Code an
				amount equal to one-tenth of one mill of the county's total general property
				tax duplicate.
R.C. 119.032 review dates:
				10/19/2011 and
				10/01/2016
Promulgated
				Under: 119.03
Statutory Authority: 3701.021
Rule
				Amplifies: 3701.021, 3701.024
Prior Effective Dates: 12/1/2001
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-43 - Program for Medically Handicapped Children › Section 3701-43-26 - Manufacturer discount program

Current through all regulations passed and filed through July 1, 2024
(A)
								 Effective
			 October 1, 2013, all prescription drugs and nutritional formulas for which BCMH
			 made payments on behalf of eligible clients shall be subject to inclusion in
			 the manufacturer discount program. The manufacturer discount program shall aply
			 to all prescription drugs and nutritional formulas for which BCMH made payments
			 on behalf of eligible clients in each state fiscal year.
(B)
								 At the end of
			 each state fiscal year and prior to the end of the first quarter of the
			 subsequent state fiscal year, BCMH shall send a letter to all applicable
			 prescription drug manufacturers requesting participation in the discount
			 program. Each letter shall contain, specific to each manufacturer:
(1)
									 Total net paid
			 by BCMH in the prior fiscal year for prescription drugs, grouped by national
			 drug code (NDC).
(2)
									 Total net paid by BCMH for all drugs produced by the
			 manufacturer.
(3)
									 A requested amount to be paid to BCMH based on the
			 payments made by BCMH for nutritional formulas produced by the
			 manufacturer.
(4)
									 A payment address to which funds may be sent, and the
			 relevant data needed in order for the Ohio department of health to process the
			 payment.
(5)
									 If a written agreement between the parties is
			 necessary, a copy of the approved agreement will be included in the
			 letter.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-44 - Ryan White Program › Section 3701-44-01 - Definitions

Current through all regulations passed and filed through July 1, 2024
As used in this chapter:
(A)
								 "AIDS" means
			 acquired immune deficiency syndrome.
(B)
								 "Department"
			 means the Ohio department of health.
(C)
								 "Director" means
			 the director of health or the director of health's designee.
(D)
								 "Family" means a
			 group of individuals who are related by blood, marriage, or adoption.
(E)
								 "HIV"
			 means human immunodeficiency virus.
(F)
								 "Ryan White part
			 B program" means the program established by the Ryan White HIV/AIDS Treatment
			 Modernization Act,
			 42
			 U.S.C. 300ff et seq. (as in effect on January
			 1, 2009), and administered by the director of health under division (D) of
			 section 3701.241 of the Revised
			 Code.
Replaces: 3701-44-01
Five Year Review (FYR) Dates:
				02/16/2017 and
				02/01/2022
Promulgated
				Under: 119.03
Statutory Authority: 3701.241
Rule
				Amplifies: 3701.241
Prior Effective Dates: 9/23/1991 (Emer.),
				12/22/91, 5/20/99, 7/20/01, 12/18/06, 8/2/09,
				11/4/11
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-44 - Ryan White Program › Section 3701-44-02 - HIV medical case management

Current through all regulations passed and filed through July 1, 2024
(A)
								 The department
			 may provide HIV medical case management services or delegate the authority to
			 provide medical case management services to another entity through the
			 department's grant process.
(B)
								 HIV medical case
			 management services shall be provided in accordance with the Ryan White part B
			 program, sections 3701.24 to
			 3701.249 of the Revised Code,
			 chapter 3701-44 of the Administrative Code and guidelines established by the
			 director.
Replaces: 3701-44-03
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-44 - Ryan White Program › Section 3701-44-03 - Eligibility for benefits under the Ryan White part B program

Current through all regulations passed and filed through July 1, 2024
(A) To be eligible
			 for benefits under the Ryan White part B program, an individual shall meet all
			 of the following requirements:
(1) The
			 individual must be an Ohio resident;
(2) The individual must have a verified HIV
			 infection ; and
(3)
									Applicants to the Ryan White
			 part B programs must meet the following financial guidelines to be
			 eligible:.
(a)
										The individual or individual's family gross income must be
			 equal to or less than five hundred per cent of the federal poverty level (FPL)
			 published in the federal register on or before the first of April of each
			 calendar year. When possible, these income calculations may be made using
			 modified adjusted gross income (MAGI);
(b)
										The calculations
			 shall exclude taxes and any mandatory retirement deduction.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-44 - Ryan White Program › Section 3701-44-04 - Waiver

Current through all regulations passed and filed through July 1, 2024
(A)
								Upon request from an applicant, client, or the
			 HIV-treating physician or nurse practitioner, or authorized representative of
			 an applicant or client, the director may waive any part of this chapter. A
			 request for a waiver shall be accompanied by documentation supporting the
			 request. The director may request additional documentation prior to making a
			 decision. Waiver requests are subject to paragraph (B) of this
			 rule.
(B)
								The director may not grant a waiver request if the
			 approval of the request is contrary to any of the following:
(1)
									The established
			 standard of care for the treatment of HIV;
(2)
									The public
			 interest;
(3)
									Federal or state law;
(4)
									The federal
			 requirements for the Ryan White part B funding; or
(5)
									There are
			 insufficient funds to support a waiver request.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-45 - Ohio Hearing Aid Assistance Program › Section 3701-45-01 - Ohio hearing aid assistance program definitions

Current through all regulations passed and filed through July 1, 2024
(A)
								 "Audiologist" means an individual authorized under
			 section 4753.07 of the Revised Code to
			 practice audiology.
(B)
								 "Audiology/Hearing Services" includes evaluations,
			 hearing aid selection, preparation, dispensing and orientation, fabricating ear
			 molds; and hearing aid adjustments made within the trial
			 period.
(C)
								 "BCMH" means the "children with medical handicaps
			 program" formerly known as the bureau for children with medical
			 handicap.
(D)
								 "Department" means the Ohio department of
			 health.
(E)
								 "Director" means the director of health or
			 designee.
(F)
								 "Eligible child" means a child from birth up to age
			 twenty-one with a permanent hearing loss who is a resident of
			 Ohio.
(G)
								 "Eligible family" means the family of the eligible
			 child who meets the income criteria for assistance through the Ohio hearing aid
			 assistance program.
(H)
								 "Federal poverty guidelines" means a minimum amount of
			 income that a family, based on the number of family members, needs for food,
			 clothing, shelter, and other necessities, as determined annually by the federal
			 government.
(I)
								 "Hearing Aid Dealer and Fitter" means an individual
			 authorized under section
			 4747.04 of the Revised Code to
			 practice dealing in or fitting of hearing aids.
(J)
								 "Income" means a
			 family's adjusted gross income based upon their most recent federal income tax
			 return.
(K)
								 "Program administrator" means an individual or
			 contractor responsible for managing the planning, implementation, and
			 evaluation of the Ohio hearing aid assistance program.
(L)
								 "Program" means
			 the Ohio hearing aid assistance program, an earmarked program funded by the
			 Ohio legislature, in Section 285.20 of Amended Substitute HB 59 of the 130th
			 General Assembly, to assist families with eligible children under twenty-one
			 years of age with purchasing hearing aids.
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-45 - Ohio Hearing Aid Assistance Program › Section 3701-45-02 - Ohio hearing aid assistance program

Current through all regulations passed and filed through July 1, 2024
(A)
								 In administering
			 funds appropriated for the program:
(1)
									 The director may, in his discretion, designate a
			 program administrator, by contract or other means, to accept applications for
			 participation in the program, verify eligibility for the program, and disburse
			 payments.
(2)
									 The director will supervise distribution of
			 funds.
(3)
									 The director shall establish eligibility criteria for
			 participation in the program.
(4)
									 The director
			 shall prescribe the manner and form for applications from eligible families and
			 audiologists for use in the program.
(5)
									 No later than
			 April first the director will issue guidelines for financial eligibility and
			 family co-payment amounts based upon income. The director will also determine
			 the maximum amount for audiology/hearing services that may be charged by an
			 audiologist or hearing aid dealer and fitter participating in the program. The
			 financial eligibility and co-payment amounts can be found at
http://www.odh.ohio.gov/odhprograms/cmh/hearaidasst/Hearing%20Aid%20Assistance%20Program
Ohio Administrative Code › Title 3701 - Department of Health - Administration and Director › Chapter 3701-45 - Ohio Hearing Aid Assistance Program › Section 3701-45-03 - Eligibility requirements for financial assistance through the Ohio hearing aid assistance program

Current through all regulations passed and filed through July 1, 2024
(A)
								 The director, or
			 program administrator, shall apply the requirements prescribed by this rule in
			 determining whether a family and child are eligible for assistance in
			 purchasing hearing aids through the program.
(B)
								 A family is
			 eligible to participate in the program if:
(1)
									 The family and
			 child are Ohio residents;
(2)
									 There is a child diagnosed with permanent hearing
			 loss;
(3)
									 The family's income is at or below four hundred per
			 cent of the federal poverty guidelines;
(4)
									 Without
			 assistance from the program, the family would be unable to obtain hearing aids
			 for the child with a permanent hearing loss; and
(5)
									 The family
			 agrees to pay to the audiologist or the hearing aid dealer and fitter the
			 co-payment amount, based on a sliding scale fee schedule, found at
http://www.odh.ohio.gov/odhprograms/cmh/hearaidasst/Hearing%20Aid%20Assistance%20Program
as set forth by the director, if required, due to family
			 income level.