Ohio Admin. Code 5160:1-2-01 - Medicaid: administrative agency responsibilities
(A) This rule describes the responsibilities
of the administrative agency.
(B)
Calculation of time periods for eligibility determinations. All calculations of
time periods used in the determination of eligibility, including an annual
renewal or a redetermination as a result of a reported change, shall be
computed as follows:
(1) When counting the
number of days in a specified time period, the initial day is excluded from the
computation and the last day is included.
(2) When the last day of the time period
falls on a Saturday, Sunday, or legal holiday, the time period shall end on the
next business day.
(C)
Effective date of applications, reported information, or requests for
applications or assistance. Applications, documents, or information submitted
or provided to the administrative agency, or requests made to the
administrative agency, are considered received by the administrative agency:
(1) That day, when received by the
administrative agency or the electronic eligibility system during the
administrative agency's business hours.
(2) On the next business day, when received
by the administrative agency or the electronic eligibility system after the
administrative agency's business hours or on a non-business day when the
administrative agency is closed.
(D) Request for application. When an
individual requests an application, the administrative agency shall:
(1) Not deny an individual's right to apply
or discourage an individual from applying.
(2) Inform the individual of the following:
(a) An online application portal is available
to complete an application for medical assistance and application assistance is
available through the portal.
(b)
The beginning date of benefits depends on the date the signed application is
received by the administrative agency.
(c) The verification requirements and
deadlines.
(d) Individuals shall
cooperate with eligibility determinations, renewals, redeterminations, audits,
and quality control processes as defined in this chapter of the Administrative
Code.
(e) The meaning of and
penalties for medicaid eligibility fraud as set forth in section
2913.401 of the Revised
Code.
(f) The Ohio attorney general
(AGO) shall seek recovery or adjustment on behalf of the administrative agency
from the estate of the following individuals, as set forth in rule
5160:1-2-07
of the Administrative Code:
(i) A permanently
institutionalized individual of any age; or
(ii) An individual fifty-five years of age or
older who is not permanently institutionalized.
(3) Fulfill a request for an application
within one business day.
(a) Fulfillment
occurs when the administrative agency sends an electronic copy of the
application or a link to an electronic copy of the application to the text or
email address provided by the individual; hands the application to the
individual; or places the application in the U.S. mail. When the application is
provided in person or via U.S. mail, the administrative agency shall enclose a
preaddressed, postage-paid envelope for return of the application.
(b) The application shall be accompanied
by:
(E) Upon a request
for assistance or receipt of an application
receipt of a request for assistance or receipt of an
application , the administrative agency shall:
(1)
Make program
information available and accessible to an individual upon request, consistent
with
42 C.F.R.
435.905 (as in effect October 1, 2019):
(a)
Provide language
services at no cost to an individual with limited English proficiency,
including oral interpretation and written translations; and
(b)
Provide auxiliary
aids and services at no cost to an individual living with a disability in
accordance with the Americans with Disabilities Act of 1990 (ADA) (
Pub.
L. No. 101-336 ) and section 504 of the
Rehabilitation Act of 1973 ( Pub. L. No. 93-112 ).
(1) Provide an interpreter at no
charge to an individual with limited English proficiency and, when available,
provide applications and important forms or brochures in the individual's
language.
(2) Distribute voter information and
registration materials as required by
42 C.F.R.
431.307 (as in effect
on October 1, 2016
2019 ).
(3) Coordinate with the special supplemental
nutrition program for women, infants and children (WIC) as required by
42
C.F.R. 431.635 (as in effect October 1, 2019)
to ensure written notice of the availability of the WIC program is provided to
an individual determined eligible for medical assistance, including an
individual who is presumptively eligible and is also a potential WIC
recipient . Advise any potential WIC recipient
of the WIC program and refer the individual to the WIC agency by forwarding a
copy of the individual's medical assistance application and any supplemental
application, unless the individual is already receiving WIC
assistance.
(a)(c)
The following individuals are potential WIC recipients:
(a)
The administrative agency shall advise a potential WIC
recipient of the WIC program and refer the individual to the WIC agency by
forwarding a copy of the individual's medical assistance application and any
supplemental application, unless the individual is already receiving WIC
assistance.
(b)
For an individual already in receipt of medical
assistance who is a potential WIC recipient, the administrative agency shall
advise the individual of the WIC program at least annually.
(i) A woman who is:
(a) Pregnant; or
(b) Within a six-month period after
termination of pregnancy
giving birth ; or
(c) Breastfeeding her infant within twelve
months after the infant's birth; or
(ii) A child younger than five years old.
(b) For any individual in receipt of
medical assistance who is a potential WIC recipient, the administrative agency
shall advise the individual of the WIC program at least
annually.
(F) Assistance.
(1) The administrative agency shall allow a
person or persons of the individual's choice to accompany, assist
with , and represent the individual in the
appliction, redetermination, or annual renewal
process.
(a) A person may accompany and assist
an individual without being an individual's authorized
representative.
(b) The
administrative agency shall not reveal confidential information, as described
in rule 5160-1-33
5160-1-32 of the Administrative Code, or send notices
or correspondence to the person assisting the individual, unless the person has
been designated in writing as an authorized representative.
(c) A person who is assisting an individual
shall provide accurate information, to the best of his or her knowledge,
regardless of whether the person is an authorized representative.
(2) When an individual has
designated in writing an authorized representative, the administrative agency
shall:
(a) Issue all notices and
correspondence to both the authorized representative and the
individual.
(b) Contact the
individual to clarify or verify information provided by an authorized
representative when the information provided on the application seems
contradictory, unclear, or unrealistic.
(c) Remove the authorized representative from
any correspondence or access to safeguarded information upon receipt of notice
that:
(i) The authorized representative is
declining or ending representation of the individual,
; or
(ii) The individual has withdrawn the
authorized representative's authority.
(3) The administrative
agency shall help complete the application when assistance is needed, including
assistance through agents of the administrative agency, such as eligibility
workers.
(a) At the individual's request, an
eligibility worker shall assist with completing the application by asking the
individual for answers needed to complete the application, then recording the
individual's answers on the application form or in the electronic eligibility
system. The eligibility worker shall not alter any answers given by the
individual.
(b) When an eligibility
worker assists with or helps
to complete an application, the worker
shall sign the application form, and
include the worker's title, as a person who
assisted in
with completing the application.
(c) The normal process of inputting data into the
electronic eligibility system or determining an individual's eligibility shall
not be construed as providing assistance.
(4) Upon request, the administrative agency
shall provide assistance to individuals having difficulty gathering
verifications.
(5) When determining
eligibility for an individual with a physical or mental impairment that
substantially limits the individual's ability to access verifications, and who
has not granted any person durable power of attorney, or who does not have a
court-appointed guardian or a person with other legal authority and obligation
to act on behalf of the individual, the administrative agency shall:
(a)
Determine
Explore
if
whether
another person is available to assist the
individual with obtaining verifications or accessing the individual's
means of self-support. For an individual who resides in
a nursing facility (NF), explore whether the person who signed the NF admission
contract is able to assist the individual.
(i) When such a
person is available
a person is available to
assist the individual , request the person assist with obtaining the
verifications or accessing the individual's means of self-support.
(ii) When verifications are provided, or when
means of self-support are able to be accessed by
the individual or on the individual's behalf by another person, the
administrative agency shall consider the verified criteria or means of
self-support in the eligibility determination process.
(b) When no person with the ability to access the individual's means of
self-support is available to assist the individual:
(i) Refer the individual's case to the
administrative agency's legal counsel and request counsel evaluate whether the
matter should be referred to the probate court, adult protective services, or
another entity deemed by the administrative agency's legal counsel to be
appropriate. For cases referred to counsel for such evaluation, the
administrative agency shall also:
(a) Note in
the individual's case record that verifications or means of self-support are
not available and shall not be considered a disqualifying factor until a means
of access to those items is obtained or established,
; and
(b) Inform the administrative agency's legal
counsel of any eligibility approval or denial.
(ii) Determine eligibility in accordance with
Chapter 5160:1-2 of the Administrative Code, but without considering
eligibility factors for which verification cannot be obtained or means of
self-support that cannot be accessed
because of the individual's physical or mental
impairment. Use the most reliable information available without delaying the
determination of eligibility.
(iii)
Redetermine eligibility once a means of access to verifications or means of
self-support is obtained or established. When such access has not been obtained
prior to a regularly-scheduled
the individual's annual renewal, determine continuing
eligibility using the most reliable information available.
(G) Receipt of
application. Upon receipt of any
a signed application for medical assistance or for
specific medical assistance services or programs, the administrative agency
shall:
(a)(3)
When an application is received from a local WIC clinic,
child and family health services (CFHS)
maternal, child and family health (MCFH) clinic, or
bureau for children with medical handicaps
(BCMH)
the children with medical handicaps
program (CMH) office within five working
business days
of the signature date, the application shall be registered using the signature
date. If the application is not received within five working
business days
of the signature date, the application shall be registered using the date
it
the
application was received by the administrative agency.
(b)(4)
When an application taken by an outstationed worker assigned to a federally
qualified health center (FQHC) or a disproportionate share hospital (DSH) is
not directly entered into the electronic eligibility system,
it
the
application shall immediately be submitted to the appropriate
administrative agency, which shall register the application using the signature
date.
(3)(5) The administrative
agency shall not delay the registration or processing of an application due to
the lack of a signed acknowledgment of an individual's rights and
responsibilities.
(4)(6)
When not previously provided, give or send a notice
meeting the requirements of section 3503.10 of the Revised Code or JFS 07217,
voter registration form as required by section 329.051 of the Revised
Code
As required by section
329.051 of the Revised Code, the
administrative agency shall:
.
(1) Give or send a receipt to the
individual showing the date of application.
(2) Accept and register
an
the
application within a
one business day of the time the signed application is
received, whether it is an original, a facsimile, a
telephonic, or an electronic signature ("e-signature"). An original signature
is not required. Only an application signed
under penalty of perjury in accordance with
42
C.F.R. 435.907 (as in effect October 1, 2019)
is considered valid.
(a)
Acceptable signatures for an application include:
(i)
An original
handwritten signature; and
(ii)
An "electronic
signature" or "e-signature," that includes electronic sounds, symbols, or
processes attached to or logically associated with records and executed or
adopted by individuals with the intent to sign a record. An electronic
signature satisfies legal requirements in accordance with section
1306.06 of the Revised Code and
includes:
(a)
An
audio or "telephonically recorded" signature obtained in accordance with
procedures approved by the Ohio department of job and family services (ODJFS)
that is retrievable and complies with federal record retention requirements in
accordance with
7 C.F.R.
272.1(f) (as in effect
October 1, 2019); and
(b)
A signature submitted electronically as part of the
online medical assistance application process; and
(c)
A handwritten
signature transmitted via any other electronic transmission, such as through
email or facsimile; and
(d)
A rubber stamp that replaces a signature for an
individual who has an inability to sign in accordance with the Rehabilitation
Act of 1973 ( Pub. L. No. 93-112 ); and
(e)
When the
signatory cannot sign with a name, an "X" is a valid signature;
and
(f)
An electronically signed application received from the
federally facilitated marketplace (FFM); and
(g)
An electronically
signed application received from the social security administration (SSA) for
the low-income subsidy (LIS) program.
(b)
An individual who
applies for health coverage through the FFM will be assessed for medicaid
eligibility with the signature provided to the FFM.
(a)
Give or send a
notice meeting the requirements of section
3503.10 of the Revised Code or
the JFS 07217 "Voter Registration Notice of Rights and Declination" (rev.
8/2009); and
(b)
Give or send the "Voter Registration Information and
Update Form" (undated) as prescribed by the secretary of state.
(H) Verifications.
Where manual verifications are required under rule
5160:1-2-10
of the Administrative Code, the administrative agency shall:
(1) Follow the safeguarding guidelines set
forth in rule
5160-1-32
of the Administrative Code when providing or gathering information by
telephone, in person, or in electronic or written form.
(2) Not require that an individual provide
verification of unchanged information unless the information is incomplete,
inaccurate, inconsistent, outdated, or missing from the case record due to
record retention limitations.
(3)
Not request that an individual provide duplicate copies of previously submitted
verifications.
(4) To the extent
possible, verify relevant eligibility criteria using electronic records
available through the electronic eligibility system. Where electronic
verification is not available, or electronic verification data conflicts with
the individual's attestation, request verifications as set out in rule
5160:1-2-10
of the Administrative Code.
(5)
When the administrative agency is unable to verify an eligibility criteria through electronic sources,
the administrative agency will
shall contact the applicant to collect information needed to
process the application. If the individual declares the verifications cannot be
accessed or submitted, the individual's statement shall be accepted. If the
administrative agency is unable to make contact with the
applicant,
provide a written
(electronic or on paper) request for the necessary information or verification
documents shall be sent .
(a) The written request shall:
(i) Include the date by which the information
shall
must be
provided to the administrative agency; and
(ii)
Inform the individual that any delay in providing requested information or
documents will delay the determination of an individual's eligibility;
and
(iii) Provide information
on
regarding
how an individual can request assistance from the
administrative agency
in
with gathering the requested documents.
(a)
The administrative agency shall assist the
individual in obtaining the verifications required for eligibility
determination.
(b)
When the normal sources of verification described in
this rule have been exhausted and no documentation can be obtained, the
administrative agency may accept the individual's statement when it is complete
and consistent with other facts and statements. The use of such a statement
shall be on a case by case basis when no other approach is possible, and shall
be used only in rare circumstances.
(b) When the information or verification
required to establish the individual's eligibility for assistance is not
received by the administrative agency by the stated date, the administrative
agency shall contact the individual in writing no more than twenty calendar
days from
following the date of the application.
(i) The follow-up letter
request for
information or verification documents :
(a) Shall be sent electronically, via postal
mail, or personally delivered to the individual.
When sent via postal mail or personally delivered, the administrative agency
shall enclose a preaddressed, postage paid envelope for return of the
verification(s); and
(b) Shall state that the required information
or verification has not been received, and
that if the information or verification is not received within ten calendar
days the administrative agency shall deny the application for medical
assistance; and
(c) Shall include a
clear statement that the administrative agency will assist with obtaining the
required information or verification if the request for assistance is received
on or prior to the given deadline; and
(d) Does not serve as a notice of denial of
the application.
(ii) When the requested information or
verification is not received by the stated deadline, the administrative agency
shall propose a denial or termination of
benefits.
(c) The
administrative agency shall deny the individual's application when the
individual fails to provide the necessary information or verifications, or
request assistance and cooperate with obtaining verifications, within the time
specified in the second verification request. When this happens:
(i) An individual may reapply at any
time.
(ii) An individual
should
shall
not be asked to re-verify information previously verified by the administrative
agency without reason to believe the information may have changed.
(6) Give or send a
dated itemized receipt for any
that lists each verification document received from an
individual.
(7) Record receipt of
all verification documents, photocopy or scan the documents, and retain copies
or images of the documents in the case record.
(8) When information is verified through a
telephone contact, record the following details:
(a) The name and telephone number of the
person giving
providing the information; and
(b)
The name of the agency or business contacted, when applicable;
and
(c) The date of the contact; and
(d) An accurate summary of the information
provided.
(I)
Determination, redetermination, and renewal of
eligibility. The administrative agency shall:
(3)(4)
Using the electronic eligibility system, the administrative agency shall:
(1) Not schedule an interview except at the
request of the applicant.
(2)
Inform all individuals at the time of application and renewal that the agency
will obtain and use information available from the income and eligibility
verification system (IEVS) to assist with the determination of eligibility, as
required by section 1137 of the Social Security Act (as in effect
on October 1, 2016
2019 ).
(3)
Require a
signature for all renewals of medical assistance where eligibility was not
passively renewed using the electronic eligibility system.
(a) Determine eligibility or renewal of an
individual's eligibility for medical assistance within the application
processing time limits set forth in this rule.
(i) The administrative agency shall not
approve medical assistance to an individual merely because of an agency error
or delay in determining eligibility. All eligibility factors shall be
met.
(ii) The administrative agency
shall not delay the approval of medical assistance due to the lack of
information or verifications necessary to determine eligibility for other
public assistance programs.
(b) Document and record determinations of
eligibility. The administrative agency shall:
(i) Record, in physical or electronic case
records, any information, action, decision, or delay in the application,
eligibility determination, or termination
discontinuance processes, as well as the reasons for
any action, decision, or delay.
(ii) Make the case records, physical or
electronic, available for compliance audits.
(c) Approve medical assistance for an
individual who:
(i) Has signed an application
under penalty of perjury; and
(ii)
Has provided all necessary verifications as set forth in rule
5160:1-2-10
of the Administrative Code; and
(iii) Meets all conditions of eligibility for
an eligibility category set forth in an approved
state plan amendment,
a medical assistance
category set forth in Chapter 5160:1-2, 5160:1-3, 5160:1-4, 5160:1-5, or
5160:1-6 of the Administrative Code. When an individual who attests to U.S.
citizenship or qualified alien
non-citizen status meets all conditions of eligibility
for an eligibility
a
medical assistance category except for verification of the individual's
citizenship or qualified alien
non-citizen status, the administrative agency shall
approve time-limited coverage during a reasonable opportunity period (ROP) as
required in rule
5160:1-2-11
or
5160:1-2-12
of the Administrative Code.
(d) Deny an application for medical
assistance for an individual who:
(i) Has not
signed an application under penalty of perjury; or
(ii) Withdraws the application; or
(iii) Fails to cooperate
in
with the
application or determination process or fails to provide all necessary
verifications set forth in rule
5160:1-2-10
of the Administrative Code; or
(iv)
Does not meet all conditions of eligibility for any eligibility
medical
assistance category set forth in Chapter 5160:1-2, 5160:1-3, 5160:1-4,
5160:1-5, or 5160:1-6 of the Administrative Code.
(e) Suspend medical assistance upon
notification that an individual meets any of the criteria for ineligibility for
payment of services set forth in rule
5160:1-1-03
of the Administrative Code.
(f)
Terminate
Discontinue medical assistance for an individual who:
(i) Requests that assistance be
terminated
discontinued ; or
(ii) Is no longer an Ohio resident, or is
deceased; or
.
(iii) Fails to cooperate in the
renewal process; or
(iv) Fails to cooperate in the
quality control process; or
(v) Fails to provide all necessary
verifications; or
(vi) Is eligible as a result of an
administrative agency error, or
(vii) Provided fraudulent
information or verifications, or
(viii) Fails or refuses to comply
with individual responsibilities as described in this chapter of the
Administrative Code, or is subject to an Ohio works first (OWF) sanction and
has not agreed to comply with the work requirements; or
(ix) No longer meets the conditions
of eligibility for an eligibility category as set forth in Chapter 5160:1-2 of
the Administrative Code. Before terminating coverage on this basis, the
administrative agency shall conduct a pre-termination review (PTR) to determine
that the individual is no longer eligible for coverage under any eligibility
category.
(J) Reinstatement of medical assistance
for individuals whose termination of medical assistance
was effective prior to March 18, 2020 .
(1) When an individual cooperates with the
renewal process, the administrative agency shall:
(a) Reinstate medical assistance,
terminated
discontinued for failure to cooperate
in
with the
renewal process or verification of a reported change, within ninety calendar
days of the termination
discontinuance date without requiring a new
application in accordance with
42 C.F.R.
435.916(a)(3)(C)(iii) (as in
effect on October 1,
2016
2019 ).
(b)
Accept the renewal form and/or verifications that caused the
termination
discontinuance of medical assistance.
(c) Reinstate medical assistance if all
eligibility criteria are met.
(d)
Reinstated medical assistance coverage shall begin on the first day of the
calendar month following the month medical assistance was
terminated
discontinued .
(2) Individuals discontinued due to returned
mail indicating whereabouts unknown.
(a) When
the individual's whereabouts become known within the eligibility period, the
administrative agency shall reinstate any discontinued
services
medical
assistance in accordance with
42 C.F.R.
431.231(d) (as in effect
on October 1, 2016
2019 ).
(b) When the individual's whereabouts become
known after the effective discontinuance date, a new application for medical
assistance will be needed
is required .
(3)
When a hearing
request is filed timely by an individual as outlined in division 5101:6 of the
Administrative Code, the administrative agency shall reinstate medical
assistance benefits at the same benefit level until a hearing decision is
rendered in accordance with
42 C.F.R.
431.230 (as in effect October 1,
2019).
(K)
Reinstatement of medical assistance for individuals
whose termination of medical assistance was effective on or after March 18,
2020. In accordance with section 6008 of the Families First Coronavirus
Response Act (FFCRA) ( Pub. L. No. 116-127 ), the administrative agency shall
reinstate medical assistance for any individual whose discontinuance of
coverage was effective on or after March 18, 2020, except when the
discontinuance was due to death, state residence, or the individual's voluntary
request.
(1) Ten
calendar days of receiving a report of a change that could affect an
individual's on-going
ongoing eligibility for medical assistance; or
(2) Forty-five calendar days from
the date of application or scheduled renewal, unless:
(a) An individual who otherwise meets the
conditions of eligibility described in this chapter of the Administrative Code
alleges blindness or disability. The administrative agency shall determine
eligibility within ninety calendar days from the date of application unless the
examining physician delays or fails to take a required action; or
(b) There is an administrative or other
emergency beyond the administrative agency's control.
(3) Forty-five calendar days of
receipt of new or changed information from IEVS. The administrative agency
shall not terminate, deny, or suspend benefits until appropriate steps have
been taken to verify the relevant information in accordance with 42 C.F.R.
435.952(d) (as in effect on October 1, 2016).
(1) Medical assistance coverage
begins on the first day of the calendar month in which the application which
resulted in eligibility was submitted to the administrative agency, except
that:
(a) An individual's coverage cannot
begin before the date on which the individual:
(i) Became a resident of Ohio,
; or
(ii) Was born.
(b) The administrative agency shall approve
retroactive eligibility for medical assistance effective no later than the
first day of the third month before the month of application if the individual:
(ii)(iii) Would have been
eligible for medical assistance at the time the services were provided if an
application had been made at that time, regardless of whether the individual
was alive when the application actually was made. Actual income received in each retroactive month shall be
used to determine eligibility for that month.
(iii)(iv) Is eligible for
a category of medical assistance other than:
(i)
Received
Reports he or she
received medical services of a type covered by medicaid
medical
assistance
at any time during that period;
and
within the three months prior to the
application month; and
(ii)
Requests retroactive eligibility be determined;
and
(a) Transitional medicaid
medical
assistance as described in rule
5160:1-4-05
of the Administrative Code; or
(b)
Medicare premium assistance as described in rule 5160:1-3-02.1 of the
Administrative Code; or
(c) Any
presumptive eligibility category described in rule
5160:1-2-13
of the Administrative Code.
(2) Medical assistance coverage
terminates
discontinues on the last day of a calendar month,
except that coverage terminates
discontinues on the date an individual:
(a) Becomes a resident of another state;
or
(b) Dies; or
(c) Requests that coverage be
terminated
discontinued .
(1)
Terminate
Discontinue
coverage under a time-limited eligibility
medical
assistance category as described in the Administrative Code rule for the
appropriate eligibility
medical assistance category. These time-limited
eligibility categories include:
(a) Any
presumptive eligibility category, as described in rule
5160:1-2-13
of the Administrative Code, and
(b)
Alien emergency medical assistance (AEMA), as described in rule
5160:1-5-06
of the Administrative Code, and
(2)
Determine
Schedule an
individual's eligibility for a renewal
of
renewal of eligibility for medical
assistance on the earlier of the
following:
twelve months after the most recent
eligibility determination.
(a) Twelve months after the most
recent eligibility determination, or
(1) When
determining an individual's eligibility for medical assistance coverage, the
agency shall use the form (or an electronic equivalent) designated by the
administrative agency to report:
(a) Possible
health insurance coverage of an individual. A separate report shall be made for
each possible health insurance policy.
(b) Potential TPL due to an injury,
disability, or court order.
(2) At renewal, or upon any reported change,
the administrative agency shall compare the individual's current information to
the information on the most recent ODM 06612 "Health Insurance Information
Sheet" (rev. 9/2016) or ODM 06613 "Accident/Injury Insurance Information" (rev. 12/2016). When any information has changed,
the administrative agency shall report the changes to ODM by submitting a new
ODM 06612 or ODM 06613, or an electronic equivalent.
(3) Upon a request by ODM, the administrative
agency shall contact the individual to obtain information
about
regarding potential TPL. When the individual fails to cooperate, the agency shall
propose to terminate or deny the individual's medical assistance for failure to
cooperate, as set forth in paragraph (I)(3) of this rule.
(1) Give or mail
to the individual a notice meeting the voter registration requirements of
section 3503.10 of the Revised
Code, and advise the individual that, upon
request, the administrative agency will help the individual register to vote or
update voter registration as outlined in rule
5101:1-2-15
of the Administrative Code.
(2)
Process an intercounty transfer (ICT) when the individual has changed residence
from one county to another. Both the county of original residence and the
county of new residence have responsibilities in the ICT process. The ICT
process shall be followed whether the individual reporting a change of
residence is an applicant or is currently in receipt of medical assistance
benefits.
(a) The county department of job and
family services (CDJFS) receiving report of a move shall determine whether the
move is a change of residence or a temporary absence from the home. When the
move is a temporary absence from the home, the county in which the individual
is physically located shall provide necessary medical and transportation
services.
(b) The CDJFS receiving
report of a change of residence shall:
(i)
Update the address in the electronic eligibility system. When the individual
does not have an address in the new county, use the address of the
administrative agency in the new county.
(ii) When the report is made to the
administrative agency in the county of new residence, inform the county of
original residence.
(c)
Record requirements for intercounty transfers within
the state.
(i)
The CDJFS in the individual's original county of residence
shall take the following actions for the identified type of case record:
(a)
Electronic
records. When the individual moves to another county within the state, the
electronic document management system shall be updated with the most recent
eligibility determination documentation no later than the end of the business
day following the date the CDJFS becomes aware of the address
change.
(b)
Online records. Prior to the online record being
transferred, the CDJFS in the individual's original county of residence shall
ensure the electronic eligibility system is updated no later than the end of
the business day following the date the CDJFS becomes aware of the address
change.
(c)
Hard copy records. Hard copy records used in the most
recent eligibility determination shall be converted into digital format in the
electronic document management system no later than the end of the business day
following the date the CDJFS becomes aware of the address change. The remaining
hard copy records shall be transferred no later than five calendar days
following the date the CDJFS becomes aware of the address change. The CDJFS in
the individual's original county of residence shall notify the CDJFS in the
individual's county of new residence when a hard copy record is being
transferred.
(ii)
The case record to be transferred shall contain the
following documents:
(a)
The most recently signed application for medical
assistance; and
(b)
Other pertinent documents, such as citizenship,
qualified noncitizen status, income, and resource verifications.
(c) The CDJFS in the county of
original residence shall transfer the case in its current status in the
electronic eligibility system within five working days of the reported change.
If any case records or physical or electronic documents are maintained by the
CDJFS outside of the electronic eligibility system, the CDJFS
shall:
(i) Transfer the case records, or a
physical or electronic copy of the records, to the county of new residence
within fifteen working days of the reported change. The case record to be
transferred shall contain the original (or, if the administrative agency uses
an imaging system, a scanned image) of the following documents:
(a)
The most recently signed application for medical
assistance benefits; and
(b)
Other pertinent documents, such as citizenship,
income or resource verifications.
(ii) Complete a notice of
intercounty transfer, attach a copy of the notice to the records being
transferred to the county of new residence, and keep a copy of the notice in
the retained case record.
(iii) Maintain a copy of transferred
documents for future reference, while providing original documents, to the
extent available, to the county of new residence.
(d) The CDJFS in the individual's county of new residence shall:
(ii)(iii) Provide the
medical assistance benefits for which the individual is eligible.
(i) Not require the individual to reapply or
cooperate with a renewal of eligibility for medical assistance merely due to
the change in county of residence.
(ii)
Verify potential
changes in income, expenses, employment, or household composition resulting
from the change in residence when the CDJFS that received the reported change
did not complete the verification prior to the intercounty
transfer.
(iii) Perform the periodic renewal
or renewal upon a change in circumstances as outlined in this
rule.
(e) When the case being transferred is
subject to a claim for overpayment as set out in rule
5160:1-2-04
of the Administrative Code:
(i) An existing
claim shall not be transferred. The records transferred to the CDJFS in the
county of new residence shall include copies of the documentation of the claim.
The CDJFS establishing
that established the claim remains responsible for any
necessary action on the claim.
(ii)
When no claim has been established and the CDJFS in each county agrees
that the CDJFS in
the county of new residence shall establish the claim, then a potential
claim may be transferred to the CDJFS in the county of new residence to be
established by the CDJFS in that county.
(1) Shall issue proper notice and
hearing rights as outlined in division 5101:6 of the Administrative
Code.
(R)
The administrative agency shall provide timely and
adequate written notice of any decision affecting an individual's eligibility,
including an approval, denial, discontinuance, or suspension of eligibility, or
a denial or change in benefits, consistent with
42
C.F.R. 435.917 (as in effect October 1, 2019)
and division 5101:6 of the Administrative Code.
Notes
Promulgated Under: 111.15
Statutory Authority: 5162.03, 5163.02
Rule Amplifies: 3501.01, 3503.10, 5162.03, 5163.02, 329.051, 2913.401
Prior Effective Dates: 10/01/2013, 01/01/2016, 01/01/2017, 01/01/2018, 07/08/2020 (Emer.)
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