Ohio Admin. Code 5160:1-2-06 - Medicaid: outstationing workers at disproportionate share hospitals and federally qualified health centers
(A) This rule describes the administrative
agency's role in facilitating outreach services for low-income children and
pregnant women through the process of outstationing workers at disproportionate
share hospitals,
and federally qualified health centers, and other designated locations where potentially eligible
children and pregnant women receive services .
(B)
Definitions.
(1)
"Administrative agency," for the purpose of this rule,
means the Ohio department of medicaid (ODM) and/or an agent of ODM authorized
to determine eligibility for a medical assistance program.
(2)
"Individual," for
the purpose of this rule, means a person who is applying for medical assistance
benefits at a disproportionate share hospital, federally qualified health
center, or another designated outstation location.
(3)
"Outstationing"
refers to the federal requirement that administrative agencies must provide
opportunities for low-income children and pregnant women to apply for medical
assistance at locations other than the local county department of job and
family services (CDJFS) office.
(1) Locations. The
administrative agency:
(a) Must establish and
staff outstation locations at each disproportionate share hospital and each
federally-qualified
federally qualified health center
participating
that
participates in the medicaid program and providing
provides
services to medicaid-eligible children and
pregnant women who are eligible for medical
assistance .
(b) May establish
additional outstation locations at any
other site
sites
where potentially eligible children or pregnant women receive services.
These additional sites
locations may include additional sites other
than
independent from the main outstation
location
locations of federally-qualified
federally qualified health centers or disproportionate
share hospitals.
(2)
Hours.
(a) Workers must be available at each
outstation location during the administrative agency's regular office operating
hours to accept applications and to assist applicants
individuals
with the application process.
(b)
If
When the
administrative agency determines that an outstation site is infrequently used
and does not require a full-time outstationed worker,
a notice must be displayed
the following must occur :
(i)
Containing
A notice must be
displayed containing the following information:
(a) The hours when an outstationed worker
will be available; and
(b) The
telephone number of the administrative agency that individuals may call for
assistance.
(ii)
Providing adequate
Adequate notice must be
provided to persons who are blind or
deaf
individuals with visual or hearing
impairments or who are unable to read or understand the English
language.
(3)
Workers and assistance.
(a) The
administrative agency may use county employees,
provider or contractor employees, or volunteers who have been properly trained
to staff outstation locations under the following conditions:
(i) County outstation intake workers may
perform all eligibility processing functions, including the eligibility
determination, if the worker is authorized to do
so
when the worker is authorized to determine
medical assistance eligibility at the
a regular intake
office.
(ii) Provider or contractor
employees and volunteers may perform only initial processing functions.
Provider and contractor employees and volunteers are subject to:
(a) The confidentiality of information rules
specified in 42 C.F.R. Part 2 (as in effect October 1,
2023) and 42 C.F.R. part 431, subpart F (as in effect
on December
October 1, 2015
2023 );
and
(b) The requirements of
42 C.F.R. section
447.10 (as in effect
on December
October 1, 2015
2023 ), which
prohibit medicaid payments to anyone other than a provider or recipient except
under specific circumstances; and
(c) All other Ohio or federal laws concerning
conflicts of interest.
(b) The outstationed worker must:
(i)
Complete the
initial processing of the application for medical assistance.
Provide for the receipt and initial processing of
medical assistance applications at each outstation location.
(a) When authorized by the administrative
agency, the outstationed worker may evaluate an
application for medical assistance
also
determine medicaid
and make a determination of
eligibility.
(b)
If
When the
outstationed worker is only performing initial processing duties, the
outstationed worker must forward the application to the administrative agency
in accordance with Chapter
Chapters 5160:1-1 and Chapter 5160:1-2 of the Administrative
Code.
(ii) Accept and
refer applications for other public assistance programs to the administrative
agency or appropriate program office for
processing. Assist individuals with connecting to
appropriate agencies, organizations, providers and other community supports as
requested.
Notes
Promulgated Under: 111.15
Statutory Authority: 5162.031, 5163.02
Rule Amplifies: 5163.02, 5163.10, 5163.101
Prior Effective Dates: 05/01/1995, 07/01/2000, 01/01/2006, 01/01/2014, 08/01/2016
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