Current through all regulations passed and filed through September 16, 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.
(B) The director may
deny an individual's application, or terminate an individual's program
enrollment, or deny an individual's access to specific services, if the
director determines:
(1) There are
insufficient funds;
(2) With
consideration given to the continuity of care, the individual does not meet the
eligibility guidelines set forth in paragraph (A) of this rule;
(3) The individual submitted false or
misleading information;
(4) The
individual abused or misused an approved benefit; or
(5) The individual failed to apply for or use
or disclose other available resources to which the individual has access to pay
for services otherwise paid for by Ryan White
part B .
(C) Pursuant to
42 U.S.C.
300ff-21 (2009) and
42 U.S.C.
300ff-22 (2009), the Ryan White part B
program funds are federal grants. If, at any time, there is insufficient
funding
to sustain the current Ryan White part B programs, the director, pursuant to
division (D) of section
3701.241 of the Revised Code, as
necessary for the effective administration of available funds to the Ryan White
part B programs, may, upon thirty-day notice to affected clients, restrict,
reduce, or eliminate existing programs. If the director
restricts or reduces existing programs by changing the maximum income threshold
set forth in paragraph (A)(3)(a) of this rule, the director shall not set the
maximum income threshold below three hundred per cent of the federal poverty
level.
(D) An individual may
seek reconsideration of a decision that is based on other than the
insufficiency of program funds pertaining to the Ryan White part B programs
.
(1) An individual seeking reconsideration of
a decision listed in paragraphs (B)(2) to (B)(5)
of this rule shall file a written request for reconsideration with the
department. The request for reconsideration must be received within thirty days
from the date the individual received a decision . The request for reconsideration
must contain a statement of the reasons that the individual believes that the
decision is incorrect or inconsistent with the Ryan White part B program
guidelines, and may include any written documentation, arguments, or other
materials that the affected party wishes to submit for the purposes of the
reconsideration.
(2) Upon receiving
a timely request for reconsideration, the director shall:
(a) Review the information submitted within
thirty days of receipt of the request. The director may request additional
information which extends the review time. Except for good cause, additional
information shall be submitted to the director within forty-five days of
receiving a request for additional information.
(b) Render a written decision to the
requestor of the reconsideration within thirty days of the receipt of the
request for reconsideration or receipt of additional information, whichever is
later. The written decision shall include the reasons for the decision. The
decision of the director is final and there is no further review.
(E)
The Ryan White part B program is the payer of last
resort.
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