Ohio Administrative Code
Title 5160:1 - Eligibility
Chapter 5160:1-2 - Medicaid Application Procedures
Section 5160:1-2-06 - Medicaid: outstationing workers at disproportionate share hospitals and federally qualified health centers
Universal Citation: OH Admin Code 5160:1-2-06
Current through all regulations passed and filed through September 16, 2024
(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, 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.
(C) Responsibilities of the administrative agency.
(1) Locations. The
administrative agency:
(a) Must establish and
staff outstation locations at each disproportionate share hospital and each
federally qualified health center
that
participates in the medicaid program and provides
services to children and
pregnant women who are eligible for medical
assistance.
(b) May establish
additional outstation locations at
other sites
where potentially eligible children or pregnant women receive services.
These additional locations may include sites independent from the main outstation
locations of 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 individuals
with the application process.
(b)
When the
administrative agency determines that an outstation site is infrequently used
and does not require a full-time outstationed worker,
the following must occur:
(i)
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)
Adequate notice must be
provided to 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, when the worker is authorized to determine
medical assistance eligibility at 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
October 1, 2023);
and
(b) The requirements of
42 C.F.R. section
447.10 (as in effect
October 1, 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)
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
and make a determination of
eligibility.
(b)
When the
outstationed worker is only performing initial processing duties, the
outstationed worker must forward the application to the administrative agency
in accordance with Chapters 5160:1-1 and 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.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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