(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.
