Ohio Admin. Code 5101:6-2-30 - State hearings: notice of medical determination
(A)
The JFS 04022 "Notice of Medical Determination
and a Right to a State Hearing" (rev. 3/2002),"
or its computer-generated equivalent shall be mailed or personally delivered to
the individual and authorized representative in the following situations:
(1) When, as the result of a preadmission
review for long-term care, the local agency receives an authorization of a
level of care that assigns a noninstitutional level of care, or a level of care
that is different from the specific level of care certified by the individual's
physician, the local agency shall send notice to the individual and authorized
representative, with a copy of the notice filed in the individual's case
record.
Notice is not required when the assigned level of care is different from the level of care certified by the individual's physician, but the individual is or will be placed in a facility with dual certification to provide the assigned level of care.
(2) When a request for prior authorization
for additional hospital stays, visits, or therapeutic leave days beyond thirty
days for a medicaid individual with a developmental disability level of care is
denied, the local agency shall send the notice to the individual and authorized
representative, with a copy of the notice filed in the individual's case
record.
(3) When a review agency
denies or modifies a request for precertification of a hospital admission or
medical procedure, the review agency shall send the notice to the individual
and authorized representative, with a copy of the notice sent to the local
agency.
(B) The notice
shall contain:
a clear
and understandable statement of the decision and the reasons for it, cite the
applicable regulations, explain the individual's right to and the method of
obtaining a state hearing, and contain a telephone number to call about free
legal services.
(1)
A clear and understandable statement of the decision
and the reasons for it.
(2)
Citations of the applicable
regulations.
(3)
An explanation of the individual's right to and the
method of obtaining a state hearing.
(4)
A telephone
number to call about free legal services.
Notes
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35, 5160.011
Prior Effective Dates: 09/01/1976, 04/01/1980, 10/01/1981, 05/01/1982, 07/01/1982, 04/01/1983, 09/24/1983, 11/01/1983 (Temp.), 12/01/1983, 01/01/1984, 03/01/1984 (Temp.), 06/01/1984, 10/03/1984 (Emer.), 12/22/1984, 04/01/1986, 04/01/1987, 09/01/1987, 07/01/1988 (Emer.), 09/25/1988, 10/01/1989, 02/01/1990, 04/01/1991, 06/01/1993, 11/01/1994, 06/01/2003, 09/01/2008, 02/28/2014
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