This SHMTL contains 6 rules from Chapters 5101:6-2 of the Administrative Code. These rules were amended as part of a five-year rule review.

The effective date of these rules is February 28, 2014.

SHM 1000:

5101:6-2-30 "State hearings: notice of medical determination." This amended rule describes the process in which a notice of a medical determination will be sent to an individual or their authorized representative. The rule explains the situations in which a notice is sent and contains the information included in that notice. The changes to this rule include updates in agency names, and minor changes in wording and punctuation which do not affect the substance of the rule.

5101:6-2-31 "State hearings: notice of denial of prior authorization for medical or dental services." This amended rule governs the process for sending notification of denial to an individual who has requested prior authorization of medical or dental services. The rule explains who receives the notification and what information the notification contains. The changes to this rule include reorganization of the rule for clarity and minor changes in wording and punctuation which do not affect the substance of the rule.

5101:6-2-32 "State hearings: notice of adverse preadmission screening and resident review (PASSR) determinations." This amended rule governs the process for sending notices for adverse preadmission screenings and resident review determinations. It describes what is contained in each notice, who receives the notice, and how the notice is delivered. The changes to this rule include updates in agency names, updates in acronyms, and minor changes in wording and punctuation which do not affect the substance of the rule.

5101:6-2-35 "State hearings: notice of a managed care plan's denial, reduction, suspension, or termination of medical services." This amended rule governs the process for notices sent for denial, reduction, suspension, or termination of a managed care plan's medical service. This rule explains the timing of when the notice is sent and explains the specific forms and situations applicable to each action described in the notice. The changes to this rule include a corrected revision date indicator and minor changes in wording and punctuation which do not affect the substance of the rule.

5101:6-2-36 "State hearings: notice of denial of just cause request for termination of managed care plan's membership." This amended rule governs the process for the sending notices of denial of a just cause request for termination of a managed care plan's membership. The rule explains why this notice is sent and what information is contained in the notice. The changes to this rule include updates in agency names, updates in acronyms, and minor changes in wording and punctuation which do not affect the substance of the rule.

5101:6-2-50 "State hearings: notice of determinations concerning spouses separated by institutionalization." This amended rule governs the process for sending a notice of determinations concerning spouses separated by institutionalization. The rule explains what notices must be sent in these situations, to whom the notices must be sent, and what information the notices shall contain. The changes to this rule include changing CRIS-E to eligibility system, corrected revision dates, and minor changes in wording and punctuation which do not affect the substance of the rule.

SHM Instructions:

This information is also available on the Internet and may be accessed at:

ODJFS Electronic Manuals: http://emanuals.jfs.ohio.gov/

InnerWeb Calendar:http://www.odjfs.state.oh.us/lpc/calendar/staff/

Internet Calendar:http://www.odjfs.state.oh/lpc/calendar/