5101:3-12-03 Medicare certified home health agencies (MCRHHA): qualifications and requirements.

(A) A medicare certified home health agency (MCRHHA) that meets the requirements in accordance with this rule is eligible to participate in the Ohio medicaid program upon execution of a provider agreement in accordance with rule 5101:3-1-17.2 of the Administrative Code.

(B) MCRHHAs are required:

(1) To be certified for medicare participation by the Ohio department of health (ODH) in accordance with Chapter 3701-60 of the Administrative Code.

(2) To meet the conditions of participation in accordance with 42 C.F.R. 484

(October 1, 2005).

(3) To implement policy components for home health and private duty nursing as specified in the "Medicare Benefit Policy Manual, Chapter Seven: Home Health Services" (August 12, 2005) for the following sections:

(a) "Determination of Coverage" section 20;

(b) "Content of the Plan of Care" section 30.2 to "Under the Care of a Physician" section 30.3 ; and

(c) "Covered Services Under a Qualifying Home Health Plan of Care" section 40 to "Medical Social Services" section 50.3.

(4) To comply with all applicable requirements for medicaid providers in Chapter 5101:3-1 of the Administrative Code.

(5) To comply with all federal, state and local laws and regulations.

(C) MCRHHAs are required:

(1) To have back up staff available to provide services when the agency's regularly scheduled staff cannot or do not meet their obligation to provide services.

(2) To submit written notification to the consumer at least thirty days prior to the last date of service when terminating a service unless:

(a) The consumer's treating physician has discontinued home health services;

(b) The treating physician has been notified that goals have been met;

(c) The consumer is no longer at the consumer's place of residence;

(d) The consumer or another person has harmed or threatened to harm the MCRHHAs staff;

(e) The consumer requested that services be terminated;

(f) The consumer has been enrolled in a medicaid managed care plan (MCP).

(3) To contact the consumer's medicaid MCP to request prior authorization for home health and PDN services.

(4) To maintain documentation on all aspects of services provided in accordance with this chapter. All documentation must be complete prior to billing for services provided in accordance with this chapter. This includes but is not limited to:

(a) Clinical records (including all signed orders) as specified in paragraph (B) of this rule.

(b) Time keeping records that indicate the date and time span of the services provided during a visit, and the type of service provided.

(c) To obtain the completed and signed JFS 07137 "Certificate of Medical Necessity Home Care Certification" (rev. 7/2006), which certifies the medical necessity for services in accordance with paragraph (C) of rule 5101:3-12-01 or paragraph (B) of rule 5101:3-12-02 of the Administrative Code.

Effective: 11/08/2007
R.C. 119.032 review dates: 07/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 4/7/77, 5/1/87, 3/30/90 (Emer), 6/29/90, 7/1/90, 3/12/92 (Emer), 6/1/92, 7/31/92 (Emer) 10/30/92, 7/1/93 (Emer), 9/1/93, 1/1/96, 7/1/98, 9/29/00, 9/1/05, 7/1/06