5101:3-30-03 Billable services.

(A) All covered services are to be billed on a unit rate basis in accordance with definitions, standards, and eligible provider of service criteria as set forth in rules 5101:3-30-01 , 5101:3-30-02, and 5101:3-30-04 of the Administrative Code.

(B) For purposes of alcohol and other drug treatment services, unless otherwise described in this chapter, a "billable unit of service" is defined as an hour-measured face-to-face contact between a client and a professional qualified to provide services delineated in rule 5101:3-30-02 of the Administrative Code as covered under the medicaid program. For an alcohol and other drug treatment service to be defined as a unit, it must meet the definition set forth in this paragraph and must be recorded in the individual client record (ICR) in accordance with rule 3793:2-1-06 of the Administrative Code.

(1) Billable units of services are limited to those which take place at the site certified as a treatment program by the Ohio department of alcohol and drug addiction services or at any other appropriate location according to the standard referenced in rule 5101:3-30-02 of the Administrative Code as relative to the covered service.

(2) Units of service with individuals other than the client (e.g., conferences and consultations with a family member) are not billable. However, individual counseling and diagnostic assessment may include face-to-face interaction with family members and/or parents, guardians and/or significant others when such intervention is part of the individualized treatment plan.

(3) Case management services can be billable units of service delivered face-to-face or by telephone and may include contact with a client or with individuals other than the client; such services must be recorded in the client's ICR.

(4) Covered services delineated in rule 5101:3-30-02 of the Administrative Code, with the exception of ambulatory detoxification, intensive outpatient services, laboratory urinalysis and opioid agonist administration are considered hour-measured billable services. Ambulatory detoxification and intensive outpatient services are considered day-measured billable services and, the laboratory urinalysis service is considered a per screening (independent of the number of panels) billable unit and opioid agonist administration is considered a per dose billable unit of service.

(C) Eligible providers may augment staff delivered services through contractual arrangements. Such arrangements are recognized to the extent that the conditions set forth in paragraphs (C)(1) and (C)(2) of this rule are met. In order for contractual arrangements to be recognized, eligible providers must provide upon request the following information to the Ohio department of alcohol and drug addiction and/or the Ohio department of job and family services :

(1) Identification by name and, where applicable, Ohio medicaid provider number of each individual practitioner providing services under contractual arrangements. Where the contract is let with a legal entity other than the individual practitioner, both the name of the legal entity and the name(s) of any individual practitioner(s) involved must be furnished.

(2) A written statement indicating, for each legal entity or individual practitioner, whether the contracted services are:

(a) To be included as billable services by the participating Ohio department of alcohol and drug addiction services certified treatment program; or

(b) To be billed independently by the legal entity or individual practitioner under contract.

Effective: 07/01/2012
R.C. 119.032 review dates: 04/16/2012 and 07/01/2017
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 3793.06 , 3793.11
Prior Effective Dates: 7/1/91 (Emer.), 9/30/91