LAW
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Ohio Laws and Rules
(A) Purpose
The purpose of this rule is to establish the procedures for applying for certification to provide waiver services under HCBS waivers administered by the department. An applicant meeting the requirements of this rule and standards established in rules adopted under Chapters 5123:2-8, 5123:2-9, 5123:2-10, and 5123:2-13 of the Administrative Code for the specific waiver services the applicant wishes to provide shall be certified in accordance with this rule.
(B) Application procedure
(1) The applicant shall submit an application to the department for the waiver services the applicant seeks certification to deliver on forms and in accordance with procedures prescribed by the department.
(2) The department shall provide the applicant with all relevant application material including, but not limited to, the following:
(a) Ohio health plan provider enrollment application/agreement (“Medicaid Program”);
(b) Electronic media notification form;
(c) Request for taxpayer identification form; and
(d) Service specific standards and assurances for the HCBS waiver and services the applicant seeks certification to deliver.
(3) If the applicant is certified as an HCBS waiver provider or as an ICF/MR, the applicant shall include the medicaid provider number on the application provided by the department.
(4) An applicant, who is not certified as an HCBS waiver provider or an ICF/MR, shall include a completed Ohio health plan provider enrollment application/agreement (“Medicaid Program”) provided by the department with the application.
(5) The applicant shall submit with the application all supporting documentation as evidence that standards are met as required by the specific services standards established under Chapter 5123. of the Administrative Code.
(6) An application is considered complete when the department has received from the applicant all completed components of the application outlined in paragraph (B)(2) of this rule, including applicable signatures and supporting documentation that demonstrates compliance with the certification standards for the waiver service(s) requested by the applicant.
(7) If the application is complete, the department shall complete a review and notify the applicant in writing of its decision to approve or deny certification within ten working days of receipt of the completed application.
(8) Upon its decision to approve an applicant’s certification, the department shall obtain a medicaid provider number from ODJFS. Within fourteen working days of receipt of the medicaid provider number, the department shall issue the certified provider a letter that shall specify the date of certification, specific service area(s), and a medicaid provider number.
(9) If the application is incomplete, the department shall, within ten working days of receipt of the application, provide the applicant with a letter outlining the problems with the application and will indicate that the applicant has ninety days to submit information needed to complete the application. When documentation received by the department within the specified ninety days results in a complete waiver application, the department shall upon approval of the application assign as an effective date for certification the date upon which all materials necessary for a complete application were received. The application will remain in a pending status for a period of up to ninety days. If after ninety days there is no response from the applicant, the application will be returned to the applicant. The department shall take no further action with respect to the application.
(10) The department shall deny an application for certification if the applicant does not meet the requirements of this rule.
(11) When denying any certification under this rule, the department shall comply with the notice and hearing requirements of Chapter 119. of the Revised Code.
(C) Procedures for obtaining additional HCBS waiver service certification under a waiver for which the provider is already certified
(1) A certified waiver provider requesting to provide additional waiver services under a waiver for which it is already certified shall request from the department an application for certification for the additional services the provider seeks to deliver.
(2) The department shall furnish the provider with all application material and all relevant standards and assurances for the services requested.
(3) The provider shall submit with the application all supporting documentation as evidence that standards are met as required by the requested specific service standard(s) established under Chapters 5123:2-8, 5123:2-9, 5123:2-10, and 5123:2-13 of the Administrative Code.
(4) If the application is complete, the department shall complete a review to determine compliance with the applicable service requirements and notify the applicant in writing of its decision to approve or deny the additional certification within ten working days of receipt of the completed application. The letter shall include the effective date of the additional approved waiver services.
(5) If the application is incomplete, the department shall, within ten working days of receipt of the application, provide the applicant with a letter outlining the problems with the application and will indicate that the applicant has ninety days to submit information needed to complete the application. When documentation received by the department within the specified ninety days results in a complete waiver application, the department shall upon approval of the application assign as an effective date for certification the date upon which all materials necessary for a complete application were received. The application will remain in a pending status for a period of up to ninety days. If after ninety days there is no response from the applicant, the application will be returned to the applicant. The department shall take no further action with respect to the application.
(6) The department shall deny an application for certification of additional waiver service(s) if the applicant does not meet the service specific requirements established under Chapters 5123:2-8, 5123:2-9, 5123:2-10, and 5123:2-13 of the Administrative Code.
(7) When denying any certification under this rule, the department shall comply with the notice and hearing requirements of Chapter 119. of the Revised Code.
Replaces: 5123:2-8-02
Effective: 07/01/2005
R.C. 119.032 review dates: 07/01/2010
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.045, 5111.871
Rule Amplifies: 5123.04, 5123.045, 5111.871
Prior Effective Dates: 4/28/03