Rule 5123-9-25 | Home and community-based services waivers - specialized medical equipment and supplies under the individual options and level one waivers.
(A) Purpose
This rule defines specialized medical equipment and supplies and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.
(B) Definitions
For the purposes of this rule, the following definitions apply:
(1) "Agency provider" has the same meaning as in rule 5123-2-08 of the Administrative Code.
(2) "Assistive technology" has the same meaning as in rule 5123-9-12 of the Administrative Code.
(3) "County board" means a county board of developmental disabilities.
(4) "Department" means the Ohio department of developmental disabilities.
(5) "Independent provider" has the same meaning as in rule 5123-2-09 of the Administrative Code.
(6) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, the person's guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.
(7) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.
(8) "Service documentation" means all records and information on one or more documents, including documents that may be created or maintained in electronic software programs, created and maintained contemporaneously with the delivery of services, and kept in a manner as to fully disclose the nature and extent of services delivered that shall include the items delineated in paragraph (E) of this rule to validate payment for medicaid services.
(9) "Specialized medical equipment and supplies" means adaptive and assistive equipment and other specialized medical equipment and supplies such as devices, controls, or appliances, specified in the individual service plan, which enable an individual to increase ability to perform activities of daily living, or to perceive, control, or communicate with the environment in which the individual lives. Specialized medical equipment and supplies includes items necessary for life support, ancillary supplies and equipment necessary to the proper functioning of such items, and durable and non-durable medical equipment not available under the medicaid state plan. All items shall meet applicable standards of manufacture, design, and installation. Specialized medical equipment and supplies does not include:
(a) Items that are not of direct medical or remedial benefit to the individual;
(b) Items otherwise available as assistive technology; or
(c) For individuals less than twenty-one years of age, equipment and supplies that are available under the medicaid state plan or covered under the provisions of 1905(r) of the Social Security Act, 42 U.S.C. 1396d, as in effect on the effective date of this rule.
(10) "Waiver eligibility span" means the twelve-month period following either an individual's initial waiver enrollment date or a subsequent eligibility re-determination date.
(C) Provider qualifications
(1) Specialized medical equipment and supplies shall be provided by an independent provider or an agency provider that meets the requirements of this rule and that has a medicaid provider agreement with the Ohio department of medicaid.
(2) A county board or a regional council of governments formed pursuant to section 5126.13 of the Revised Code by two or more county boards may provide specialized medical equipment and supplies only when no other certified provider is willing and able.
(3) An applicant seeking approval to provide specialized medical equipment and supplies shall complete and submit an application through the department's website (http://dodd.ohio.gov).
(4) An applicant seeking approval to provide specialized medical equipment and supplies shall submit to the department documentation verifying the applicant's experience in providing specialized medical equipment and supplies.
(5) A veterinarian who is attending to service animals shall be licensed to engage in the practice of veterinary medicine in accordance with Chapter 4741. of the Revised Code.
(6) Failure to comply with this rule and as applicable, rule 5123-2-08 or 5123-2-09 of the Administrative Code, may result in denial, suspension, or revocation of the provider's certification.
(D) Requirements for service delivery
(1) Specialized medical equipment and supplies shall be provided pursuant to an individual service plan that conforms to the requirements of rule 5123-4-02 of the Administrative Code.
(2) The provider of specialized medical equipment and supplies shall:
(a) Ensure proper installation of equipment, if required;
(b) Provide training to the individual, family, and other persons, as applicable, in the proper utilization of equipment;
(c) Properly maintain rental equipment, if required;
(d) Repair equipment as authorized by the county board representative; and
(e) Assume full liability for equipment improperly installed or maintained.
(E) Documentation of services
Service documentation for specialized medical equipment and supplies shall include each of the following to validate payment for medicaid services:
(1) Type of service.
(2) Date of service.
(3) Place of service.
(4) Name of individual receiving service.
(5) Medicaid identification number of individual receiving service.
(6) Name of provider.
(7) Provider identifier/contract number.
(8) Written or electronic signature of the person delivering the service, or initials of the person delivering the service if a signature and corresponding initials are on file with the provider.
(9) Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided.
(F) Payment standards
(1) The billing unit, service codes, and payment rates for specialized medical equipment and supplies are contained in the appendix to this rule.
(2) Payment for specialized medical equipment and supplies shall not exceed ten thousand dollars per item.
Last updated April 15, 2024 at 3:48 PM
Supplemental Information