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This website publishes administrative rules on their effective dates, as designated by the adopting state agencies, colleges, and universities.

Chapter 5160-27 | Community Behavioral Health Agency Services

 
 
 
Rule
Rule 5160-27-01 | Eligible provider for behavioral health services.
 

(A) An "eligible behavioral health provider" for purposes of this chapter is a provider of a mental health or substance use disorder treatment service covered in agency 5160 of the Administrative Code and is one of the following:

(1) An entity operating in accordance with section 5119.36 of the Revised Code and Chapters 5122-24 to 5122-29 and Chapter 5160-1 of the Administrative Code and providing mental health or substance use disorder treatment services.

(2) An entity furnishing mental health and/or substance use disorder services and operating in accordance with rule 5160-1-11 of the Administrative Code.

(3) Physician, as described in Chapter 4731. of the Revised Code, or physician assistant, as described in Chapter 4730. of the Revised Code, in accordance with agency 4731 and agency 4730 of the Administrative Code, respectively, and Chapter 5160-4 of the Administrative Code, or a clinical nurse specialist or certified nurse practitioner, as described in Chapter 4723. of the Revised Code. The practitioner described in this paragraph must be an employee or an independent contractor of an entity operating in accordance with paragraph (A)(1) or (A)(2) of this rule.

(4) Registered nurse or licensed practical nurse as defined in section 4723.01 of the Revised Code. The nurse must be an employee or an independent contractor of an entity operating in accordance with paragraph (A)(1) or (A)(2) of this rule. A registered nurse or licensed practical nurse must work under an order authorized by one of the practitioners listed in paragraph (A)(3) of this rule, except when a registered nurse performs a nursing regimen in accordance with section 4723.01 of the Revised Code or rule 5160-27-11 of the Administrative Code.

(5) A practitioner type described in rule 5160-8-05 of the Administrative Code who is an employee or an independent contractor of, or is a supervised trainee with, an entity operating in accordance with paragraph (A)(1) or (A)(2) of this rule.

(6) An unlicensed practitioner operating in accordance with the following requirements as applicable:

(a) An unlicensed practitioner providing mental health services who holds a valid high school diploma or equivalent and has both work experience and training related to the service(s) being provided, and is an employee or an independent contractor of an entity operating in accordance with paragraph (A)(1) or (A)(2) of this rule. These practitioners must operate under the general supervision of one of the practitioners listed in paragraphs (D)(1) to (D)(16) of this rule, in accordance with paragraph (D)(2)(b) of rule 5160-8-05 of the Administrative Code.

(b) An unlicensed practitioner providing substance use disorder services must operate under the general supervision, in accordance with paragraph (D)(2)(b) of rule 5160-8-05 of the Administrative Code, of one of the practitioners listed in paragraphs (D)(1) to (D)(16) of this rule, be an employee or an independent contractor of an entity operating in accordance with paragraph (A)(1) or (A)(2) of this rule, and be one of the following provider types:

(i) A chemical dependency counselor assistant operating in accordance with agency 4758 of the Administrative Code, and rule 5160-8-05 of the Administrative Code.

(ii) A peer recovery supporter who is :

(a) Certified as a peer recovery supporter by the Ohio department of mental health and addiction services; and

(b) Eighteen years of age or older and has a high school diploma or equivalent.

(iii) A care management specialist who meets the following criteria :

(a) Be eighteen years of age or older and have a high school diploma or equivalent.

(b) Have an understanding of substance use disorder treatment and recovery including how to engage a person in treatment and recovery.

(c) Have an understanding of health care systems, social service systems, and the criminal justice system.

(7) A pharmacist operating in accordance with rule 5160-8-52 of the Administrative Code. The pharmacist will be an employee or an independent contractor of an entity described in paragraph (A)(1) or (A)(2) of this rule.

(B) All practitioners shall practice within their professional scope of practice.

(C) Supervisors shall ensure that individuals whom they supervise meet the appropriate education and training qualifications for the service(s) they render.

(D) Supervising practitioners operating within their scope of practice, licensure, or certification:

(1) Physician.

(2) Physician assistant.

(3) Certified nurse practitioner.

(4) Clinical nurse specialist.

(5) Psychologist.

(6) Board licensed school psychologist.

(7) Licensed independent social worker.

(8) Licensed professional clinical counselor.

(9) Licensed independent marriage and family therapist.

(10) Licensed independent chemical dependency counselor.

(11) Registered nurse.

(12) Licensed marriage and family therapist.

(13) Licensed chemical dependency counselor II.

(14) Licensed chemical dependency counselor III.

(15) Licensed professional counselor.

(16) Licensed social worker.

Last updated November 3, 2023 at 3:16 PM

Supplemental Information

Authorized By: 5162.02, 5164.02
Amplifies: 5162.03, 5164.02, 5162.371, 5119.391
Five Year Review Date: 12/27/2023
Prior Effective Dates: 1/1/2018, 8/1/2019 (Emer.), 1/17/2021
Rule 5160-27-02 | Coverage and limitations of behavioral health services.
 

(A) This rule sets forth coverage and limitations for behavioral health services rendered to medicaid recipients by behavioral health provider agencies who meet all requirements found in agency 5160 of the Administrative Code unless otherwise specified.

(1) All claims for behavioral health services submitted to the Ohio department of medicaid (ODM) must include an ICD-10 diagnosis of mental illness or substance use disorder. The list of recognized diagnoses can be accessed at www.medicaid.ohio.gov.

(2) Medicaid reimbursable behavioral health services are limited to medically necessary services defined in rule 5160-8-05 of the Administrative Code and Chapter 5160-27 of the Administrative Code. Providers shall follow the requirements in rule 5160-8-05 of the Administrative Code and Chapter 5160-27 of the Administrative Code regarding services that cannot be billed in combination with other services.

(B) The following services have limitations on the amount, scope or duration of service that can be rendered to a recipient within a certain timeframe. These limits can be exceeded with prior authorization from ODM or its designee.

(1) Screening, brief intervention and referral to treatment (SBIRT) as defined by the American medical association's current procedural terminology book. Limitation for this service is one per code, per recipient, per billing provider, per calendar year.

(2) Assertive community treatment (ACT) as defined in rule 5160-27-04 of the Administrative Code is available on or after the date as determined by prior authorization approval.

(3) Community psychiatric supportive treatment (CPST) services as defined in rule 5122-29-17 of the Administrative Code and meet the following requirements:

(a) All CPST services provided in social, recreational, vocational, or educational settings are allowable only if they are documented mental health service interventions addressing the specific individualized mental health treatment needs as identified in the recipient's individualized service plan.

(b) A billable unit of service for CPST may include contact between the mental health professional and the recipient or an individual essential to the mental health treatment of the recipient.

(c) CPST services are not covered under this rule when provided in a hospital setting, except for the purpose of coordinating admission to the inpatient hospital or facilitating discharge from an inpatient hospital.

(d) Medicaid reimbursement of CPST services is described in rule 5160-27-03 of the Administrative Code.

(4) Psychiatric diagnostic evaluation and psychiatric diagnostic evaluation with medical services are each limited to one encounter per recipient, per billing provider, per calendar year.

(C) The following services delivered to recipients with substance use disorders have limitations on the amount, scope or duration of service that can be rendered to a recipient within a certain timeframe. These limits can be exceeded with prior authorization from the ODM designated entity.

(1) Substance use disorder assessment as referenced in rule 5160-27-09 of the Administrative Code is limited to two assessments per recipient, per billing agency, per calendar year.

(2) Substance use disorder urine drug screening as referenced in rule 5160-27-09 of the Administrative Code, is limited to one per day, per recipient.

(3) Peer recovery support as referenced in rules 5160-27-09 and 5160-43-04 of the Administrative Code is limited to four hours per day per recipient.

(4) Substance use disorder partial hospitalization as described in rule 5160-27-09 of the Administrative Code.

(5) Substance use disorder residential level of care as described in rule 5160-27-09 of the Administrative Code.

(D) The medications listed in the appendix to rule 5160-27-03 or appendix DD to rule 5160-1-60 of the Administrative Code are covered by ODM when rendered and billed by an eligible provider as described in rule 5160-27-01 of the Administrative Code. The medication must be administered by a qualified practitioner acting within their professional scope of practice.

(E) Laboratory services, vaccines, and medications administered in a prescriber office may be administered in accordance with rule 5160-1-60 of the Administrative Code.

(F) Medical and evaluation and management services stated in the appendix to rule 5160-27-03 of the Administrative Code or appendix DD to rule 5160-1-60 of the Administrative Code are covered by ODM when rendered by:

(1) A practitioner as described in paragraphs (A)(3) and (A)(4) of rule 5160-27-01 of the Administrative Code and operating within their scope of practice; or

(2) A pharmacist, rendering services in accordance with rule 5160-8-52 of the Administrative Code.

(G) CMS place of service code set descriptions may be found at www.cms.gov. The department further defines place of service 99 as "community," and this place of service may only be used when a more specific place of service is not available. Place of service 99 shall not be used to provide services to a recipient of any age if the recipient is being held in a public institution as defined in 42 C.F.R. 435.1010 (October 1, 2016).

(H) The activities that comprise or are included in the aforementioned medicaid reimbursable behavioral health services must be intended to achieve identified treatment plan goals or objectives. Providers shall maintain treatment records and progress notes as specified in rules 5160-01-27 and 5160-8-05 of the Administrative Code. A treatment plan for mental health services may only be developed by a practitioner who, at a minimum, meets the practitioner requirements found in paragraph (A)(6)(a) of rule 5160-27-01 of the Administrative Code. A treatment plan for substance use disorder services may only be developed by a practitioner who, at a minimum meets the practitioner requirements found in paragraph (A)(6)(b)(i) or (A)(6)(b)(iii) of rule 5160-27-01 of the Administrative Code.

(I) The medications and services listed in the appendix to rule 5160-27-03 of the Administrative Code or the opiate treatment service section of appendix DD to rule 5160-1-60 of the Administrative Code are reimbursed by the department when rendered and billed by an opiate treatment program as described in Chapter 5122-40 of the Administrative Code and licensed as such by the Ohio department of mental health and addiction services and/or federally certified as such as stated in 42 CFR 8.11 (October 1, 2016). Reimbursement rates are determined by the methodology described in paragraph (E) of rule 5160-4-12 of the Administrative Code or as listed in the appendix to rule 5160-27-03 of the Administrative Code or as listed in appendix DD to rule 5160-1-60 of the Administrative Code.

(J) When permitted, provision of any service addressed in Chapter 5160-27 of the Administrative Code by telehealth as defined in rule 5122-29-31 of the Administrative Code, must comply with the appropriate telehealth requirement(s) found in rule 5160-1-18 of the Administrative Code.

(K) The services described in this chapter shall not substitute or supplant natural supports and do not include any of the following:

(1) Educational, vocational, or job training services.

(2) Room and board.

(3) Habilitation services including but not limited to financial management, supportive housing, supportive employment services, and basic skill acquisition services that are habilitative in nature.

(4) Services to recipients who are being held in a public institution as defined in 42 C.F.R. 435.1010 (October 1, 2016);

(5) Services to individuals residing in institutions for mental diseases as described in 42 C.F.R. 435.1010 (October 1, 2016);

(6) Recreational and social activities, including but not limited to art, music, and equine therapies;

(7) Services that are covered elsewhere in agency 5160 of the Administrative Code; and

(8) Transportation for the recipient or family.

(L) Peer recovery services defined as peer support services in rule 5122-29-15 of the Administrative Code are covered when delivered:

(1) Through the specialized recovery services program in accordance with rule 5160-43-04 of the Administrative Code; or

(2) As a component of assertive community treatment as defined in rule 5160-27-04 of the Administrative Code: or

(3) As a component of substance use disorder residential treatment as defined in rule 5160-27-09 of the Administrative Code; or

(4) As a substance use disorder outpatient treatment service in accordance with rule 5160-27-09 of the Administrative Code; or

(5) As a component of intensive home-based treatment service as defined in rule 5122-29-28 of the Administrative Code; or

(6) As a component of mobile response and stabilization service in accordance with rule 5122-29-14 of the Administrative Code.

(M) The "Ohio children's initiative brief CANS assessment" and the "Ohio children's initiative comprehensive CANS assessment" are covered as defined in rule 5160-59-01 of the Administrative Code and may be billed separately for reimbursement. Payment for CPST, therapeutic behavioral services, or psychiatric diagnostic evaluation is not allowable for provision of the Ohio brief or Ohio comprehensive CANS assessment.

Last updated March 25, 2024 at 9:13 AM

Supplemental Information

Authorized By: 5164.02, 5162.05, 5162.02
Amplifies: 5164.02, 5164.88, 5164.76, 5164.15, 5164.03
Five Year Review Date: 7/1/2027
Prior Effective Dates: 5/3/2018, 6/12/2020 (Emer.)
Rule 5160-27-03 | Reimbursement for community behavioral health services.
 

(A) This rule sets forth the reimbursement requirements and rates for behavioral health services as described in Chapter 5160-27 of the Administrative Code and applies to providers as described in rule 5160-27-01 of the Administrative Code.

(B) With the exception of pharmacists as described in paragraph (A)(7) of rule 5160-27-01 of the Administrative Code, medicaid reimbursement rates for services and practitioners described in Chapter 5160-27 of the Administrative Code are listed in the appendix to this rule. Ohio medicaid will reimburse the provider the lower of either their usual and customary charges or the reimbursement amount described in the appendix to this rule. Practitioner-specific reimbursement rates that are not otherwise stated in the appendix to this rule are determined by paragraphs (B)(1) to (B)(5) of this rule.

(1) The reimbursement rate for physicians, as described in paragraph (A)(3) of rule 5160-27-01 of the Administrative Code, is one hundred per cent of the medicaid maximum rate stated in the appendix to this rule.

(2) The reimbursement rate for clinical nurse specialists, certified nurse practitioners, and physician assistants, as described in paragraph (A)(3) of rule 5160-27-01 of the Administrative Code, is eighty-five per cent of the medicaid maximum rate stated in the appendix to this rule; except for evaluation and management office/outpatient visits, psychiatric diagnostic evaluations, and smoking and tobacco cessation counseling the reimbursement rate is one hundred per cent of the medicaid maximum rate stated in the appendix to this rule.

(3) The reimbursement rate for practitioners described in paragraph (A)(5) of rule 5160-27-01 of the Administrative Code is the reimbursement rate percentage described in rule 5160-8-05 of the Administrative Code (medicaid maximum rate stated in the appendix to this rule). The reimbursement rates for services not defined in rule 5160-8-05 of the Administrative Code are stated in the appendix to this rule.

(4) The reimbursement rates for practitioners described in rule 5160-27-01 of the Administrative Code and not otherwise addressed in paragraph (B) of this rule, are stated in the appendix to this rule.

(5) The reimbursement rate for pharmacists as described in paragraph (A)(7) of rule 5160-27-01 of the Administrative Code is set forth in rule 5160-8-52 of the Administrative Code.

(C) The medicaid reimbursement rate for any of the following services provided for more than ninety minutes by the same billing provider, to the same recipient, on the same calendar day will be fifty per cent of the rate listed in appendix to this rule.

(1) Community psychiatric supportive treatment as described in rule 5122-29-17 of the Administrative Code.

(2) Therapeutic behavioral service as described in rule 5160-27-08 of the Administrative Code when delivered in an office setting.

(3) Psychosocial rehabilitation as described in rule 5160-27-08 of the Administrative Code when delivered in an office setting.

(4) Substance use disorder targeted case management as described in rule 5160-27-10 of the Administrative Code.

(D) Place of service (POS) codes for behavioral health services as described in paragraph (G) of rule 5160-27-02 of the Administrative Code are stated in the appendix to this rule. If POS codes are not specified for a service, any valid POS code may be used.

(E) Laboratory services, vaccines, and medications, not stated in the appendix to this rule, and administered in a prescriber office, may be reimbursed in accordance with rule 5160-1-60 of the Administrative Code.

View Appendix

Last updated January 2, 2024 at 9:02 AM

Supplemental Information

Authorized By: 5162.02, 5164.02
Amplifies: 5162.05, 5164.02 , 5164.03, 5164.15, 5164.76
Five Year Review Date: 1/1/2029
Prior Effective Dates: 1/1/2018, 1/1/2022
Rule 5160-27-04 | Mental health assertive community treatment service.
 

(A) For the purposes of medicaid reimbursement, assertive community treatment (ACT) refers to the evidence based model of delivering comprehensive community based behavioral health services to adults with certain serious and persistent mental illnesses who have not benefited from traditional outpatient treatment. The ACT model utilizes a multidisciplinary team of practitioners to deliver services to eligible individuals.

(B) For the purposes of this rule, collateral contact occurs when the practitioner contacts individuals who play a significant role in a medicaid recipients life. The information gained from the collateral contact can provide insight into treatment or the basic psychoeducation provided to that collateral contact can assist with the treatment of the medicaid recipient.

(C) The ACT team is the sole provider to ACT recipients of outpatient behavioral health services, including level one outpatient services as defined by the American society of addiction medicine.

(D) ACT services include but are not limited to the following:

(1) Psychiatry and primary care as related to the mental health or substance use disorder diagnoses;

(2) Service coordination;

(3) Crisis assessment and intervention;

(4) Symptom assessment and management;

(5) Community based rehabilitative services;

(6) Education, support, and consultation to families, legal custodians, and significant others who are part of the recipient's support network.

(E) The desired outcomes of ACT intervention for medicaid recipients include but are not limited to:

(1) Achieving and maintaining a stable life in a community based setting;

(2) Reducing the need for inpatient hospital admission and emergency department visits;

(3) Improving mental and physical health status, and improving life satisfaction.

(F) A medicaid recipient may receive ACT services when determined by the ODM designated entity to have met all of the following:

(1) The recipient has a diagnosis of schizophrenia, bipolar, or major depressive disorder with psychosis, in accordance with the ICD-10 diagnosis code group list found at https://bh.medicaid.ohio.gov/manuals;

(2) The recipient has a supplemental security income or social security disability insurance determination or has a score of two or greater on at least one of the items in the "mental health needs" or "risk behaviors" sections or a score of three on at least one of the items in the "life domain function" section of the adult needs and strengths assessment (ANSA) administered by an individual with a bachelor's degree or higher and with training in the administration of the assessment; and

(3) The recipient has one or more of the following:

(a) Two or more admissions to a psychiatric inpatient hospital setting during the past twelve months; or

(b) Two or more occasions of utilizing psychiatric emergency services during the past twelve months; or

(c) Significant difficulty meeting basic survival needs within the last twenty-four months; or

(d) History within the past two years of criminal justice involvement including but not limited to arrest, incarceration, or probation; and

(4) The recipient experiences one or more of the following:

(a) Persistent or recurrent severe psychiatric symptoms; or

(b) Coexisting substance use disorder of more than six month in duration; or

(c) Residing in an inpatient or supervised residence, but clinically assessed to be able to live in a more independent living situation if intensive services are provided; or

(d) At risk of psychiatric hospitalization, institutional or supervised residential placement if more intensive services are not available; or

(e) Has been unsuccessful in using traditional office-based outpatient services; and

(5) The recipient is eighteen years of age or older at the time of ACT enrollment.

(G) Prior authorization of ACT services.

(1) The provider must submit a request for prior authorization and receive approval from the ODM designated entity before ACT services can be rendered. The request for prior authorization must be accompanied by the appropriate documentation which includes, but is not limited to, the ANSA results or the documentation that supports the social security determination. The maximum amount of ACT service which may be prior authorized at any one time is twelve months.

(2) At the conclusion of the previous ACT service period, the provider agency may request additional ACT service to be prior authorized by the ODM designated entity.

(3) The provider may begin submitting claims for medicaid reimbursement of ACT services for dates of service within the subsequent calendar month following the date on which prior authorization is approved by the ODM designated entity.

(H) Disenrollment of a recipient from ACT. Upon planned or unplanned disenrollment of an ACT recipient, the ACT team shall document the circumstances regarding disenrollment in the recipient's medical record.

(1) A planned disenrollment from ACT occurs when a recipient, or recipient's guardian and ACT team members mutually agree to the termination of ACT services and transition of the recipient to a different care setting, provider, or benefit package. A planned disenrollment is appropriate when:

(a) The recipient has successfully reached established goals for disenrollment and the recipient and/or their guardian and ACT team members agree to the discharge from ACT; or

(b) The recipient moves outside the geographic area of the ACT team's responsibility. In such cases, the ACT team shall arrange to transfer mental health and substance use disorder service responsibility to another ACT program or other provider wherever the recipient is moving. The ACT team shall maintain contact with the recipient until the transfer is complete; or

(c) The recipient or their guardian requests a disenrollment; or

(d) The recipient is determined by the ODM designated entity to no longer meet the eligibility or medical necessity criteria for ACT.

(2) As part of a planned disenrollment, the ACT team shall document that the recipient has actively participated in disenrollment activities by documenting in the recipient's medical record the following information:

(a) The reason(s) for the recipients disenrollment as stated by both the recipient and the ACT team;

(b) The recipient's progress toward the goals set forth in the treatment plan;

(c) Documentation that the recipient's behavioral health care is being linked and transfered to a provider other than the ACT team;

(d) The signature of the recipient or their guardian, the ACT team leader, and the psychiatric prescriber.

(3) A recipients disenrollment from ACT may be unplanned and due to circumstances facilitated by:

(a) The inability of the ACT team to locate the recipient for more than forty-five days; or

(b) The recipients incarceration, hospitalization or admission to a residential substance use disorder treatment facility. In these circumstances, the primary responsibility for the recipients health care is transferred to the aforementioned setting.

(i) The ACT team is expected to maintain contact with the recipient to assist with transition between settings if the recipient is likely to be discharged and resume service from the ACT team within two months.

(ii) If the recipients stay is predicted to be longer than two months, the recipient shall be disenrolled from the ACT team.

(iii) The recipient may be re-enrolled with the ACT team when discharged from the incarcerated, inpatient or residential setting. Any re-enrollment shall follow the eligibility determination criteria described in paragraph (F) of this rule.

(4) Except for services found in paragraph (O) of this rule, a recipient may not obtain behavioral health services from a provider other than the ACT team unless the recipient is disenrolled from ACT services.

(5) The provider must inform the ODM designated entity of disenrollment within three business days of the discharge date. The ODM designated entity shall deactivate the authorization for the ACT service. Failure to timely dis-enroll the recipient from ACT may result in claim denial for other mental health or substance use disorder services.

(I) A provider furnishing ACT services must meet both of the following criteria:

(1) Meets the eligibility requirements found in paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code; and

(2) Employs one or more teams of mental health and substance use disorder practitioners who comprise the ACT treatment team.

(J) Each team must meet the following criteria:

(1) Completed a fidelity review within the previous twelve months by an independent validation entity recognized by ODM. In year one of an ACT teams participation with Ohio medicaid the team must participate in a fidelity review based on the dartmouth assertive community treatment scale (DACTS) and performed by an independent validation entity recognized by ODM. The DACTS fidelity scale and protocol can be found at www.medicaid.ohio.gov.

(a) Fidelity reviews of ACT teams must be repeated every twelve months from the report date of the previous fidelity review.

(b) An ACT team must have documented evidence of compliance to the requirements stated in paragraph (J) of this rule prior to submitting any prior authorization requests for recipients of ACT services.

(2) Each team shall have a designated full-time team leader who may serve in that capacity with only one team.

(a) An ACT team leader shall have a national provider identification number and be actively enrolled as an Ohio medicaid provider.

(b) A team leader shall have psychiatric training and shall hold one of the following valid licenses from the appropriate Ohio professional licensure board or licensure equivalents for ACT teams located in other states:

(i) Licensed independent social worker.

(ii) Licensed independent marriage and family therapist.

(iii) Licensed professional clinical counselor.

(iv) Licensed psychologist.

(v) Physician medical doctor, psychiatrist, doctor of osteopathy.

(vi) Clinical nurse specialist

(vii) Certified nurse practitioner.

(viii) Physician assistant.

(ix) Registered nurse.

(c) Team leaders who are licensed in accordance with paragraph (A)(5) of rule 5160-27-01 of the Administrative Code but do not have independent licensure status from one of the boards referenced in paragraph (A)(5) of rule 5160-27-01 of the Administrative Code must receive approval from ODM before the ACT team to which they are assigned can begin billing Ohio medicaid.

(3) ACT teams that employ peer recovery supporters must ensure that they meet the criteria and requirements for the peer recovery support services set forth in rule 5160-43-09 of the Administrative Code.

(4) ACT teams must have a caseload no greater than one hundred and twenty and must maintain an average caseload ratio of one practitioner for every ten ACT recipients. Upon request from the ODM, the ACT team must provide to the ODM or its designated entity the ACT team caseload size and composition of medicaid and non-medicaid enrollees.

(K) ODM reserves the right to suspend or terminate the payment of ACT services and to require subsequent review of an ACT team's fidelity performance if ODM has reason to believe that the ACT team's fidelity to the DACTS model described in paragraph (J)(1) of this rule may be in question. ODM may, at its discretion, suspend payment of ACT medicaid claims from the provider agency employing the ACT team until such time as ODM receives documentation from its independent validation entity that the team does meet the fidelity criteria described in paragraph (J)(1) of this rule.

(L) A provider employing an ACT team may bill up to four ACT units per month per recipient when all clinical and billing requirements for each unit are met. The billing of ACT units are subject to the following limits per provider category, per recipient, per month:

(1) Not more than one unit may be billed per medicaid recipient per month for services rendered by the ACT team medical prescriber including physician, clinical nurse specialist, certified nurse practitioner, or physician assistant operating within their respective scopes of practice.

(2) Not more than one unit per medicaid recipient per month may be billed for services rendered by any one of the following ACT team members: psychologist, licensed independent social worker, licensed social worker, licensed clinical social worker, licensed professional counselor, licensed professional clinical counselor, licensed independent clinical counselor, licensed independent marriage and family therapist, licensed marriage and family therapist, licensed practical nurse, registered nurse, licensed independent chemical dependency counselor, licensed chemical dependency counselor II or licensed chemical dependency counselor III.

(3) Not more than two units per medicaid recipient per month may be billed by an ACT team member not listed in paragraph (L)(1) or (L)(2) of this rule. This unit category includes: psychology assistant, psychology intern, psychology trainee, social worker assistant, social worker trainee, marriage and family therapist trainee, counselor trainee, chemical dependency counselor assistant, qualified mental health specialist (QMHS), including QMHS with three or more years of experience, and peer recovery supporter.

(M) The medicaid payment rates for ACT are stated in the appendix to rule 5160-27-03 of the Administrative Code. Payment for services provided by authorized ACT teams is only available for dates of services on or after January 1, 2018.

(N) ACT teams shall maintain regular contact and deliver all medically necessary outpatient mental health and substance use disorder services and supports to ACT recipients enrolled with their team.

(O) Services rendered by the ACT team medical prescriber, including physician, clinical nurse specialist, certified nurse practitioner, or physician assistant, are billable when rendered to an ACT recipient or via a case specific consultation with another member of the ACT team regarding the medical aspects of the ACT recipient's treatment plan. The ACT team medical prescriber must have at least one contact with each ACT recipient every three months.

(P) When a recipient is enrolled on an ACT team, no other medicaid community behavioral health services, as defined in Chapter 5160-27 of the Administrative Code, are eligible for reimbursement except:

(1) Supported employment as identified on a recipient's specialized recovery services program treatment plan if applicable, as described in rule 5160-43-01 of the Administrative Code.

(2) Substance use disorder services that are not considered part of the benefit package encompassed under level one of the american society of addiction medicine (ASAM) as defined in rule 5160-27-09 of the Administrative Code. Prior authorization from the ODM designated entity is required.

(3) Crisis services furnished by a provider other than the billing provider agency employing the ACT team.

(Q) Documentation requirements for ACT.

(1) Documentation in the recipient's medical record of the services provided by the ACT team must meet the requirements stated in this paragraph as well as those stated in rules 5160-1-27 and 5160-8-05 of the Administrative Code.

(2) The ACT team must develop a specific treatment plan for each enrolled recipient. The treatment plan must, at a minimum, meet the requirements of rule 5160-8-05 of the Administrative Code plus the following additional requirements:

(a) The treatment plan shall be individualized based on the recipient's needs, strengths, and preferences and shall set measurable long-term and short-term goals and specify approaches and interventions necessary for the recipient to achieve the recipient goals. The treatment plan shall also identify who will carry out the approaches and interventions.

(b) The treatment plan shall address, at a minimum, the following key areas:

(i) Psychiatric illness or symptom reduction.

(ii) Stable, safe, and affordable housing.

(iii) Activities of daily living.

(iv) Daily structure and activities, including employment if appropriate.

(v) Family and social relationships.

(c) The treatment plan shall be reviewed and revised by a member of the ACT team with the recipient whenever a change is needed in the recipient's course of treatment or at least every six months. In conjunction with a treatment plan review, the ACT team member shall prepare a summary of the recipient's progress, goal attainment, effectiveness of the intervention and recipient's satisfaction with the ACT team interventions since enactment of the previous treatment plan.

(d) The treatment plan, and all subsequent revisions of it, shall be reviewed and signed by the recipient and the ACT team practitioner.

(R) The following activities performed by members of the ACT team are not eligible for reimbursement:

(1) Time spent attending or participating in recreational activities.

(2) Services provided to teach academic subjects or as a substitute for educational personnel, including but not limited to a teacher, teacher's aide, or an academic tutor.

(3) Habilitative services for the recipient to acquire, retain, and improve the self-help, socialization, and adaptive skills necessary to reside successfully in community settings.

(4) Child care services or services provided as a substitute for the parent or other individuals responsible for providing care and supervision.

(5) Respite care.

(6) Transportation for the recipient or family.

(7) Services provided to children, spouse, parents, or siblings of the eligible recipient under treatment or others in the eligible recipient's life to address problems not directly related to the eligible recipient's issues and not listed in the eligible recipient's ACT treatment plan.

(8) Art, movement, dance, or drama therapies.

(9) Services provided to collaterals of the recipient.

(10) Contacts that are not medically necessary.

(11) Any service outside the responsibility of the ACT team.

(12) Vocational training and supported employment services, unless the recipient is enrolled in the specialized recovery services program as described in rule 5160-43-01 of the Administrative Code.

(13) Crisis intervention provided by the provider agency employing the ACT team.

Supplemental Information

Authorized By: 5162.02, 5164.02
Amplifies: 5164.02 , 5164.03
Five Year Review Date: 12/27/2023
Prior Effective Dates: 1/1/2018, 8/1/2019 (Emer.), 6/12/2020 (Emer.)
Rule 5160-27-06 | Therapeutic behavioral group service-hourly and per diem.
 

(A) For the purpose of medicaid reimbursement, therapeutic behavioral (day treatment), group service-hourly and per diem, is defined as an intensive, structured, goal-oriented, distinct and identifiable group treatment service that addresses the individualized mental health needs of the client. The therapeutic behavioral group service-hourly and per diem is clinically indicated by assessment. The environment at this level of treatment is highly structured, and has an appropriate staff-to-client ratio to guarantee sufficient therapeutic services and professional monitoring, control, and protection. The purpose and intent of therapeutic behavioral group service-hourly and per diem is to stabilize, increase or sustain the highest level of functioning.

(1) Therapeutic behavioral group service-hourly and per diem must be a group treatment service that includes but is not limited to the following:

(a) Skills development of interpersonal and social competency, problem solving, conflict resolution, and emotions/behavior management,

(b) Developing of positive coping mechanisms,

(c) Managing mental health and behavioral symptoms to enhance independent living, and

(d) Psychoeducational services including instruction and training of persons served in order to increase their knowledge and understanding of their psychiatric diagnosis(es), prognosis(es), treatment, and rehabilitation in order to enhance their acceptance, increase their cooperation and collaboration with treatment and rehabilitation, and favorably affect their outcomes.

(B) Service requirements.

(1) When the service is provided for less than 2.5 hours per day, the therapeutic behavioral group service hourly billing code must be used.

(2) When the service is provided for 2.5 or more hours per day, the therapeutic behavioral group service per diem must be used and the service must:

(a) Be delivered at a nationally-accredited program and must be provided by a licensed practitioner, or an unlicensed mental health practitioner as described in paragraph (A)(2) of rule 5160-27-08 of the Administrative Code.

(b) The staff to client ratio cannot exceed 1:12.

(C) Limitations.

(1) Reimbursement for therapeutic behavioral group service-hourly and per diem will not be made while the patient is enrolled in assertive community treatment (ACT), or a substance use disorder (SUD) residential treatment facility.

(2) For adults, reimbursement for the following medically necessary behavioral health group services will be limited to no more than four fifteen-minute units, or one hour per day on the same day as the therapeutic behavioral group service (hourly, or per diem) except when prior authorized.

(a) Group psychotherapy for mental health or substance use disorder diagnoses.

(b) Group therapeutic behavioral services as defined in rule 5160-27-08 of the Administrative Code.

(c) SUD group counseling.

(d) Group community psychiatric supportive treatment.

(3) A therapeutic behavioral group service per diem and therapeutic behavioral group service hourly reimbursement will not be reimbursed when delivered on the same day by the same billing provider for the same individual.

(4) A medicaid recipient can receive one therapeutic behavioral group service per diem service per day per provider. Reimbursement of therapeutic behavioral group service per diem and therapeutic behavioral service hourly by more than one billing provider to the same individual on the same day is allowable with prior authorization.

(5) Other behavioral health individual services may be reimbursed on the same day as therapeutic behavioral group service-hourly or therapeutic behavioral group service per diem.

(D) Providers must adhere to documentation requirements set forth in rules 5160-1-27 and 5160-8-05 of the Administrative Code.

Last updated March 1, 2022 at 8:33 AM

Supplemental Information

Authorized By: 5164.02, 5162.05, 5162.02
Amplifies: 5164.02, 5164.03
Five Year Review Date: 12/27/2023
Prior Effective Dates: 1/1/2018
Rule 5160-27-08 | Mental health therapeutic behavioral services and psychosocial rehabilitation.
 

(A) For the purposes of medicaid reimbursement, therapeutic behavioral services (TBS) are goal-directed supports and solution-focused interventions.

(1) Activities included must be intended to achieve the identified goals or objectives as set forth in the individual's treatment plan. Activities include but are not limited to the following:

(a) Treatment planning. Participating in and utilizing strengths based treatments/planning which may include assisting the individual and family members or other collaterals with identifying strengths and needs.

(b) Identification of strategies or treatment options. Assisting the individual and family members or other collaterals to identify strategies or treatment options associated with the individual's mental illness.

(c) Developing and providing solution focused interventions and emotional and behavioral management drawn from evidence-based psychotherapeutic treatments.

(d) Restoration of social skills. Rehabilitation and support with the restoration of social and interpersonal skills to increase community tenure, enhance personal relationships, establish support networks, increase community awareness, develop coping strategies, and promote effective functioning in the individual's social environment including home, work and school.

(e) Restoration of daily functioning. Assisting the individual to restore daily functioning specific to managing their own home including managing their money, medications, and using community resources and other self-care requirements; and

(f) Crisis prevention and amelioration. Assisting the individual with effectively responding to or avoiding identified precursors or triggers that would risk their remaining in a community setting or that result in functional impairments. Activities may include, but not be limited to, assisting the individual and family members or other collaterals with identifying a potential psychiatric or personal crisis, developing a crisis management plan, and/or, as appropriate, seeking other supports to restore stability and functioning.

(2) Eligible providers must be a licensed or an unlicensed mental health practitioner in accordance with rule 5160-27-01 of the Administrative Code who have at a minimum:

(a) A bachelor's or a master's degree in social work, psychology, nursing, or in related human services, or

(b) A high school diploma with a minimum of three years of relevant experience as determined by the employing agency and documented in the employee's record.

(B) For the purposes of this rule, collateral/collateral supports contact occurs when the practitioner contacts individuals who play a significant role in a medicaid recipient's life. The information gained from the collateral contact can provide insight into the individual's treatment. Basic psychoeducation provided to a medicaid recipient's collateral contacts can assist with their treatment.

(C) For the purposes of medicaid reimbursement, psychosocial rehabilitation (PSR) assists individuals with implementing interventions outlined on a treatment plan to compensate for or eliminate functional deficits and interpersonal and/or mental health barriers associated with an individual's mental health diagnosis.

(1) Activities include:

(a) Restoration, rehabilitation and support of daily functioning to improve self-management of the negative effects of psychiatric or emotional symptoms that interfere with a person's daily functioning.

(b) Supporting the individual with restoration and implementation of daily functioning and daily routines critical to remaining successful in home, school, work, and community.

(c) Rehabilitation and support to restore skills to function in a natural community environment.

(2) Eligible providers are unlicensed mental health practitioners in accordance with rule 5160-27-01 of the Administrative Code, are at least eighteen years of age and who have, at a minimum, a high school diploma with appropriate mental health training as determined by the employing agency and documented in the employee's record.

(D) Limitations.

(1) TBS and PSR will not be reimbursed when a patient is enrolled in assertive community treatment (ACT) or receiving residential substance use disorder treatment services. A separate payment will not be made for TBS and PSR while a youth is enrolled in intensive home based treatment (IHBT) unless the service is prior authorized.

(2) TBS must be delivered as an individual or group intervention with the individual, family/caregiver and/or other collateral supports.

(3) PSR must be delivered as an intervention with the individual, not in a group setting.

(E) Providers shall adhere to documentation requirements set forth in rules 5160-01-27 and 5160-8-05 of the Administrative Code.

Last updated March 1, 2022 at 8:33 AM

Supplemental Information

Authorized By: 5162.02, 5164.02
Amplifies: 5164.02 , 5164.03
Five Year Review Date: 12/27/2023
Prior Effective Dates: 1/1/2018, 8/1/2019 (Emer.)
Rule 5160-27-09 | Substance use disorder treatment services.
 

(A) For the purpose of medicaid reimbursement, substance use disorder treatment services shall be defined by and shall be provided according to the American society of addiction medicine also known as the ASAM treatment criteria for addictive, substance related and co-occurring conditions for admission, continued stay, discharge, or referral to each level of care (LOC).

(B) Medicaid will reimburse for the services provided under the following ASAM levels of care:

(1) LOC 1: outpatient services. LOC 1 services are designed to treat the recipients level of clinical severity and function. These services may be delivered in a variety of settings. Addiction, mental health, or general health care treatment personnel provide professionally directed screening, evaluation, treatment, and ongoing recovery and disease management services. Such services are provided in regularly scheduled sessions and follow a defined set of policies and procedures or medical protocols. Service provision is limited to less than nine hours per week for adults and less than six hours per week for adolescents.

(2) LOC 2: intensive outpatient/partial hospitalization including LOC 2 withdrawal management (WM). LOC 2 services are capable of meeting the complex needs of people with addiction and co-occurring conditions. They can be rendered during the day, before or after work or school, in the evening, and/or on weekends.

(3) LOC 3: residential services/inpatient services including LOC 3 WM. These services are co-occurring capable, co-occurring enhanced, and complexity capable in nature and provided by addiction treatment, mental health and general medical personnel in a twenty four hour treatment setting. Services are provided in Ohio department of mental health and addiction services certified permanent facilities which are staffed twenty four hours a day. The following services are included in the residential treatment service and will not be reimbursed separately:

(a) Ongoing assessments and diagnostic evaluations.

(b) Crisis intervention.

(c) Individual, group, family psychotherapy and counseling.

(d) Case management.

(e) Substance use disorder peer recovery services.

(f) Urine drug screens.

(g) Medical services.

(4) The following services are considered non-covered for individuals in residential treatment:

(a) Therapeutic behavioral services.

(b) Psychosocial rehabilitation.

(c) Community psychiatric supportive treatment.

(d) Mental health day treatment.

(e) Assertive community treatment.

(f) Intensive home based treatment.

(C) Individuals in residential treatment may receive medically necessary services from practitioners who are not affiliated with the residential treatment program. Examples include, but are not limited to, psychiatry, medication assisted treatment, or other medical treatment that is outside the scope of the residential level of care as defined by the American society of addiction medicine. Medicaid will reimburse providers of these services outside the per diem rate paid to residential treatment programs. All treatment services, regardless of whether they are rendered by the residential treatment program or unaffiliated billing practitioners or agencies must be documented in the clients treatment plan maintained by the residential treatment provider.

(D) The entity providing a residential service must ensure that the medicaid recipient has access to the appropriate practitioner for receipt of clinical services as stated in the ASAM treatment criteria.

(E) Eligible practitioners of substance use disorder treatment services must meet all applicable requirements stated in rule 5160-27-01 of the Administrative Code. Qualified mental health specialists are not eligible to be a residential treatment team practitioner.

(F) Limitations.

(1) Residential levels of care are mutually exclusive, therefore a patient can only receive services through one level of care at a time.

(2) Prior authorization is required for LOC 2.5 (partial hospitalization) which requires a minimum of twenty hours of services per week. If, after the first four consecutive weeks of treatment, the amount of services provided is less than twenty hours, the prior authorization will be rescinded but services may still be reimbursed at a lower level of care not to exceed 19.9 hours per week.

(3) Prior authorization is required for LOC 3 residential treatment according to the following:

(a) Up to thirty consecutive days without prior authorization per medicaid enrollee for the first and second admission in a calendar year. If the stay continues beyond the thirty days of the first or second stay, prior authorization is required to support the medical necessity of the continued stay. If medical necessity is not substantiated and approved by the ODM designated entity, only the initial thirty consecutive days will be reimbursed.

(b) Third and subsequent admissions during the same calendar year must be prior authorized from the first day of admission.

(G) The patients medical record must substantiate the medical necessity of services performed. Providers shall adhere to documentation requirements set forth in rules 5160-1-27 and 5160-8-05 of the Administrative Code.

Last updated August 5, 2021 at 9:02 AM

Supplemental Information

Authorized By: 5162.02, 5162.05, 5164.02
Amplifies: 5164.02, 5164.03
Five Year Review Date: 12/27/2023
Rule 5160-27-10 | Substance use disorder targeted case management.
 

(A) Targeted case management assists an individual within the eligible target population to gain access to needed medical, social, educational and other services.

(1) Targeted case management services shall include, at a minimum, the following activities:

(a) Comprehensive assessment and periodic reassessment of individual needs to determine the need for any medical, educational, social or other services. Assessment activities include taking client history; identifying the individuals needs and completing related documentation and gathering information from other sources such as family members, medical providers, social workers and educators to form a complete assessment of the eligible individual.

(b) Development and periodic revision of a specific care plan that is based on the information gathered through the assessment. The care plan must include the following requirements:

(i) Goals and actions to address the medical, social, educational and other services needed by the individual; and

(ii) A plan to ensure the active participation of the eligible individual and or their authorized health care decision maker; and

(iii) A course of action to respond to the assessed needs of the eligible individual.

(c) Referral and related activities to help the eligible individual obtain needed services

(d) Monitoring and follow-up activities or contacts that are necessary to ensure that the care plan is implemented and adequately addresses the eligible individuals needs. Changes in needs or status must be reflected in the care plan. Monitoring shall be performed no less frequently than annually. Monitoring may be performed in person or by electronic communication.

(B) In order to provide targeted case management, practitioners must meet the requirements in paragraph (A)(6) of rule 5160-27-01 of the Administrative Code. For the purposes of this rule, the following unlicensed practitioners are excluded: qualified mental health specialists and peer recovery supporters.

(C) The following activities or contacts do not constitute targeted case management and are ineligible for reimbursement as targeted case management:

(1) Transportation.

(2) Waiting with an individual for appointments at social service agencies, court hearings and similar activities does not, in and of itself, constitute case management.

(3) Direct services to which the client has been referred such as medical, educational or social services.

(4) Internal quality assurance activities, such as clinical supervisory activities and/or case review/staffing sessions.

(D) Targeted case management services will not be separately reimbursed when a recipient is enrolled in a substance use disorder (SUD) residential treatment facility.

(E) Targeted case management services require prior authorization from the Ohio department of medicaid (ODM) designated entity when a recipient is enrolled in an assertive community treatment (ACT) or intensive home based treatment (IHBT) team.

(F) Providers shall adhere to documentation requirements set forth in rules 5160-1-27 and 5160-8-05 of the Administrative Code.

Last updated October 27, 2023 at 4:03 PM

Supplemental Information

Authorized By: 5162.02, 5162.05, 5164.02
Amplifies: 5164.02, 5164.03
Five Year Review Date: 12/27/2023
Rule 5160-27-11 | Behavioral health nursing services.
 

(A) Behavioral health nursing services are mental health and substance use disorder (SUD) nursing services performed by registered nurses or licensed practical nurses. They include those activities that are performed within professional scope of practice and in authorized settings by staff that are licensed by the Ohio board of nursing and are intended to address the behavioral and other physical health needs of individuals receiving treatment for psychiatric symptoms or substance use disorders.

(B) Activities may include but are not limited to performance of the following:

(1) Health care screenings

(2) Nursing assessments

(3) Nursing exams

(4) Checking vital signs

(5) Monitoring the effects of medication

(6) Monitoring symptoms

(7) Behavioral health education

(8) Collaboration with the individual and/or family as clinically indicated

(9) Group nursing services

(C) Eligible providers.

(1) Registered nurse (RN) as described in rule 5160-27-01 of the Administrative Code.

(2) Licensed practical nurse (LPN) as described in rule 5160-27-01 of the Administrative Code.

(D) Limitations.

(1) Group nursing services and nursing assessments must be provided by an RN.

(2) When behavioral health nursing services are provided, medication administration will not be reimbursed when provided by the same practitioner, to the same recipient, on the same day.

(3) Behavioral health nursing services will not be reimbursed when a recipient in enrolled in assertive community treatment (ACT) or in a SUD residential treatment facility.

(E) Providers shall adhere to documentation requirements set forth in rules 5160-1-27 and 5160-8-05 of the Administrative Code.

Last updated October 27, 2023 at 4:03 PM

Supplemental Information

Authorized By: 5164.02, 5162.05, 5162.02
Amplifies: 5164.02, 5164.03
Five Year Review Date: 12/27/2023
Rule 5160-27-12 | Behavioral health crisis intervention provided by unlicensed practitioners.
 

(A) For the purpose of medicaid reimbursement, behavioral health crisis intervention is a timely intervention with medicaid recipients who are experiencing a life threatening or complex emergent situation related to mental illness or a substance use disorder.

(1) The goals of crisis intervention are to ease the crisis, re-establish safety and institute interventions to minimize psychological trauma.

(2) Activities may include but are not limited to: emergent care, assessment, immediate stabilization, de-escalation, counseling, care planning and resolution.

(B) In order to provide behavioral health crisis intervention, practitioners must meet the requirements in paragraph (A)(6) of rule 5160-27-01 of the Administrative Code.

(1) For the purposes of this rule, the following unlicensed practitioners are excluded: care management specialist and peer recovery supporter.

(2) Practitioners of crisis intervention shall have current certification in first aid and cardio-pulmonary resuscitation (CPR).

(C) Limitations: crisis intervention will not be reimbursed when a recipient is enrolled in assertive community treatment (ACT), intensive home based treatment (IHBT) or receiving services in a substance use disorder (SUD) residential treatment facility.

(D) Providers shall adhere to documentation requirements set forth in rules 5160-1-27 and 5160-8-05 of the Administrative Code.

(E) Crisis psychotherapy rendered by licensed practitioners is authorized in rule 5160-8-05 of the Administrative Code and as defined by the American medical association's current procedural terminology book.

Supplemental Information

Authorized By: 5162.02, 5162.05, 5164.02
Amplifies: 5164.03, 5164.02
Five Year Review Date: 12/27/2023
Rule 5160-27-13 | Mobile response and stabilization service.
 

(A) For the purposes of this rule, mobile response and stabilization service (MRSS), is the service as set forth by the Ohio department of mental health and addiction services (OhioMHAS) in rule 5122-29-14 of the Administrative Code.

(B) Eligible providers.

(1) Providers certified by OhioMHAS in accordance with rule 5122-29-14 of the Administrative Code are eligible for MRSS reimbursement.

(2) Services rendered by MRSS team staff described in rule 5122-29-14 of the Administrative Code that are eligible providers of behavioral health services in accordance with rule 5160-27-01 of the Administrative Code are reimbursable.

(C) Coverage.

(1) The following MRSS activities are reimbursable:

(a) Mobile response activities as described in rule 5122-29-14 of the Administrative Code.

(b) Stabilization services as described in rule 5122-29-14 of the Administrative Code.

(2) Prior authorization is not needed for mobile response activities.

(3) Prior authorization is needed for stabilization services rendered more than six weeks from the completion of mobile response.

(4) For individuals enrolled in either a medicaid managed care organization (MCO) or the OhioRISE plan, it is the responsibility of the provider to notify the individual's MCO or the OhioRISE plan within three business days of initiation, termination, and transition from stabilization services. For individuals enrolled in both a medicaid managed care organization (MCO) and the OhioRISE plan, it is the responsibility of the provider to notify the OhioRISE plan within three business days of initiation, termination, and transition from stabilization services.

(D) Limitations.

(1) The following activities are not billable as MRSS:

(a) Childcare services or services provided as a substitute for the parent or other individuals responsible for providing care and supervision.

(b) Respite care.

(c) Transportation activities that do not include the provision of a mobile response activity or stabilization service.

(d) MRSS screening and triage activities described in rule 5122-29-14 of the Administrative Code.

(e) Activities not described in paragraph (C) of this rule.

(2) Reimbursement will not be made for stabilization services described in paragraph (C)(1) of this rule when an individual is:

(a) Enrolled in intensive home-based treatment as described in rule 5122-29-28 of the Administrative Code.

(b) Receiving substance use disorder residential treatment services as described in rule 5160-27-09 of the Administrative Code, except for MRSS necessary to support admission to the facility.

(c) Enrolled in assertive community treatment as described in rule 5160-27-04 of the Administrative Code.

(d) Receiving inpatient hospital psychiatric services as described in Chapter 5160-2 of the Administrative Code, except for MRSS necessary to support admission to the hospital.

(e) Receiving psychiatric residential treatment facility services as described in 42 C.F.R. 441.150 (October 1, 2021) through 42 C.F.R. 441.184 (October 1, 2021) except for MRSS necessary to support admission to the facility.

(E) Reimbursement. The medicaid reimbursement rate for MRSS is stated in the appendix to rule 5160-27-03 of the Administrative Code.

Last updated March 25, 2024 at 9:14 AM

Supplemental Information

Authorized By: 5164.02, 5162.05, 5162.02
Amplifies: 5162.02, 5162.03
Five Year Review Date: 7/1/2027