Rule 5160-45-04 | Ohio department of medicaid (ODM) -administered waiver program: provider enrollment process.
(A) Ohio department of medicaid (ODM) -administered waiver provider applicants must successfully complete the provider enrollment process set forth in this rule and receive approval from ODM before furnishing services to an individual enrolled on an ODM-administered waiver. Services furnished before ODM approves and enrolls the provider applicant and before the provider is added to the approved person-centered services plan are not reimbursable.
(B) The provider applicant completes and submits a provider application to ODM in accordance with rule 5160-1-17 of the Administrative Code.
(C) Upon receipt of the provider application, ODM or its designee shall verify the provider applicant has submitted and meets all applicable ODM-administered waiver provider regulations set forth in Chapters 5160-1, 5160-44, 5160-45, 5160-46, and 5160-58 of the Administrative Code.
(D) ODM or its designee shall notify the provider applicant if the application does not contain all of the required documentation. The provider applicant shall have thirty calendar days from the date of written notification to submit the requested documentation. If the provider applicant does not submit the documentation within the prescribed time frame, ODM or its designee may reject the provider application.
(E) ODM shall enroll or deny enrollment of the provider applicant based upon its own review and the review and recommendation of its designee.
(F) ODM shall notify the provider applicant in writing of its decision. If ODM denies enrollment, it shall either issue the provider applicant appeal rights in accordance with Chapter 119. of the Revised Code, or reconsideration rights in accordance with rule 5160-70-02 of the Administrative Code.
(G) When a current ODM-administered waiver service provider submits its medicaid provider agreement revalidation application, or applies for a specialty under their current provider type, ODM shall ensure that criminal record check requirements set forth in Chapter 5160-45 of the Administrative Code are satisfied. ODM shall also review the provider's history, including but not limited to medicaid program compliance and performance. ODM may approve or deny revalidation based on its findings and in accordance with rule 5160-1-17.6 of the Administrative Code.
(H) When a former medicaid provider applies for enrollment to become an ODM-administered waiver provider, in addition to following the process outlined in paragraphs (A) to (F) of this rule, ODM shall also review the provider applicant's history including, but not limited to medicaid program compliance and performance. ODM may approve or deny enrollment based on its findings and in accordance with rules 5160-1-17.6 and 5160-1-17.7 of the Administrative Code.
Last updated October 12, 2021 at 12:28 PM