Ohio Administrative Code Search

... of the care provided to the member. (1) The OhioRISE plan has to ensure decisions rendered through the UM program are based on medical necessity. (2) The UM program has to be based on written policies and procedures that include, at a minimum: (a) The information sources used to make determinations of medical necessity; (b) The criteria, based on sound clinical evidence, to make UM decision...

... of the care provided to the member. (1) The OhioRISE plan has to ensure decisions rendered through the UM program are based on medical necessity. (2) The UM program has to be based on written policies and procedures that include, at a minimum: (a) The information sources used to make determinations of medical necessity; (b) The criteria, based on sound clinical evidence, to make UM decisions and the specific p...

... youth or family capacity and choice. (1) Moderate care coordination (MCC) is recommended for youth six years of age and older when paragraph (A)(1)(a) and either paragraph (A)(1)(b) or (A)(1)(c) of this rule are met: (a) An Ohio children's initiative child and adolescent needs and strengths (CANS) assessment, the tool available on https://www.medicaid.ohio.gov (September 20, 2021), indicates for behavioral/emotion...

... youth or family capacity and choice. (1) Moderate care coordination (MCC) is recommended for youth six years of age and older when paragraph (A)(1)(a) and either paragraph (A)(1)(b) or (A)(1)(c) of this rule are met: (a) An Ohio children's initiative child and adolescent needs and strengths (CANS) assessment, the tool available on https://www.medicaid.ohio.gov (September 20, 2021), indicates fo...

... addiction services (OhioMHAS) in rule 5122-29-28 of the Administrative Code. (C) Eligible providers of IHBT services. (1) Providers eligible for medicaid payment for IHBT will: (a) Meet the criteria in paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code; and (b) Provide the service in accordance with rule 5122-29-28 of the Administrative Code. (D) Coverage. (1) Payment may be made for IHBT...

...iction services (OhioMHAS) in rule 5122-29-28 of the Administrative Code. (C) Eligible providers of IHBT services. (1) Providers eligible for medicaid payment for IHBT will: (a) Meet the criteria in paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code; and (b) Provide the service in accordance with rule 5122-29-28 of the Administrative Code. (D) Coverage. (1) Payment may ...

...ule, the following definitions apply: (1) "Behavioral health respite services" are services that provide short-term, temporary relief to the primary caregiver of an OhioRISE plan enrolled youth, in order to support and preserve the primary caregiving relationship. (2) "Foster home" has the same meaning as "certified foster home" in rule 5101:2-1-01 of the Administrative Code. (3) "Kin" has the same meaning as in r...

... the following definitions apply: (1) "Behavioral health respite services" are services that provide short-term, temporary relief to the primary caregiver of an OhioRISE plan enrolled youth, in order to support and preserve the primary caregiving relationship. (2) "Foster home" has the same meaning as "certified foster home" in rule 5101:2-1-01 of the Administrative Code. (3) "Kin" has ...

...(OhioRISE) program. (B) Definitions. (1) "Primary flex funds" are services, equipment, or supplies not otherwise provided through the medicaid state plan benefit or the OhioRISE program that address a youth's identified need as documented in the child and family-centered care plan. Primary flex funds are intended to enhance and supplement the array of services available to a youth enrolled in the OhioRISE program a...

...oRISE) program. (B) Definitions. (1) "Primary flex funds" are services, equipment, or supplies not otherwise provided through the medicaid state plan benefit or the OhioRISE program that address a youth's identified need as documented in the child and family-centered care plan. Primary flex funds are intended to enhance and supplement the array of services available to a youth enrolled in th...

...ule, the following definitions apply: (1) "Bed hold day" means a day for which a bed is reserved for a resident of a PRTF through medicaid reimbursement while the resident is temporarily absent from the PRTF for hospitalization, therapeutic leave, or a family visit. A youth on bed hold day status is not considered discharged from the PRTF. (2) "Direct care costs" are costs for services delivered...

...ome and community-based services (HCBS) 1915(c) waiver (waiver), a youth will be determined by the Ohio department of medicaid (ODM) to meet all of the following: (1) Meet eligibility criteria set forth in paragraphs (A)(1) to (A)(3) of rule 5160-59-02 of the Administrative Code; (2) Be determined to meet the following level of care (LOC) criteria for an inpatient psychiatric (IP) services through an IP LOC assessm...

...and community-based services (HCBS) 1915(c) waiver (waiver), a youth will be determined by the Ohio department of medicaid (ODM) to meet all of the following: (1) Meet eligibility criteria set forth in paragraphs (A)(1) to (A)(3) of rule 5160-59-02 of the Administrative Code; (2) Be determined to meet the following level of care (LOC) criteria for an inpatient psychiatric (IP) services t...

...ome and community-based services (HCBS) 1915(c) waiver (waiver), a youth will be determined by the Ohio department of medicaid (ODM) to meet all of the following: (1) Meet eligibility criteria set forth in paragraphs (A)(1) to (A)(3) of rule 5160-59-02 of the Administrative Code; (2) Be determined to meet the following level of care (LOC) criteria for an inpatient psychiatric (IP) services through an IP LOC assessm...

...ome and community-based services (HCBS) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act 42 U.S.C. 1396n (January 1, 2022), and the providers eligible to deliver those services to youth enrolled on the waiver. (B) Providers seeking to deliver services in the waiver program will meet the criteria in Chapter 5160-59 and set forth in rules 5160-44-02 and 5160-44-31 of t...

...(waiver) established in accordance with 1915(c) of the Social Security Act 42 U.S.C. 1396n (January 1, 2025), and the providers eligible to deliver those services to youth enrolled on the waiver. (B) Providers seeking to deliver services in the waiver program will meet the criteria in Chapter 5160-59 and rules 5160-44-02 and 5160-44-31 of the Administrative Code, as appropriate. Upon prior approval by the Ohio depa...

...rated systems and excellence (OhioRISE) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act, 42 U.S.C. 1396n (January 1, 2022). (B) Definitions. For this rule, the following definitions apply: (1) "Community respite" has the same meaning as set forth in rule 5123-9-22 of the Administrative Code. (2) "Intermediate care facility for individuals with intellectual disabili...

...d systems and excellence (OhioRISE) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act, 42 U.S.C. 1396n (January 1, 2022). (B) Definitions. For this rule, the following definitions apply: (1) "Community respite" has the same meaning as set forth in rule 5123-9-22 of the Administrative Code. (2) "Intermediate care facility for individuals wi...

...rated systems and excellence (OhioRISE) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act 42, U.S.C. 1396n (January 1, 2022). (B) Definitions. For this rule, the following definitions apply: (1) "Homemaker/personal care" has the same meaning as set forth in rule 5123-9-30 of the Administrative Code. (2) "Transitional services and supports" (TSS) is a service designe...

...d systems and excellence (OhioRISE) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act 42, U.S.C. 1396n (January 1, 2022). (B) Definitions. For this rule, the following definitions apply: (1) "Homemaker/personal care" has the same meaning as set forth in rule 5123-9-30 of the Administrative Code. (2) "Transitional services and supports" (TSS) ...

...(waiver) established in accordance with 1915(c) of the Social Security Act 42, U.S.C. 1396n (January 1, 2025). (B) Definitions. For this rule, the following definitions apply: (1) "Homemaker/personal care" has the same meaning as set forth in rule 5123-9-30 of the Administrative Code. (2) "Transitional services and supports" (TSS) is a service designed to provide family stability supports for the youth, primary c...

...rated systems and excellence (OhioRISE) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act, 42 U.S.C. 1396n (January 1, 2022). (B) Definitions. For this rule, the following definitions apply: (1) "Emergency funds" are an additional allotment of waiver funding used for the purchase of approved secondary flex funds based on a youth's unmet needs as ...

...cility (PRTF), as defined in Chapter 5160-59 of the Administrative Code, is to submit cost reports that cover a consecutive twelve-month period of the provider's operations as designated by the department. (A) Effective for medicaid cost reports filed for cost-reporting periods ending in state fiscal year (SFY) 2024, the PRTF will annually complete and submit the ODM 10278 "Ohio Medicaid Psychiatri...

...(A) Chapter 5160-70 of the Administrative Code prescribes the procedures to be followed when medicaid providers seek review of actions or proposed actions of the department, except for any action taken or decision made by the department with respect to entering into or refusing to enter into a contract with a managed care organization pursuant to section 5167.10 of the Revised Code and any action taken under section ...

...(A) Notice of intended action (1) Whenever ODM proposes to take an action that the Ohio general assembly has expressly made subject to the administrative adjudication procedure outlined in Chapter 119. of the Revised Code, ODM shall give notice of the intended action to the party informing the party of the party's right to a hearing. Notice shall be given by certified mail, return receipt requested, and shall, at ...