Ohio Administrative Code Search

...(A) Definitions and explanations. (1) "Multiple-user lactation pump" is a lactation pump that is safe for sequential use by multiple individuals. (The term "hospital-grade," which is often applied to such a pump, is not recognized by the United States food and drug administration.) A multiple-user lactation pump comes with a separate set of accessories (e.g., breast shields, tubing) for each ...

...(A) Definitions. (1) "Sensor-augmented insulin pump system" is an insulin infusion pump equipped with a continuous glucose monitoring (CGM) sensor. The pump uses the glucose readings taken by the CGM sensor to modify the amount of insulin infused. (2) "Insulin pump," for purposes of this rule, is a collective term encompassing a portable external insulin infusion pump and a sensor-augmented insu...

...s chapter of the Administrative Code. (1) "Clinical consultation" is the formal evaluation by a physician or other qualified healthcare professional, performed on the written order of a treating practitioner, of test results that appear to be abnormal. Payment for the clinical consultation is based on the physician fee schedule relative value file published by the centers for medicare and medicai...

...n 42 C.F.R. part 486 subpart C (October 1, 2020). (B) Coverage. (1) The radiology procedures performed by a portable x-ray supplier have both a professional component and a technical component. (a) In general, a portable x-ray supplier performs the technical component of a procedure. (b) A portable x-ray supplier may receive payment for the technical component alone if it performs only the technic...

...(A) Providers. (1) An entity may enroll in medicaid as an independent diagnostic testing facility (IDTF) only if it meets the following criteria: (a) It meets all standards set forth in and provide services in accordance with 42 C.F.R. 410.33 (October 1, 2020); (b) It takes the following measures to establish accountability: (i) It ensures that each supervising practitioner attests in writin...

...gery as authorized under Chapter 4731. of the Revised Code. Advanced practice registered nurses in accordance with rule 5160-4-04 of the Administrative Code or a physician assistant in accordance with rule 5160-4-03 of the Administrative Code have the authority to conduct the face-to-face encounter. The face-to-face encounter with the individual will occur independent of any provision of home ...

...he definition in paragraph (A) of rule 5160-12-04 of the Administrative Code and be more than four hours in length but less than or equal to twelve hours in length per nurse, on the same date or during a twenty-four hour time period, unless: (1) An unforseen event causes a medically necessary scheduled visit to end at four or less hours, or extend beyond twelve hours, up to and including, but no ...

...eet the requirements set forth in rule 5160-12-02 of the Administrative Code, as applicable, which require the individual to receive PDN authorization from the Ohio department of medicaid (ODM) or its designee. (B) The procedures set forth in this paragraph must be followed when securing a PDN authorization for individuals who are not enrolled on a home and community-based services (HCBS) waiver. (1) The PDN provid...

...ider agreement in accordance with rule 5160-1-17.2 of the Administrative Code. (B) MCHHAs are required to: (1) Be certified for medicare participation by the Ohio department of health (ODH) in accordance with Chapter 3701-60 of the Administrative Code. (2) Meet the conditions of participation in accordance with 42 C.F.R. Part 484 (October 1, 2014). (3) Implement policy components for home health and private duty ...

... nursing (PDN) in accordance with rule 5160-12-02 of the Administrative Code. (B) A "non-agency nurse" that meets the requirements in accordance with this rule is eligible to participate in the Ohio medicaid program upon execution of a provider agreement in accordance with rule 5160-1-17.2 of the Administrative Code. A non-agency nurse is required to: (1) Be a registered nurse or licensed practical nurse at the dir...

...ate during the same time period. (1) A visit begins with the provision of a covered service and ends when the in-person or telehealth encounter ends. (2) A visit must have a lapse of time of two or more hours between any previous or subsequent visit for the provision of the same covered service unless the length of a private duty nursing visit requires an agency to provide a change in staff...

...h in appendix A to this rule are: (1) "Base rate", as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid: (a) For the initial thirty-five to sixty minutes of home health aide service delivered; (b) For the initial thirty-five to sixty minutes of home health nursing service delivered; or (c) Up to the first four units of initial home health skilled t...

...h in appendix A to this rule are: (1) "Base rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid: (a) For the initial thirty-five to sixty minutes of home health aide service delivered; (b) For the initial thirty-five to sixty minutes of home health nursing service delivered; or (c) Up to the first four units of initial home health skilled t...

...h in appendix A to this rule are: (1) "Base rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid: (a) For the initial thirty-five to sixty minutes of home health aide service delivered; (b) For the initial thirty-five to sixty minutes of home health nursing service delivered; or (c) Up to the first four units of initial home health skilled t...

...forth in appendix A to this rule are: (1) "Base rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid for the initial thirty-five to sixty minutes of service delivered. (2) "Unit rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid for each fifteen minute units of service delivered when the initial visit is: (a) Greate...

...forth in appendix A to this rule are: (1) "Base rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid for the initial thirty-five to sixty minutes of service delivered. (2) "Unit rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid for each fifteen minute units of service delivered when the initial ...

...forth in appendix A to this rule are: (1) "Base rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid for the initial thirty-five to sixty minutes of service delivered. (2) "Unit rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid for each fifteen minute units of service delivered when the initial ...

...uirements of paragraphs (D)(2) of rule 5160-12-01 and (E)(2) of rule 5160-12-02 of the Administrative Code are not met due to any of the following: (1) Services are not identified on the all services plan when the individual is enrolled on an Ohio department of medicaid (ODM)-administered waiver, and the provider has documented attempts to work with the case manager and the case manager's supervisors to identify the...

...(A) For the purpose of this rule: (1) A "plan of care" is the medical treatment plan that is established, approved, and signed by a treating physician, advance practice nurse or physician's assistant in accordance with the Coronavirus Aid, Relief, and Economic Security (CARES) Act, S.3548 (2020), prior to a provider requesting reimbursement for a service. The plan of care has the same meaning...

...(A) For the purpose of this rule: (1) A "plan of care" is the medical treatment plan that is established, approved, and signed by a treating physician, advance practice nurse or physician's assistant in accordance with the Coronavirus Aid, Relief, and Economic Security (CARES) Act, S.3548 (2020), prior to a provider requesting reimbursement for a service. The plan of care has the same meaning...

...ified in the Revised Code or in agency 5160 of the Administrative Code apply to services addressed in this rule. (B) Definitions. (1) "Clinic" is an entity that meets all of the following criteria: (a) It renders clinic services on an outpatient basis under the direction of a physician or dentist. Clinic services are defined in 42 CFR 440.90 (October 1, 2016). (b) It operates from a fixed location, a specifically...

...ified in the Revised Code or in agency 5160 of the Administrative Code apply to services addressed in this rule. (B) This rule does not apply to federally qualified health centers (FQHCs) nor to rural health clinics (RHCs), policies for which are set forth in Chapter 5160-28 of the Administrative Code. (C) Definition. "Clinic" is an entity that meets all of the following criteria: (1) It render...

...ance with other chapters of agency 5160 of the Administrative Code. (B) The following definitions apply to this chapter: (1) Terms that have the same meaning as in 42 C.F.R. 414.605 (October 1, 2020) include the following items: (a) "Advanced life support, level 1 (ALS1)"; (b) "Advanced life support, level 2 (ALS2)"; (c) "Basic life support (BLS)"; (d) "EMT-basic," "EMT-intermediate, and...

...(A) Definitions. (1) "Private transportation vendor (PTV)" is an entity that meets the following criteria: (a) It seeks to establish or to maintain a contract with a county department of job and family services (CDJFS) to supply transportation service to medicaid recipients in accordance with rule 5160-15-10 of the Administrative Code; and (b) It is not a government agency, transit authority, p...

...(A) Definitions. (1) "Private transportation vendor (PTV)" is an entity that meets the following criteria: (a) It seeks to establish or to maintain a contract with a county department of job and family services (CDJFS) to supply transportation service to medicaid recipients in accordance with rule 5160-15-10 of the Administrative Code; and (b) It is not a government agency, transit authority, p...