Ohio Administrative Code Search

...t 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 servi...

...h 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) Providers rendering community behavioral health services will abide by all applicable requirements stated in rules 5160-01-02 and 5160-27-01 of the Administrative Code. (C) With the exception of pharmacists as described in paragraph (A...

...h 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) Providers rendering community behavioral health services shall abide by all applicable requirements stated in rules 5160-01-02 and 5160-27-01 of the Administrative Code. (C) Records related to services reimbursed under this rule are su...

...h 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) Providers rendering community behavioral health services shall abide by all applicable requirements stated in rules 5160-01-02 and 5160-27-01 of the Administrative Code. (C) Records related to services reimbursed under this rule are su...

...ealth 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) Providers rendering community behavioral health services will abide by all applicable requirements stated in rules 5160-01-02 and 5160-27-01 of the Administrative Code. (C) With the exception of pharmacists as described in paragraph (A)(7) of rule 5160-27...

...h 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 li...

...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 wh...

...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 ...

...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 beha...

...er the following ASAM levels of care: (1) LOC 1: outpatient services. LOC 1 services are designed to treat the recipient's 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 managemen...

...cial, 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 individual's needs and completing related doc...

...ited 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 n...

...ness 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 int...

...iction 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 accord...

...iction services (OhioMHAS) in rule 5122-29-14 of the Administrative Code. (B) Eligible providers. (1) Providers eligible to provide MRSS in accordance with rule 5122-29-14 of the Administrative Code and designated by OhioMHAS as regional MRSS providers are eligible for MRSS reimbursement. (2) Eligible rendering providers are MRSS team staff described in rule 5122-29-14 of the Administrative...

...iction services (OhioMHAS) in rule 5122-29-15 of the Administrative Code. (B) Eligible providers. (1) An eligible rendering provider of peer support services is: (a) A person who is eligible to provide peer support services in accordance with rule 5122-29-15.1 of the Administrative Code; and (b) An eligible provider of behavioral health services in accordance with rule 5160-27-01 of the Admini...

...ice clinics are set forth in Chapter 5160-13 of the Administrative Code. (A) "Change in scope of service" is an alteration in aspects of a service such as the procedures or items that are furnished, the frequency with which they are furnished, and the personnel who furnish them. (1) Factors that constitute a change in scope of service include but are not limited to the following examples: (a) The...

...e type of personnel who furnish them. (1) A change in scope of service is characterized by such factors as are specified in the following non-exhaustive list: (a) The addition or discontinuation of a PPS service; (b) The addition or discontinuation of a procedure or class of procedures within a PPS service that involves the skills and training of a higher-level practitioner, such as the expansi...

... of the following FQHC PPS services: (1) In accordance with section 330 of the Public Health Services Act, 42 U.S.C. chapter 6A (October 1, 2021), medical services, which comprise any of four types of services: (a) Services referenced at 42 U.S.C. 1395x(aa)(3) (October 1, 2021), including but not limited to an evaluation and management (E&M) service, another medical or surgical procedure, or th...

...le cost reimbursement," 42 C.F.R. part 413 (October 1, 2021). (B) For purposes of payment determination, an FQHC or RHC submits a cost report in any of the following circumstances: (1) An FQHC or RHC that is newly enrolled as a medicaid provider submits a cost report covering the twelve-month period beginning either on the first day of the first calendar month or on the first day of the first fu...

...RHC or related off-site location. (1) For all FQHC or RHC sites that are already enrolled as medicaid providers, ODM establishes new PVPAs equal to the current PVPAs revised to reflect the latest available medicare economic index (MEI) percentage. The new PVPAs are established by October first of each year and are in effect from October first through the following September thirtieth. (2) Wh...

...RHC or related off-site location. (1) For all FQHC or RHC sites that are already enrolled as medicaid providers, the Ohio department of medicaid (ODM) establishes new PVPAs equal to the current PVPAs revised to reflect the latest available medicare economic index (MEI) percentage. The new PVPAs are established by October first of each year and are in effect from October first through the foll...

...o define the terms used in Chapter 5160-31 of the Administrative Code governing the preadmission screening system providing options and resources today (PASSPORT) home and community-based services (HCBS) waiver program. As used in this chapter: (B) "Activities of Daily Living (ADL)" means activities of daily living as defined in rule 5160-3-05 of the Adminstrative Code. (C) "Assessment" means a...

...o define the terms used in Chapter 5160-31 of the Administrative Code governing the preadmission screening system providing options and resources today (PASSPORT) home and community-based services (HCBS) waiver program. (B) "Assessment" means an evaluation used to obtain information about an individual including their condition, personal goals and preferences, functional limitations, health statu...

...ll of the following requirements: (1) The individual must have been determined eligible for medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code. (2) The cost of waiver services in the person-centered services plan does not exceed the individual cost limit at the time of initial enrollment. The individual cost limit is equal to fourteen thousand and seven hund...