Ohio Administrative Code Search

...tered waiver in accordance with rule 5160-46-02 of the Administrative Code will be informed of their rights and responsibilities. Individuals also have choice and control over the arrangement and provision of home and community-based waiver services, and the selection and control over the direction of approved waiver service providers. (A) Individual rights. An individual enrolled in an ODM-administered ...

... planning process outlined in rule 5160-44-02 of the Administrative Code. (B) For purposes of this rule and rule 5160-45-03.5 of the Administrative Code: (1) Home and community-based services (HCBS) are services available under the "Ohio Home Care" and "MyCare" waiver programs as described in chapters 5160-46 and 5160-58 of the Administrative Code. (2) Individuals are people enrolled on or ...

...ervices, equipment, or supplies that: (1) Are not available through the medicaid state plan benefit or a home and community-based services (HCBS) waiver program; (2) Address an individual's assessed need and are included on the person-centered services plan; and (3) Supplement the medicaid state plan benefit and HCBS waiver services to help the individual successfully remain in the communit...

...web portal in accordance with rule 5160-1-17.2 of the Administrative Code. (C) Upon receipt of the waiver provider application, ODM or its designee shall verify all of the following: (1) The provider applicant submits and meets all applicable ODM-administered waiver provider requirements set forth in Chapters 5160-1, 5160-45 and 5160-46 of the Administrative Code. (2) The provider applicant...

...ation 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 applican...

...l include, but not be limited to: (1) A structural review of compliance with all ODM-administered waiver provider requirements in accordance with paragraph (B) of this rule. (2) Investigation of provider occurrences in accordance with paragraph (C) of this rule. (B) Structural reviews. (1) Medicare-certified and otherwise accredited agency providers as defined in rule 5160-45-01 of the ...

...l include, but not be limited to: (1) A structural review of compliance with all ODM-administered waiver provider requirements in accordance with paragraph (B) of this rule. (2) Investigation of provider occurrences in accordance with paragraph (C) of this rule. (B) Structural reviews. (1) Medicare-certified and otherwise accredited agency providers as defined in rule 5160-45-01 of the ...

...7.31, 2907.32, 2907.321, 2907.322, 2907.323, 2907.33, 2909.02, 2909.03, 2909.04, 2909.22, 2909.23, 2909.24, 2911.01, 2911.02, 2911.11, 2911.12, 2911.13, 2913.02, 2913.03, 2913.04, 2913.05, 2913.11, 2913.21, 2913.31, 2913.32, 2913.40, 2913.41, 2913.42, 2913.43, 2913.44, 2913.441, 2913.45, 2913.46, 2913.47, 2913.48, 2913.49, 2913.51, 2917.01, 2917.02, 2917.03, 2917.31, 2919.12, 2919.121, 2919.123, 2...

...7.31, 2907.32, 2907.321, 2907.322, 2907.323, 2907.33, 2909.02, 2909.03, 2909.04, 2909.22, 2909.23, 2909.24, 2911.01, 2911.02, 2911.11, 2911.12, 2911.13, 2913.02, 2913.03, 2913.04, 2913.05, 2913.11, 2913.21, 2913.31, 2913.32, 2913.40, 2913.41, 2913.42, 2913.43, 2913.44, 2913.441, 2913.45, 2913.46, 2913.47, 2913.48, 2913.49, 2913.51, 2917.01, 2917.02, 2917.03, 2917.31, 2919.12, 2919.121, 2919.321, 2...

...istered waiver service providers. (1) ODM and its designee shall conduct ongoing monitoring and oversight of ODM-administered waiver service providers to verify that each provider is: (a) Complying with the terms and conditions of its medicaid provider agreement, the ODM-administered waiver program and all applicable federal, state and local laws and regulations. (b) Ensuring the health and wel...

...atter involving a minor); (y) 2907.323 (illegal use of a minor in nudity-oriented material or performance); (z) 2909.22 (soliciting or providing support for act of terrorism); (aa) 2909.23 (making terroristic threats); (bb) 2909.24 (terrorism); (cc) 2913.40 (medicaid fraud); (dd) If related to another offense under paragraph (C)(1) of this rule, 2923.01 (conspiracy), 2923.02 (at...

...atter involving a minor); (y) 2907.323 (illegal use of a minor in nudity-oriented material or performance); (z) 2909.22 (soliciting or providing support for act of terrorism); (aa) 2909.23 (making terroristic threats); (bb) 2909.24 (terrorism); (cc) 2913.40 (medicaid fraud); (dd) If related to another offense under paragraph (C)(1) of this rule, 2923.01 (conspiracy), 2923.02 (at...

...ll of the following requirements: (1) Be between the ages of birth through age fifty-nine. (2) Be determined eligible for Ohio medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code.; (3) Participate in an initial assessment to determine if the individual has needs that can be met through the Ohio home care waiver program. (4) Be determined to have a nursing ...

...ll of the following requirements: (1) Be between the ages of birth through age fifty-nine. (2) Be determined eligible for Ohio medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code. (3) Participate in an initial assessment to determine if the individual has needs that can be met through the Ohio home care waiver program. (4) Be determined to have a nursing ...

...s of participation set forth in rule 5160-44-31 of the Administrative Code. Services are reimbursed in accordance with rule 5160-46-06 of the Administrative Code. (A) Personal care aide services. (1) "Personal care aide services" are defined as services provided pursuant to the person-centered services plan that assist the individual with activities of daily living (ADL) and instrumental activit...

...s of participation set forth in rule 5160-44-31 of the Administrative Code. Services are reimbursed in accordance with rule 5160-46-06 of the Administrative Code. (A) Personal care aide services. (1) "Personal care aide services" are defined as services provided pursuant to the person-centered services plan that assist the individual with activities of daily living (ADL) and instrumental activit...

...s of participation set forth in rule 5160-44-31 of the Administrative Code. Services are reimbursed in accordance with rule 5160-46-06 of the Administrative Code. (A) Personal care aide services. (1) "Personal care aide services" are defined as services provided pursuant to the person-centered services plan (PCSP) that assist the individual with activities of daily living (ADL) and instrumental...

...ed for billing and calculating rates. (1) "Base rate," as used in table A, column 3 of paragraph (B) of this rule, means the amount reimbursed by the Ohio department of medicaid (ODM) for the first thirty-five to sixty minutes of service delivered. (2) "Bid rate," as used in table B, column 3 of paragraph (B) of this rule, means the per job bid rate negotiated between the provider and the individual's case manager....

...ed for billing and calculating rates. (1) "Base rate," as used in table A, column 3 of paragraph (B) of this rule, means the amount reimbursed by the Ohio department of medicaid (ODM) for the first thirty-five to sixty minutes of service delivered. (2) "Bid rate," as used in table B, column 3 of paragraph (B) of this rule, means the per job bid rate negotiated between the provider and the individual's case manager....

...care attendant services (HCAS) rates. (1) "Base rate," as set forth in column 3 of tables A and B of this rule, means the amount reimbursed by Ohio medicaid for the first thirty-five to sixty minutes of assistance with self-administration of medications and the performance of nursing tasks provided during a single visit. (2) "Continuous nursing" means nursing services (waiver nursing and/or private duty nursing) th...

...(A) Purpose. (1) This rule specifies the conditions for medicaid payment of targeted case management (TCM), which is comprised of those activities described in section 5126.15 of the Revised Code and in rule 5123:2-1-11 of the Administrative Code, but only to the extent that they are listed in paragraph (D) of this rule as reimbursable activities for medicaid eligible individuals with developmental disabilities. (2...

...(A) Purpose. (1) This rule specifies the conditions for medicaid payment of targeted case management (TCM), which is associated with activities described in section 5126.15 of the Revised Code and in rule 5123-4-02 of the Administrative Code, but only to the extent that they are listed in paragraph (D) of this rule as reimbursable activities for medicaid eligible individuals with developmental di...

...(A) Purpose. (1) This rule specifies the conditions for medicaid payment of targeted case management (TCM), which is associated with activities described in section 5126.15 of the Revised Code and in rule 5123-4-02 of the Administrative Code, but only to the extent that they are listed in paragraph (D) of this rule as reimbursable activities for medicaid eligible individuals with intellectual and...

... community setting. (B) Definitions (1) "Assessment" means an in-person meeting with the HOME choice applicant to determine eligibility for the program, conducted by the Ohio department of medicaid (ODM) or its designee. (2) "Community setting" means a location that meets the home and community-based setting requirements set forth in rule 5160-44-01 of the Administrative Code or for those moving f...

... community setting. (B) Definitions (1) "Community setting" means a location that meets the home and community-based setting requirements set forth in rule 5160-44-01 of the Administrative Code or for those moving from an intermediate care facility for individuals with intellectual disabilities the requirements set forth in rule 5123:2-9-02 of the Administrative Code. (2) "HOME choice part...