Ohio Administrative Code Search

...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...

... (ODM) in accordance with sections 5162.35 and 173.52 of the Revised Code. ODA will establish processes and procedures to enroll individuals on the waiver that is in accordance with rule 173-42-03 of the Administrative Code. (B) An individual is eligible for the medicaid-funded component of the PASSPORT program only if the individual meets all of the following criteria: (1) The individual is ...

...ASSPORT services in appendix A to rule 5160-1-06.1 of the Administrative Code. Payment for PASSPORT waiver services constitutes payment in full and shall not be construed as a partial payment when the payment amount is less than the provider's usual and customary rate. The provider shall not bill the individual for any difference between the medicaid payment and the provider's rate or request the ...

...ASSPORT services in appendix A to rule 5160-1-06.1 of the Administrative Code. Payment for PASSPORT waiver services constitutes payment in full and will not be construed as a partial payment when the payment amount is less than the provider's usual and customary rate. In accordance with rule 5160-1-13.1 of the Administrative Code, the provider will not bill the individual for any difference betwee...

...EVV program, required under Section 1903 of the Social Security Act (42 U.S.C. 1396b) as in effect on the effective date of this rule. (B) For purposes of this chapter, EVV is the use of technology to verify certain data elements related to the delivery of medicaid-covered services. (C) Ohio medicaid services subject to the EVV program include any medicaid state plan or 1915 (c) home and c...

...is to define the terms used in Chapter 5160-33 of the Administrative Code governing the medicaid assisted living HCBS waiver program. As used in this chapter: (B) "ADL" means activities of daily living including bathing; grooming; toileting; dressing; eating; and mobility, which refers to bed mobility, transfer, and locomotion as these are defined in 5160-3-05 of the Administrative Code. (C) "Assessment" means a...

...o define the terms used in Chapter 5160-33 of the Administrative Code governing the medicaid assisted living HCBS waiver program. As used in this chapter: (B) "Assessment" means a face-to-face evaluation used to obtain information about an individual including his or her condition, personal goals and preferences, functional limitations, health status and other factors that are relevant to the au...

...l must meet all of the following: (1) Be eligible for medicaid in accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative Code. (2) Have an intermediate or skilled level of care in accordance with rule 5160-3-08 of the Administrative Code. If the individual requires skilled nursing care beyond supervision of special diets, application of dressings, or administration of medica...

...l must meet all of the following: (1) Be eligible for medicaid in accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative Code. (2) Have an intermediate or skilled level of care in accordance with rule 5160-3-08 of the Administrative Code. If the individual requires skilled nursing care beyond supervision of special diets, application of dressings, or administration of medica...

...r enrollment, an individual must: (1) Have been determined to meet the eligibility requirements set forth in rule 5160-33-03 of the Administrative Code; and (2) Upon initial and continued enrollment, reside in an approved living unit in accordance with paragraph (C) of rule 173-38-03 of the Administrative Code, located in a licensed residential care facility (RCF) certified by the Ohio depar...

... accordance with the provisions of rule 173-39-03 of the Administrative Code. (C) Individuals enrolled in the assisted living HCBS waiver shall be given a free choice of qualified providers in accordance with rule 173-42-06 of the Administrative Code and 42 C.F.R. 431.51 (as in effect on October 1, 2016).

...provider in accordance with Chapter 173-39 of the Administrative Code. (C) Individuals enrolled in the assisted living HCBS waiver are given a free choice of qualified providers in accordance with rule 173-42-06 of the Administrative Code and 42 C.F.R. 431.51 (as in effect on October 1, 2021).

...as set forth in appendix A to rule 5160-1-06.5 of the Administrative Code. (B) Provider rates are determined for the following categories: (1) Per-job bid rate or deposit made. (2) Unit rate. (C) A per-job bid rate or deposit made shall be determined on a per-job basis for the community transition service as set forth in rule 173-39-02.17 of the Administrative Code. The cost per job shall b...

...ram (IEP) is as defined in section 3323.011 of the Revised Code. (9) Licensed practitioner of the healing arts: for purposes of these rules, includes the qualified practitioners delineated in rule 5160-35-05 of the Administrative Code. (10) Local education agency: school districts of the state as defined in sections 3311.01 to 3311.05 of the Revised Code. (11) Medicaid authorized prescriber: a...

...n MSP provider. (B) An MSP provider: (1) Is one of the following: (a) A local education agency (LEA) city school district, local school district, exempted village school district, or any other school district as defined in sections 3311.01 to 3111.05 of the Revised Code; (b) A state school for the deaf as defined by section 3325.01 of the Revised Code; (c) A state school for the blind as defined by...

... (MSP) providers as defined in Chapter 5160-35 of the Administrative Code. (B) The CPT (common procedural terminology) and HCPCS (healthcare common procedure coding system) covered services provided through MSP providers that are allowable for medicaid reimbursement are listed on the department's website, http://medicaid.ohio.gov and are provided in accordance with Chapter 5160-35 and rule 5160-8...

...services an MSP provider may provide: (1) Occupational therapy services: (a) Description: services that evaluate and treat, as well as services to analyze, select, and adapt activities for an eligible child whose functioning is impaired by developmental deficiencies, physical injury or illness. The occupational therapy service will be recommended by a licensed occupational therapist acting withi...

...verage, beyond those indicated in rule 5160-35-05 of the Administrative Code, that a MSP provider can provide, and to set forth the conditions for providing the services. (B) In addition to the services indicated in rule 5160-35-05 of the Administrative Code, a MSP provider may render and receive payment for the following services: (1) Transportation: (a) For purposes of Chapter 5160-35 of the Adm...

...e" has the same meaning as in rule 5160:1-1-01 of the Administrative Code. (B) "Capitated payment" means the monthly payment paid to the program of all inclusive care for the elderly PACE organization by the Ohio department of medicaid (ODM) for medical care and services provided to medicaid recipients enrolled in PACE. (C) "Individual" is the applicant for or recipient of a medical assistance p...

...(A) In accordance with section 173.50 of the Revised Code, the Ohio department of aging (ODA) shall serve as the designated state administering agency for PACE and shall adhere to and monitor the implementation of all applicable requirements for the program's administration as set forth in 42 C.F.R Part 460 as in effect on October 1, 2019. (B) ODA shall: (1) Facilitate the process in which ...

...rticipant eligibility set forth in rule 173-50-02 of the Administrative Code. (B) Individuals seeking enrollment in PACE through medicaid shall be determined by their county department of job and family services (CDJFS) to be eligible for Ohio medicaid in accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative Code. (C) If a PACE participant who is also enrolled in medicaid has a per...

...rticipant eligibility set forth in rule 173-50-02 of the Administrative Code and will have been determined to be eligible for medicaid in accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative Code. (B) If a PACE participant who is also enrolled in medicaid has a continuous period of institutionalization as defined in rule 5160:1-6-01.1 of the Administrative Code, that individual's p...

...R. Part 460 as in effect on October 1, 2019. (B) PACE organizations shall ensure that all participants have access to all medically necessary services including, but not limited to, services covered by Ohio's medicaid program, in addition to those prescribed in 42 C.F.R. Part 460.92 as in effect on October 1, 2019 to 42 C.F.R. Part 460.96 as in effect on October 1, 2019. (1) Services provided ...

... permitted under 42 C.F.R. Part 460.182(c) as in effect on October 1, 2019.

...(A) Purpose (1) The purpose of this rule is to establish the individual options waiver as a component of the medicaid home and community-based services program pursuant to sections 5166.02 and 5166.20 of the Revised Code. (2) The individual options waiver program provides necessary waiver services to individuals who meet the criteria for a developmental disabilities level of care in accordance w...