Ohio Administrative Code Search

... forth terms used throughout Chapter 5160-56 of the Administrative Code. (A) "Advance directive" refers to written instructions recognized under state law that are related to the provisions of health care when the individual is incapacitated. Samples of advance directive documents include a living will, a declaration as defined in Chapter 2133. of the Revised Code, and a durable power of attorney ...

... forth terms used throughout Chapter 5160-56 of the Administrative Code. (A) "Advance directive" refers to written instructions recognized under state law that are related to the provisions of health care when the individual is incapacitated. Samples of advance directive documents include a living will, a declaration as defined in Chapter 2133. of the Revised Code, and a durable power of attorney ...

...prior to furnishing hospice care: (1) The designated hospice has a certification of the terminal illness on behalf of the individual, obtained in accordance with 42 C.F.R. 418.22 (October 1, 2017); (2) A hospice election statement, completed by the individual, has been obtained by the designated hospice pursuant to paragraphs (B) and (C) of this rule; (3) The individual has a hospice plan of ...

...prior to furnishing hospice care: (1) The designated hospice has a certification of the terminal illness on behalf of the individual, obtained in accordance with 42 C.F.R. 418.22 (October 1, 2023); (2) A hospice election statement, completed by the individual, has been obtained by the designated hospice pursuant to paragraphs (B) and (C) of this rule; (3) The individual has a hospice plan of ...

...and/or the designated hospice's care: (1) Discharge from the designated hospice's care shall occur when the individual: (a) Dies/expires; (b) No longer meets the hospice enrollment or eligibility criteria; (c) No longer is terminally ill, e.g., physician discharges or does not recertify the individual; (d) Moves out of the service area; (e) Enters a facility where the designated hospice has no a...

...fit or the designated hospice's care: (1) Discharge from the designated hospice's care should occur when the individual: (a) Dies; (b) No longer meets the hospice enrollment or eligibility criteria; (c) No longer is terminally ill, e.g., physician discharges or does not recertify the individual; (d) Moves out of the designated hospice provider's service area; (e) Enters a facility where the desi...

...pice care in accordance with Chapter 5160-56 of the Administrative Code, including individuals who may be covered by third-party insurance, such as medicare, for which the hospice seeks reimbursement. (A) The designated hospice shall report the required enrollment information to the Ohio department of medicaid using the medicaid information technology system (MITS) for the following: (1) Individua...

...ider agreement in accordance with rule 5160-1-17.2 of the Administrative Code. (B) Meet the medicare guidelines in accordance with 42 C.F.R. part 418 (October 1, 2017). (C) Be licensed under Ohio law in accordance with Chapter 3712. of the Revised Code by the Ohio department of health. (D) Comply with all requirements for medicaid providers in Chapter 5160-1 of the Administrative Code. (E) Ensure ...

... in accordance with 42 C.F.R. part 418 (October 1, 2023). (B) Be authorized to provide services under Ohio law in accordance with Chapter 3712. of the Revised Code by the Ohio department of health. (C) Ensure that all hospice employees, volunteers, and contracted staff who provide direct services to hospice individuals are trained, licensed, certified, or registered in accordance with applicable...

...ed personnel pursuant to 42 C.F.R. 418.114 (October 1, 2017), who are employed by the hospice, under an individual contract, or under arrangement with another provider. (D) The following services are covered by medicaid when furnished or arranged by the designated hospice based on the individual's needs, appropriate level of care, and plan of care: (1) Core hospice services may be provided ...

...ed personnel pursuant to 42 C.F.R. 418.114 (October 1, 2023), who are employed by the hospice, under an individual contract, or under arrangement with another provider. (D) The following services are covered by medicaid when furnished or arranged by the designated hospice based on the individual's needs, appropriate level of care, and plan of care: (1) Core hospice services: (a) Nursing ca...

...r the array of services listed in rule 5160-56-05 of the Administrative Code, except for: (1) Services pursuant to paragraph (E) of this rule which are paid directly to the physician; and (2) Services furnished by a non-hospice provider pursuant to paragraph (I) of this rule for the concurrent care of an individual under the age of twenty-one. (B) Reimbursement rates paid by ODM to the designat...

...r the array of services listed in rule 5160-56-05 of the Administrative Code, except for: (1) Services pursuant to paragraph (E) of this rule which are paid directly to the physician; and (2) Services furnished by a non-hospice provider pursuant to paragraph (I) of this rule for the concurrent care of an individual under the age of twenty-one. (B) Reimbursement rates paid by ODM to the designat...

... Ohio's program implementing section 4201 of the American Recovery and Reinvestment Act of 2009 (ARRA), Pub. L. No. 111-5, and the published regulations in 42 C.F.R. Part 495. Certain medicaid eligible professionals and hospitals are eligible to participate in MPIP. Funding for this program ends in 2021. (B) An eligible professional participating in Ohio's MPIP program is a provider that meets el...

... The definitions set forth in rule 5160-26-01 of the Administrative Code apply to the MyCare Ohio rules set forth in Chapter 5160-58 of the Administrative Code. (B) In addition to the definitions set forth in rule 5160-26-01 of the Administrative Code, the following definitions apply to Chapter 5160-58 of the Administrative Code: (1) "Assessment" means a comprehensive evaluation of an individual...

... The definitions set forth in rule 5160-26-01 of the Administrative Code apply to the MyCare Ohio rules set forth in Chapter 5160-58 of the Administrative Code. (B) In addition to the definitions set forth in rule 5160-26-01 of the Administrative Code, the following definitions apply to Chapter 5160-58 of the Administrative Code: (1) "Assessment" means a comprehensive evaluation of an individual...

... The definitions set forth in rule 5160-26-01 of the Administrative Code apply to the MyCare Ohio rules set forth in Chapter 5160-58 of the Administrative Code. (B) In addition to the definitions set forth in rule 5160-26-01 of the Administrative Code, the following definitions apply to Chapter 5160-58 of the Administrative Code: (1) "Assessment" means a comprehensive evaluation of an individual...

...ns (MCPs) in the following rules: (1) Rule 5160-26-05 of the Administrative Code; (2) Rule 5160-26-05.1 of the Administrative Code; (3) Rule 5160-26-06 of the Administrative Code; (4) Rule 5160-26-08.3 of the Administrative Code; (5) Rule 5160-26-09 of the Administrative Code; (6) Rule 5160-26-09.1 of the Administrative Code; (7) Rule 5160-26-10 of the Administrative Code; and ...

...(A) Eligibility. (1) Except as specified in paragraph (A)(2) of this rule, in mandatory service areas as permitted by 42 C.F.R. 438.52 (October 1, 2016), an individual must be enrolled in a MyCare Ohio plan (also known as "plan") if he or she meets all of the following criteria: (a) Age eighteen or older at the time of enrollment in the plan; (b) Eligible for medicare parts A, B and D, and full benefits under the ...

...(A) Eligibility. (1) Except as specified in paragraph (A)(2) of this rule, in mandatory service areas as permitted by 42 C.F.R. 438.52 (October 1, 2021), an individual must be enrolled in a MyCare Ohio plan (MCOP) if he or she meets all of the following criteria: (a) Age eighteen or older at the time of enrollment in the MCOP; (b) Eligible for medicare parts A, B and D, and full benefits under ...

...n") for any of the following reasons: (1) The member becomes ineligible for full medicaid or medicare parts A or B or D. Termination of plan enrollment is effective the end of the last day of the month in which the member became ineligible. (2) The member's permanent place of residence is moved outside the plan's service area. Termination of plan enrollment is effective the end of the last day o...

...OP) for any of the following reasons: (1) The member becomes ineligible for full medicaid or medicare parts A or B or D. Termination of MCOP enrollment is effective the end of the last day of the month in which the member became ineligible. (2) The member's permanent place of residence is moved outside the plan's service area. Termination of MCOP enrollment is effective the end of the last day o...

...OP) for any of the following reasons: (1) The member becomes ineligible for full medicaid or medicare parts A or B or D. Termination of MCOP enrollment is effective the end of the last day of the month in which the member became ineligible. (2) The member's permanent place of residence is moved outside the plan's service area. Termination of MCOP enrollment is effective the end of the last day o...

...et all of the following requirements: (1) Be enrolled in the MyCare Ohio demonstration at the time of application for the MyCare Ohio waiver; (2) Be determined to have a nursing facility-based level of care (i.e., intermediate or skilled) in accordance with rule 5160-3-08 or 5160-3-09 of the Administrative Code; (3) In the absence of the MyCare Ohio waiver, require hospitalization or institutio...

...et all of the following requirements: (1) Be enrolled in the MyCare Ohio demonstration at the time of application for the MyCare Ohio waiver; (2) Be determined to have a nursing facility-based level of care (i.e., intermediate or skilled) in accordance with rule 5160-3-08 or 5160-3-09 of the Administrative Code; (3) In the absence of the MyCare Ohio waiver, require hospitalization or institutio...