Ohio Administrative Code Search

... and recovery management contractors: (1) ODM and/or its designee (hereafter referred to as ODM) shall conduct ongoing monitoring and oversight of providers and contractors, to verify each provider is: (a) Complying with the terms and conditions of its medicaid provider agreement or contract, the program and all applicable federal, state and local regulations; (b) Ensuring the health and welfar...

... recovery management contractors: (1) ODM and/or its designee (hereafter referred to as ODM) shall conduct ongoing monitoring and oversight of providers and contractors, to verify each provider is: (a) Complying with the terms and conditions of its medicaid provider agreement or contract, the program and all applicable federal, state and local regulations; (b) Ensuring the health and welfar...

...ed for billing and calculating rates. (1) "Billing unit" as used in column 4 of paragraph (C) of this rule, means a single fixed item, amount of time or measurement. (2) "Unit rate" as used in column 3 of paragraph (C) of this rule, means the amount reimbursed by the Ohio department of medicaid (ODM) for each fifteen minutes of service delivered. (B) Payment rates for individualized placement and support - support...

...ed for billing and calculating rates. (1) "Billing unit" as used in column 4 of paragraph (C) of this rule, means a single fixed item, amount of time or measurement. (2) "Unit rate" as used in column 3 of paragraph (C) of this rule, means the amount reimbursed by the Ohio department of medicaid (ODM) for each fifteen minutes of service delivered. (B) Payment rates for individualized placement and support - support...

...or billing and calculating rates. (1) "Billing unit" as used in column 4 of paragraph (C) of this rule, means a single fixed item, amount of time or measurement. (2) "Unit rate" as used in column 3 of paragraph (C) of this rule, means the amount reimbursed by the Ohio department of medicaid (ODM) for each fifteen minutes of service delivered, not to exceed a maximum of 8.5 units of service p...

...ed for billing and calculating rates. (1) "Billing unit" as used in column 4 of paragraph (C) of this rule, means a single fixed item, amount of time or measurement. (2) "Unit rate" as used in column 3 of paragraph (C) of this rule, means the amount reimbursed by the Ohio department of medicaid (ODM) for each fifteen minutes of service delivered. (B) Payment rates for individualized placement and support - support...

...B) For the purposes of this rule: (1) "Agency" means an entity certified by the Ohio department of mental health and addiction services under section 5119.36 of the Revised Code. (2) "Chief administrator" means the head of an agency, or his or her designee. (3) "Criminal records check" has the same meaning as in section 109.572 of the Revised Code. (4) "Disqualifying offense" means...

...B) For the purposes of this rule: (1) "Agency" means an entity certified by the Ohio department of mental health and addiction services under section 5119.36 of the Revised Code. (2) "Chief administrator" means the head of an agency, or his or her designee. (3) "Criminal records check" has the same meaning as in section 109.572 of the Revised Code. (4) "Disqualifying offense" means...

...B) For the purposes of this rule: (1) "Agency" means an entity certified by the Ohio department of mental health and addiction services under section 5119.36 of the Revised Code. (2) "Chief administrator" means the head of an agency, or his or her designee. (3) "Criminal records check" has the same meaning as in section 109.572 of the Revised Code. (4) "Disqualifying offense" means...

...er program authorized under section 1915(c) of the Social Security Act (as in effect on January 1, 2020) or the Ohio medicaid state plan authorized under section 1915(i) of the Social Security Act (as in effect on January 1, 2020) must reside in and/or receive HCBS in a private residence or another setting that meets the home and community-based setting requirements set forth in this rule. (1) A ...

...er program authorized under section 1915(c) of the Social Security Act (as in effect on January 1, 2021) or the Ohio medicaid state plan authorized under section 1915(i) of the Social Security Act (as in effect on January 1, 2021) must reside in and/or receive HCBS in a private residence or another setting that meets the home and community-based setting requirements set forth in this rule. (1) A ...

...er program authorized under section 1915(c) of the Social Security Act (as in effect on January 1, 2023) or the Ohio medicaid state plan authorized under section 1915(i) of the Social Security Act (as in effect on January 1, 2023) have to reside in and/or receive HCBS in a private residence or another setting that meets the home and community-based setting requirements set forth in this rule. (1)...

...er program authorized under section 1915(c) of the Social Security Act (as in effect on January 1, 2016) or the Ohio medicaid state plan authorized under section 1915(i) of the Social Security Act (as in effect on January 1, 2016) will lead the person-centered planning process where possible. The individual's authorized representative should have a participatory role, as needed, and as defined by ...

...er program authorized under section 1915(c) of the Social Security Act (as in effect on January 1, 2021) or the Ohio medicaid state plan authorized under section 1915(i) of the Social Security Act (as in effect on January 1, 2021) will lead the person-centered planning process where possible. The individual's authorized representative should have a participatory role, as needed, and as defined by ...

...er program authorized under section 1915(c) of the Social Security Act (as in effect on January 1, 2024) or the Ohio medicaid state plan authorized under section 1915(i) of the Social Security Act (as in effect on January 1, 2024) will lead the person-centered planning process where possible. The individual's authorized representative should have a participatory role, as needed, and as defined by ...

... the following definitions apply: (1) "Care management entity" means an entity delegated or contracted by ODA or ODM to perform care management activities and related functions for individuals enrolled on a waiver, or enrolled concurrently on the MyCare Ohio managed care program and the SRS program. (2) "Critical incident" means incidents identified in paragraph (C) of this rule. (3) "...

... the following definitions apply: (1) "Care management entity" (CME) means the agency described in rule 5160-59-03.2 of the Administrative Code. (2) "Health and safety action plan" or "HSAP" means a document developed by the waiver case management agency or recovery management agency that identifies situations, circumstances, and behaviors that without intervention may jeopardize the ind...

... shall include an overnight stay. (1) An out-of-home respite provider shall make available the following: (a) Waiver nursing services as set forth in rule 5160-44-22 of the Administrative Code; (b) Personal care services as set forth in rule 5160-46-04 of the Administrative Code if the individual is enrolled on an Ohio department of medicaid (ODM) -administered waiver, or rule 173-39-02.11 of t...

...e will include an overnight stay. (1) An out-of-home respite provider will make available the following: (a) Waiver nursing services as set forth in rule 5160-44-22 of the Administrative Code; (b) Personal care services as set forth in rule 5160-46-04 of the Administrative Code if the individual is enrolled on an Ohio department of medicaid (ODM) -administered waiver, or rule 173-39-02.11 of th...

... (LPN) at the direction of an RN. (1) All nurses providing waiver nursing services to individuals shall: (a) Possess a current, valid and unrestricted license with the Ohio board of nursing; (b) Possess an active medicaid provider agreement or be employed by an entity that has an active medicaid provider agreement; and (c) Provide services within the nurse's scope of practice as set forth in ...

... (LPN) at the direction of an RN. (1) All nurses providing waiver nursing services to individuals will: (a) Possess a current, valid and unrestricted license with the Ohio board of nursing; and (b) Possess an active medicaid provider agreement or be employed by an entity that has an active medicaid provider agreement; and (c) Provide services within the nurse's scope of practice as set forth ...

...S) setting that is compliant with rule 5160-44-01 of the Administrative Code. Community transition services: (1) Include expenses necessary to enable an individual to establish a basic household. Examples include: (a) Security deposits and rental expenses required to obtain a residential lease; (b) Basic household items required to occupy and maintain housing, including window coverings, food p...

...etting that is compliant with rule 5160-44-01 of the Administrative Code. Community transition: (1) Community transition includes the following: (a) Expenses necessary to enable an individual to establish a basic household. Examples include: (i) Security deposits and rental fees needed to obtain a lease on an apartment or home and rental expenses required to obtain a residential lease;...

...ce" has the same meaning as in section 3719.01 of the Revised Code. (4) "Custodian" has the same meaning as in section 2151.011 of the Revised Code. (5) "Gastrostomy tube" means a percutaneously inserted catheter that terminates in the stomach. (6) "Group setting" means a situation in which a home care attendant service provider furnishes home care attendant services in accordance with thi...

...ce" has the same meaning as in section 3719.01 of the Revised Code. (4) "Custodian" has the same meaning as in section 2151.011 of the Revised Code. (5) "Gastrostomy tube" means a percutaneously inserted catheter that terminates in the stomach. (6) "Group setting" means a situation in which a home care attendant service provider furnishes home care attendant services in accordance with thi...