Ohio Administrative Code Search

...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...

...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" 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 activities of daily living (IADL) n...

...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....

...covered by the Ohio home care waiver: (1) Home delivered meals as described in rule 5160-44-11 of the Administrative Code (2) Home maintenance and chores as described in rule 5160-44-12 of the Administrative Code (3) Home modification as described in rule 5160-44-13 of the Administrative Code (4) Community integration as described in rule 5160-44-14 of the Administrative Code (5) Personal emer...

...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...

...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) "Vehicle modifications" are adaptations or alterations to an automobile that is identified as the individual's primary means of transportation, that are needed in order to accommodate the needs of the individual. Vehicle modification...

...ons 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) "Supplemental adaptive and assistive device services" are medical equipment, supplies, and devices that not otherwise available through any other funding source and that are suitable to enable the individual to function with greater ...

...ons 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) "Adult day health center services (ADHCS)" are regularly scheduled services delivered at an adult day health center to individuals who are age eighteen years or older. A qualifying adult day health center will be a freestanding buil...

...(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...

... 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...