Ohio Administrative Code Search

...tities (MCEs) in the following rules: (1) Rule 5160-26-05 of the Administrative Code with the exception of paragraphs (B)(4), (B)(5), (D)(21), (D)(25), and (D)(26); (2) Rule 5160-26-05.1 of the Administrative Code with the exception of paragraph (B)(1); (3) Rule 5160-26-06 of the Administrative Code; (4) Rule 5160-26-08.3 of the Administrative Code with the exception of paragraphs (A)(19) and ...

...eligibility and enrollment in rule 5160-59-02.1 of the Administrative Code or the criteria in paragraphs (A)(1) to (A)(3) and either paragraph (A)(4), (A)(5), (A)(6) or (B) of this rule. (1) Be twenty years of age or younger at the time of enrollment; (2) Be determined eligible for Ohio medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code; (3) Not be enrolled...

...eligibility and enrollment in rule 5160-59-02.1 of the Administrative Code or the criteria in paragraphs (A)(1) to (A)(3) and either paragraph (A)(4), (A)(5), (A)(6) or (B) of this rule. (1) Be twenty years of age or younger at the time of enrollment; (2) Be determined eligible for Ohio medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code; (3) Not be enrolled...

...eligibility and enrollment in rule 5160-59-02.1 of the Administrative Code or the criteria in paragraphs (A)(1) to (A)(3) and either paragraph (A)(4), (A)(5), (A)(6) or (B) of this rule. (1) Be twenty years of age or younger at the time of enrollment; (2) Be determined eligible for Ohio medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code; (3) Not be enrolled...

...eligibility and enrollment in rule 5160-59-02.1 of the Administrative Code or the criteria in paragraphs (A)(1) to (A)(3) along with either paragraph (A)(4), (A)(5), (A)(6) or (B) of this rule. (1) Be twenty years of age or younger at the time of enrollment; (2) Be determined eligible for Ohio medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code; (3) Not be e...

...olled in OhioRISE as set forth in rule 5160-59-02 of the Administrative Code. (B) Eligibility. For individuals who meet criteria in paragraphs (B)(1) to (B)(4) of this rule, enrollment will be mandatory in the OhioRISE program on the first day the program is in effect: (1) Be twenty years of age or younger; (2) Be determined eligible for Ohio medicaid in accordance with Chapters 5160:1-1 to...

...llence (OhioRISE) plan has to ensure: (1) Services are sufficient in amount, duration, and scope to reasonably be expected to achieve the purpose for which the services are provided; (2) The amount, duration, and scope of a medically necessary service is not arbitrarily denied or reduced solely because of the diagnosis, type of illness, or condition; (3) Prior authorization is available for ser...

... of the care provided to the member. (1) The OhioRISE plan has to ensure decisions rendered through the UM program are based on medical necessity. (2) The UM program has to be based on written policies and procedures that include, at a minimum: (a) The information sources used to make determinations of medical necessity; (b) The criteria, based on sound clinical evidence, to make UM decision...

... youth or family capacity and choice. (1) Moderate care coordination (MCC) is recommended for youth six years of age and older when paragraph (A)(1)(a) and either paragraph (A)(1)(b) or (A)(1)(c) of this rule are met: (a) An Ohio children's initiative child and adolescent needs and strengths (CANS) assessment, the tool available on https://www.medicaid.ohio.gov (September 20, 2021), indicates for behavioral/emotion...

... youth or family capacity and choice. (1) Moderate care coordination (MCC) is recommended for youth six years of age and older when paragraph (A)(1)(a) and either paragraph (A)(1)(b) or (A)(1)(c) of this rule are met: (a) An Ohio children's initiative child and adolescent needs and strengths (CANS) assessment, the tool available on https://www.medicaid.ohio.gov (September 20, 2021), indicates fo...

... addiction services (OhioMHAS) in rule 5122-29-28 of the Administrative Code. (C) Eligible providers of IHBT services. (1) Providers eligible for medicaid payment for IHBT will: (a) Meet the criteria in paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code; and (b) Provide the service in accordance with rule 5122-29-28 of the Administrative Code. (D) Coverage. (1) Payment may be made for IHBT...

...iction services (OhioMHAS) in rule 5122-29-28 of the Administrative Code. (C) Eligible providers of IHBT services. (1) Providers eligible for medicaid payment for IHBT will: (a) Meet the criteria in paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code; and (b) Provide the service in accordance with rule 5122-29-28 of the Administrative Code. (D) Coverage. (1) Payment may ...

...ule, the following definitions apply: (1) "Behavioral health respite services" are services that provide short-term, temporary relief to the primary caregiver of an OhioRISE plan enrolled youth, in order to support and preserve the primary caregiving relationship. (2) "Foster home" has the same meaning as "certified foster home" in rule 5101:2-1-01 of the Administrative Code. (3) "Kin" has the same meaning as in r...

... the following definitions apply: (1) "Behavioral health respite services" are services that provide short-term, temporary relief to the primary caregiver of an OhioRISE plan enrolled youth, in order to support and preserve the primary caregiving relationship. (2) "Foster home" has the same meaning as "certified foster home" in rule 5101:2-1-01 of the Administrative Code. (3) "Kin" has ...

...(OhioRISE) program. (B) Definitions. (1) "Primary flex funds" are services, equipment, or supplies not otherwise provided through the medicaid state plan benefit or the OhioRISE program that address a youth's identified need as documented in the child and family-centered care plan. Primary flex funds are intended to enhance and supplement the array of services available to a youth enrolled in the OhioRISE program a...

...oRISE) program. (B) Definitions. (1) "Primary flex funds" are services, equipment, or supplies not otherwise provided through the medicaid state plan benefit or the OhioRISE program that address a youth's identified need as documented in the child and family-centered care plan. Primary flex funds are intended to enhance and supplement the array of services available to a youth enrolled in th...

...ule, the following definitions apply: (1) "Bed hold day" means a day for which a bed is reserved for a resident of a PRTF through medicaid reimbursement while the resident is temporarily absent from the PRTF for hospitalization, therapeutic leave, or a family visit. A youth on bed hold day status is not considered discharged from the PRTF. (2) "Direct care costs" are costs for services delivered...

...ome and community-based services (HCBS) 1915(c) waiver (waiver), a youth will be determined by the Ohio department of medicaid (ODM) to meet all of the following: (1) Meet eligibility criteria set forth in paragraphs (A)(1) to (A)(3) of rule 5160-59-02 of the Administrative Code; (2) Be determined to meet the following level of care (LOC) criteria for an inpatient psychiatric (IP) services through an IP LOC assessm...

...and community-based services (HCBS) 1915(c) waiver (waiver), a youth will be determined by the Ohio department of medicaid (ODM) to meet all of the following: (1) Meet eligibility criteria set forth in paragraphs (A)(1) to (A)(3) of rule 5160-59-02 of the Administrative Code; (2) Be determined to meet the following level of care (LOC) criteria for an inpatient psychiatric (IP) services t...

...ome and community-based services (HCBS) 1915(c) waiver (waiver), a youth will be determined by the Ohio department of medicaid (ODM) to meet all of the following: (1) Meet eligibility criteria set forth in paragraphs (A)(1) to (A)(3) of rule 5160-59-02 of the Administrative Code; (2) Be determined to meet the following level of care (LOC) criteria for an inpatient psychiatric (IP) services through an IP LOC assessm...

...ome and community-based services (HCBS) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act 42 U.S.C. 1396n (January 1, 2022), and the providers eligible to deliver those services to youth enrolled on the waiver. (B) Providers seeking to deliver services in the waiver program will meet the criteria in Chapter 5160-59 and set forth in rules 5160-44-02 and 5160-44-31 of t...

...rated systems and excellence (OhioRISE) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act, 42 U.S.C. 1396n (January 1, 2022). (B) Definitions. For this rule, the following definitions apply: (1) "Community respite" has the same meaning as set forth in rule 5123-9-22 of the Administrative Code. (2) "Intermediate care facility for individuals with intellectual disabili...

...d systems and excellence (OhioRISE) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act, 42 U.S.C. 1396n (January 1, 2022). (B) Definitions. For this rule, the following definitions apply: (1) "Community respite" has the same meaning as set forth in rule 5123-9-22 of the Administrative Code. (2) "Intermediate care facility for individuals wi...

...rated systems and excellence (OhioRISE) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act 42, U.S.C. 1396n (January 1, 2022). (B) Definitions. For this rule, the following definitions apply: (1) "Homemaker/personal care" has the same meaning as set forth in rule 5123-9-30 of the Administrative Code. (2) "Transitional services and supports" (TSS) is a service designe...

...d systems and excellence (OhioRISE) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act 42, U.S.C. 1396n (January 1, 2022). (B) Definitions. For this rule, the following definitions apply: (1) "Homemaker/personal care" has the same meaning as set forth in rule 5123-9-30 of the Administrative Code. (2) "Transitional services and supports" (TSS) ...