Ohio Administrative Code Search

...(A) To be eligible for enrollment in the Ohio resilience through integrated systems and excellence (OhioRISE) program, an individual has to meet the criteria for first day 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 younge...

...(A) To be eligible for enrollment in the Ohio resilience through integrated systems and excellence (OhioRISE) program, an individual has to meet either the criteria for first day 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 ...

...(A) Scope. This rule sets forth the provisions for eligibility and enrollment into Ohio resilience through integrated systems and excellence (OhioRISE) on the first day the program is effective. Individuals that do not meet the OhioRISE first day eligibility criteria described in paragraph (B) of this rule will have the opportunity to be enrolled in OhioRISE as set forth in rule 5160-59-02 of the ...

...(A) The Ohio resilience through integrated systems and excellence (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, ...

...(A) The Ohio resilience through integrated systems and excellence (OhioRISE) plan will assign a care coordination tier for all youth eligible for enrollment in the OhioRISE plan. Tier assignment of limited, moderate, or intensive is based on assessed or indicated needs and may be modified to be based on individual circumstances or to best fit the youth or family capacity and choice. (1) Moderate care coordination (M...

...(A) The Ohio resilience through integrated systems and excellence (OhioRISE) plan will assign a care coordination tier for all youth eligible for enrollment in the OhioRISE plan. Tier assignment of limited, moderate, or intensive is based on assessed or indicated needs and may be modified to be based on individual circumstances or to best fit the youth or family capacity and choice. (1) Moderate ...

...(A) Scope. This rule sets forth provisions governing coverage for primary flex funds provided as part of the Ohio resilience through integrated systems and excellence (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...

...(A) Scope. This rule sets forth provisions governing coverage for primary flex funds provided as part of the Ohio resilience through integrated systems and excellence (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...

...(A) This rule sets forth provisions governing coverage for the psychiatric residential treatment facility (PRTF) service furnished as part of the Ohio resilience through integrated systems and excellence (OhioRISE) program. (B) Definitions. For purposes of this rule, the following definitions apply: (1) "Bed hold day" means a day for which a bed is reserved for a resident of a PRTF through m...

...(A) To be eligible for the Ohio resilience through integrated systems and excellence (OhioRISE) home 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 ...

...(A) To be eligible for the Ohio resilience through integrated systems and excellence (OhioRISE) home 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 determine...

...(A) To be eligible for the Ohio resilience through integrated systems and excellence (OhioRISE) home 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 ...

...(A) Scope. This rule sets forth provisions governing coverage for transitional services and supports provided as part of the Ohio resilience through integrated 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 ...

...(A) Scope. This rule sets forth provisions governing coverage for transitional services and supports provided as part of the Ohio resilience through integrated 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: ...

...(A) Scope. This rule sets forth provisions governing coverage for transitional services and supports provided as part of the Ohio resilience through integrated systems and excellence (OhioRISE) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act 42, U.S.C. 1396n (January 1, 2025). (B) Definitions. For this rule, the following definitions apply: (1) "Homemaker/personal care" ha...

...For cost reporting purposes, each eligible psychiatric residential treatment facility (PRTF), as defined in Chapter 5160-59 of the Administrative Code, is to submit cost reports that cover a consecutive twelve-month period of the provider's operations as designated by the department. (A) Effective for medicaid cost reports filed for cost-reporting periods ending in state fiscal year (SFY) 2024, the P...

...(A) Chapter 5160-70 of the Administrative Code prescribes the procedures to be followed when medicaid providers seek review of actions or proposed actions of the department, except for any action taken or decision made by the department with respect to entering into or refusing to enter into a contract with a managed care organization pursuant to section 5167.10 of the Revised Code and any action taken under section ...

...(A) Notice of intended action (1) Whenever ODM proposes to take an action that the Ohio general assembly has expressly made subject to the administrative adjudication procedure outlined in Chapter 119. of the Revised Code, ODM shall give notice of the intended action to the party informing the party of the party's right to a hearing. Notice shall be given by certified mail, return receipt requested, and shall, at ...

...(A) Making a request for hearing (1) A request for hearing must be submitted to the depository agent in writing by the medical assistance recipient or by the medical assistance recipient's authorized representative or attorney and shall be subject to the requirements of this rule. (2) The request for hearing shall address only the issue of whether the amount determined for reimbursement...

...(A) This rule contains definitions generally used in determining eligibility for medical assistance. (B) Definitions. (1) "Abuse" means any action by an individual or entity that results in unnecessary costs to the medical assistance program. (2) "Administrative agency" means the Ohio department of medicaid (ODM) and/or an agent of ODM authorized to determine eligibility for a medical assistance program. (3) "Ali...

...(A) This rule contains definitions generally used in determining eligibility for medical assistance. (B) Definitions. (1) "Abuse" means any action by an individual or entity that results in unnecessary costs to the medical assistance program in accordance with 42 C.F.R 455.2 (as in effect October 1, 2021). (2) "Administrative agency" means the Ohio department of medicaid (ODM) and/or an agent o...

...(A) This rule contains definitions generally used in determining eligibility for medical assistance. (B) Definitions. (1) "Abuse" means any action by an individual or entity that results in unnecessary costs to the medical assistance program in accordance with 42 C.F.R 455.2 (as in effect October 1, 2022). (2) "Administrative agency" means the Ohio department of medicaid (ODM) and/or an agent o...

...(A) Medicaid will not pay for services provided under the conditions set out in paragraph (C) of this rule, even if an individual has been found eligible for a medical assistance category and is enrolled in medicaid. (B) Definitions. (1) "Inmate" means an individual who is serving time for a criminal offense or who is confined in a state or federal prison, jail, detention facility, or other pena...

...(A) Medicaid will not pay for services provided under the conditions set out in paragraph (C) of this rule, even when an individual has been found eligible for a medical assistance category and is enrolled in medicaid. (B) Definitions. (1) "Inmate" means an individual who is serving time for a criminal offense or who is confined in a state or federal prison, jail, detention facility, or other pe...

...(A) Medicaid will not pay for services provided under the conditions set out in paragraph (C) of this rule, even when an individual has been found eligible for a medical assistance category and is enrolled in medicaid. (B) Definitions. For the purposes of this rule: (1) "Eligible juvenile" means: (a) An individual under the age of twenty-one; or (b) A former foster care child up to the age...