Ohio Administrative Code Search

...ty for individuals with an intellectual disability.

... individuals with an intellectual disability.

...iagnosis and past history of disease or disability; and (7) Any information received in connection with the identification of third party coverage; and (8) Any information received for verifying income eligibility and amount of medical assistance payments. Income information received from the social security administration (SSA) or the internal revenue service (IRS) must be safeguarded according to the requirements...

...osis and past history of disease or disability; (7) Any information received in connection with the identification of third party coverage; and (8) Any information received for verifying income eligibility and amount of medical assistance payments. Income information received from the social security administration (SSA) or the internal revenue service (IRS) should be safeguarded according to t...

... sixty years of age, and has a physical disability or mental impairment. (b) "Home care service provider" is: (i) A medicare certified home health agency or other accredited agency in accordance with Chapter 5160-12 of the Administrative Code that provides service in the home to the home care dependent adult; or (ii) A medicare certified hospice provider in accordance with Chapter 5160-56 of the Administrative Cod...

...ntal illness (SMI) and/or developmental disability (DD) as defined in paragraphs (B)(6) and (B)(28) of this rule when the individual's circumstances fall within one of the following two categories: (a) The individual requires an 'emergency nursing facility stay', as defined in paragraph (B)(7) of this rule; (b) The individual is seeking admission to a nursing facility for a 'respite nursing facili...

...al illness (SMI) and/or a developmental disability (DD) as defined in rules 5122-21-03 and 5123-14-01 of the Administrative Code are identified and not admitted to a NF unless a thorough evaluation indicates that such placement is appropriate and adequate services will be provided regardless of payor source. (B) A level I screening as defined in rule 5160-3-15 of the Administrative Code is requir...

...eir mental illness or developmental disability status. (B) Resident review requirements. (1) No individual with SMI or DD can be retained as a resident in a nursing facility (NF), regardless of payment source, unless it has been determined in accordance with rules 5122-21-03 and 5123:14-01 of the Administrative Code, that: (a) The individual needs the level of services provided by a NF; or ...

... retardation or other developmental disability; (d) Terminal illness; (e) Congenital heart defect, with or without associated arrhythmia; (f) History of apnea in immediate siblings; (g) History of monitor use with immediate siblings; (h) History of apnea or SIDS in family members other than immediate siblings; (i) Parental anxiety or family request for a monitor; and (j) Need to monitor blo...

...cated hydrocephalus; (c) Developmental disability; (d) Terminal illness; (e) Congenital heart defect, with or without associated arrhythmia; (f) History of apnea in immediate siblings; (g) History of monitor use with immediate siblings; (h) History of apnea or SIDS in family members other than immediate siblings; (i) Parental anxiety or family request for a monitor; and (j) Need to monitor blo...

...nce of illness, injury, impairment, disability, or other condition that limits ambulation. Therefore, a wheelchair needs to provide mobility to an individual for whom ambulation is not possible, takes inordinate physical effort, or causes considerable physical discomfort. (b) A wheelchair also needs to be suited to the purposes and daily routines of the individual using it. (c) A manual wheelcha...

..., developmental delay, or developmental disability causing the incontinence; (c) The type of incontinence; and (d) The type and quantity of incontinence garments or incontinence supplies being prescribed. (2) Payment cannot be made for items related to stress incontinence to which no specific physiological, psychological, or physiopsychological cause can be attributed. (3) A certification ...

... developmental delay, or developmental disability causing the incontinence; (c) The type of incontinence; and (d) The type and quantity of incontinence garments or incontinence supplies being prescribed. (2) An increase in the prescribed quantity of an incontinence item is subject to PA, as is a change in the type of incontinence item. (No additional authorization is needed for a decrease in q...

...gion, race, color, national origin, disability, age, sex, military status, health status, number of pregnancies, or marital status. (2) A medicaid recipient must be able to obtain pregnancy prevention services voluntarily, free from coercion or pressure and free to choose the type or method of service to be used. (3) A medicaid provider must not make the receipt of pregnancy prevention servi...

...gion, race, color, national origin, disability, age, sex, sexual orientation, gender identity, gender expression, military status, health status, number of pregnancies, or marital status. (2) Medicaid-eligible individuals can obtain medicaid-covered pregnancy prevention services voluntarily, free from coercion or pressure and free to choose the type or method of service to be used. (3) The r...

...ising out of an injury, disease, or disability to the member. (OOO) "Waste" means payment for or the attempt to obtain payment for items or services when there may be no intent to deceive or misrepresent, but poor or inefficient billing or treatment methods result in unnecessary costs.

...ividuals diagnosed with a developmental disability who have a level of care that meets the criteria specified in rule 5123-8-01 of the Administrative Code and receive services through a HCBS waiver administered by the Ohio department of developmental disabilities (DODD). (4) Except for individuals receiving medicaid in the adult extension category under section 1902(a)(10)(A)(i)(VIII) of the Soci...

...ender identity, sexual orientation, disability, national origin, race, color, religion, military status, ancestry, genetic information, health status or need for health services. The MCO may not use a policy or practice that has the effect of discrimination on the basis of the criteria listed in this rule. (c) If a member requests disenrollment because he or she meets the requirements of paragrap...

...formation, sexual orientation, age, disability, national origin, military status, ancestry, health status, or need for health services. (9) An agreement by the provider to not hold liable ODM or members in the event that the MCE cannot or will not pay for services performed by the provider pursuant to the contract with the exception that: (a) Federally qualified health centers (FQHCs) and rural ...

...ace, color, national origin, age or disability in the receipt of health services. (21) Appeal to or file directly with the ODM office of civil rights any complaints of discrimination on the basis of race, color, religion, gender, gender identity, sexual orientation, age, disability, national origin, military status, genetic information, ancestry, health status or need for health services in t...

...ntal security income or social security disability insurance determination or has a score of two or greater on at least one of the items in the "mental health needs" or "risk behaviors" sections or a score of three on at least one of the items in the "life domain function" section of the adult needs and strengths assessment (ANSA) administered by an individual with a bachelor's degree or higher an...

... for individuals with an intellectual disability (ICF-IID) or another licensed/certified facility, any facility covered by section 1616(e) of the Social Security Act (42 U.S.C. 1382e(e) (January 1, 2021) residential care facility, adult foster home or another group living arrangement subject to state licensure or certification. (10) The individual is age sixty or older at the time of enrollment...

... for individuals with an intellectual disability (ICF-IID) or another licensed/certified facility, any facility covered by section 1616(e) of the Social Security Act (42 U.S.C. 1382e(e) (January 1, 2024) residential care facility, adult foster home or another group living arrangement subject to state licensure or certification. (10) The individual is age sixty or older at the time of enrollment...

...or individuals with an intellectual disability (ICF-IID), or another licensed or certified facility, any facility covered by section 1616(e) of the Social Security Act (42 U.S.C. 1382(e) (January 1, 2025) residential care facility or another group living arrangement subject to state licensure or certification. (8) The individual is age sixty years or older at the time of enrollment. (9) The ...

...ose of correcting, or alleviating a disability. The physical therapy service will be recommended by a licensed physical therapist acting within the scope of his or her practice under Ohio law who holds a current, valid license to practice physical therapy issued under Chapter 4755. of the Revised Code. (b) Qualified practitioners who can deliver the services: (i) Licensed physical therapist who ...