Ohio Administrative Code Search

...(A) "Structured Family Caregiving (SFC)" is a service in which an individual at least eighteen years of age who is enrolled on either the MyCare Ohio, Ohio home care, or pre-admission screening system providing options and resources today (PASSPORT) waiver program, resides with a caregiver who provides daily care and support to the individual when the individual meets the following criteria: (1)...

...(A) "Structured Family Caregiving (SFC)" is a service in which an individual at least eighteen years of age who is enrolled on either the MyCare Ohio, Ohio home care, or pre-admission screening system providing options and resources today (PASSPORT) waiver program, resides with a caregiver who provides daily care and support to the individual when the individual meets the following criteria: (1)...

...The following terms apply to Ohio department of medicaid (ODM) -administered waiver programs: (A) "Abuse" has the same meaning as set forth in rule 5160-44-05 of the Administrative Code. (B) "Accreditation commission for health care" or "(ACHC)" is a national organization that evaluates and accredits agencies seeking to participate in the medicare and medicaid programs. For the purpose of prov...

...The following terms apply to Ohio department of medicaid (ODM) -administered waiver programs: (A) "Abuse" has the same meaning as set forth in rule 5160-44-05 of the Administrative Code. (B) "Accreditation commission for health care" or "(ACHC)" is a national organization that evaluates and accredits agencies seeking to participate in the medicare and medicaid programs. For the purpose of prov...

...(A) The Ohio department of medicaid (ODM) or its designee shall continuously monitor every ODM-administered waiver provider. Monitoring activities shall include, but not be limited to: (1) A structural review of compliance with all ODM-administered waiver provider requirements in accordance with paragraph (B) of this rule. (2) Investigation of provider occurrences in accordance with paragrap...

...(A) The Ohio department of medicaid (ODM) or its designee shall continuously monitor every ODM-administered waiver provider. Monitoring activities shall include, but not be limited to: (1) A structural review of compliance with all ODM-administered waiver provider requirements in accordance with paragraph (B) of this rule. (2) Investigation of provider occurrences in accordance with paragrap...

...(A) The Ohio department of medicaid (ODM) or its designee shall continuously monitor every ODM-administered waiver provider. Monitoring activities shall include, but not be limited to: (1) A structural review of compliance with all ODM-administered waiver provider requirements in accordance with paragraph (B) of this rule. (2) Investigation of provider occurrences in accordance with paragraph (C) of this rule. (...

...(A) Unless otherwise stated in paragraphs (A)(1) and (A)(2) of this rule, this rule sets forth the process and requirements for the criminal records checks of persons under final consideration for employment with a waiver agency, and existing employees with a waiver agency in a full-time, part-time or temporary position, and who are providing home and community-based services (HCBS) in an Ohio dep...

...(A) Unless otherwise stated in paragraphs (A)(1) and (A)(2) of this rule, this rule sets forth the process and requirements for the criminal records checks of persons under final consideration for subcontract or employment with a waiver agency, and existing subcontractors or employees with a waiver agency in a full-time, part-time or temporary position who are providing home and community-based services (HCBS) in an ...

...(A) This rule sets forth the process and requirements for the criminal records checks of independent providers of home and community-based services (HCBS) in Ohio department of medicaid (ODM) -administered waiver programs. (B) For the purposes of this rule, (1) "Anniversary date" means the later of the effective date of the provider agreement relating to the independent provider or sixty day...

...(A) This rule sets forth the process and requirements for the criminal records checks of independent providers of home and community-based services (HCBS) in Ohio department of medicaid (ODM) -administered waiver programs. (B) For the purposes of this rule: (1) "Applicant" means a person who has applied for a medicaid provider agreement to provide HCBS as an independent provider under an ODM...

...(A) Except as set forth in paragraph (H) of this rule, a waiver agency may employ an applicant or continue to employ an employee who has been convicted of or pleaded guilty to an offense listed in paragraph (B)(6) of rule 5160-45-07 of the Administrative Code in a position involving providing home and community-based services (HCBS) to an individual enrolled on an Ohio department of medicaid (ODM)...

...(A) Except as set forth in paragraph (H) of this rule, a waiver agency may employ an applicant or continue to employ an employee who has been convicted of or pleaded guilty to an offense listed in paragraph (B)(6) of rule 5160-45-07 of the Administrative Code in a position involving providing home and community-based services (HCBS) to an individual enrolled on an Ohio department of medicaid (ODM)...

...(A) Except as set forth in paragraph (H) of this rule, a waiver agency may only employ an applicant, or continue to employ an employee, or continue to contract with a subcontractor who has been convicted of or pleaded guilty to an offense listed in divisions (A)(3)(a) to (A)(3)(e) of section 109.572 of the Revised Code in a position providing home and community-based services (HCBS) to an individu...

...(A) To be eligible for enrollment in the Ohio home care waiver program, an individual must meet all of the following requirements: (1) Be between the ages of birth through age fifty-nine. (2) Be determined eligible for Ohio medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code.; (3) Participate in an initial assessment to determine if the individual has needs ...

...(A) To be eligible for enrollment in the Ohio home care waiver program, an individual must meet all of the following requirements: (1) Be between the ages of birth through age fifty-nine. (2) Be determined eligible for Ohio medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code. (3) Participate in an initial assessment to determine if the individual has needs t...

...(A) An individual is eligible for enrollment in the Ohio home care waiver program only if the individual meets all of the following criteria: (1) The individual is between the ages of birth through age fifty-nine years. (2) The individual is determined eligible for Ohio medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code. (3) The individual participates in...

...(A) Definitions of terms used 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...

...(A) Definitions of terms used 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...

...(A) The following waiver services are 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 ...

...(A) Definitions of terms used for billing and calculating home 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 n...

...(A) Helping Ohioans move, expanding choice (HOME choice) assists individuals to transition from an institutional setting into a 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 me...

...(A) Helping Ohioans move, expanding choice (HOME choice) assists individuals to transition from an institutional setting into a 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 ...

...This rule sets forth the criteria that must be met for an individual eligible for medicaid to receive the Ohio medicaid hospice benefit. (A) To be covered under Ohio medicaid, the designated hospice must ensure the following criteria are met prior to furnishing hospice care: (1) The designated hospice has a certification of the terminal illness on behalf of the individual, obtained in accordance...

...This rule sets forth the Ohio department of medicaid (ODM) payment for hospice services and care. (A) ODM will directly pay the designated hospice to care for an individual enrolled in medicaid hospice. Payment to the designated hospice shall cover the array of services listed in rule 5160-56-05 of the Administrative Code, except for: (1) Services pursuant to paragraph (E) of this rule which are p...