Ohio Administrative Code Search

...d goods and services and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service. (B) Definitions For the purposes of this rule, the following definitions apply: (1) "Community respite" has the same meaning as in rule 5123-9-22 of the Administrative Code. (2) "County board" means a county board of develo...

...stability assistance and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for these services. (B) Definitions (1) "Agency provider" means an entity that directly employs at least one person in addition to the chief executive officer for the purpose of providing services for which the entity must be certified in accorda...

...stability assistance and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service. (B) Definitions (1) "Agency provider" has the same meaning as in rule 5123-2-08 of the Administrative Code. (2) "County board" means a county board of developmental disabilities. (3) "Department" means the Ohio department of ...

...es support brokerage and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service. (B) Definitions (1) "Agency provider" means an entity that directly employs at least one person in addition to the chief executive officer for the purpose of providing services for which the entity must be certified in accordance wit...

...community transition and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service. (B) Definitions For the purposes of this rule, the following definitions shall apply: (1) "Agency provider" means an entity that employs at least one person in addition to the chief executive officer for the purpose of providing ser...

...community transition and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service. (B) Definitions For the purposes of this rule, the following definitions shall apply: (1) "Agency provider" has the same meaning as in rule 5123-2-08 of the Administrative Code. (2) "Community transition" means reimbursement fo...

...C. (7) "Early intervention service provider" means an entity that, or an individual who, provides early intervention services under part C, and may include, where appropriate, the department and a public agency responsible for providing early intervention services under part C. (8) "Early intervention services" means developmental services described in appendix A to rule 5123-10-02 of the Ad...

...n of, an early intervention service provider to identify, at the earliest possible age, children suspected of having a developmental delay or disability. (6) "Duration" means projecting when a given service will no longer be provided (such as when a child is expected to achieve the outcomes in his or her individualized family service plan or until a child turns three years of age). (7) "Earl...

...ily for the economic benefit of the provider nor for the convenience of the provider or anyone else other than the recipient. (12) "Parent" means a biological or adoptive parent of a child, a guardian, a foster parent or person acting in place of a biological or adoptive parent with whom the child lives, or an appointed surrogate parent, consistent with 34 C.F.R. 303.27, as in effect on the e...

...st is an early intervention service provider who provides expertise in: (i) Infant and toddler development; (ii) Promotion of an infant's or toddler's acquisition of functional skills across developmental areas, including cognitive processes and social interaction through adaptation of the child's learning environment and activities; (iii) Developing individualized, evidence...

...mental service. (e) When a residential provider is receiving a per diem payment for items or services which otherwise might qualify as a supplemental service, attempt to ascertain the unavailability of per diem funds for that purpose prior to making an expenditure. (2) The beneficiary of a supplemental services trust shall not have any authority to compel the trustee under any circumstances to f...

...rnal revenue service; (b) Not be a provider of services, other than protective services or support brokerage, or control the provision of services to individuals with developmental disabilities; (c) Have and maintain a bond or other insurance in an amount in excess of the value of all trusteeship funds or other funds held by the contract agency for the benefit of its clients; (d) Maintain quali...

... boards, developmental centers, and providers of services to individuals with developmental disabilities. (C) Definitions For the purposes of this rule, the following definitions shall apply: (1) "Administrative investigation" means the gathering and analysis of information related to a major unusual incident so that appropriate action can be taken to address any harm or risk of harm and pr...

...maintained at the community residential provider for a period of three years after the close of the department's fiscal year. The originals are to be submitted on or before the fifth of each month to the department's regional office responsible for the provider's operation for validation. Upon validation, a regional office staff member will sign and forward the originals to the central office bureau of accounting, r...

...ontract with each community residential provider from which residential services are to be purchased. The contract shall: (1) Include all terms of the contract in one instrument, be dated, and be executed by authorized representatives of all parties to the contract, prior to the date of implementation, unless emergency approval is given. (2) Have a definite effective date and a maximum durational term for the provi...

... medications. (iii) The prescribing provider reevaluates a prescription prior to its renewal. (b) Procedures for medication receipt, storage, dispensing, and administration or distribution. (c) Maximum security storage and periodic inventory of all controlled substances, syringes, and needles. (d) Dispensing of medicine in conformance with appropriate federal and state laws. (e) Admi...

...edications, and (c) the prescribing provider reevaluates a prescription prior to its renewal. (2) Procedures for medication receipt, storage, dispensing, and administration or distribution. (3) Maximum security storage and periodic inventory of all controlled substances, syringes, and needles. (4) Dispensing of medicine in conformance with appropriate federal and state laws. (5) Admini...

...edications, and (c) the prescribing provider reevaluates a prescription prior to its renewal. (2) Procedures for medication receipt, storage, dispensing, and administration or distribution. (3) Maximum security storage and periodic inventory of all controlled substances, syringes, and needles. (4) Dispensing of medicine in conformance with appropriate federal and state laws. (5) Admini...

...imarily for the economic benefit of the provider nor for the convenience of the provider or anyone else other than the recipient. (D) The fact that a physician, dentist or other licensed practitioner renders, prescribes, orders, certifies, recommends, approves, or submits a claim for a procedure, item, or service does not, in and of itself make the procedure, item, or service medically necessary and does not guarant...

...imarily for the economic benefit of the provider nor for the sole convenience of the provider or anyone else other than the recipient. (D) The fact that a physician, dentist or other licensed practitioner renders, prescribes, orders, certifies, recommends, approves, or submits a claim for a procedure, item, or service does not, in and of itself make the procedure, item, or service medically necessary and does not gu...

... the scope of practice of the rendering provider as defined by applicable federal, state, and local laws and regulations. (6) The service is rendered by a provider assigned to or selected by the medicaid-covered individual or medicaid-covered individual's authorized representative, with the exception of medicaid-covered individuals enrolled in the coordinated services program as defined in Chapte...

...d medicare managed care plan, preferred provider organization, private fee-for-service plans, or medicare specialty plans. (5) "Medicare Cost Sharing" for the purpose of this rule means the portion of a medicare crossover claim paid by medicaid. (6) "Dual Eligibles or Dually Eligible Individuals" are individuals who are entitled to medicare hospital insurance and SMI and are eligible for medicai...

...as cost sharing the lesser of: (1) The provider's billed charges for the service (except for hospital and nursing facility services); or (2) The deductible, coinsurance and co-payment amount as provided by the medicare part C plan; or (3) The difference between the medicare part C plan's payment to a provider for a service or services identified and the medicaid maximum allowable reimbursement rate for the same id...

... of the following amounts: (1) The provider's billed charges for the service (except for hospital and nursing facility services); or (2) The deductible, coinsurance and co-payment amount as provided by the medicare part C plan; or (3) The difference between the medicare part C plan's payment to a provider for a service or services identified and the medicaid maximum allowable reimbursem...

... not make any additional payment to the provider, or will make a payment of zero dollars, and the service(s) are considered to be paid in full to the provider.