Ohio Administrative Code Search

...ces waivers. (J) "Certification" means providers are approved by the Ohio department of aging (ODA) to provide services for PASSPORT as established in Chapter 173-39 of the Administrative Code. (K) "Financial management service (FMS)" is a support provided to waiver participants who direct some or all of their waiver services. In the PASSPORT waiver, this support is conducted as an administrativ...

...de. (C) Services shall be delivered by providers in a manner that is consistent with the individual's person-centered services plan as documented in the PASSPORT information management system (PIMS). (D) In accordance with the federally approved PASSPORT waiver, the services identified in this paragraph are subject to employer and/or budget authority if elected by the individual. Services shall be ...

... establish the conditions under which providers are able to participate in the preadmission screening system providing options and resources today (PASSPORT) home and community based services (HCBS) waiver program. (B) In order to obtain a medicaid provider agreement to be a PASSPORT provider furnishing services in rule 5160-31-05 of the Administrative Code the provider shall be certified by the ...

...escribe the methods used to determine provider rates for the PASSPORT program. (A) Rates determined under this rule shall not exceed the maximum allowable rates for PASSPORT services in appendix A to rule 5160-1-06.1 of the Administrative Code. Payment for PASSPORT waiver services constitutes payment in full and shall not be construed as a partial payment when the payment amount is less than the pr...

...) "Certified" or "certification" means providers certified by the Ohio department of aging (ODA) to provide services for assisted living HCBS waiver individuals pursuant to Chapter 173-39 of the Administrative Code. (K) "HCBS" or "home and community-based services" means services furnished under the provisions set forth in 42 C.F.R. 441 Subpart G (October 1, 2016) that permit individuals to live in a home setting r...

...rtified" or "certification" means a provider's state of being certified by the Ohio department of aging (ODA) as an assisted living provider pursuant to Chapter 173-39 of the Administrative Code or the certification ODA gives to a certified assisted living provider. (G) "HCBS" or "home and community-based services" means services furnished under the provisions set forth in 42 C.F.R. Part 441 ...

...eral benefit level minus fifty dollars. Providers shall not charge or collect room and board payments from individuals in excess of the room and board payment calculated in accordance with this paragraph. In the event an individual does not have sufficient personal income: (a) An individual may arrange for informal supports to provide a supplemental payment to the provider in order to meet room and b...

...ces by an ODA certified assisted living provider. The waiver program enrollment date shall in no way restrict retroactive eligibility for non-assisted living waiver services available to individuals through the medicaid state plan. (E) Any applicant for the assisted living waiver program is entitled to notice and hearing rights as set forth in section 5101.35 of the Revised Code and division 5101...

...to establish the conditions under which providers are able to participate in the assisted living HCBS waiver program. (B) In order to obtain a medicaid provider agreement to be an assisted living services provider, the provider must be certified by the Ohio department of aging (ODA) or its designee in accordance with the provisions of rule 173-39-03 of the Administrative Code. (C) Individuals enrolled in the assist...

...stablish the conditions under which providers are able to participate in the assisted living HCBS waiver program. (B) In order to obtain a medicaid provider agreement to be an assisted living services provider, the provider will be certified by the Ohio department of aging (ODA) as an assisted living provider in accordance with Chapter 173-39 of the Administrative Code. (C) Individuals enrolled ...

...cribe the methods used to determine provider rates for the assisted living HCBS waiver as set forth in appendix A to rule 5160-1-06.5 of the Administrative Code. (B) Provider rates are determined for the following categories: (1) Per-job bid rate or deposit made. (2) Unit rate. (C) A per-job bid rate or deposit made shall be determined on a per-job basis for the community transition service...

...r which the medicaid school program provider has contracted for the delivery of services, where the child's confidentiality can be maintained when a service is being rendered. (3) Community school: a public school, independent of any school district, established in accordance with Chapter 3314. of the Revised Code that is part of the state's program of education. (4) Common procedural termin...

... to become a medicaid school program provider (MSP) and requirements to be followed by an MSP provider. (B) An MSP provider: (1) Is one of the following: (a) A local education agency (LEA) city school district, local school district, exempted village school district, or any other school district as defined in sections 3311.01 to 3111.05 of the Revised Code; (b) A state school for the deaf as defin...

...es by medicaid school program (MSP) providers as defined in Chapter 5160-35 of the Administrative Code. (B) The CPT (common procedural terminology) and HCPCS (healthcare common procedure coding system) covered services provided through MSP providers that are allowable for medicaid reimbursement are listed on the department's website, http://medicaid.ohio.gov and are provided in accordance wit...

...orized for medicaid coverage that a MSP provider can provide, and to set forth the conditions for providing the services. (B) A MSP provider may provide skilled services. Following are the skilled services an MSP provider may provide: (1) Occupational therapy services: (a) Description: services that evaluate and treat, as well as services to analyze, select, and adapt activities for an eligible chi...

... the Administrative Code, that a MSP provider can provide, and to set forth the conditions for providing the services. (B) In addition to the services indicated in rule 5160-35-05 of the Administrative Code, a MSP provider may render and receive payment for the following services: (1) Transportation: (a) For purposes of Chapter 5160-35 of the Administrative Code, "transportation" is specialized...

...means an entity that has a medicaid provider agreement and also has in effect a PACE agreement with the centers for medicare and medicaid services (CMS) and the Ohio department of aging (ODA). (H) "PACE agreement" means an agreement between a PACE organization, CMS, and ODA. (I) "Participant" means a person enrolled in and receiving services through PACE. (J) "Private pay participant" means an ...

...ding PACE services have signed medicaid provider agreements as required by rule 5160-1-17 of the Administrative Code. (4) Work with PACE organizations to assist individuals seeking enrollment in PACE. (5) Manage PACE enrollment. (6) Adopt rules including, but not limited to, participant eligibility, participant enrollment, participant voluntary disenrollment and participant involuntary disenrol...

...h paragraph (H) of this rule. (7) "Provider" means a person or agency certified or licensed by DODD that has met the provider qualification requirements to provide the specific individual options waiver service as specified in paragraph (J)(1) of this rule and holds a valid medicaid provider agreement in accordance with paragraph (J)(2) of this rule. (8) "SSA" means a service and support adm...

...ODD) must meet to assure free choice of provider. (B) The (DODD), through an interagency agreement with the Ohio department of medicaid (ODM), acts as the administrative agency for components of the medicaid home and community-based services programs in accordance with section 5162.35 of the Revised Code. In accordance with section 5166.21 of the Revised Code, the DODD, as the designated administrator, shall promulg...

... must meet to assure free choice of provider. (B) The DODD through an interagency agreement with the Ohio department of medicaid (ODM), acts as the administrative agency for components of the medicaid home and community-based services programs in accordance with section 5162.35 of the Revised Code. In accordance with section 5166.21 of the Revised Code, the DODD, as the designated administrator, ...

...0 of the Administrative Code. (6) "Provider" means a person or agency certified or licensed by DODD that has met the provider qualification requirements to provide the specific self-empowered life funding waiver service as specified in paragraph (J)(1) of this rule and holds a valid medicaid provider agreement in accordance with paragraph (J)(2) of this rule. (7) "SSA" means a service and ...

...h paragraph (H) of this rule. (5) "Provider" means a person or agency certified or licensed by DODD that has met the provider qualification requirements to provide specific waiver services, as specified in paragraph (J)(1) of this rule, with a valid medicaid provider agreement as specified in paragraph (J)(2) of this rule. (6) "SSA" means a service and support administrator who is certified ...

...on that must be maintained by a service provider. (6) "Home and community-based services (HCBS) setting" has the same meaning as set forth in rule 5160-44-01 of the Administrative Code. (7) "Incident" means an alleged, suspected or actual event that is not consistent with the routine care of and/or service delivery to an individual as set forth in rule 5160-43-06 of the Administrative Code. Incidents include, but a...

...hat must be maintained by a service provider. (4) "Health and safety action plan" means the document created between the Ohio department of medicaid (ODM) or its designee and an individual enrolled in the program that identifies the interventions recommended by the recovery manager to remedy risks to the health and welfare of the individual. (5) "Home and community-based services (HCBS) sett...