Ohio Administrative Code Search

... in which a home care attendant service provider furnishes home care attendant services in accordance with this rule and as authorized by the Ohio department of medicaid (ODM), or certified by the Ohio department of aging (ODA), to two or three individuals who reside at the same address. (7) "Guardian" has the same meaning as in section 2111.01 of the Revised Code. (8) "Health care professio...

... An ODM-administered waiver service provider shall maintain a professional relationship with the individuals to whom they provide services. Providers shall furnish services in a manner that is in accordance with the individual's approved person-centered services plan, is attentive to the individual's needs, and maximizes the individual's independence. A provider shall refrain from any behavior tha...

... An ODM-administered waiver service provider shall maintain a professional relationship with the individuals to whom they provide services. Providers shall furnish services in a manner that is in accordance with the individual's approved person-centered services plan, is attentive to the individual's needs, and maximizes the individual's independence. A provider shall refrain from any behavior tha...

...f the Administrative Code. (D) "Agency provider" is an entity that is eligible to furnish services in the medicaid program upon execution of a medicaid provider agreement in accordance with rule 5160-1-17.2 of the Administrative Code. (E) "Applicant" is a person who is requesting a determination of eligibility for enrollment in an ODM-administered waiver. (F) "Authorized representative" is a pe...

... direction of approved waiver service providers. (A) Individual rights. An individual enrolled in an ODM-administered waiver has the right to: (1) Be treated with dignity and respect. (2) Be protected from abuse, neglect, exploitation and other threats to personal health, safety and well-being. (3) Appoint an authorized representative to act on their behalf in accordance with 5160-1-33 of t...

... direction of approved waiver service providers. (A) Individual rights. An individual enrolled in an ODM-administered waiver has the right to: (1) Be treated with dignity and respect. (2) Be protected from abuse, neglect, exploitation and other threats to personal health, safety and well-being. (3) Appoint an authorized representative to act on their behalf in accordance with 5160-1-33 of t...

...medicaid (ODM) -administered waiver provider applicants must successfully complete the provider enrollment process set forth in this rule and receive approval from ODM before furnishing services to an individual enrolled on an ODM-administered waiver. Services furnished before ODM approves and enrolls the provider applicant are not reimbursable. (B) The provider applicant must complete and su...

... of medicaid (ODM) -administered waiver provider applicants must successfully complete the provider enrollment process set forth in this rule and receive approval from ODM before furnishing services to an individual enrolled on an ODM-administered waiver. Services furnished before ODM approves and enrolls the provider applicant and before the provider is added to the approved person-centered services plan are not rei...

...nitor 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. (B) Structural reviews. (1) Medicare-certified and ot...

...nitor 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. (B) Structural reviews. (1) Medicare-certified and ot...

...so a community-based long term care provider who are subject to database reviews and criminal records checks in accordance with section 173.38 of the Revised Code and rules adopted thereunder. (B) For the purposes of this rule, (1) "Applicant" means a person who is under final consideration for employment with a waiver agency in a full-time, part-time or temporary position that involves prov...

... 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 days after the effective date of section 5164.341 of the Revised...

...all ODM-administered waiver service providers and all ODM-administered waiver contractors in order to assure providers' and contractors' compliance with ODM-administered waiver program requirements. (B) Monitoring and oversight of ODM-administered waiver service providers. (1) ODM and its designee shall conduct ongoing monitoring and oversight of ODM-administered waiver service providers to ...

... this rule, an applicant or independent provider who has been convicted of or pleaded guilty to an offense listed in paragraph (B)(5) of rule 5160-45-08 of the Administrative Code may be selected by an individual enrolled on an ODM-administered waiver program to provide them with HCBS pursuant to the timeframes set forth in this rule. (C) Tier I. Permanent exclusion. (1) No waiver agency sha...

... this rule, an applicant or independent provider who has been convicted of or pleaded guilty to an offense listed in paragraph (B)(5) of rule 5160-45-08 of the Administrative Code may be selected by an individual enrolled on an ODM-administered waiver program to provide them with HCBS pursuant to the timeframes set forth in this rule. (C) Tier I. Permanent exclusion. (1) No waiver agency sha...

...e waiver. This rule also sets forth the provider requirements and specifications for the delivery of those Ohio home care waiver services. Providers are also subject to the conditions of participation set forth in rule 5160-44-31 of the Administrative Code. Services are reimbursed in accordance with rule 5160-46-06 of the Administrative Code. (A) Personal care aide services. (1) "Personal care aide ...

...e waiver. This rule also sets forth the provider requirements and specifications for the delivery of those Ohio home care waiver services. Providers are also subject to the conditions of participation set forth in rule 5160-44-31 of the Administrative Code. Services are reimbursed in accordance with rule 5160-46-06 of the Administrative Code. (A) Personal care aide services. (1) "Personal care aide ...

...per job bid rate negotiated between the provider and the individual's case manager. (3) "Billing unit," as used in table B, column 3 of paragraph (B) of this rule, means a single fixed item, amount of time or measurement (e.g., a meal, a day, or mile, etc.). (4) "Caretaker relative" has the same meaning as in rule 5160:1-1-01 of the Administrative Code. (5) "Group rate," as used in paragraph (D)(1) of this rule, m...

...graph (C) of this rule and by qualified providers as defined in paragraph (E) of this rule. Payment for targeted case management services may not duplicate payments made to public agencies or private entities under other program authorities for this same purpose. Medicaid reimbursable TCM services are: (a) Assessment. Activities reimbursable under the assessment category are limited to the following: (i) Activities...

...h (C) of this rule and by qualified providers as defined in paragraph (E) of this rule. Payment for targeted case management services may not duplicate payments made to public agencies or private entities under other program authorities for this same purpose. Medicaid reimbursable TCM services are: (a) Assessment. Activities reimbursable under the assessment category are limited to the following:...

...able date on which a designated hospice provider delivers hospice services to an individual. (F) "Benefit period" or "election benefit period" refers to a span for which the individual is enrolled in the hospice benefit. Benefit periods consist of two ninety day benefit periods, followed by an unlimited number of sixty day benefit periods. The benefit periods may be used consecutively or at inter...

... of the hospice staff. (2) The hospice provider must notify the Ohio department of medicaid (ODM) through the medicaid information technology system (MITS) or its designee of the individual's discharge from the designated hospice's care so that the designated hospice's services and billings coincide with the date of the individual's discharge and/or so that hospice services may continue with ...

...requirement for recording the hospice provider span for individuals receiving medicaid hospice care in accordance with Chapter 5160-56 of the Administrative Code, including individuals who may be covered by third-party insurance, such as medicare, for which the hospice seeks reimbursement. (A) The designated hospice shall report the required enrollment information to the Ohio department of medicaid using...

...edicaid program upon execution of a provider agreement in accordance with rule 5160-1-17.2 of the Administrative Code. (B) Meet the medicare guidelines in accordance with 42 C.F.R. part 418 (October 1, 2017). (C) Be licensed under Ohio law in accordance with Chapter 3712. of the Revised Code by the Ohio department of health. (D) Comply with all requirements for medicaid providers in Chapter 516...

...edicaid covered services that hospice providers may or must furnish to individuals to the extent specified by the individual's plan of care. (A) The designated hospice shall ensure the hospice services furnished to an individual in accordance with this rule are reasonable and necessary for the palliation and management of the terminal illness and related conditions. (B) Unless otherwise specified, c...