Ohio Administrative Code Search

...(A) Provider requirement. A provider of custom-made or custom-fitted compression garments must either employ or contract with a certified fitter and must keep documentation of this relationship on file. (B) Coverage. (1) The default certificate of medical necessity (CMN) form is the ODM 01905, "Certificate of Medical Necessity: Compression Garments" (rev. 7/2018). (2) Payment may be made on...

...For a gradient compression garment, the provider specifies at least one clinical indication such as but not limited to the conditions identified in the following list: (1) Elephantiasis; (2) Lymphedema; (3) Milroy's disease; (4) Orthostatic hypotension; (5) Post-thrombotic syndrome; (6) Stasis dermatitis; (7) Stasis ulcers; (8) Symptomatic chronic venous insufficiency (characterized by, for ex...

...er for rechargeable batteries. (B) Provider requirement. A provider of transcutaneous electrical nerve stimulation (TENS) units must have a physical location available for face-to-face fitting and instruction purposes. (C) Coverage. (1) Payment may be made for a TENS unit on a rental/purchase basis. (2) The default certificate of medical necessity (CMN) form is the ODM 03402, "Certificate ...

... amount for a two-lead unit unless the provider obtains and maintains documentation in the individual's file establishing the medical necessity of a four-lead unit. (D) Claim payment. The lump-sum payment for TENS supplies is twenty-five dollars.

...lchair or a power mobility device. (B) Providers. (1) Prescribing providers. Eligible medicaid providers of the following types, acting within their scope of practice, may certify the medical necessity of a wheelchair: (a) A physician; (b) An advanced practice registered nurse with a relevant specialty; (c) A physician assistant; or (d) A podiatrist. (2) Evaluators. The following profession...

...) Payment may be made directly to a provider for a pneumatic compression device or a related accessory only if the equipment and supplies are used to treat either lymphedema in the extremities or chronic venous insufficiency (CVI) with venous stasis ulcers. Accessories used for pneumatic compression of the chest or trunk are not covered. Before prescribing a pneumatic compression device, a practit...

...) Payment may be made directly to a provider for a pneumatic compressor or a related appliance or accessory only if the following conditions are satisfied: (1) The equipment is used to treat either lymphedema in the extremities or chronic venous insufficiency (CVI) with venous stasis ulcers; and (2) The prescribing practitioner has determined either that there was no significant improvement or t...

... mattress) does not require PA. The provider, however, must keep on file a completed CMN. The default form is the ODM 02910. (2) If an accessory is to be used with a hospital bed, then the medical necessity of the hospital bed must also have been established. (D) Coverage of pressure-reducing support surfaces. (1) The default CMN form is the ODM 02904, "Certificate of Medical Necessity: Pre...

...vice is effective. (C) Constraint. The provider of a positive airway pressure device cannot perform the qualifying respiratory study.

...ties representing one month's supply. A provider must not dispense additional incontinence items to an individual who already has at least a month's supply on hand. Before dispensing additional items, therefore, providers must make contact, either orally or in writing, with each individual (or the individual's authorized representative) to verify the current need. Providers must keep on file a sum...

...ties representing one month's supply. A provider is expected to verify and document an individual's current need before dispensing additional items. Medicaid payment for excessive quantities of items is subject to recovery. (4) Payment will not be made for more incontinence items than are prescribed or authorized.

...(A) Condition of provider participation. A provider of in-home use ventilators needs to have available a licensed respiratory care professional (LRCP) twenty-four hours a day to provide respiratory care, technical support, and clinical ventilator services and to perform emergency servicing of equipment on two-hour notice. (B) Coverage. (1) Separate payment may be made for a ventilator furnished ...

...et the individual's needs, then the provider may choose to submit a request for payment of one month's rental. (5) The department will consider coverage of SGDs in any of several forms, including but not limited to the following examples: (a) A standalone unit running dedicated, proprietary software; (b) Commercially available software and, if necessary, hardware to run it (e.g., a portable...

...et the individual's needs, then the provider may choose to submit a request for payment of one month's rental. (5) The department will consider coverage of SGDs in any of several forms, including but not limited to the following examples: (a) A standalone unit running dedicated, proprietary software; (b) Commercially available software and, if necessary, hardware to run it (e.g., a portable...

.... During the initial rental period, the provider must obtain a revised copy of the previously completed CMN, on which the prescriber includes the following information: (a) A description, including approximate age and ownership, of any similar equipment currently in the individual's possession; (b) An explanation of why additional rental of the multiple-user lactation pump is warranted; and (c)...

...be made only to a medicaid-enrolled provider that is a member in good standing of the human milk banking association of North America. (b) The provider must keep on file the following documents: (i) An explanation by a prescriber of the medical necessity of human milk for the recipient; (ii) An attestation that the prescriber has given the recipient's parent or guardian information ...

...can be made only to a medicaid-enrolled provider that is a member in good standing of the human milk banking association of North America. (b) The provider keeps on file the following documents: (i) An explanation by a prescriber of the medical necessity of human milk for the recipient; (ii) An attestation that the prescriber has given the recipient's parent or guardian information ...

... for at least three months, which the provider substantiates with the following documentation: (i) At least two sets of images including multiple views of the fracture site, the first and last of which were taken at least ninety days apart; and (ii) A written statement by a qualified interpreting practitioner that there has been no clinically significant evidence of fracture healing du...

...or at least three months, which the provider substantiates with the following documentation: (i) At least two sets of images including multiple views of the fracture site, the first and last of which were taken at least ninety days apart; and (ii) A written statement by a qualified interpreting practitioner that there has been no clinically significant evidence of fracture healing du...

...ring the initial rental period, the provider obtains a revised copy of the previously completed CMN, on which the prescriber attests that the individual (or someone assisting the individual) is capable of managing the pump and that the desired improvement in metabolic control can be achieved. (C) Constraints and limitations. (1) The use of an insulin pump is contraindicated by either of the foll...

...iting to the medical necessity, and the provider keeps a copy of this document in the individual's file. (d) For a trunk-support walker, the prescriber describes and attests in writing to the medical necessity, and the provider keeps a copy of this document in the individual's file. (e) For walker leg extensions, the individual stands at least six feet tall. (f) For a white cane that is to be used ...

...iting to the medical necessity, and the provider keeps a copy of this document in the individual's file. (d) For a trunk-support walker, the prescriber describes and attests in writing to the medical necessity, and the provider keeps a copy of this document in the individual's file. (e) For walker leg extensions, the individual stands at least six feet tall. (f) For a white cane that is to be used ...

...mity must be well documented in the provider's records. If there is insufficient evidence of need for a custom-molded shoe, then payment will be limited to the cost of the least expensive medically appropriate alternative. (6) No payment is made for the following items: (a) Inserts that are compression-molded to the foot over time by the heat and pressure of being worn inside a shoe; (b) Insert...

...ity is to be well documented in the provider's records. If there is insufficient evidence of need for a custom-molded shoe, then payment will be limited to the cost of the least expensive medically appropriate alternative. (6) No payment is made for the following items: (a) Inserts that are compression-molded to the foot over time by the heat and pressure of being worn inside a shoe; (b) Insert...

...nd performed by a qualified health care provider. Frequent evaluation is expected if a wound is heavily draining or infected. The evaluation report must include wound type; wound location; wound length, width, and depth; the amount of drainage; and any other relevant clinical information. Any such report must be made available to the department on request. (2) The provider must keep the prescript...