Ohio Administrative Code Search

...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...

...und performed by a qualified healthcare provider. Frequent evaluation is expected if a wound is heavily draining or infected. Each evaluation report, which will be made available to the department on request, includes the wound type; wound location; wound length, width, and depth; the amount of drainage; and any other relevant clinical information. (2) The provider keeps the prescription for dres...

...Before dispensing additional units, the provider makes contact, either verbally or in writing, with the individual (or the individual's authorized representative) to verify the current need. The provider keeps on file a summary of this contact. If the individual has one unit or less, the provider may dispense up to three units.

...m a continued need for oxygen. (5) The provider of a RAD cannot perform the qualifying respiratory study.

... procedure code.) (3) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (4) "Global procedure" or "total procedure" is a procedure, in its entirety, that comprises both a technical component (the part of a laboratory procedure that relies on the technical skill of a trained individual to secure a specimen and prepare it for analysis) and a professio...

...(A) Providers. An entity may enroll in medicaid as a portable x-ray supplier only if it complies with the conditions set forth in 42 C.F.R. part 486 subpart C (October 1, 2020). (B) Coverage. (1) The radiology procedures performed by a portable x-ray supplier have both a professional component and a technical component. (a) In general, a portable x-ray supplier performs the technical component ...

...(A) Providers. (1) An entity may enroll in medicaid as an independent diagnostic testing facility (IDTF) only if it meets the following criteria: (a) It meets all standards set forth in and provide services in accordance with 42 C.F.R. 410.33 (October 1, 2020); (b) It takes the following measures to establish accountability: (i) It ensures that each supervising practitioner attests in writin...

...in accordance with the individual's provider of hospice services when the individual has elected the hospice benefit. (6) Access home health services in accordance with the individual's managed care plan when the individual is enrolled in a medicaid managed care plan. (G) Covered home health services: (1) "Home health nursing" is a nursing service that requires the skills of and is performed ...

...rovided by more than one non-agency provider. (B) For PDN to be covered, the service: (1) Must be performed within the nurse's scope of practice as defined in Chapter 4723. of the Revised Code and rules adopted thereunder; (2) Must be provided and documented in accordance with the individual's plan of care in accordance with rule 5160-12-03 of the Administrative Code; (3) Must be medically...

...ed services (HCBS) waiver. (1) The PDN provider shall submit a referral for PDN authorization to ODM using the ODM 02374, "Private Duty Nursing (PDN) Services Request" (3/2015), along with any additional supporting documentation requested by ODM. (2) ODM shall conduct an in-person assessment and/or perform a desk review to determine if, in accordance with rule 5160-12-02 of the Administrative Code, the individual h...

...io medicaid program upon execution of a provider agreement in accordance with rule 5160-1-17.2 of the Administrative Code. (B) MCHHAs are required to: (1) Be certified for medicare participation by the Ohio department of health (ODH) in accordance with Chapter 3701-60 of the Administrative Code. (2) Meet the conditions of participation in accordance with 42 C.F.R. Part 484 (October 1, 2014). (3) Implement policy ...

...io medicaid program upon execution of a provider agreement in accordance with rule 5160-1-17.2 of the Administrative Code. A non-agency nurse is required to: (1) Be a registered nurse or licensed practical nurse at the direction of a registered nurse practicing within the scope of his or her nursing license pursuant to Chapter 4723. of the Revised Code as an independent provider. (2) Comply with the requirements of...

...ons that apply to its provision and the provider who renders the service(s). (C) Each covered visit must be billed as a separate line item. The number of lines /procedure codes must reflect the number of visits provided with one line equaling one visit. (D) A "group visit" is a visit where the service(s) is provided to more than one person. During a group visit: (1) The ratio of provider to...

...th visit shall be the lesser of the provider's billed charge or the medicaid maximum rate. The medicaid maximum rate is determined by using a combination of the base rate and/or unit rate found in appendix A as applicable to this rule using the number of units of service that were provided during a visit in accordance with this chapter as follows: (1) Each visit must be less than or equal to ...

...th visit shall be the lesser of the provider's billed charge or the medicaid maximum rate. The medicaid maximum rate is determined by using a combination of the base rate and/or unit rate found in appendix A as applicable to this rule using the number of units of service that were provided during a visit in accordance with this chapter as follows: (1) Each visit must be less than or equal to ...

...lth visit will be the lesser of the provider's billed charge or the medicaid maximum rate. The medicaid maximum rate is determined by using a combination of the base rate and/or unit rate found in appendix A as applicable to this rule using the number of units of service that were provided during a visit in accordance with this chapter as follows: (1) Each visit will be less than or equal to ...

... a PDN visit shall be the lesser of the provider's billed charge or the medicaid maximum rate. The medicaid maximum rate is determined by using a combination of the base rate and unit rate found in appendix A to this rule using the number of units of service that were provided during a visit in accordance with this chapter. (D) The amount of reimbursement for a PDN visit shall be the lesser of the provider's billed ...

...DN visit shall be the lesser of the provider's billed charge or the medicaid maximum rate. The medicaid maximum rate is determined by using a combination of the base rate and unit rate found in appendix A to this rule using the number of units of service that were provided during a visit in accordance with this chapter. (D) The amount of reimbursement for a PDN visit shall be the lesser of the pr...

...PDN visit will be the lesser of the provider's billed charge or the medicaid maximum rate. The medicaid maximum rate is determined by using a combination of the base rate and unit rate found in appendix A to this rule using the number of units of service that were provided during a visit in accordance with this chapter. (D) The amount of reimbursement for a PDN visit will be the lesser of the pro...

... and private duty nursing (PDN) service providers may be reimbursed when any of the exceptions set forth in this rule apply through no fault of the provider: (A) Requirements of paragraphs (D)(2) of rule 5160-12-01 and (E)(2) of rule 5160-12-02 of the Administrative Code are not met due to any of the following: (1) Services are not identified on the all services plan when the individual is enrolled on an Ohio depar...