Ohio Administrative Code Search

... the Administrative Code. (B) Eligible providers. (1) An eligible rendering provider of peer support services is: (a) A person who is eligible to provide peer support services in accordance with rule 5122-29-15.1 of the Administrative Code; and (b) An eligible provider of behavioral health services in accordance with rule 5160-27-01 of the Administrative Code. (2) An eligible billing provider...

...id Services (CMS) Publication 15-1, Provider Reimbursement Manual - Part 1" (October 1, 2015) or chapter 9 of "Centers for Medicare and Medicaid Services (CMS) Publication 100-04, Medicare Claims Processing Manual" (July 25, 2014), both of which are available at http://www.cms.gov; or (3) "Statement on Auditing Standards (SAS) No. 91, Federal GAAP Hierarchy" (April 2000), which may be obtained at...

...) encounter between a patient and a provider; for medicaid payment purposes, a covered service rendered through telehealth by an FQHC or RHC practitioner is a face-to-face encounter. For transportation services, a visit is a one-way trip provided to or from a site where a covered service is rendered on the same date. (a) Multiple encounters with one health professional or encounters with mult...

...(A) No provider may be simultaneously enrolled in medicaid as more than one type of cost-based clinic. (B) Unless otherwise noted, any limitations or requirements specified in the Revised Code or in agency 5160 of the Administrative Code apply to services rendered by a cost-based clinic. (C) Federally qualified health center (FQHC). (1) An FQHC must submit to the department a copy of the no...

...e obtains and uses its own medicaid provider number. No FQHC site is allowed to use the provider number of another FQHC site, even if the two share the same parent organization. (3) The responsibility of an FQHC to pay a health professional for performing a service is described in a written agreement between the FQHC and the health professional. (4) An FQHC notifies ODM in writing not later ...

...dministration of a vaccine or other provider-administered pharmaceutical; (b) Professional services (including the administration of a vaccine) furnished by a qualified healthcare practitioner (physician, physician assistant, advanced practice registered nurse, dietitian, pharmacist, registered nurse working under supervision), along with any services or supplies furnished incident to the profess...

...hat is newly enrolled as a medicaid provider submits a cost report covering the twelve-month period beginning either on the first day of the first calendar month or on the first day of the first full fiscal year after enrollment. (2) An FQHC or RHC that requests an adjustment of a per-visit payment amount (PVPA) based on a change in scope of an existing FQHC or RHC PPS service submits a cost ...

...s that are already enrolled as medicaid providers, ODM establishes new PVPAs equal to the current PVPAs revised to reflect the latest available medicare economic index (MEI) percentage. The new PVPAs are established by October first of each year and are in effect from October first through the following September thirtieth. (2) When an enrolled FQHC or RHC site requests adjustment of a PVPA, ODM ...

...s that are already enrolled as medicaid providers, the Ohio department of medicaid (ODM) establishes new PVPAs equal to the current PVPAs revised to reflect the latest available medicare economic index (MEI) percentage. The new PVPAs are established by October first of each year and are in effect from October first through the following September thirtieth. (2) On the effective date of this rule,...

...ually as recruitment cost incurred by a provider of FQHC medical service. (B) Tests of reasonableness are applied to the allowable costs to establish limits. (1) For each FQHC service except transportation, a limit is established by dividing the allowable cost by the greater of two figures: (a) The number of allowable encounters; or (b) The product of the actual number of direct hours worked b...

...y as recruitment cost incurred by a provider of FQHC medical service. (B) Limits are established by applying tests of reasonableness to the allowable costs. (1) For each PPS service except transportation, a limit is established by dividing the allowable cost by the greater of two figures: (a) The total number of visits; or (b) The product of the actual number of direct hours worked by the prof...

...y as recruitment cost incurred by a provider of FQHC medical service. (B) Limits are established by applying tests of reasonableness to the allowable costs. (1) For each PPS service except transportation, a limit is established by dividing the allowable cost by the greater of two figures: (a) The total number of visits; or (b) The product of the actual number of direct hours worked by the prof...

... or RHC is newly enrolled as a medicaid provider; or (2) The FQHC or RHC plans to request the establishment or adjustment of a PVPA based on a change in scope of a prospective payment system (PPS) service. (C) The time period covered by the applicable cost report may be altered in one of the following ways: (1) The length of the period is set at not less than eight consecutive months nor more than twelve consecuti...

...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...

...44-02 of the Administrative Code. (P) "Provider" means an agency or a person with a signed medicaid provider agreement with ODM and certified by ODA.

...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 ...

...ode. (C) Services will be delivered by providers who meet the requirements in Chapter 173-39 of the Administrative Code 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 an...

...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...

...escribe the methods used to determine provider rates for the pre-admission screening system providing options and resources today (PASSPORT) program. (A) Rates determined under this rule will 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 will not be constr...

...ed. To obtain approval, the service provider will submit the request using the exemption process found on ODM's website https://medicaid.ohio.gov/INITIATIVES/Electronic-Visit-Verification/. (F) The Ohio department of aging, Ohio department of developmental disabilities, Ohio department of medicaid (ODM), and managed care entities are responsible to: (1) Establish and maintain processes ...

...available at no cost to the service provider. ODM's contracted entity is responsible for electronic device distribution, collection, and ongoing maintenance activities. (b) A mobile electronic device owned by the service provider or direct care worker. (i) ODM is not responsible for any costs incurred. (ii) Data services connected to the service provider or direct care worker owned de...

... is available at no cost to the service provider. ODM's contracted entity is responsible for electronic device distribution, collection, and ongoing maintenance activities. (b) A mobile electronic device owned by the service provider or direct care worker. (i) ODM is not responsible for any costs incurred. (ii) Data services connected to the service provider or direct care worker owned device will be used to tra...

...use an alternate EVV vendor, agency providers should: (1) Notify the Ohio department of medicaid (ODM) or its contracted entity of the intent to seek ODM approval to utilize the selected alternate EVV vendor; and (2) Complete alternate system aggregator training. (D) The agency provider is responsible to ensure: (1) The visit data in the aggregator is correct and reflects the visit as it ...

...r. (C) To use an alternate EVV vendor, providers should: (1) Notify the Ohio department of medicaid (ODM) or its contracted entity of the intent to seek ODM approval to utilize the selected alternate EVV vendor; and (2) Complete alternate system aggregator training. (D) The provider is responsible to ensure: (1) The visit data in the aggregator is correct and reflects the visit as it occurred; and (2) Billing...

...e establishes Ohio medicaid service provider requirements for services subject to EVV as described in rule 5160-32-01 of the Administrative Code. (B) All providers and financial management service vendors will: (1) Complete initial and ongoing training per Ohio department of medicaid (ODM) instructions published on the ODM website https://medicaid.ohio.gov/resources-for-providers/special-pr...