Ohio Administrative Code Search

... 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...

...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...

...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 ...

...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...

...) "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...

...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...

... inclusive community setting. (9) "Provider" means a person or agency who is eligible per Chapter 5123-2 of the Administrative Code and rule 5160-1-17.2 of the Administrative Code to provide IO waiver services as specified in this rule. (10) "SSA" means a service and support administrator who is eligible to perform the functions of service and support administration per rules 5123-4-02 and ...

...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...