Ohio Administrative Code Search

... 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 ...

...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...

... care aide services and as well as the provider requirements and specifications for the delivery of the service. 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" are defined as services provided pursuant to the per...

...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...

...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...

...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 (C) 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 para...

..."Group rate" means the amount that HCAS providers will be reimbursed when the service is provided in a group setting. (4) "Group setting" means a situation in which an HCAS provider furnishes HCAS in accordance with rule 5160-44-27 of the Administrative Code, and as authorized by the Ohio department of medicaid (ODM), to two or three individuals who reside at the same address. (5) "HCAS visit" is a visit during whi...

...e modification service as well as the provider requirements and specifications for the delivery of the service. 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) "Vehicle modifications" are adaptations or alterations to an automobile that is id...

...l transportation service as well as the provider requirements and specifications for the delivery of the service. 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) "Supplemental transportation services" are transportation services that are not av...

...istive and adaptive devices service and provider requirements and specifications for the delivery of the service. 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) "Supplemental adaptive and assistive device services" are medical equipment, suppl...

...ay health center service as well as the provider requirements and specifications for the delivery of the service. 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) "Adult day health center services (ADHCS)" are regularly scheduled services deliv...

...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:...

...h (C) of this rule and by qualified providers as defined in paragraph (E) of this rule. Payment for TCM services will 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 per...

...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...

...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...

...ices through the PACE site's network of providers. (E) If the individual is enrolled in a medicaid managed care organization (MCO) , the individual should access hospice services through the MCO's network of providers. (F) If the individual is enrolled in a home and community based services (HCBS) waiver, the designated hospice will assist the individual in coordinating concurrent care and waiver se...

... 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 ...

...(d) Moves out of the designated hospice provider's service area; (e) Enters a facility where the designated hospice has no access or cannot enter to provide care; (f) Revokes the hospice benefit in accordance with paragraph (B) of this rule; (g) Transfers to another hospice in accordance with paragraph (E) of this rule; or (h) Is discharged for cause, such as compromising the safety of self or...

...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...