Ohio Administrative Code Search

...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...

...n for which the medicaid school program provider has contracted for the delivery of services, where the eligible child's privacy 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 terminology (CPT): also k...

... 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...

...ons to become a medicaid school program provider (MSP) and processes 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 3311.04 of the Revised Code; (b) A state school for the deaf as defined by section 33...

...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...

...rized for medicaid coverage that an MSP provider can provide, and to set forth the conditions for providing the services. (B) The MSP provider will only submit claims for services which it has statutory authority to provide, including medically necessary services to eligible children in accordance with this rule and rules 5160-35-06 and 5160-35-07 of the Administrative Code that are appropriately documented in the f...

... 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...

... of 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 rules 5160-35-05 and 5160-35-07 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...

...of the Administrative Code, that an MSP provider can provide, and to set forth the conditions for providing the services. (B) MSP providers listed in rule 5160-35-05 of the Administrative Code are authorized to provide services to eligible children without a school services plan of care or an IEP defined in paragraph (B) of rule 5160-35-05 of the Administrative Code with sufficient documentation of medical necessity...

...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...

... 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, ...

...0 of the Administrative Code. (6) "Provider" means a person or agency certified or licensed by DODD that has met the provider qualification requirements to provide the specific self-empowered life funding 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. (7) "SSA" means a service and ...

...ost inclusive community setting. (12) "Provider" means a person or agency who is eligible per Chapter 5123-2 and rule 5160-1-17.2 of the Administrative Code to provide the specific SELF waiver service as specified in this rule. (13) "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 5123-5-02 of t...

...h paragraph (H) of this rule. (5) "Provider" means a person or agency certified or licensed by DODD that has met the provider qualification requirements to provide specific waiver services, as specified in paragraph (J)(1) of this rule, with a valid medicaid provider agreement as specified in paragraph (J)(2) of this rule. (6) "SSA" means a service and support administrator who is certified ...

...most inclusive community setting. (7) "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 L1 waiver services as specified in this rule. (8) "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 5...

...on that must be maintained by a service provider. (6) "Home and community-based services (HCBS) setting" has the same meaning as set forth in rule 5160-44-01 of the Administrative Code. (7) "Incident" means an alleged, suspected or actual event that is not consistent with the routine care of and/or service delivery to an individual as set forth in rule 5160-43-06 of the Administrative Code. Incidents include, but a...

...hat must be maintained by a service provider. (4) "Health and safety action plan" means the document created between the Ohio department of medicaid (ODM) or its designee and an individual enrolled in the program that identifies the interventions recommended by the recovery manager to remedy risks to the health and welfare of the individual. (5) "Home and community-based services (HCBS) sett...

...hat must be maintained by a service provider. (4) "Health and safety action plan" means the document created between the Ohio department of medicaid (ODM) or its designee and an individual enrolled in the program that identifies the interventions recommended by the recovery manager to remedy risks to the health and welfare of the individual. (5) "Home and community-based services (HCBS) sett...