Ohio Administrative Code Search

... (a) Maintain an active, valid medicaid provider agreement as defined and set forth in rule 5160-1-17.2 of the Administrative Code; (b) Comply with all applicable provider requirements set forth in this rule; (c) Participate in initial and ongoing training, coaching, and supports from an independent validation entity recognized by the Ohio department of medicaid (ODM) to ensure consistency in de...

... the Administrative Code. (C) Eligible providers of IHBT services. (1) Providers eligible for medicaid payment for IHBT will: (a) Meet the criteria in paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code; and (b) Provide the service in accordance with rule 5122-29-28 of the Administrative Code. (D) Coverage. (1) Payment may be made for IHBT services rendered face-to-face in person or via tel...

... the Administrative Code. (C) Eligible providers of IHBT services. (1) Providers eligible for medicaid payment for IHBT will: (a) Meet the criteria in paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code; and (b) Provide the service in accordance with rule 5122-29-28 of the Administrative Code. (D) Coverage. (1) Payment may be made for IHBT services rendered face-to-face ...

... the Administrative Code. (C) Eligible providers of OhioRISE respite services. (1) Behavioral health respite services can be provided by the following individuals or organizations: (a) Behavioral health entities operating in accordance with paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code. Rendering practitioners will meet the critera to be an eligible provider of behavioral health services...

... Administrative Code. (C) Eligible providers of OhioRISE respite services. (1) Behavioral health respite services can be provided by the following individuals or organizations: (a) Behavioral health entities operating in accordance with paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code. Rendering practitioners will meet the criteria to be an eligible provider of b...

...der the OhioRISE program. (C) Eligible providers and conditions of participation. (1) The provider of primary flex funds will be the FMS entity under contract with the OhioRISE plan to complete the purchase and reimbursement of primary flex funds approved by the OhioRISE plan. (2) With the exception of paragraph (B)(14) of rule 5160-44-31 of the Administrative Code, the provider will comply with conditions of par...

...der the OhioRISE program. (C) Eligible providers and conditions of participation. (1) The provider of primary flex funds will be the FMS entity under contract with the OhioRISE plan to complete the purchase and reimbursement of primary flex funds approved by the OhioRISE plan. (2) With the exception of paragraph (B)(14) of rule 5160-44-31 of the Administrative Code, the provider will compl...

... transition planning. (C) Eligible providers. (1) A "PRTF provider" for purposes of Chapter 5160-59 of the Administrative Code is an entity covered in agency 5160 of the Administrative Code that provides psychiatric services to individuals twenty years of age or younger in an inpatient setting; and (a) Meets the provisions in 42 CFR Part 441 Subpart D and 42 CFR Part 483 Subpart G (October ...

...titutional services; and (b) Choice of providers who meet provider qualifications as described in Chapter 5160-59 of the Administrative Code to provide services under the waiver. (7) Have needs that can be safely met in an HCBS setting through the waiver as determined by ODM or its designee. (8) Meet the following age criteria: (a) Be between the ages of birth and twenty years of age at the time of initial enroll...

...ed clinician that is the treating provider dated no more than two years prior to the date of application for the OhioRISE waiver, accompanied by the diagnostic assessment that resulted in the applicable SED diagnosis performed by a licensed clinician. (d) Have documented functional impairment and behaviors that substantially interfere with or limit the youth's role or functioning in ...

...licensed clinician that is the treating provider dated no more than two years prior to the date of application for the OhioRISE waiver, accompanied by the diagnostic assessment that resulted in the applicable SED diagnosis performed by a licensed clinician. (d) Have documented functional impairment and behaviors that substantially interfere with or limit the youth's role or functioning in family, school, or communi...

...U.S.C. 1396n (January 1, 2022), and the providers eligible to deliver those services to youth enrolled on the waiver. (B) Providers seeking to deliver services in the waiver program will meet the criteria in Chapter 5160-59 and set forth in rules 5160-44-02 and 5160-44-31 of the Administrative Code, as appropriate. Providers that have responsibility for developing the child and family-centered care plan cannot prov...

... the Administrative Code. (C) Eligible providers and conditions of participation. (1) The following providers are eligible to provide the out-of-home respite service available under the waiver program: (a) An ICF/IID who is certified by the Ohio department of health (ODH), holds certification as a residential respite provider, and has an active license with the Ohio department of developmental disabilities (DODD)....

... Administrative Code. (C) Eligible providers and conditions of participation. (1) The following providers are eligible to provide the out-of-home respite service available under the waiver program: (a) An ICF/IID who is certified by the Ohio department of health (ODH), holds certification with the Ohio department of developmental disabilities (DODD) as a residential respite provider as set ...

... the Administrative Code. (C) Eligible providers and conditions of participation. (1) The following providers are eligible to provide TSS under the waiver program: (a) An entity operating in accordance with paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code. Eligible rendering practitioners employed by or under contract with the entity include those described in paragraph (A)(3), (A)(4), (A)(...

... Administrative Code. (C) Eligible providers and conditions of participation. (1) The following providers are eligible to provide TSS under the waiver program: (a) An entity operating in accordance with paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code. Eligible rendering practitioners employed by or under contract with the entity include those described in paragraph ...

... consecutive twelve-month period of the provider's operations as designated by the department. (A) Effective for medicaid cost reports filed for cost-reporting periods ending in state fiscal year (SFY) 2024, the PRTF will annually complete and submit the ODM 10278 "Ohio Medicaid Psychiatric Residential Treatment Facility (PRTF) Cost Report" that is applicable to the state fiscal year and each state...

...society or association. (15) "Medicaid provider" or "provider" means a person or governmental entity with a valid provider agreement to provide medical services or supplies to medicaid recipients. To the extent appropriate in the context, "medicaid provider" or "provider" includes a person or governmental entity applying for a provider agreement, a former medicaid provider, or both. (16) "Notice by ordinary mail" m...

...procedures to be followed when medicaid providers seek review of actions or proposed actions of the department, except for any action taken or decision made by the department with respect to entering into or refusing to enter into a contract with a managed care organization pursuant to section 5167.10 of the Revised Code and any action taken under section 5165.60 to 5165.89 of the Revised Code. The rules in Chapter 5...

...e documentation or information that the provider failed, upon request, to furnish to ODM or its contractor during the final fiscal audit process unless ODM agrees to the admissibility of such post final fiscal audit production of documentation or information; (4) The authority to hold pre-hearing conferences for the purpose of resolving issues that can be resolved by the participants in the hearing, including facili...

...Is created or received by a health care provider, health plan, employer or health care clearinghouse; and (b) Relates to the past, present, or future physical condition or mental health condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual and either: (i) Identifies the individual; or (ii) There is a reas...

...ormation, and to uniformly identify providers. (37) "Immigrant" means a person who comes to the United States (U.S.) with plans to live in the country permanently. This term includes, but is not limited to, an individual who is a refugee, asylee, parolee, or other entrant regardless of whether he or she is residing in the U.S. legally. (38) "Income" means cash, in-kind income as defined in p...

...ormation, and to uniformly identify providers. (38) "Immigrant" means a person who comes to the United States (U.S.) with plans to live in the country permanently. This term includes, but is not limited to, an individual who is a refugee, asylee, parolee, or other entrant regardless of whether he or she is residing in the U.S. legally. (39) "Income" means cash, in-kind income as defined in p...

...a) The agency may use county employees, provider or contractor employees, or volunteers who have been properly trained to staff outstation locations under the following conditions: (i) County outstation intake workers may perform all eligibility processing functions, including the eligibility determination, if the worker is authorized to do so at the regular intake office. (ii) Provider or...

...rative agency may use county employees, provider or contractor employees, or volunteers who have been properly trained to staff outstation locations under the following conditions: (i) County outstation intake workers may perform all eligibility processing functions, including the eligibility determination, when the worker is authorized to determine medical assistance eligibility at a regul...