Ohio Administrative Code Search

...hopping" means the ability to obtain or purchase one's necessary items. Necessary items include, but are not limited to, groceries, clothing, and household items. Shopping does not include handling finances or accessing transportation. (18) "Less than twenty-four hour support" means that an individual requires the presence of another person, or the presence of a remote monitoring device that does not require the ind...

...ligible to retain a PNA account for the purchase of items and services of his or her choice. (2) The PNA account is the exclusive property of the resident, who may use the funds in the account as he or she chooses to meet personal needs. (3) Unless a medicaid resident receives additional irregular contributions from another source, all of his or her personal expenses shall be met through the PNA...

...x-ray services. Costs incurred for the purchase and administration of tuberculin tests, and for drawing specimens and forwarding specimens to a laboratory, are paid through the NF per diem. All costs of laboratory and x-ray procedures covered under the medicaid program are paid directly to the laboratory or x-ray provider in accordance with Chapter 5160-11 of the Administrative Code. (E) Medical...

...d this rule, a "sale" occurs when a purchase agreement or similar document that outlines the terms of the purchase and results in the payment of money for the business or bed license, is signed or, if the signature is not dated, the effective date specified in the purchase agreement or similar document. (B) Any nursing facility that sells any of its business or bed licenses in accordance with...

... laboratory holding a current volume purchase contract: (a) Scratch-resistant coated plastic and polycarbonate lenses monofocal, bifocal, or trifocal; (b) Aphakic monofocal and multifocal lenses; (c) A moderately-priced standard acetate or metal frame; and (d) The following items or services: (i) Frosted lenses; (ii) High-index plastic lenses; (iii) Lenses of ...

...f the Administrative Code. (5) "Volume purchase contract," for purposes of this rule, is the current contract designated "medicaid vision volume purchase program: ophthalmic laboratory services and delivery" that is maintained by the Ohio department of administrative services. The contract can be accessed at https://ohiobuys.ohio.gov/page.aspx/en/ctr/contract_browse_public. (C) Providers. (1) R...

... the actual amount the provider paid to purchase the prescribed drug. ODM acquires AAC data through one or more of the following: national survey of retail pharmacy providers, e.g., national average drug acquisition cost (NADAC) rate process, states' surveys of retail pharmacy providers e.g., Ohio average acquisition cost (OAAC), and published compendia prices, e.g., wholesale acquisition cost (WA...

... the actual amount the provider paid to purchase the prescribed drug. ODM acquires AAC data through one or more of the following: national survey of retail pharmacy providers, e.g., national average drug acquisition cost (NADAC) rate process, states' surveys of retail pharmacy providers, and published compendia prices, e.g., wholesale acquisition cost (WAC). (3) "Administration fee" means the max...

...review." This form along with copies of purchase records for the national drug code (NDC) are submitted to pharmacy pricing and audit consultant (PPAC). This information is found at https://medicaid.ohio.gov/stakehiolders-and-partners/phm. (a) PPAC staff evaluate and recommend whether an OAAC rate adjustment is warranted. (b) All OAAC rate adjustments are sent by PPAC to ODM for final approval...

... department to consider whether the purchase of a new piece of equipment might be more cost-effective than continued repair. (10) "Private residence" is a recipient's place of residence other than a long-term care facility (LTCF). (11) "Provider cost" is the amount paid for an item by a DMEPOS provider to a supplier or manufacturer, exclusive of discounts, rebates, and situation-specific ...

... department to consider whether the purchase of a new piece of DME might be more cost-effective than continued repair. (13) "Prior authorization (PA)" has the same meaning as in rule 5160-1-31 of the Administrative Code. (14) "Private residence" is a medicaid-eligible individual's place of residence other than a long-term care facility (LTCF). (15) "Provider cost" is the amount paid for...

...(c) The provision of or payment for the purchase of a medically necessary bathing seat for a resident of a long-term care facility (LTCF) is the responsibility of the LTCF. Therefore, claims submitted to the department for bathing seats furnished to LTCF residents will be denied. (d) Bathing seats on wheels are not to be used simply as transport chairs from which an individual then transfers to a...

...(c) The provision of or payment for the purchase of a medically necessary bathing seat for a resident of a long-term care facility (LTCF) is the responsibility of the LTCF. Therefore, claims submitted to the department for bathing seats furnished to LTCF residents will be denied. (d) Bathing seats on wheels are not to be used simply as transport chairs from which an individual then transfers to a bat...

... oscillation (HFCWO) device on a rental/purchase basis. (2) The default certificate of medical necessity (CMN) is form ODM 10229, "Certificate of Medical Necessity: High-Frequency Chest Wall Oscillation Devices" (7/2018). (3) An initial trial period of at least two months is required. Payment may be made for rental during this trial period, excluding any portion that coincides with an inpati...

... oscillation (HFCWO) device on a rental/purchase basis. (2) Purchase of a HFCWO device will not be considered without an initial trial period lasting at least two months, excluding any portion that coincides with an inpatient hospital stay. Payment may be made for rental during this trial period. (3) The default certificate of medical necessity (CMN) is form ODM 10229, "Certificate of Medical Ne...

...de for an apnea monitor on a rental/purchase basis. (2) The monitoring unit must meet current United States food and drug administration guidelines. (3) The default certificate of medical necessity (CMN) form is the ODM 02900, "Certificate of Medical Necessity: Apnea Monitors" (rev. 7/2018). (4) Payment for the initial rental of an apnea monitor is limited to four months. For this initial renta...

...ade either for additional rental or for purchase, only if the following conditions are satisfied: (a) The monitoring unit meets current United States food and drug administration guidelines. (b) The provider is capable of performing all of the following services: (i) Arranging to have certified individuals provide infant cardiopulmonary resuscitation (CPR) training to caregivers; (ii) Prov...

...be made for a TENS unit on a rental/purchase basis. (2) The default certificate of medical necessity (CMN) form is the ODM 03402, "Certificate of Medical Necessity: Transcutaneous Electrical Nerve Stimulation (TENS) Units" (rev. 7/2018). The CMN must include one of the following statements of need: (a) For neurogenic pain, the following information: (i) An attestation that the individual ...

...be made for a TENS unit on a rental/purchase basis. (2) The default certificate of medical necessity (CMN) form is the ODM 03402, "Certificate of Medical Necessity: Transcutaneous Electrical Nerve Stimulation (TENS) Units" (rev. 7/2018). The CMN includes one of the following statements of need: (a) For neurogenic pain, the following information: (i) An attestation that the individual is exper...

...me with a wheelchair at the time of purchase: (a) A sling or solid seat with back, a captain's chair, or a stadium-style seat; (b) Standard casters or wheels with tires; (c) Standard armrests; (d) Standard front rigging, such as non-elevating legrests with footrests or a footplate; (e) Wheel locks or brakes; (f) With a power mobility device, motors; (g) With a power mobility device, a non-expandab...

... limb. (B) Payment may be made for the purchase of a pneumatic appliance. Payment may be made on a rental/purchase basis for a pneumatic compressor. (C) The default form is the ODM 02929, "Certificate of Medical Necessity: Pneumatic Compression Devices and Accessories" (rev. 7/2018). The CMN must include the following information: (1) A statement that previous treatment produced no signific...

... months), for rental with subsequent purchase, or for purchase outright, as the prescribing practitioner determines to be appropriate. For a covered pneumatic appliance or accessory, payment is made for purchase.

...made for a hospital bed on a rental/purchase basis. (2) The default certificate of medical necessity (CMN) form is the ODM 02910, "Certificate of Medical Necessity: Hospital Beds and Bed Accessories" (rev. 7/2018). The CMN must include an attestation that at least one of the following criteria is met: (a) The individual's condition (e.g., congestive heart failure, chronic obstructive pulmonary d...

...made for a hospital bed on a rental/purchase basis. (2) The default certificate of medical necessity (CMN) form is the ODM 02910, "Certificate of Medical Necessity: Hospital Beds and Bed Accessories" (rev. 7/2018). The CMN includes an attestation that at least one of the following criteria is met: (a) The individual's condition (e.g., congestive heart failure, chronic obstructive pulmonary disea...

...de for a pulse oximeter on a rental/purchase basis. The default certificate of medical necessity (CMN) form is the ODM 03401, "Certificate of Medical Necessity: Pulse Oximeters" (rev. 7/2018). The CMN must include an attestation by a prescriber that a need exists either for diagnostic monitoring or for continuous monitoring: (a) For diagnostic monitoring undertaken in response to an acute cli...