Ohio Administrative Code Search

...(A) "Private duty nursing (PDN)" is a continuous nursing service that requires the skills of and is performed by either a registered nurse (RN) or a licensed practical nurse (LPN) at the direction of a registered nurse. A service is not considered a PDN service merely because it was performed by a licensed nurse. A covered PDN visit must meet the definition in paragraph (A) of rule 5160-12-04 of t...

...(A) As a prerequisite to receiving private duty nursing (PDN) services, an individual must meet the requirements set forth in rule 5160-12-02 of the Administrative Code, as applicable, which require the individual to receive PDN authorization from the Ohio department of medicaid (ODM) or its designee. (B) The procedures set forth in this paragraph must be followed when securing a PDN authorization for individuals wh...

...(A) A medicare certified home health agency (MCHHA) that meets the requirements of this rule is eligible to participate in the Ohio medicaid program upon execution of a provider agreement in accordance with rule 5160-1-17.2 of the Administrative Code. (B) MCHHAs are required to: (1) Be certified for medicare participation by the Ohio department of health (ODH) in accordance with Chapter 3701-60 of the Administrati...

...(A) "Non-agency nurses" and "otherwise-accredited agencies" who meet the qualifications and requirements of this rule can provide private duty nursing (PDN) in accordance with rule 5160-12-02 of the Administrative Code. (B) A "non-agency nurse" that meets the requirements in accordance with this rule is eligible to participate in the Ohio medicaid program upon execution of a provider agreement in accordance with rul...

...(A) Reimbursement of home health or private duty nursing (PDN) services in accordance with this chapter are on a per visit basis. A "visit" is the duration of time that a covered home health service or private duty nursing (PDN) service is provided during an in-person or telehealth encounter to one or more individuals receiving medicaid at the same residence on the same date during the same time p...

...(A) Definitions of terms used for billing home health services rates set forth in appendix A to this rule are: (1) "Base rate", as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid: (a) For the initial thirty-five to sixty minutes of home health aide service delivered; (b) For the initial thirty-five to sixty minutes of home health nursing service d...

...(A) Definitions of terms used for billing home health services rates set forth in appendix A to this rule are: (1) "Base rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid: (a) For the initial thirty-five to sixty minutes of home health aide service delivered; (b) For the initial thirty-five to sixty minutes of home health nursing service d...

...(A) Definitions of terms used for billing home health services rates set forth in appendix A to this rule are: (1) "Base rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid: (a) For the initial thirty-five to sixty minutes of home health aide service delivered; (b) For the initial thirty-five to sixty minutes of home health nursing service d...

...(A) Definitions of terms used for billing private duty nursing services (PDN) rates set forth in appendix A to this rule are: (1) "Base rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid for the initial thirty-five to sixty minutes of service delivered. (2) "Unit rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid f...

...(A) Definitions of terms used for billing private duty nursing services (PDN) rates set forth in appendix A to this rule are: (1) "Base rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid for the initial thirty-five to sixty minutes of service delivered. (2) "Unit rate," as used in this rule and appendix A to this rule, means the amount reimburse...

...(A) Definitions of terms used for billing private duty nursing services (PDN) rates set forth in appendix A to this rule are: (1) "Base rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid for the initial thirty-five to sixty minutes of service delivered. (2) "Unit rate," as used in this rule and appendix A to this rule, means the amount reimburse...

...Home health, RN assessment, RN consultation, and private duty nursing (PDN) service providers may be reimbursed when any of the exceptions set forth in this rule apply through no fault of the provider: (A) Requirements of paragraphs (D)(2) of rule 5160-12-01 and (E)(2) of rule 5160-12-02 of the Administrative Code are not met due to any of the following: (1) Services are not identified on the all services plan when...

...(A) For the purpose of this rule: (1) A "plan of care" is the medical treatment plan that is established, approved, and signed by a treating physician, advance practice nurse or physician's assistant in accordance with the Coronavirus Aid, Relief, and Economic Security (CARES) Act, S.3548 (2020), prior to a provider requesting reimbursement for a service. The plan of care has the same meaning...

...(A) For the purpose of this rule: (1) A "plan of care" is the medical treatment plan that is established, approved, and signed by a treating physician, advance practice nurse or physician's assistant in accordance with the Coronavirus Aid, Relief, and Economic Security (CARES) Act, S.3548 (2020), prior to a provider requesting reimbursement for a service. The plan of care has the same meaning...

...(A) Unless otherwise noted, any limitations or requirements specified in the Revised Code or in agency 5160 of the Administrative Code apply to services addressed in this rule. (B) Definitions. (1) "Clinic" is an entity that meets all of the following criteria: (a) It renders clinic services on an outpatient basis under the direction of a physician or dentist. Clinic services are defined in 42 CFR 440.90 (October ...

...(A) Unless otherwise noted, any limitations or requirements specified in the Revised Code or in agency 5160 of the Administrative Code apply to services addressed in this rule. (B) This rule does not apply to federally qualified health centers (FQHCs) nor to rural health clinics (RHCs), policies for which are set forth in Chapter 5160-28 of the Administrative Code. (C) Definition. "Clinic" is an...

...(A) Provisions in this chapter do not necessarily apply to transportation furnished in accordance with other chapters of agency 5160 of the Administrative Code. (B) The following definitions apply to this chapter: (1) Terms that have the same meaning as in 42 C.F.R. 414.605 (October 1, 2020) include the following items: (a) "Advanced life support, level 1 (ALS1)"; (b) "Advanced life suppor...

...(A) Definitions. (1) "Private transportation vendor (PTV)" is an entity that meets the following criteria: (a) It seeks to establish or to maintain a contract with a county department of job and family services (CDJFS) to supply transportation service to medicaid recipients in accordance with rule 5160-15-10 of the Administrative Code; and (b) It is not a government agency, transit authority, p...

...(A) Definitions. (1) "Private transportation vendor (PTV)" is an entity that meets the following criteria: (a) It seeks to establish or to maintain a contract with a county department of job and family services (CDJFS) to supply transportation service to medicaid recipients in accordance with rule 5160-15-10 of the Administrative Code; and (b) It is not a government agency, transit authority, p...

...(A) Definition. "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (B) Transportation-specific criteria. For each entity enrolled as an eligible provider of transportation services, the following conditions are met: (1) The entity, each crew member, and each attendant comply with all applicable local, state, and federal laws, regulations, and rules, inc...

...(A) Payment may be made for the following wheelchair van services: (1) Transport by wheelchair van; (2) Mileage, wheelchair van; and (3) Attendant services, wheelchair van. (B) Payment may be made only if all the conditions in this paragraph are met. (1) The necessity of the wheelchair van service is established. A necessary wheelchair van service is presumed to satisfy the criteria ...

...(A) Payment may be made for the following ground ambulance services: (1) Basic life support, provided in a non-emergency (BLS non-emergency); (2) Basic life support, provided in an emergency (BLS emergency); (3) Advanced life support, level 1, provided in a non-emergency (ALS1 non-emergency); (4) Advanced life support, level 1, provided in an emergency (ALS1 emergency); (5) Advanced life ...

...(A) No payment can be made for the following services and associated costs: (1) Transportation services for an individual who is not medicaid-eligible at the time of transport; (2) Transportation of a medicaid-eligible individual for a purpose other than the receipt of medicaid-coverable services; (3) Transportation of a medicaid-eligible individual to or from a service provided outside the...

...(A) Certification is needed to confirm the necessity of wheelchair van services and most non-emergency ambulance services. No certification is needed for transportation services furnished by an eligible provider that are automatically deemed to be necessary in accordance with rule 5160-15-22, 5160-15-23, or 5160-15-24 of the Administrative Code. A medicaid managed care organization (MCO) is not ob...

...(A) Purpose. This rule implements section 5164.96 of the Revised Code regarding supplemental medicaid payments to eligible emergency medical services organizations operated by a government entity. (B) Definitions applicable to this rule. (1) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (2) "Ground ambulance transport" comprises the following ...