Ohio Administrative Code Search

...(A) For the purposes of medicaid reimbursement, therapeutic behavioral services (TBS) are goal-directed supports and solution-focused interventions. (1) Activities included must be intended to achieve the identified goals or objectives as set forth in the individual's treatment plan. Activities include but are not limited to the following: (a) Treatment planning. Participating in and utilizing s...

...(A) For the purpose of medicaid reimbursement, substance use disorder treatment services shall be defined by and shall be provided according to the American society of addiction medicine also known as the ASAM treatment criteria for addictive, substance related and co-occurring conditions for admission, continued stay, discharge, or referral to each level of care (LOC). (B) Medicaid will reimburs...

...(A) Targeted case management assists an individual within the eligible target population to gain access to needed medical, social, educational and other services. (1) Targeted case management services shall include, at a minimum, the following activities: (a) Comprehensive assessment and periodic reassessment of individual needs to determine the need for any medical, educational, social or o...

...(A) Behavioral health nursing services are mental health and substance use disorder (SUD) nursing services performed by registered nurses or licensed practical nurses. They include those activities that are performed within professional scope of practice and in authorized settings by staff that are licensed by the Ohio board of nursing and are intended to address the behavioral and other physical ...

...(A) For the purpose of medicaid reimbursement, behavioral health crisis intervention is a timely intervention with medicaid recipients who are experiencing a life threatening or complex emergent situation related to mental illness or a substance use disorder. (1) The goals of crisis intervention are to ease the crisis, re-establish safety and institute interventions to minimize psychological ...

...(A) For the purposes of this rule, mobile response and stabilization service (MRSS), is the service as set forth by the Ohio department of mental health and addiction services (OhioMHAS) in rule 5122-29-14 of the Administrative Code. (B) Eligible providers. (1) Providers certified by OhioMHAS in accordance with rule 5122-29-14 of the Administrative Code are eligible for MRSS reimbursement. (2) ...

...(A) For the purposes of this rule, mobile response and stabilization service (MRSS), is the service as set forth by the Ohio department of mental health and addiction services (OhioMHAS) in rule 5122-29-14 of the Administrative Code. (B) Eligible providers. (1) Providers eligible to provide MRSS in accordance with rule 5122-29-14 of the Administrative Code and designated by OhioMHAS as regional ...

...(A) For the purposes of this rule, behavioral health peer support service is the service as set forth by the Ohio department of mental health and addiction services (OhioMHAS) in rule 5122-29-15 of the Administrative Code. (B) Eligible providers. (1) An eligible rendering provider of peer support services is: (a) A person who is eligible to provide peer support services in accordance with rule ...

...The following definitions apply for purposes of this chapter. Policies governing fee-for-service clinics are set forth in Chapter 5160-13 of the Administrative Code. (A) "Change in scope of service" is an alteration in aspects of a service such as the procedures or items that are furnished, the frequency with which they are furnished, and the personnel who furnish them. (1) Factors that constitute a...

...(A) "Change in scope of service" is an alteration in aspects of a prospective payment system (PPS) service such as the procedures or items that are furnished, the frequency with which they are furnished, and the type of personnel who furnish them. (1) A change in scope of service is characterized by such factors as are specified in the following non-exhaustive list: (a) The addition or discontin...

...(A) A federally qualified health center (FQHC) may receive prospective payment system (PPS) payment for providing any of the following FQHC PPS services: (1) In accordance with section 330 of the Public Health Services Act, 42 U.S.C. chapter 6A (October 1, 2021), medical services, which comprise any of four types of services: (a) Services referenced at 42 U.S.C. 1395x(aa)(3) (October 1, 2021...

...(A) Data entered into a cost report should represent "reasonable and allowable costs," which are defined in "Principles of reasonable cost reimbursement," 42 C.F.R. part 413 (October 1, 2021). (B) For purposes of payment determination, an FQHC or RHC submits a cost report in any of the following circumstances: (1) An FQHC or RHC that is newly enrolled as a medicaid provider submits a cost report...

...(A) A discrete, all-inclusive per-visit payment amount (PVPA) is established for each FQHC PPS service provided at an FQHC or related off-site location and for an RHC PPS service provided at an RHC or related off-site location. (1) For all FQHC or RHC sites that are already enrolled as medicaid providers, ODM establishes new PVPAs equal to the current PVPAs revised to reflect the latest available...

...(A) A discrete, all-inclusive per-visit payment amount (PVPA) is established for each FQHC PPS service provided at an FQHC or related off-site location and for an RHC PPS service provided at an RHC or related off-site location. (1) For all FQHC or RHC sites that are already enrolled as medicaid providers, the Ohio department of medicaid (ODM) establishes new PVPAs equal to the current PVPAs revis...

...(A) The purpose of this rule is to define the terms used in Chapter 5160-31 of the Administrative Code governing the preadmission screening system providing options and resources today (PASSPORT) home and community-based services (HCBS) waiver program. As used in this chapter: (B) "Activities of Daily Living (ADL)" means activities of daily living as defined in rule 5160-3-05 of the Adminstrative ...

...(A) To be eligible for the medicaid-funded component of the pre-admission screening system providing options and resources today (PASSPORT) program, an individual must meet all of the following requirements: (1) The individual must have been determined eligible for medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code. (2) The cost of waiver services in the per...

...(A) To be eligible for the medicaid-funded component of the pre-admission screening system providing options and resources today (PASSPORT) program, an individual must meet all of the following requirements: (1) The individual must have been determined eligible for medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code. (2) The cost of waiver services in the per...

...The purpose of this rule is to describe the methods used to determine provider rates for the PASSPORT program. (A) Rates determined under this rule shall not exceed the maximum allowable rates for PASSPORT services in appendix A to rule 5160-1-06.1 of the Administrative Code. Payment for PASSPORT waiver services constitutes payment in full and shall not be construed as a partial payment when the paymen...

...The purpose of this rule is to describe the methods used to determine provider rates for the pre-admission screening system providing options and resources today (PASSPORT) program. (A) Rates determined under this rule will not exceed the maximum allowable rates for PASSPORT services in appendix A to rule 5160-1-06.1 of the Administrative Code. Payment for PASSPORT waiver services constitutes paymen...

...(A) This rule establishes Ohio medicaid programs and program services subject to participation in the EVV program, required under Section 1903 of the Social Security Act (42 U.S.C. 1396b) as in effect on the effective date of this rule. (B) For purposes of this chapter, EVV is the use of technology to verify certain data elements related to the delivery of medicaid-covered services. (C) Ohio m...

...(A) The purpose of this rule is to define the terms used in Chapter 5160-33 of the Administrative Code governing the medicaid assisted living HCBS waiver program. As used in this chapter: (B) "ADL" means activities of daily living including bathing; grooming; toileting; dressing; eating; and mobility, which refers to bed mobility, transfer, and locomotion as these are defined in 5160-3-05 of the Administrative Co...

...(A) The purpose of this rule is to define the terms used in Chapter 5160-33 of the Administrative Code governing the medicaid assisted living HCBS waiver program. As used in this chapter: (B) "Assessment" means a face-to-face evaluation used to obtain information about an individual including his or her condition, personal goals and preferences, functional limitations, health status and other fa...

...(A) The purpose of this rule is to outline the requirements that must be met for an individual to be eligible to enroll in the medicaid funded component of the assisted living program. (B) To be eligible for the medicaid funded component of the assisted living program, an individual must meet all of the following: (1) Be eligible for medicaid in accordance with Chapters 5160:1-3 to 5160:1-6 ...

...(A) The purpose of this rule is to outline the requirements that must be met for an individual to be eligible to enroll in the medicaid funded component of the assisted living program. (B) To be eligible for the medicaid funded component of the assisted living program, an individual must meet all of the following: (1) Be eligible for medicaid in accordance with Chapters 5160:1-3 to 5160:1-6 ...

...(A) The purpose of this rule is to outline the requirement that must be met for an individual to enroll in the medicaid-funded component of the assisted living waiver program. (B) To be eligible for enrollment, an individual must: (1) Have been determined to meet the eligibility requirements set forth in rule 5160-33-03 of the Administrative Code; and (2) Upon initial and continued enrollme...