Ohio Administrative Code Search

...(A) Coverage. (1) Separate payment may be made for a speech-generating device (SGD) furnished to a resident of a long-term care facility (LTCF). (2) The default certificate of medical necessity (CMN) form is the ODM 02924, "Certificate of Medical Necessity: Speech-Generating Devices" (rev. 7/2018). The CMN must include the following elements: (a) A formal, written report of a face-to-face evalu...

...(A) Coverage. (1) Separate payment may be made for a speech-generating device (SGD) furnished to a resident of a long-term care facility (LTCF). (2) The default certificate of medical necessity (CMN) form is the ODM 02924, "Certificate of Medical Necessity: Speech-Generating Devices" (rev. 7/2018). The CMN includes the following elements: (a) A formal, written report of a face-to-face evaluatio...

...(A) Definitions and explanations. (1) "Multiple-user lactation pump" is a lactation pump that is safe for sequential use by multiple individuals. (The term "hospital-grade," which is often applied to such a pump, is not recognized by the United States food and drug administration.) A multiple-user lactation pump comes with a separate set of accessories (e.g., breast shields, tubing) for each ...

...(A) Definitions. (1) "Sensor-augmented insulin pump system" is an insulin infusion pump equipped with a continuous glucose monitoring (CGM) sensor. The pump uses the glucose readings taken by the CGM sensor to modify the amount of insulin infused. (2) "Insulin pump," for purposes of this rule, is a collective term encompassing a portable external insulin infusion pump and a sensor-augmented insu...

...(A) Definitions. (1) "Ambulation aid" is a collective term for a cane, crutch, or walker. (2) "Ambulatory limitation" is an impediment to walking that has either of two effects: (a) It prevents an individual from completing activities of daily living within a reasonable time (or at all); or (b) It places an individual at a demonstrably higher risk of injury, exacerbation of illness, or death w...

...(A) Definitions. (1) "Ambulation aid" is a collective term for a cane, crutch, or walker. (2) "Ambulatory limitation" is an impediment to walking that has either of two effects: (a) It prevents an individual from completing activities of daily living within a reasonable time (or at all); or (b) It places an individual at a demonstrably higher risk of injury, exacerbation of illness, or death w...

...(A) Definitions and explanations that apply to this chapter of the Administrative Code. (1) "Clinical consultation" is the formal evaluation by a physician or other qualified healthcare professional, performed on the written order of a treating practitioner, of test results that appear to be abnormal. Payment for the clinical consultation is based on the physician fee schedule relative value ...

...(A) Providers. An entity may enroll in medicaid as a portable x-ray supplier only if it complies with the conditions set forth in 42 C.F.R. part 486 subpart C (October 1, 2020). (B) Coverage. (1) The radiology procedures performed by a portable x-ray supplier have both a professional component and a technical component. (a) In general, a portable x-ray supplier performs the technical component ...

...(A) Providers. (1) An entity may enroll in medicaid as an independent diagnostic testing facility (IDTF) only if it meets the following criteria: (a) It meets all standards set forth in and provide services in accordance with 42 C.F.R. 410.33 (October 1, 2020); (b) It takes the following measures to establish accountability: (i) It ensures that each supervising practitioner attests in writin...

...(A) "Home health services" includes home health nursing, home health aide services and skilled therapies. (B) Home health services are reimbursable only if a qualifying treating physician, advance practice nurse or physician assistant certifying the need for home health services documents that he or she had a face-to-face encounter with the individual within ninety days prior to the start of ...

...(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 ...