Ohio Administrative Code Search

...(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. (B) "Assessment" means an evaluation used to obtain information about an individual including their condition, personal goals and preferences, fun...

...(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...

...(A) The "Ohio department of aging (ODA)" is the agency responsible for daily operations for the pre-admission screening system providing options and resources today (PASSPORT) home and community-based services (HCBS) waiver. ODA will operate this waiver pursuant to an interagency agreement with the Ohio department of medicaid (ODM) in accordance with sections 5162.35 and 173.52 of the Revised Code...

...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...

...(A) The purpose of this rule is to establish the conditions under which providers are able to participate in the assisted living HCBS waiver program. (B) In order to obtain a medicaid provider agreement to be an assisted living services provider, the provider must be certified by the Ohio department of aging (ODA) or its designee in accordance with the provisions of rule 173-39-03 of the Administrative Code. (C) In...

...(A) The purpose of this rule is to establish the conditions under which providers are able to participate in the assisted living HCBS waiver program. (B) In order to obtain a medicaid provider agreement to be an assisted living services provider, the provider will be certified by the Ohio department of aging (ODA) as an assisted living provider in accordance with Chapter 173-39 of the Administrat...

...(A) The purpose of this rule is to describe the methods used to determine provider rates for the assisted living HCBS waiver as set forth in appendix A to rule 5160-1-06.5 of the Administrative Code. (B) Provider rates are determined for the following categories: (1) Per-job bid rate or deposit made. (2) Unit rate. (C) A per-job bid rate or deposit made shall be determined on a per-job basi...

...(A) For the purposes of Chapter 5160-35 of the Administrative Code, the following terms are defined as: (1) At the direction of: communication of a plan of care to a licensed practical nurse by a licensed physician or registered nurse who is acting within the scope of his or her practice under Ohio law for the provision of nursing services by the licensed practical nurse. (2) Clinical setting: f...

...(A) The purpose of this rule is to set forth the qualifications to become a medicaid school program provider (MSP) and requirements to be followed by an MSP provider. (B) An MSP provider: (1) Is one of the following: (a) A local education agency (LEA) city school district, local school district, exempted village school district, or any other school district as defined in sections 3311.01 to 3111.05...

...(A) The purpose of this rule is to set forth the provisions for claiming to receive medicaid reimbursement for the provision of services by medicaid school program (MSP) providers as defined in Chapter 5160-35 of the Administrative Code. (B) The CPT (common procedural terminology) and HCPCS (healthcare common procedure coding system) covered services provided through MSP providers that are allowa...

...(A) The purpose of this rule is to set forth the services authorized for medicaid coverage that a MSP provider can provide, and to set forth the conditions for providing the services. (B) A MSP provider may provide skilled services. Following are the skilled services an MSP provider may provide: (1) Occupational therapy services: (a) Description: services that evaluate and treat, as well as ser...

...(A) The purpose of this rule is to set forth the services authorized for medicaid coverage, beyond those indicated in rule 5160-35-05 of the Administrative Code, that a MSP provider can provide, and to set forth the conditions for providing the services. (B) In addition to the services indicated in rule 5160-35-05 of the Administrative Code, a MSP provider may render and receive payment for the f...

...(A) "Authorized representative" has the same meaning as in rule 5160:1-1-01 of the Administrative Code. (B) "Capitated payment" means the monthly payment paid to the program of all inclusive care for the elderly PACE organization by the Ohio department of medicaid (ODM) for medical care and services provided to medicaid recipients enrolled in PACE. (C) "Individual" is the applicant for or recipi...

...(A) In accordance with section 173.50 of the Revised Code, the Ohio department of aging (ODA) shall serve as the designated state administering agency for PACE and shall adhere to and monitor the implementation of all applicable requirements for the program's administration as set forth in 42 C.F.R Part 460 as in effect on October 1, 2019. (B) ODA shall: (1) Facilitate the process in which ...

...(A) To be eligible and maintain eligibility for PACE an individual shall meet the requirements for PACE participant eligibility set forth in rule 173-50-02 of the Administrative Code. (B) Individuals seeking enrollment in PACE through medicaid shall be determined by their county department of job and family services (CDJFS) to be eligible for Ohio medicaid in accordance with Chapters 5160:1-3...

...(A) To be eligible and maintain eligibility for PACE, an individual will meet the requirements for PACE participant eligibility set forth in rule 173-50-02 of the Administrative Code and will have been determined to be eligible for medicaid in accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative Code. (B) If a PACE participant who is also enrolled in medicaid has a continuous perio...

...(A) Each PACE organization shall establish and maintain at each PACE center an interdisciplinary team to assess the care and service needs of participants. The composition, qualifications, and activities of the interdisciplinary team shall be consistent with 42 C.F.R. Part 460 as in effect on October 1, 2019. (B) PACE organizations shall ensure that all participants have access to all medically n...