Ohio Administrative Code Search

...This rule sets forth the requirement for recording the hospice provider span for individuals receiving medicaid hospice care in accordance with Chapter 5160-56 of the Administrative Code, including individuals who may be covered by third-party insurance, such as medicare, for which the hospice seeks reimbursement. (A) The designated hospice shall report the required enrollment information to the Ohio dep...

...This rule sets forth the responsibilities, including the conditions of participation for a hospice engaged in the provision of medicaid hospice services. To be eligible to provide and to request reimbursement for hospice services, a designated hospice must: (A) Be eligible to participate in the Ohio medicaid program upon execution of a provider agreement in accordance with rule 5160-1-17.2 of the Admin...

...This rule sets forth the responsibilities, including the conditions of participation for a hospice engaged in the provision of medicaid hospice services. To be eligible to provide and to request reimbursement for hospice services, a designated hospice should: (A) Meet the medicare guidelines in accordance with 42 C.F.R. part 418 (October 1, 2023). (B) Be authorized to provide services under Ohio law in ...

...This rule sets forth medicaid covered services that hospice providers may or must furnish to individuals to the extent specified by the individual's plan of care. (A) The designated hospice shall ensure the hospice services furnished to an individual in accordance with this rule are reasonable and necessary for the palliation and management of the terminal illness and related conditions. (B) Unless ...

...This rule sets forth medicaid covered services that hospice providers should furnish to individuals to the extent specified by the individual's plan of care. (A) The designated hospice will ensure the hospice services furnished to an individual in accordance with this rule are reasonable and necessary for the palliation and management of the terminal illness and related conditions. (B) Unless otherw...

...This rule sets forth the Ohio department of medicaid (ODM) payment for hospice services and care. (A) ODM will directly pay the designated hospice to care for an individual enrolled in medicaid hospice. Payment to the designated hospice shall cover the array of services listed in rule 5160-56-05 of the Administrative Code, except for: (1) Services pursuant to paragraph (E) of this rule which are p...

...This rule sets forth the Ohio department of medicaid (ODM) payment for hospice services and care. (A) ODM will directly pay the designated hospice to care for an individual enrolled in medicaid hospice. Payment to the designated hospice will cover the array of services listed in rule 5160-56-05 of the Administrative Code, except for: (1) Services pursuant to paragraph (E) of this rule which are pa...

...(A) The medicaid provider incentive program (MPIP) is Ohio's program implementing section 4201 of the American Recovery and Reinvestment Act of 2009 (ARRA), Pub. L. No. 111-5, and the published regulations in 42 C.F.R. Part 495. Certain medicaid eligible professionals and hospitals are eligible to participate in MPIP. Funding for this program ends in 2021. (B) An eligible professional partic...

...(A) Program integrity. (1) MPIP legal notice. (a) All eligible professionals and eligible hospitals submitting an application to receive an MPIP payment are required to sign the MPIP legal notice before confirming and submitting their application. (b) All program applicants are bound by the requirements of the MPIP legal notice. (2) Eligible professional and eligible hospital MPIP applications...

...(A) The definitions set forth in rule 5160-26-01 of the Administrative Code apply to the MyCare Ohio rules set forth in Chapter 5160-58 of the Administrative Code. (B) In addition to the definitions set forth in rule 5160-26-01 of the Administrative Code, the following definitions apply to Chapter 5160-58 of the Administrative Code: (1) "Assessment" means a comprehensive evaluation of an individ...

...(A) The definitions set forth in rule 5160-26-01 of the Administrative Code apply to the MyCare Ohio rules set forth in Chapter 5160-58 of the Administrative Code. (B) In addition to the definitions set forth in rule 5160-26-01 of the Administrative Code, the following definitions apply to Chapter 5160-58 of the Administrative Code: (1) "Assessment" means a comprehensive evaluation of an individ...

...(A) The definitions set forth in rule 5160-26-01 of the Administrative Code apply to the MyCare Ohio rules set forth in Chapter 5160-58 of the Administrative Code. (B) In addition to the definitions set forth in rule 5160-26-01 of the Administrative Code, the following definitions apply to Chapter 5160-58 of the Administrative Code: (1) "Assessment" means a comprehensive evaluation of an individ...

...(A) MyCare Ohio plans must comply with all of the requirements applicable to managed care plans (MCPs) in the following rules: (1) Rule 5160-26-05 of the Administrative Code; (2) Rule 5160-26-05.1 of the Administrative Code; (3) Rule 5160-26-06 of the Administrative Code; (4) Rule 5160-26-08.3 of the Administrative Code; (5) Rule 5160-26-09 of the Administrative Code; (6) Rule 5160-2...

...(A) Eligibility. (1) Except as specified in paragraph (A)(2) of this rule, in mandatory service areas as permitted by 42 C.F.R. 438.52 (October 1, 2016), an individual must be enrolled in a MyCare Ohio plan (also known as "plan") if he or she meets all of the following criteria: (a) Age eighteen or older at the time of enrollment in the plan; (b) Eligible for medicare parts A, B and D, and full benefits under the ...

...(A) Eligibility. (1) Except as specified in paragraph (A)(2) of this rule, in mandatory service areas as permitted by 42 C.F.R. 438.52 (October 1, 2021), an individual must be enrolled in a MyCare Ohio plan (MCOP) if he or she meets all of the following criteria: (a) Age eighteen or older at the time of enrollment in the MCOP; (b) Eligible for medicare parts A, B and D, and full benefits under ...

...(A) A member will be terminated from enrollment in a MyCare Ohio plan ("plan") for any of the following reasons: (1) The member becomes ineligible for full medicaid or medicare parts A or B or D. Termination of plan enrollment is effective the end of the last day of the month in which the member became ineligible. (2) The member's permanent place of residence is moved outside the plan's service ...

...(A) A member will be terminated from enrollment in a MyCare Ohio plan (MCOP) for any of the following reasons: (1) The member becomes ineligible for full medicaid or medicare parts A or B or D. Termination of MCOP enrollment is effective the end of the last day of the month in which the member became ineligible. (2) The member's permanent place of residence is moved outside the plan's service ar...

...(A) A member will be terminated from enrollment in a MyCare Ohio plan (MCOP) for any of the following reasons: (1) The member becomes ineligible for full medicaid or medicare parts A or B or D. Termination of MCOP enrollment is effective the end of the last day of the month in which the member became ineligible. (2) The member's permanent place of residence is moved outside the plan's service ar...

...(A) To be eligible for enrollment in the MyCare Ohio waiver, a member must meet all of the following requirements: (1) Be enrolled in the MyCare Ohio demonstration at the time of application for the MyCare Ohio waiver; (2) Be determined to have a nursing facility-based level of care (i.e., intermediate or skilled) in accordance with rule 5160-3-08 or 5160-3-09 of the Administrative Code; (3) In...

...(A) To be eligible for enrollment in the MyCare Ohio waiver, a member must meet all of the following requirements: (1) Be enrolled in the MyCare Ohio demonstration at the time of application for the MyCare Ohio waiver; (2) Be determined to have a nursing facility-based level of care (i.e., intermediate or skilled) in accordance with rule 5160-3-08 or 5160-3-09 of the Administrative Code; (3) In...

...(A) A MyCare Ohio plan (MCOP) must ensure members have access to all medically-necessary medical, drug, behavioral health, nursing facility and home and community-based services (HCBS) covered by Ohio medicaid. After consideration of verified third party liability including medicare coverage pursuant to rule 5160-26-09.1 of the Administrative Code, the MCOP must ensure: (1) Services are suffi...

...(A) A MyCare Ohio plan (MCOP) must ensure members have access to all medically-necessary medical, drug, behavioral health, nursing facility and home and community-based services (HCBS) covered by Ohio medicaid. After consideration of verified third party liability including medicare coverage pursuant to rule 5160-26-09.1 of the Administrative Code, the MCOP must ensure: (1) Services are suffi...

...(A) A MyCare Ohio plan (MCOP) will ensure each member has a primary care provider (PCP) who will serve as an ongoing source of primary care and assist with care coordination appropriate to the member's needs. (1) The MCOP will ensure PCPs are in compliance with the following triage requirements. Members with: (a) Emergency care needs will be triaged and treated immediately on presentation at...

...A member and/or an authorized representative who is acting on behalf of a member (hereinafter "member") who is enrolled in the MyCare Ohio waiver in accordance with rule 5160-58-02.2 of the Administrative Code has choice and control over the arrangement and provision of home and community-based services (HCBS). Members also have choice over the selection and control over the direction of approved waiver ser...

...(A) A member may choose to receive MyCare Ohio waiver services from any combination of providers on the provider panel of the MyCare Ohio plan selected by the member pursuant to paragraph (B) of rule 5160-58-04 of the Administrative Code. (B) A member receiving waiver services from any MyCare Ohio waiver provider will: (1) Participate with the waiver service coordinator in the development of th...