Ohio Administrative Code Search

...(A) Definitions of terms used for billing and calculating rates. (1) "Base rate," as used in table A, column 3 of paragraph (B) of this rule, means the amount reimbursed by the Ohio department of medicaid (ODM) for the first thirty-five to sixty minutes of service delivered. (2) "Bid rate," as used in table B, column 3 of paragraph (B) of this rule, means the per job bid rate negotiated between the provider and the...

...(A) Definitions of terms used for billing and calculating rates. (1) "Base rate," as used in table A, column 3 of paragraph (B) of this rule, means the amount reimbursed by the Ohio department of medicaid (ODM) for the first thirty-five to sixty minutes of service delivered. (2) "Bid rate," as used in table B, column 3 of paragraph (B) of this rule, means the per job bid rate negotiated between the provider and the...

...(A) The following waiver services are covered by the Ohio home care waiver: (1) Home delivered meals as described in rule 5160-44-11 of the Administrative Code (2) Home maintenance and chores as described in rule 5160-44-12 of the Administrative Code (3) Home modification as described in rule 5160-44-13 of the Administrative Code (4) Community integration as described in rule 5160-44-14 of ...

...(A) Definitions of terms used for billing and calculating home care attendant services (HCAS) rates. (1) "Base rate," as set forth in column 3 of tables A and B of this rule, means the amount reimbursed by Ohio medicaid for the first thirty-five to sixty minutes of assistance with self-administration of medications and the performance of nursing tasks provided during a single visit. (2) "Continuous nursing" means n...

...This rule sets forth the definition of the vehicle modification service as well as the provider requirements and specifications for the delivery of the service. Providers are also subject to the conditions of participation set forth in rule 5160-44-31 of the Administrative Code. Services are reimbursed in accordance with rule 5160-46-06 of the Administrative Code. (A) "Vehicle modifications" are adapt...

...This rule sets forth the definition of the supplemental assistive and adaptive devices service and provider requirements and specifications for the delivery of the service. Providers are also subject to the conditions of participation set forth in rule 5160-44-31 of the Administrative Code. Services are reimbursed in accordance with rule 5160-46-06 of the Administrative Code. (A) "Supplemental adaptive an...

...This rule sets forth the definition of the adult day health center service as well as the provider requirements and specifications for the delivery of the service. Providers are also subject to the conditions of participation set forth in rule 5160-44-31 of the Administrative Code. Services are reimbursed in accordance with rule 5160-46-06 of the Administrative Code. (A) "Adult day health center serv...

...(A) Purpose. (1) This rule specifies the conditions for medicaid payment of targeted case management (TCM), which is comprised of those activities described in section 5126.15 of the Revised Code and in rule 5123:2-1-11 of the Administrative Code, but only to the extent that they are listed in paragraph (D) of this rule as reimbursable activities for medicaid eligible individuals with developmental disabilities. (2...

...(A) Purpose. (1) This rule specifies the conditions for medicaid payment of targeted case management (TCM), which is associated with activities described in section 5126.15 of the Revised Code and in rule 5123-4-02 of the Administrative Code, but only to the extent that they are listed in paragraph (D) of this rule as reimbursable activities for medicaid eligible individuals with developmental di...

...(A) Purpose. (1) This rule specifies the conditions for medicaid payment of targeted case management (TCM), which is associated with activities described in section 5126.15 of the Revised Code and in rule 5123-4-02 of the Administrative Code, but only to the extent that they are listed in paragraph (D) of this rule as reimbursable activities for medicaid eligible individuals with intellectual and...

...(A) Helping Ohioans move, expanding choice (HOME choice) assists individuals to transition from an institutional setting into a community setting. (B) Definitions (1) "Assessment" means an in-person meeting with the HOME choice applicant to determine eligibility for the program, conducted by the Ohio department of medicaid (ODM) or its designee. (2) "Community setting" means a location that me...

...(A) Helping Ohioans move, expanding choice (HOME choice) assists individuals to transition from an institutional setting into a community setting. (B) Definitions (1) "Community setting" means a location that meets the home and community-based setting requirements set forth in rule 5160-44-01 of the Administrative Code or for those moving from an intermediate care facility for individuals with ...

...This rule set forth terms used throughout Chapter 5160-56 of the Administrative Code. (A) "Advance directive" refers to written instructions recognized under state law that are related to the provisions of health care when the individual is incapacitated. Samples of advance directive documents include a living will, a declaration as defined in Chapter 2133. of the Revised Code, and a durable power...

...This rule set forth terms used throughout Chapter 5160-56 of the Administrative Code. (A) "Advance directive" refers to written instructions recognized under state law that are related to the provisions of health care when the individual is incapacitated. Samples of advance directive documents include a living will, a declaration as defined in Chapter 2133. of the Revised Code, and a durable power...

...This rule sets forth the criteria that must be met for an individual eligible for medicaid to receive the Ohio medicaid hospice benefit. (A) To be covered under Ohio medicaid, the designated hospice must ensure the following criteria are met prior to furnishing hospice care: (1) The designated hospice has a certification of the terminal illness on behalf of the individual, obtained in accordance...

...(A) To be covered under Ohio medicaid, the designated hospice will ensure the following criteria are met prior to furnishing hospice care: (1) The designated hospice has a certification of the terminal illness on behalf of the individual, obtained in accordance with 42 C.F.R. 418.22 (October 1, 2023); (2) A hospice election statement, completed by the individual, has been obtained by the designa...

...This rule sets forth the requirements for discharging an individual from the designated hospice's care and/or the hospice benefit. (A) Discharge refers to the end the hospice benefit and/or the designated hospice's care: (1) Discharge from the designated hospice's care shall occur when the individual: (a) Dies/expires; (b) No longer meets the hospice enrollment or eligibility criteria; (c) No lon...

...This rule sets forth the requirements for discharging an individual from the designated hospice's care and/or the hospice benefit. (A) Discharge refers to the end the hospice benefit or the designated hospice's care: (1) Discharge from the designated hospice's care should occur when the individual: (a) Dies; (b) No longer meets the hospice enrollment or eligibility criteria; (c) No longer is term...

...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...