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This website publishes administrative rules on their effective dates, as designated by the adopting state agencies, colleges, and universities.

Ohio Administrative Code Search

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Rule 5160-33-05 | Provider conditions of participation for the assisted living home and community based services (HCBS) waiver program.

...(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...

Rule 5160-33-05 | Provider conditions for the assisted living home and community based services (HCBS) waiver program.

...(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...

Rule 5160-33-07 | Assisted living home and community based services (HCBS) waiver rate setting.

...(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...

Rule 5160-35-01 | Definitions.

...(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...

Rule 5160-35-02 | Qualifications to be a medicaid school program (MSP) provider.

...(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...

Rule 5160-35-04 | Reimbursement for services provided by medicaid school program (MSP) providers.

...(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...

Rule 5160-35-05 | Services authorized for medicaid coverage that can be provided by medicaid school program (MSP) providers.

...(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...

Rule 5160-35-06 | Other services, medical supplies and equipment authorized for medicaid coverage that can be provided by medicaid school program (MSP) providers.

...(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...

Rule 5160-36-01 | Program of all-inclusive care for the elderly (PACE) definitions.

...(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...

Rule 5160-36-02 | Program of all-inclusive care for the elderly (PACE) administration.

...(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 ...

Rule 5160-36-03 | Program of all-inclusive care for the elderly (PACE) eligibility.

...(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...

Rule 5160-36-03 | Medicaid funded program of all-inclusive care for the elderly (PACE) eligibility.

...(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...

Rule 5160-36-05 | Program of all-inclusive care for the elderly (PACE): Care Coordination.

...(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...

Rule 5160-36-06 | Program of all-inclusive care for the elderly (PACE): organization reimbursement.

...(A) PACE is a full-risk program in which the PACE organization assumes all financial risk for the cost of the medical care and services provided to participants. (B) PACE organizations shall receive a monthly capitated payment from the Ohio department of medicaid (ODM) for each PACE participant enrolled in the medicaid program including individuals enrolled in both medicaid and medicare. (C) The...

Rule 5160-40-01 | Medicaid home and community-based services program - individual options waiver.

...(A) Purpose (1) The purpose of this rule is to establish the individual options waiver as a component of the medicaid home and community-based services program pursuant to sections 5166.02 and 5166.20 of the Revised Code. (2) The individual options waiver program provides necessary waiver services to individuals who meet the criteria for a developmental disabilities level of care in accordance w...

Rule 5160-40-01 | Medicaid home and community-based services program - individual options waiver.

...(A) Purpose (1) The Ohio department of developmental disabilities (DODD) is responsible for the daily operations of the individual options (IO) waiver which will be administered pursuant to sections 5166.02 and 5166.20 of the Revised Code. (2) DODD operates the IO waiver program pursuant to an interagency agreement with the Ohio department of medicaid (ODM) in accordance with section 5162.35 of...

Rule 5160-41-05 | Waiting lists for home and community-based services administered by the Ohio department of developmental disabilities.

...(A) Purpose This rule sets forth the requirements of a county board of developmental disabilities to establish and maintain a waiting list for home and community-based services. (B) Definitions (1) "County board" means a county board of developmental disabilities established under Chapter 5126. of the Revised Code with local administrative authority. (2) "DODD" means the Ohio department of dev...

Rule 5160-41-05 | Waiting lists for home and community-based services administered by the Ohio department of developmental disabilities.

...(A) Purpose This rule sets forth the requirements of a county board of developmental disabilities to establish and maintain a waiting list for home and community-based services. (B) Definitions (1) "County board" means a county board of developmental disabilities (CBDD) established under Chapter 5126. of the Revised Code with local administrative authority. (2) "DODD" means the Ohio department...

Rule 5160-41-08 | Free choice of provider requirements for medicaid home and community-based services programs administered by the Ohio department of developmental disabilities.

...(A) The purpose of this rule is to set forth the requirements the Ohio department of developmental disabilities (DODD) must meet to assure free choice of provider. (B) The DODD through an interagency agreement with the Ohio department of medicaid (ODM), acts as the administrative agency for components of the medicaid home and community-based services programs in accordance with section 5162.35 of...

Rule 5160-41-17 | Medicaid home and community-based services program - self-empowered life funding waiver.

...(A) Purpose. (1) The purpose of this rule is to establish the self-empowered life funding waiver as a component of the medicaid home and community-based services program pursuant to sections 5166.02 and 5166.20 of the Revised Code. (2) The self-empowered life funding waiver program provides necessary waiver services to individuals who meet criteria for a developmental disabilities level of care ...

Rule 5160-41-17 | Medicaid home and community-based services program - self-empowered life funding waiver.

...(A) Purpose. (1) The Ohio department of developmental disabilities (DODD) is responsible for the daily operation of the self-empowered life funding (SELF) waiver which will be administered pursuant to sections 5166.02 and 5166.20 of the Revised Code. (2) DODD operates the SELF waiver program pursuant to an interagency agreement with the Ohio department of medicaid (ODM) in accordance with sectio...

Rule 5160-41-18 | Individual options waiver-payment standards.

...(A) Purpose. The purpose of this rule is to establish the payment standards for the individual options home and community-based services (HCBS) waiver for services provided to individuals enrolled in a HCBS program, as a component of the medicaid program and as administered by the Ohio department of developmental disabilities (DODD) in accordance with sections 5166.02 and 5166.23 of the Revised...

Rule 5160-41-19 | Level one waiver-payment standards.

...(A) Purpose. The purpose of this rule is to establish the payment standards for the level one home and community-based services (HCBS) waiver for services provided to individuals enrolled in a HCBS program, as a component of the medicaid program and as administered by the department of developmental disabilities (DODD) in accordance with sections 5166.02 and 5166.23 of the Revised Code. (B) T...

Rule 5160-41-20 | Self-empowered life funding waiver - payment standards.

...(A) Purpose. The purpose of this rule is to establish the payment standards for the self-empowered life funding (SELF) home and community-based services (HCBS) waiver for services provided to individuals enrolled in a HCBS program, as a component of the medicaid program and as administered by the department of developmental disabilities (DODD) in accordance with sections 5166.02 and 5166.23 of th...

Rule 5160-42-01 | Medicaid home and community-based services program - level one waiver.

...(A) The purpose of this rule is to establish the level one waiver as a component of the medicaid home and community-based services program pursuant to sections 5166.20 and 5166.02 of the Revised Code. (1) The level one waiver program provides necessary waiver services to individuals of any age who meet the criteria for a developmental disabilities level of care in accordance with rule 5123-8-01 ...