Ohio Administrative Code
Title 173 - Department of Aging
Chapter 173-39 - Certification of Community-Based Long-Term Care Service Providers
Section 173-39-02.7 - ODA provider certification: home medical equipment and supplies
Universal Citation: OH Admin Code 173-39-02.7
Current through all regulations passed and filed through September 16, 2024
(A) "Home medical equipment and supplies" (HME) means a service providing rented or purchased home medical equipment and supplies to individuals to enable those individuals to function safely in their homes with greater independence, thereby eliminating the need for placement in a nursing facility.
HME is limited to equipment and supplies allowed under Chapter 5160-10 of the Administrative Code, miscellaneous equipment and supplies, equipment repairs, and equipment and supplies not paid (in full or in part) by medicare, state plan medicaid, or another third-party payer.
(B) Requirements for ODA-certified providers of home medical equipment and supplies:
(1)
General requirements: The agency provider shall comply with the requirements
for every ODA-certified agency provider in rule
173-39-02 of the Administrative
Code and the non-agency provider shall comply with the requirements for every
ODA-certified agency provider in rule
173-39-02 of the Administrative
Code.
(2) Ongoing assistance: The
provider shall provide professional, ongoing assistance when needed to evaluate
and adjust equipment and supplies delivered, and/or to instruct the individual
or the individual's caregiver in the use of equipment and supplies.
(3) Repairs and replacements: The provider
shall assume liability for equipment warranties and shall install, maintain,
and/or replace any defective parts or items specified in those warranties.
Replacement items or parts for HME are not payable as rental
equipment.
(4) Billing:
(a) Before ODA's designee may authorize
equipment or supplies, the provider shall document the equipment and supplies
to be purchased were not covered (in full or in part) by medicare, state plan
medicaid, and any other third-party payer.
(b) The provider shall, in collaboration with
the
ODA's designee, ascertain and recoup any third-party
resource(s) available to the individual before billing ODA or its designee. ODA
or its designee may then pay the unpaid balance up to the lesser of the
provider's billed charge or the maximum allowable payment established in
the appendix to rule
5160-1-06.1 of the
Administrative Code.
(c) The
provider shall
provide the price for an item to be purchased or
rented to the ODA's designee no more than two
business days after the
ODA's designee's request. The provider shall
purchase, deliver, and install (as appropriate) the authorized item(s) before
billing ODA's designee. The billed amount for
each item shall not exceed the item rate authorized by
ODA's designee.
(5) Delivery and verification:
(a) The provider shall verify the successful
completion of each activity (i.e., delivery, installation, or education) it
provides using either an electronic or manual system and shall retain
records verifying the delivery of HME. Regardless of
the system used, the verification shall include the individual's name, date of
delivery, installation, or education, and itemization of each activity
completed.
(b) Delivery verification
methods:
The provider shall
verify the delivery of HME by
one of the following methods:
(i) A unique
identifier of the individual.
(ii)
If a provider uses a common carrier to deliver HME, the provider shall verify
the success of the delivery by using the method in paragraph (B)(5)(b)(i) of
this rule or by retaining the common carrier's tracking statement or returned
postage-paid delivery invoice.
(c) If a provider leaves
an HME item
outside the door of an individual's home, the provider shall contact the
individual by telephone at least once per month to alert them to any delivery
left outside the door to their home.
(d) The provider shall replace (at no cost to
the individual, ODA, or ODA's designee) any HME item lost or stolen between the
time of delivery and receipt by the individual.
(e) If a single visit by the provider
includes more than one HME activity, the provider may verify the success of all
the activities it provides by obtaining only one verification.
(f) The provider shall not verify an HME
activity was successfully provided with the signature of the provider, an
employee of the provider, or any other person with a financial interest in the
HME.
(C) Units and rates:
(1) A unit of HME is the item
purchased or rented, and the unit rate is the purchase, installation, and/or
rental price authorized for the item by ODA's designee.
(2) The appendix to rule
5160-1-06.1 of the
Administrative Code establishes the maximum rate allowable for one unit of
HME.
(3) Rule
5160-31-07 of the Administrative
Code establishes rate-setting methodology for units of
HME.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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