Current through all regulations passed and filed through March 18, 2024
(A)
Initial steps:
(1)
To apply for
certification, a provider shall complete an application in the provider
management system, which includes electronic submission of all supporting
records required as part of the application. If the provider does not complete
the application within ninety days, the application expires.
(2)
ODA shall review
an application to determine if the application meets the requirements for the
certification the provider is seeking.
(a)
ODA shall
initiate the process for a pre-certification review if ODA determines that a
provider submitted a complete application.
(b)
If ODA determines
that the supporting records do not demonstrate that the provider submitted a
complete application, then ODA shall email the provider to give the provider a
deadline to submit supporting records that demonstrate that the provider meets
the requirements for certification that is the earlier of thirty days after the
email or the deadline in paragraph (A)(1) of this rule.
(B)
Voluntary withdrawal of application for
certification:
(1)
A provider may withdraw its application at any time
before enrollment with ODM unless ODA issued a notice of denial of
certification.
(2)
A provider that withdrew its application may later
reapply for certification.
(C)
Pre-certification
review:
(1)
For
all providers except providers of community transition provided through the
home choice program under rule
5160-51-10 of the Administrative
Code and participant-directed providers:
(a)
ODA's designee
shall visit the provider's business site to determine if the provider meets the
applicable requirements in rule
173-39-02 of the Administrative
Code and any additional requirements in this chapter regulating a service the
provider is seeking certification to provide. During a state of emergency
declared by the governor, a federal public health emergency, or during another
time if authorized by ODA, ODA's designee may conduct a desk review of the
provider's business site in lieu of a visit.
(b)
ODA's designee
shall complete the review and notify ODA of its recommendation within sixty
days after receiving a complete application to become any other type of
provider, unless ODA approves an extended deadline.
(c)
ODA's designee
shall recommend approval of the provider's application if a provider other than
an ADS or assisted living provider complies with all applicable
requirements.
(d)
Paragraph (D) of this rule applies if ODA's designee
determines that an ADS or assisted living provider complies with all applicable
requirements.
(e)
ODA's designee shall recommend denial of the
application if the provider does not comply with all applicable
requirements.
(2)
For providers of community transition provided through
the home choice program under rule
5160-51-10 of the Administrative
Code:
(a)
ODA
may direct its designee to conduct the pre-certification review to determine if
the provider meets the applicable requirements in rules
173-39-02 and
173-39-02.17 of the
Administrative Code.
(b)
ODA or its designee shall determine whether the
provider complies with all applicable requirements and either approve or deny
the provider's application pursuant to this rule.
(3)
For
participant-directed providers, ODA's designee shall conduct a precertification
review within thirty days after receiving a complete application to determine
whether the provider meets the applicable requirements in rule
173-39-02 of the Administrative
Code and any additional requirements in this chapter regulating a service the
provider is seeking certification to provide, unless ODA approves an extended
deadline.
(D)
HCBS settings requirements: A provider may qualify for
certification only if the provider provides its services in the individual's
home or another setting meeting the HCBS settings requirements in
42 C.F.R.
441.301 and rule
5160-44-01 of the Administrative
Code as determined by ODA on form ODM10172 (revised, June 2021), which is
entitled, "Home and Community Based Services (HCBS) Settings Evaluation
Tool."
(1)
ODA
may certify the provider if ODA determines the setting is presumed to have the
qualities of a HCBS setting and the setting is not subject to the heightened
scrutiny described in rule
173-39-03.1 of the Administrative
Code.
(2)
The setting is subject to the heightened scrutiny
described in rule
173-39-03.1 of the Administrative
Code if ODA determines the setting is presumed to have the qualities of an
institution. ODA defers action on the application for certification until the
conclusion of the heightened scrutiny. ODA shall notify the provider that
action on the provider's application is deferred.
(E)
Final
determination: ODA bases its final determination of whether to certify a
provider on the review of the application materials and the recommendation of
ODA's designee.
(F)
Approved application:
(1)
Applications for
all services except community transition provided through the home choice
program under rule
5160-51-10 of the Administrative
Code:
(a)
When
ODA approves an application, ODA notifies ODA's designee for the region in
which the provider is being certified to provide services.
(b)
ODA's designee
shall enter into an agreement with each provider specifying, at a minimum, the
following:
(i)
The time period during which the agreement is in
effect.
(ii)
The region for which the provider is
certified.
(iii)
The rate of payment per unit the provider is willing to
accept subject to any limits ODM established in rule
5160-31-07 of the Administrative
Code and the appendix to rule
5160-1-06.1 of the
Administrative Code for the PASSPORT program, and rule
5160-33-07 of the Administrative
Code and the appendix to rule
5160-1-06.5 of the
Administrative Code for the assisted living program.
(2)
Applications for community transition provided through the
home choice program under rule
5160-51-10 of the Administrative
Code: After ODA approves an application to be a provider of community
transition through the home choice program, ODA's designee shall enter into an
agreement with the provider specifying the items under paragraph (F)(1) of this
rule.
(G)
Deemed providers: ODA may deem any provider certified
by ODM or the department of developmental disabilities to provide one or more
services through a medicaidwaiver program as having satisfied the requirements
for certification by ODA for the same or similar services under this chapter,
as determined by ODA. The effective period for a provider to be deemed an
ODA-certified provider under this paragraph begins when the provider completes
the deeming application process and has a provider agreement with ODA's
designee, and ends if the provider cannot comply with all the requirements of
Chapter 173-9 of the Administrative Code and this chapter within sixty days
after initial deeming or a medicaid provider agreement is terminated, whichever
occurs first.
(H)
Denied application:
(1)
ODA may deny a
provider's application for any of the following reasons:
(a)
The provider made
false representations, by omission or commission, on the provider's
application.
(b)
The provider made false statements, provided false
information, or altered records or documents.
(c)
The provider is
disqualified under section
173.38 or
173.381 of the Revised Code or
under Chapter 173-9 of the Administrative Code.
(d)
The provider does
not meet the applicable requirements in rule
173-39-02 of the Administrative
Code or any requirements in this chapter regulating a service that the provider
is seeking certification to provide.
(e)
ODA previously
revoked the provider's certification.
(f)
Any reason
permitted or required by state or federal law.
(2)
When ODA denies a
provider's application, ODA notifies the provider of its final determination
and any applicable hearing rights established in section
173.391 of the Revised
Code.
(3)
When ODA denies a provider's application, the provider
is ineligible to reapply for certification for one year after the mailing date
of ODA's final adjudication order.
Replaces: 173-39-03