Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-12 - Ohio Home Care Program
Section 5160-12-03 - Medicare certified home health agencies: qualifications and requirements
Universal Citation: OH Admin Code 5160-12-03
Current through all regulations passed and filed through September 16, 2024
(A) A medicare certified home health agency (MCHHA) that meets the requirements of this rule is eligible to participate in the Ohio medicaid program upon execution of a provider agreement in accordance with rule 5160-1- 17.2 of the Administrative Code.
(B) MCHHAs are required to:
(1)
Be
certified for medicare participation by the Ohio department of health (ODH) in
accordance with Chapter 3701-60 of the Administrative Code.
(2)
Meet the conditions of
participation in accordance with 42 C.F.R. Part
484 (October 1, 2014).
(3)
Implement policy components for home health and
private duty nursing (PDN) as specified in the
"medicare benefit policy manual,
chapter seven: home health services" (January 14, 2014) for the
following sections:
(a)
Section 20 "Conditions to be met for coverage of home health
services" ;
(b)
Secton
30.2"Services are provided under a plan of care established by
and approved by a physician" to Section 30.3 "under the care of a physician"
; and
(c)
Section 40
"Covered services under a qualifying home health
plan of care"
to Section 50.3 "medical
social
services" .
(4)
Comply with all applicable requirements for medicaid
providers in Chapter 5160-1 of the Administrative Code.
(5)
Comply with all federal, state
and local laws and regulations as applicable.
(6)
Have
back up staff available to provide services when the MCHHA's
regularly scheduled staff cannot or do not meet their obligation to provide
services.
(7)
Submit written notification to the
individual at least thirty days prior to the last date
of service when terminating a service unless:
(a) The
individual's treating physician has discontinued home
health services;
(b) The treating
physician has been notified that goals have been met;
(c) The
individual
no longer resides at their known place of
residence or their whereabouts are
unknown;
(d) The
individual or another person has harmed or threatened
to harm staff of the MCHHA
;
(e) The
individual
requested that services be terminated; or
(f) The
individual
has been enrolled in a medicaid managed care plan (MCP).
(8)
Contact the individual's medicaid MCP when
applicable to request prior authorization for home health and PDN
services.
(9)
Maintain documentation on all aspects of services
provided in accordance with this chapter. All documentation must be complete
prior to billing for services provided in accordance with this chapter
and is subject to monitoring by ODM . This
includes but is not limited to:
(a) Clinical
records ,
including all signed orders.
(b) Time keeping records that indicate the
date and time span of the services provided during
each visit, and the
type of service provided.
(10)
Obtain the completed and signed
ODM 07137
"Certificate of Medical Necessity for Home Health Services and
Private Duty Nursing Services" (rev. 7/2014), which
certifies the medical necessity for services in accordance with
rule
5160-12-01 or rule 5160-12-02 of the Administrative Code.
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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