Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-12 - Ohio Home Care Program
Section 5160-12-05 - Reimbursement: home health services
Current through all regulations passed and filed through September 16, 2024
(A) Definitions of terms used for billing home health services rates set forth in appendix A to this rule are:
(B) Home health services are delivered and billed in accordance with this chapter by medicare certified home health agencies (MCHHA).
(C) The amount of reimbursement for a home health visit will be the lesser of the provider's billed charge or the medicaid maximum rate. The medicaid maximum rate is determined by using a combination of the base rate and/or unit rate found in appendix A as applicable to this rule using the number of units of service that were provided during a visit in accordance with this chapter as follows:
(D) The amount of reimbursement for a visit will be the lesser of the provider's billed charge or seventy-five per cent of the total medicaid maximum as specified in paragraph (C) of this rule when billing with the modifier HQ "group setting" for group visits conducted in accordance with rule 5160-12-04 of the Administrative Code.
(E) The modifiers set forth in appendix B to this rule will be used to provide additional information in accordance with this chapter. A visit made for the purpose of home infusion therapy in accordance with 5160-12-01 of the Administrative Code will be billed using the U1 modifier.
(F) The "place of service" code "02" will be used to indicate a visit was completed using telehealth.
(G) A visit conducted by a registered nurse (RN) for the provision of home health nursing services will be billed to Ohio medicaid using the billing code G0299 as found in appendix A to this rule. A visit conducted by a licensed practical nurse (LPN) for the provision of home health nursing services will be billed to Ohio medicaid using the billing code G0300 as found in appendix A to this rule.
(H) An MCHHA will not be reimbursed for home health services provided to an individual that duplicates same or similar services already paid by medicaid or another funding source. For example, if the facility/home where a residential state supplement recipient or individual receiving medicaid resides, such as an adult foster home, adult family home, adult group home, residential care facility, or other facility is paid to provide personal care or nursing services, home health services are not reimbursable by medicaid.
(I) An MCHHA may be reimbursed for home health services provided to an individual residing in a facility/home if the provider has written documentation from the facility/home stating that it is not responsible for providing the same or similar home health services to the individual.
(J) Home health services provided to an individual enrolled on an assisted living home and community based services waiver in accordance with rule 5160-1-06 and Chapter 173-39 of the Administrative Code do not constitute a duplication of services.
