Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-27 - Community Mental Health Agency Services
Section 5160-27-13 - Mobile response and stabilization service
Universal Citation: OH Admin Code 5160-27-13
Current through all regulations passed and filed through September 16, 2024
(A) For the purposes of this rule, mobile response and stabilization service (MRSS), is the service as set forth by the Ohio department of mental health and addiction services (OhioMHAS) in rule 5122-29-14 of the Administrative Code.
(B) Eligible providers.
(1)
Providers
certified by OhioMHAS in accordance with rule
5122-29-14 of the Administrative
Code are eligible for MRSS reimbursement.
(2)
Services rendered
by MRSS team staff described in rule
5122-29-14 of the Administrative
Code that are eligible providers of behavioral health services in accordance
with rule
5160-27-01 of the Administrative
Code are reimbursable.
(C) Coverage.
(1)
The following
MRSS activities are reimbursable:
(a)
Mobile response activities as described in rule
5122-29-14 of the Administrative
Code.
(b)
Stabilization services as described in rule
5122-29-14 of the Administrative
Code.
(2)
Prior authorization is not needed for mobile response
activities.
(3)
Prior authorization is needed for stabilization
services rendered more than six weeks from the completion of mobile
response.
(4)
For individuals enrolled in either a medicaid managed
care organization (MCO) or the OhioRISE plan, it is the responsibility of the
provider to notify the individual's MCO or the OhioRISE plan within three
business days of initiation, termination, and transition from stabilization
services. For individuals enrolled in both a medicaid managed care organization
(MCO) and the OhioRISE plan, it is the responsibility of the provider to notify
the OhioRISE plan within three business days of initiation, termination, and
transition from stabilization services.
(D) Limitations.
(1)
The following activities are not billable as
MRSS:
(a)
Childcare services or services provided as a substitute for
the parent or other individuals responsible for providing care and
supervision.
(b)
Respite care.
(c)
Transportation
activities that do not include the provision of a mobile response activity or
stabilization service.
(d)
MRSS screening and triage activities described in rule
5122-29-14 of the Administrative
Code.
(e)
Activities not described in paragraph (C) of this
rule.
(2)
Reimbursement will not be made for stabilization
services described in paragraph (C)(1) of this rule when an individual
is:
(a)
Enrolled
in intensive home-based treatment as described in rule
5122-29-28 of the Administrative
Code.
(b)
Receiving substance use disorder residential treatment
services as described in rule
5160-27-09 of the Administrative
Code, except for MRSS necessary to support admission to the
facility.
(c)
Enrolled in assertive community treatment as described
in rule 5160-27-04 of the Administrative
Code.
(d)
Receiving inpatient hospital psychiatric services as
described in Chapter 5160-2 of the Administrative Code, except for MRSS
necessary to support admission to the hospital.
(e)
Receiving
psychiatric residential treatment facility services as described in
42 C.F.R.
441.150 (October 1, 2021) through
42 C.F.R.
441.184 (October 1, 2021) except for MRSS
necessary to support admission to the facility.
(E) Reimbursement. The medicaid reimbursement rate for MRSS is stated in the appendix to rule 5160-27-03 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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