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 March 18, 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.
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