Current through all regulations passed and filed through September 16, 2024
(A)
This rule
establishes Ohio medicaid programs and program services subject to
participation in the EVV program, required under Section 1903 of the Social
Security Act (42 U.S.C.
1396b) as in effect on the effective date of
this rule.
(B)
For purposes of this chapter, EVV is the use of
technology to verify certain data elements related to the delivery of
medicaid-covered services.
(C)
Ohio medicaid
services subject to the EVV program include any medicaid state plan or 1915 (c)
home and community-based services (HCBS) waiver program meeting the following
criteria:
(1)
Service definition includes one of the following:
(a)
Assistance with
activities of daily living, as described in rule
5160-3-05 of the Administrative
Code; or
(b)
Includes activities provided by a licensed healthcare
professional; and
(2)
The service is
provided in the home or community of the individual; and
(3)
The service is
measured and paid in units of hours, partial hours, or per
assessment.
(D)
The following are subject to the EVV program:
(1)
Nursing
facility-based level of care HCBS waiver programs:
(a)
Programs:
(i)
Ohio home care
waiver, described in Chapter 5160-46 of the Administrative
Code;
(ii)
MyCare Ohio waiver, described in Chapter 5160-58 of the
Administrative Code; and
(iii)
Preadmission
screening system providing options and resources today (PASSPORT) waiver,
described in Chapter 5160-31 of the Administrative Code.
(b)
Services:
(i)
Choices home care attendant;
(ii)
Enhanced
community living;
(iii)
Home care attendant;
(iv)
Personal care
aide; and
(v)
Waiver nursing service.
(2)
Developmental disabilities level of care-based waiver
programs:
(a)
Programs
(i)
Individual options (IO) waiver, described in Chapter
5160-40 of the Administrative Code;
(ii)
Level 1 waiver,
described in Chapter 5160-41 of the Administrative Code; and
(iii)
Self-empowered
life funding (SELF) waiver, described in Chapter 5160-41 of the Administrative
Code.
(b)
Services
(i)
Homemaker/personal care;
(ii)
Participant-directed homemaker/personal
care;
(iii)
Residential respite, when billed in fifteen-minute
units;
(iv)
Waiver nursing delegation; and
(v)
Waiver nursing
service.
(3)
State plan
program services, described in Chapter 5160-12 of the Administrative
Code.
(a)
Home
health services:
(i)
Home health aide;
(ii)
Home health
nursing; and
(iii)
Home health therapies.
(b)
Private duty
nursing;
(c)
Registered nurse assessment; and
(d)
Registered nurse
consultation.
(E)
Exemptions
(1)
Services provided
using telehealth as the direct delivery method in accordance with rule
5160-1-18 of the Administrative
Code are exempt from this rule.
(2)
Live-in caregiver
exemption: visits in which the direct care service worker is a resident of the
same household as the individual receiving services are exempt from this rule
when the EVV system reflects approval from ODM has been granted. To obtain
approval, the service provider will submit the request using the exemption
process found on ODM's website
https://medicaid.ohio.gov/INITIATIVES/Electronic-Visit-Verification/.
(F)
The Ohio
department of aging, Ohio department of developmental disabilities, Ohio
department of medicaid (ODM), and managed care entities are responsible
to:
(1)
Establish and maintain processes to ensure proper payment of
claims paid by each entity, in accordance with EVV guidelines;
and
(2)
Provide assistance and education to service providers
and program participants.
(G)
Service providers
billing for programs and services subject to the EVV program will comply with
provisions of Chapter 5160-32 of the Administrative Code.
Replaces: 5160-1-40
