Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-45 - Administered Waiver Service Providers
Section 5160-45-08 - ODM-administered waiver programs: criminal records checks involving independent providers
Universal Citation: OH Admin Code 5160-45-08
Current through all regulations passed and filed through September 16, 2024
(A) This rule sets forth the process and requirements for the criminal records checks of independent providers of home and community-based services (HCBS) in Ohio department of medicaid (ODM) -administered waiver programs.
(B) For the purposes of this rule,
(1) "Anniversary date"
means the later of the effective date of the provider agreement relating to the
independent provider or sixty days after the effective date of section
5164.341
of the Revised
Code (September 26, 2003).
(2)
"Applicant" means a person who has applied for a medicaid provider agreement to
provide HCBS as an independent provider under an ODM-administered waiver program.
(3) "Criminal records check" has the same
meaning as in section
109.572 of the Revised Code.
(4) "Disqualifying
offense" means any of the following:
(a) A
violation of section 959.13,
959.131,
2903.01,
2903.02,
2903.03,
2903.04,
2903.041,
2903.11,
2903.12,
2903.13,
2903.15,
2903.16,
2903.21,
2903.211,
2903.22,
2903.34,
2903.341,
2905.01,
2905.02,
2905.05,
2905.11,
2905.12,
2905.32,
2905.33,
2907.02,
2907.03,
2907.04,
2907.05,
2907.06,
2907.07,
2907.08,
2907.09,
2907.21,
2907.22,
2907.23,
2907.24,
2907.25,
2907.31,
2907.32,
2907.321,
2907.322,
2907.323,
2907.33,
2909.02,
2909.03,
2909.04,
2909.22,
2909.23,
2909.24,
2911.01,
2911.02,
2911.11,
2911.12,
2911.13,
2913.02,
2913.03,
2913.04,
2913.05,
2913.11,
2913.21,
2913.31,
2913.32,
2913.40,
2913.41,
2913.42,
2913.43,
2913.44,
2913.441,
2913.45,
2913.46,
2913.47,
2913.48,
2913.49,
2913.51,
2917.01,
2917.02,
2917.03,
2917.31,
2919.12,
2919.121, 2919.321,
2919.22,
2919.23,
2919.24,
2919.25,
2921.03,
2921.11,
2921.12,
2921.13,
2921.21,
2921.24,
2921.32, 2921.123,
2921.34,
2921.35,
2921.36,
2921.51,
2923.12,
2923.122,
2923.123,
2923.13,
2923.161,
2923.162,
2923.21,
2923.32,
2923.42,
2925.02,
2925.03,
2925.04,
2925.041,
2925.05,
2925.06,
2925.09,
2925.11,
2925.13,
2925.14,
2925.141,
2925.22,
2925.23,
2925.24,
2925.36,
2925.55,
2925.56,
2927.12 or
3716.11 of the Revised Code,
felonious sexual penetration in violation of former section
2907.12 of the Revised Code, a
violation of section 2905.04 of the Revised Code as
it existed prior to July 1, 1996; or
(b) A violation of section
2923.01,
2923.02, or
2923.03 of the Revised Code when
the underlying offense that is the object of the conspiracy, attempt, or
complicity is one of the offenses listed in paragraph (B)(5)(a) of this rule;
or
(c) A violation of an existing
or former municipal ordinance or law of the state of Ohio, any other state, or
the United States that is substantially equivalent to any of the disqualifying
offenses set forth in paragraph (B) (5)(a) or (B)(5)(b) of this rule.
(5) "Effective date of provider agreement" means the
month in which the initial provider agreement was entered into between
ODM and the independent
provider.
(6) "Home and community-based services medicaid waiver
component" has the same meaning as in section
5166.01
of the Revised
Code.
(7) "Independent provider" means a person who has a
medicaid provider agreement to provide HCBS as an independent provider in
an
ODM-administered waiver program. The term
"independent provider" is interchangeable with the term "non-agency provider"
in Chapters
5160-46 and 5160-58 of the
Administrative Code.
(8)
"Retained applicant fingerprint database" or "RAPBACK"
means the database maintained by the bureau of criminal investigation (BCI)
pursuant to section 109.5721 of the Revised Code
that contains the fingerprints of individuals on whom BCI has conducted
criminal record checks to determine whether an applicant is ineligible for a
medicaid provider agreement pursuant to this rule.
(9) "Superintendent" means superintendent of
the BCI.
(C) ODM or its designee shall deny an applicant's application for a medicaid provider agreement, and shall immediately take steps to terminate an independent provider's medicaid provider agreement, if any of the following applies:
(1) After the applicant
is given the
information and notification required by paragraphs (D)(6)(a), (D)(6)(b)
and (D)(6)(c) of this rule, the applicant
fails to do any of
the following:
(a) Access, complete, and
forward to the superintendent of BCI the form prescribed pursuant to division (C)(1) of
section 109.572 of the Revised Code, or
the standard impression sheet prescribed pursuant to division (C)(2) of that
section;
(b) Instruct the
superintendent to submit the completed report of the criminal records check
directly to ODM or its designee.
(2) Except as provided in paragraph (F) of this rule, the
applicant or independent provider is found by a criminal records check to have
been convicted of, or pleaded guilty to, a disqualifying offense, regardless of
the date of the conviction, or the date of entry of the guilty plea. If
ODM
determines that two or more convictions or guilty pleas result from or
are connected with the same act or result from offenses committed at the same
time, they shall be counted as one conviction or guilty plea.
(3)
The applicant or
independent provider fails to comply with the provisions of this
rule.
(D) Process for conducting criminal records checks.
(1)
Each applicant, at the time of initial
application for a medicaid provider agreement, shall provide a set of his or
her fingerprints, and a criminal records check shall be conducted as a
condition of ODM's approving the application.
(2)
Each applicant and independent provider shall be
subject to the database check requirements set forth in rule
5160-1-17.8 of the
Administrative Code.
(3)
If the applicant or independent provider does not
present proof of having been a resident of the state of Ohio for the five-year
period immediately prior to the date the criminal records check is requested,
or provide evidence that within that five-year period the superintendent has
requested information about the applicant or independent provider from the
federal bureau of investigation (FBI) in a criminal records check, ODM or its
designee shall request that the superintendent obtain a criminal records check
from the FBI as part of the criminal records check.
(4)
Even if an
applicant or independent provider presents proof of having been a resident of
the state of Ohio for the five-year period, ODM or its designee may request the
superintendent obtain information from the FBI in the criminal records
check.
(5)
In order to maintain active provider status, each
independent provider must have his or her fingerprints submitted to BCI to be
maintained in RAPBACK. ODM shall pay BCI any reasonable fees associated with
receiving notifications under division (D) of section
109.5721 of the Revised
Code.
(6)
ODM or its designee shall
provide the following to each applicant and independent provider for whom a
criminal records check is required by this rule:
(a) Information about accessing, completing
and forwarding to the superintendent the form prescribed pursuant to division
(C)(1) of section 109.572 of the Revised Code and
the standard fingerprint impression sheet prescribed pursuant to division
(C)(2) of that section;
(b)
Information about
accessing, completing and forwarding to the superintendent the information
required for RAPBACK pursuant to section
109.5721 of the Revised
Code.
(c) Written notification that the applicant or
independent provider is to instruct the superintendent to submit the completed
report of the criminal records check directly to ODM or its designee.
(7)
Each applicant and independent provider shall pay
BCI the
fee prescribed pursuant to division (C)(3) of section
109.572 of the Revised Code for
each criminal records check conducted on his or her behalf pursuant to
paragraphs (D)(1), (D)(3) and (D)(4) of this
rule.
(8) Reports of any criminal records checks conducted
by BCI in
accordance with this rule are not public records for the purposes of section
149.43 of the Revised Code and
shall not be made available to any person other than the following:
(a) The person who is the subject of the
criminal records check or his or her representative;
(b) The director of
ODM and
the staff of ODM
involved in the administration of the Ohio medicaid program;
(c)
ODM's designee;
(d) An individual who receives, or may
receive, waiver services from the person who is the subject of the criminal
records check; and
(e) A court,
hearing officer or other necessary individual involved in a case dealing with
either a denial or termination of a medicaid provider agreement related to the
criminal records check, or a civil or criminal action regarding the Ohio
medicaid program.
(E) An individual may choose to receive waiver services from an applicant or independent provider who has been convicted of, or pleaded guilty to, a disqualifying offense set forth in paragraph (B)(5) of this rule if:
(1) The applicant or independent provider has
satisfied the conditions associated with the exclusionary periods set forth in
rule 5160-45-11 of the Administrative Code; or
(2) The applicant or independent provider has
obtained a certificate of qualification for employment issued by a court of
common pleas with competent jurisdiction pursuant to section
2953.25 of the Revised Code, and
in accordance with rule 5160-45-11 of the Administrative Code; or
(3) The applicant or independent provider has
obtained a certificate of achievement and employability in an HCBS-related
field issued by the Ohio department of rehabilitation and corrections pursuant
to section 2961.22 of the Revised Code, and
in accordance with rule 5160-45-11 of the Administrative Code.
(F) Pardons.
A conviction of, or a plea of guilty to, an offense as set forth in paragraph (B)(5) of this rule shall not prevent a consumer from choosing to receive services from an applicant or independent provider if any of the following circumstances apply:
(1) The applicant or independent provider has
been granted an unconditional pardon for the offense pursuant to Chapter 2967.
of the Revised Code;
(2) The
applicant or independent provider has been granted an unconditional pardon for
the offense pursuant to an existing or former law of the state of Ohio, any
other state, or the United States, if the law is substantially equivalent to
Chapter 2967. of the Revised Code;
(3) The applicant or independent provider has
been granted a conditional pardon for the offense pursuant to Chapter 2967. of
the Revised Code, and the condition(s) under which the pardon was granted have
been satisfied; or
(4) The
applicant's or independent providers' conviction or guilty plea has been set
aside pursuant to law.
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