Ohio Admin. Code 173-39-03 - ODA provider certification: applying for certification
ODA will be unable to process any applications while ODA and ODM develop a new electronic infrastructure for processing applications. ODA will reject any incomplete applications in the current system. If ODA rejects a provider's incomplete application, the provider may reapply for certification when the new electronic infrastructure is operational.
(A) Initial steps:
(1) To apply for certification, a provider
shall submit
complete an online application on
http://www.aging.ohio.gov/. The
provider shall complete the application within ninety days after the provider
starts the online application. If the provider does not complete the
application within ninety days, the application shall expire.
(2) If an individual (i.e., participant)
wishes to employ (i.e., direct) a provider as his or her participant-directed
provider, the individual shall interview the provider before the provider
submits
completes an online application.
(B) Withdrawal:
(1) A provider may withdraw its application
at any time.
(2) A provider that
withdrew its application may later reapply for
certification.
(C)
Pre-certification review:
(1) For all
providers except providers of community transition provided through the home
choice program under rule
5160-51-10
of the Administrative Code:
(a) ODA's
designee shall visit the provider's business site to determine if the provider
meets the applicable requirements in rule
173-39-02
of the Administrative Code and any additional requirements in this chapter
regulating a service the provider is seeking certification to provide. During a
state of emergency declared by the governor, a federal
public health emergency , or during another time if authorized by
by ODA, ODA's designee may conduct a desk
review of the provider's business site in lieu of a visit.
(b) ODA's designee shall complete the review
and notify ODA of its recommendation within ninety days after receiving a
complete application, unless ODA approves an extended deadline.
(c) If ODA's designee determines a provider,
other than an ADS or assisted living provider, complies with all applicable
requirements, it shall recommend approval of the provider's
application.
(d) If ODA's designee
determines a provider for ADS or assisted living complies with all applicable
requirements, paragraph (D) of this rule applies.
(e) ODA's designee may conduct the review of
a participant-directed provider at the individual's home and the individual
must be present for the review, unless the individual agrees, in writing, to an
alternate location and to not participate.
(f) If ODA's designee determines the provider
does not comply with all applicable requirements, it shall recommend denial of
the application.
(2) For
providers of community transition provided through the home choice program
under rule
5160-51-10
of the Administrative Code:
(a)
ODA or, at ODA's sole discretion, ODA may
direct its designee to conduct the pre-certification review to determine if the
provider meets the applicable requirements in rules
173-39-02
and 173-39-02.17 of the Administrative Code.
(b) ODA or its designee shall determine
whether the provider complies with all applicable requirements, and either approve or deny the provider's
application pursuant to this rule.
(D) HCBS settings requirements: HCBS shall
only be provided in an individual's residence or another setting
that meets
meeting the HCBS settings requirements specified in
42 C.F.R.
441.301 and rule
5160-44-01
of the Administrative Code. ODA shall use form
ODM10172, "Home and Community Based Services (HCBS) Settings Evaluation Tool"
(revised, June 2021), to determine if a setting is presumed to have the
qualities of an institution.
(1) If ODA
determines the setting is presumed to have the qualities of a HCBS setting, the
setting does not require heightened scrutiny as described in rule 173-39-03.1
of the Administrative Code and ODA may certify the provider.
(2) If ODA determines the setting is presumed
to have the qualities of an institution, the setting shall undergo heightened
scrutiny as described in rule 173-39-03.1 of the Administrative Code.
(3) If paragraph (D)(2) of this rule requires
a setting to undergo heightened scrutiny, ODA shall defer action on the
application for certification until the conclusion of the review described in
rule 173-39-03.1 of the Administrative Code. ODA shall notify the provider if
action on its application is deferred under this paragraph.
(E) Final determination: ODA shall base its
final determination of whether to certify a provider based on the review of the
application materials and the recommendation of ODA's designee.
(F) Approved application:
(1) Applications for all services except
community transition provided through the home choice program under rule
5160-51-10
of the Administrative Code:
(a) If ODA
approves the application, ODA shall notify ODA's designee for the region in
which the provider is being certified to provide services.
(b) ODA's designee shall enter into an
agreement with each provider specifying, at a minimum, the following:
(i) The time period during which the
agreement is in effect.
(ii) The
region for which the provider is certified.
(iii) The rate of payment per unit the
provider is willing to accept, which shall not exceed any limits ODM
establishes in rule
5160-31-07
of the Administrative Code and appendix A to rule 5160-1-06.1 of the
Administrative Code for the PASSPORT program, and rule
5160-33-07
of the Administrative Code and appendix A to rule 5160-1-06.5 of the
Administrative Code for the assisted living
program.
(2)
Applications for community transition provided through the home choice program
under rule
5160-51-10
of the Administrative Code: If ODA approves an application to be a provider of
community transition through the home choice program, ODA shall enter into an
agreement with the provider or, at ODA's sole discretion, ODA may direct its
designee to enter into an agreement with the provider specifying the items in
paragraphs (E)(1)(b)(i) to (E)(1)(b)(iii) of this rule.
(G) Deemed providers: ODA may deem any
provider certified by ODM or the department of developmental disabilities to
provide one or more services through a medicaidwaiver program as having
satisfied the requirements for certification by ODA for the same or similar
services under this chapter, as determined by ODA. The effective period for a
provider to be deemed an ODA-certified provider under this paragraph begins
on June 11, 2020
when the provider completes an online application followed
with an email to provider_enrollment@age.ohio.gov and ends if the
provider cannot comply with all the requirements of Chapter 173-9 of the
Administrative Code and this chapter within sixty days after initial deeming or
a medicaid provider agreement is terminated, whichever occurs first.
(H) Denied application:
(1) ODA may deny a provider's application for
any of the following reasons:
(a) The
provider made false representations, by omission or commission, on the
provider's application.
(b) The
provider made false statements, provided false information, or altered records
or documents.
(c) The provider is
prohibited from being certified pursuant to section
173.38 or
173.381
of the Revised Code, or Chapter 173-9 of the Administrative Code.
(d) The provider does not meet the applicable
requirements in rule
173-39-02
of the Administrative Code or any requirements in this chapter regulating a
service the provider is seeking certification to provide.
(e) Any reason permitted or required by state
or federal law.
(2) If
ODA denies a provider's application, ODA shall notify the provider of its final
determination and any applicable hearing rights established in section
173.391
of the Revised Code.
(3) If ODA
denies a provider's application, the provider is ineligible to reapply for
certification for one year after the mailing date of ODA's final adjudication
order.
Notes
Promulgated Under: 119.03
Statutory Authority: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Rule Amplifies: 173.39, 173.391, 173.52, 173.522, 173.54, 173.543; 42 CFR 441.352
Prior Effective Dates: 03/31/2006, 08/30/2010, 03/17/2011, 07/01/2019, 10/10/2019, 06/11/2020 (Emer.), 01/10/2021
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