Ohio Admin. Code 3701-8-09 - Criteria for reimbursement of home visiting services

Current through all regulations passed and filed through March 11, 2022

(A) Home visiting services shall be reimbursed per the terms and rate set forth in the provider agreement. Minutes of service provided to an eligible individual will be aggregated by covered services in accordance with paragraph (B) of this rule, within each day. The number of units of covered services is the total minutes divided by fifteen plus one additional unit if the remaining number of minutes is at least eight minutes, for each covered service.

(B) Provider shall accept reimbursement for all reimbursable services as payment in full. Services shall be reimbursed when:

(1) The provider is qualified in accordance with rule 3701-8-03 of the Administrative Code;

(2) The home visitor delivering the service meets requirements for education and training set forth in rule 3701-8-04 of the Administrative Code;

(3) All required data prescribed by the Administrative Code is entered into the statewide data system and approved by the assigned supervisor of the individual delivering the service. The supervisor shall serve concurrently as the billing approver to ensure accuracy and quality of services delivered;

(4) The service for which reimbursement is sought is allowable under paragraph (C) of this rule and are clearly identified in the family goal plan or record.

(C) Reimbursable home visiting services include:

(1) Preparing materials and information for a completed home visit;

(2) Conducting assessments, including the administration of approved screening tools, monitoring, and follow-up with families during a home visit, in accordance with timeframes specified within provider agreements;

(3) Developing and managing a family goal plan during home visits, when such goals are related to the program goals;

(4) Department approved parenting education curriculum provided to families during home visits;

(5) Referral and referral follow-up activities facilitated by the assigned home visitor to link families and caregivers to services that address identified goals or needs in the family goal plan or record;

(6) Traveling to and from the home visit; when the home visit is successfully completed;

(7) Documentation and data entry into the statewide data system.

(D) Providers may be reimbursed up to the department caps set forth in the provider agreement.

(E) Activities not reimbursable for home visiting services include, but are not limited to:

(1) Time spent in training;

(2) Time spent in supervision;

(3) Time spent on activities for a home visit that was not successfully completed;

(4) Time spent on administrative task or duties;

(5) Vacation leave, sick leave or other related benefits.

(F)(E) Documentation for the provision of each service shall be maintained in the statewide data system for purposes of supporting payment, delivery of the service, and to provide an audit trail. Documentation shall include:

(1) The activity service that was provided;

(2) The date inclusive of day, month, and year that the activity was provided;

(3) The first and last name of the individual for whom the activity was provided;

(4) The duration in minutes or time in and time out of the activity provided; and

(5) The signature or initials of the person delivering the service on each entry of service delivery.

(G)(F) Records necessary to fully disclose the extent of services provided and costs associated with these services shall be maintained for a period of six years from the date of receipt of payment based upon those records or until any initiated audit, review, investigation or other activities are completed and appropriately resolved, whichever is longer. Records shall be made available upon request to the Ohio department of health or designee. Failure to supply requested records, documentation and/or information may result in non-payment for outstanding services or recoupment of funds.

(H)(G) The Ohio department of health, or a designee, may conduct audits, reviews, investigations, or any other activities necessary to assure a home visiting provider, its sub grantee or sub provider are compliant with federal and state requirements. Based on the results of an audit, review, investigation or other activities, the Ohio department of health may seek legal recourse, including but not limited to, recoupment of funding related to over payments, misuse, fraud waste or abuse or noncompliance with federal or state requirements from the home visiting provider.

Notes

Ohio Admin. Code 3701-8-09

Effective: 1/31/2022
Five Year Review (FYR) Dates: 7/1/2023
Promulgated Under: 119.03
Statutory Authority: 3701.61
Rule Amplifies: 3701.61
Prior Effective Dates: 09/03/2012, 07/01/2018