Ohio Admin. Code 5160-12-03 - Medicare certified home health agencies: qualifications and requirements

(A) A medicare certified home health agency (MCRHHA MCHHA) that meets the requirements in accordance with of this rule is eligible to participate in the Ohio medicaid program upon execution of a provider agreement in accordance with rule 5101:3-1- 17.2 5160-1- 17.2 of the Administrative Code.
(B) MCRHHAs MCHHAs are required to:
(1) To be Be certified for medicare participation by the Ohio department of health (ODH) in accordance with Chapter 3701-60 of the Administrative Code.
(2) To meet Meet the conditions of participation in accordance with 42 C.F.R. Part 484 (October 1, 2005 2014).
(3) To implement Implement policy components for home health and private duty nursing (PDN) as specified in the "Medicare Benefit Policy Manual, Chapter Seven: Home Health Services medicare benefit policy manual, chapter seven: home health services" (August 12, 2005 January 14, 2014) for the following sections:
(a) Section 20 "Determination of Coverage Conditions to be met for coverage of home health services" section 20;
(b) Secton 30.2"Content of the Plan of Care Services are provided under a plan of care established by and approved by a physician" section 30.2 to Section 30.3 "Under the Care of a Physician under the care of a physician" section 30.3; and
(c) Section 40 "Covered Services Under services under a Qualifying Home Health Plan qualifying home health plan of Care care" section 40 to Section 50.3 "Medical Social medical social Services services" section 50.3.
(4) To comply Comply with all applicable requirements for medicaid providers in Chapter 5101:3-1 5160-1 of the Administrative Code.
(5) To comply Comply with all federal, state and local laws and regulations as applicable.

(C) MCRHHAs are required:

(1) (6) To have Have back up staff available to provide services when the agency's MCHHA's regularly scheduled staff cannot or do not meet their obligation to provide services.
(2) (7) To submit Submit written notification to the consumer individual at least thirty days prior to the last date of service when terminating a service unless:
(a) The consumer's individual's treating physician has discontinued home health services;
(b) The treating physician has been notified that goals have been met;
(c) The consumer individual is no longer at the consumer's no longer resides at their known place of residence or their whereabouts are unknown;
(d) The consumer individual or another person has harmed or threatened to harm staff of the MCRHHAs MCHHA staff;
(e) The consumer individual requested that services be terminated; or
(f) The consumer individual has been enrolled in a medicaid managed care plan (MCP).
(3) (8) To contact Contact the consumer's individual's medicaid MCP when applicable to request prior authorization for home health and PDN services.
(4) (9) To maintain Maintain documentation on all aspects of services provided in accordance with this chapter. All documentation must be complete prior to billing for services provided in accordance with this chapter and is subject to monitoring by ODM . This includes but is not limited to:
(a) Clinical records ( , including all signed orders) as specified in paragraph (B) of this rule.
(b) Time keeping records that indicate the date and time span of the services provided during a each visit, and the type of service provided.
(c) (10) To obtain Obtain the completed and signed JFS ODM 07137 "Certificate of Medical Necessity Home Care Certification for Home Health Services and Private Duty Nursing Services" (rev. 7/2006 7/2014), which certifies the medical necessity for services in accordance with paragraph (C) of rule 5101:3-12-01 5160-12-01 or paragraph (B) of rule 5101:3-12-02 5160-12-02 of the Administrative Code.


Ohio Admin. Code 5160-12-03
Effective: 7/1/2015
Five Year Review (FYR) Dates: 04/14/2015 and 07/01/2020
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02, 5162.03
Prior Effective Dates: 4/7/77, 5/1/87, 3/30/90 (Emer), 6/29/90, 7/1/90, 3/12/92 (Emer), 6/1/92, 7/31/92 (Emer) 10/30/92, 7/1/93 (Emer), 9/1/93, 1/1/96, 7/1/98, 9/29/00, 9/1/05, 7/1/06, 11/08/07

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