Reimbursement of home health or private
duty nursing (PDN) services in accordance with this chapter are on a per visit
basis. A "visit" is the duration of time that a covered home health service or
private duty nursing (PDN) service is provided during an in-person
encounter to one or more
individuals receiving medicaid at the same residence on the same date during
the same time period.
A visit begins with
the provision of a covered service and ends when the in-person
(2) A visit must have a lapse of time of two
or more hours between any previous or subsequent visit for the provision of the
same covered service unless the length of a private duty nursing visit requires
an agency to provide a change in staff.
(3) A visit must have a lapse of two or more
hours between the provision of home health nursing and PDN service.
A visit must be verified using an
ODM-approved electronic visit verification (EVV) system in accordance with rule
of the Administrative Code.
(B) When an individual is enrolled in a home
and community based services (HCBS) waiver and is receiving consecutive home
health or PDN service(s) with waiver service(s) that have the same scope of
service, there must be a lapse of time of two or more hours between the
services. A "scope" of a service includes the definition of the service and the
conditions that apply to its provision and the provider who renders the
(C) Each covered visit
must be billed as a separate line item. The number of lines /procedure codes
must reflect the number of visits provided with one line equaling one
A "group visit" is a
visit where the service(s) is provided to more than one person. During a group
(1) The ratio of provider to the
individuals being served may never exceed one to three.
(2) An entire visit is considered a group
visit even if only a portion of the visit met the definition of a group
A modifier HQ must be
used when billing to identify each group setting in accordance with rule
of the Administrative Code.
A "multiple visit" is when the provision
of the same home health service or PDN by the same provider occurs on the same
date of service for the same individual separated by a lapse of two hours.
Multiple visits must be medically necessary in accordance with rule
of the Administrative Code due to the functional limitations and/or medical
condition of the individual as documented in the plan of care, and if the
individual is enrolled in HCBS waiver, the services plan or all services plan.
Documentation must support the medical need for multiple visits. After the
initial visit, multiple visits must either be billed with a U2 modifier for the
second visit or U3 for the third or any subsequent visit.
Ohio Admin. Code
Five Year Review (FYR) Dates:
Authority: Ohio Revised Code Section
Amplifies: Ohio Revised Code Sections
Effective Dates: 04/07/1977, 05/01/1987, 04/01/1988, 05/15/1989, 03/30/1990
(Emer.), 06/29/1990, 07/01/1990, 03/12/1992 (Emer.), 06/01/1992, 07/31/1992
(Emer.), 10/30/1992, 04/30/1993 (Emer.), 07/01/1993 (Emer.), 07/30/1993,
09/01/1993, 01/01/1996, 07/01/1998, 09/29/2000, 09/01/2005, 07/01/2006,