Ohio Admin. Code 5160-27-13 - [Effective 7/1/2025] Mobile response and stabilization service

(A) For the purposes of this rule, mobile response and stabilization service (MRSS), is the service as set forth by the Ohio department of mental health and addiction services (OhioMHAS) in rule 5122-29-14 of the Administrative Code.

(B) Eligible providers.

(1) Providers eligible to provide MRSS in accordance with rule 5122-29-14 of the Administrative Code and designated by OhioMHAS as regional MRSS providers are eligible for MRSS reimbursement.

(2) Eligible rendering providers are MRSS team staff described in rule 5122-29-14 of the Administrative Code that are eligible providers of behavioral health services in accordance with rule 5160-27-01 of the Administrative Code and employed by or under contract with an eligible provider described in paragraph (B)(1) of this rule or with an organization providing MRSS under a contract or agreement with an eligible provider described in paragraph (B)(1) of this rule.

(3) Grandfathering: As determined by the Ohio department of medicaid (ODM), providers who are eligible to provide MRSS in accordance with rule 5122-29-14 of the Administrative Code but are not designated by OhioMHAS as regional MRSS providers may continue to provide and be reimbursed for MRSS until the OhioMHAS designated regional MRSS provider takes full responsibility for the region. ODM will provide a written notifiction to each provider eligible to receive reimbursement under this section and will provide ten business days written notice when the provider is determined no longer eligible for reimbursement.

(C) Coverage. The following services and activities provided in accordance with rule 5122-29-14 of the Administrative Code to individuals twenty years of age or younger are covered services:

(1) Mobile response activities as described in rule 5122-29-14 of the Administrative Code.

(2) Stabilization services as described in rule 5122-29-14 of the Administrative Code.

(D) Limitations. The following are not covered as MRSS:

(1) Childcare services or services provided as a substitute for the parent or other individuals responsible for providing care and supervision.

(2) Respite care.

(3) Transportation activities that do not include the provision of a mobile response activity or stabilization service.

(4) A service that is covered as part of another medicaid reimbursable service, including but not limited to:

(a) Intensive home-based treatment as described in rule 5122-29-28 of the Administrative Code except when a mobile response team is dispatched to de-escalate a presenting crisis as described in rule 5122-29-14 of the Administrative Code.

(b) Substance use disorder residential treatment services as described in rule 51602-27-09 of the Administrative Code, except for MRSS necessary to support admission to or discharge from the facility.

(c) Assertive community treatment as described in rule 5160-27-04 of the Administrative Code.

(d) Inpatient or outpatient hospital services as described in Chapter 5160-2 of the Administrative Code, except for MRSS necessary to support admission to or discharge from the hospital.

(e) Psychiatric residential treatment facility services as described in rule 5160-59-03.6 of the Administrative Code, except for MRSS necessary to support admission to or discharge from the facility.

(E) Reimbursement.

(1) Providers described in paragraph (B)(1) of this rule will be reimbursed in accordance with the contracted rates described in their OhioMHAS provider agreements.

(2) Providers described in paragraph (B)(3) of this rule will be reimbursed in accordance with the fee schedule stated in the appendix to rule 5160-27-03 of the Administrative Code.

Replaces: 5160-27-13

Notes

Ohio Admin. Code 5160-27-13

Effective: 7/1/2025
Five Year Review (FYR) Dates: 07/01/2030
Promulgated Under: 119.03
Statutory Authority: 5164.02, 5162.02
Rule Amplifies: 5162.02, 5162.03, 5162.05
Prior Effective Dates: 07/01/2022