(A) Ohio department of medicaid (ODM)
-administered waiver provider applicants must successfully complete the
provider enrollment process set forth in this rule and receive approval from
ODM before furnishing services to an individual enrolled on an ODM-administered
waiver. Services furnished before ODM approves and enrolls the provider
applicant and before the provider is added to the
approved person-centered services plan are not reimbursable.
(B) The provider applicant
must completes and submits a
waiver provider application to ODM
through its medicaid information technology system
(MITS) web portal in accordance with rule 5160-1-17- 17.2 of the
Administrative Code.
(C) Upon
receipt of the
waiver provider application,
ODM or its designee shall verify
all of the
following:
the provider applicant has submitted
and meets all applicable ODM-administered waiver provider regulations set forth
in Chapters 5160-1, 5160-44, 5160-45, 5160-46, and 5160-58 of the
Administrative Code.
(1) The provider applicant submits
and meets all applicable ODM-administered waiver provider requirements set
forth in Chapters 5160-1, 5160-45 and 5160-46 of the Administrative
Code.
(2) The provider applicant has
included a statement affirming the provider applicant is aware of, understands
and agrees to all of the Administrative Code rules governing the
ODM-administered waiver program.
(3) The non-agency provider
applicant, agency provider applicant and/or the agency's primary officer,
director or owner are not on any federal or state exclusionary lists ODM
considers when determining medicaid provider eligibility.
(D) ODM or its designee shall
notify the provider applicant if the application does not contain all of the
required documentation. The provider applicant shall have thirty calendar days
from the date of written notification to submit the requested documentation. If
the provider applicant does not submit the documentation within the prescribed
time frame, ODM or its designee may reject the provider application.
(E) ODM shall enroll or deny enrollment of
the provider applicant based upon its own review and the review and
recommendation of its designee.
(F)
ODM shall notify the provider applicant in writing of its decision. If ODM
denies enrollment, it shall
either issue the
provider applicant appeal rights in accordance with Chapter 119. of the Revised
Code
, or reconsideration rights in accordance with rule
5160-70-02 of the Administrative
Code.
(G) When a current
ODM-administered waiver service provider submits its medicaid provider
agreement revalidation application, and/or
or applies for an
additional provider type(s), and/or speciality (ies)
a specialty under their current provider type,
ODM shall ensure that criminal record check requirements set forth in Chapter
5160-45 of the Administrative Code are satisfied. ODM shall also review the
provider's history, including but not limited to medicaid program compliance
and performance. ODM may approve or deny revalidation based on its findings and
in accordance with rule 5160-1- 17.6 of the Administrative Code.
(H) When a former medicaid provider applies
for enrollment to become an ODM-administered waiver provider, in addition to
following the process outlined in paragraphs (A) to (F) of this rule, ODM shall
also review the provider applicant's history including, but not limited to
medicaid program compliance and performance. ODM may approve or deny enrollment
based on its findings and in accordance with rule
rules 5160-1-
17.6and 5160-1- 17.7 of the Administrative
Code.
Notes
Ohio Admin. Code
5160-45-04
Effective:
10/11/2021
Five Year Review (FYR) Dates:
7/16/2021 and
10/11/2026
Promulgated
Under: 119.03
Statutory
Authority: 5166.02
Rule
Amplifies: 5162.03,
5164.02,
5166.02
Prior
Effective Dates: 07/01/2004, 09/19/2009, 04/01/2011, 05/01/2016, 06/12/2020
(Emer.), 12/10/2020
