Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-12 - Ohio Home Care Program › Section 5160-12-03 - Medicare certified home health agencies: qualifications and requirements

Current through all regulations passed and filed through July 1, 2024
(A) A medicare
			 certified home health agency (MCHHA) that meets the requirements
			 
								of this rule is eligible to participate in the Ohio
			 medicaid program upon execution of a provider agreement in accordance with rule
			 5160-1- 17.2 of the Administrative Code.
(B)
								MCHHAs are
			 required to:
(1)
									
									Be
			 certified for medicare participation by the Ohio department of health (ODH) in
			 accordance with Chapter 3701-60 of the Administrative Code.
(2)
									
									Meet the conditions of
			 participation in accordance with 42 C.F.R. Part
			 484 (October 1, 2014).
(3)
									
									Implement policy components for home health and
			 private duty nursing (PDN) as specified in the
			 "medicare benefit policy manual,
			 chapter seven: home health services" (January 14, 2014) for the
			 following sections:
(a)
										Section 20 "Conditions to be met for coverage of home health
			 services" ;
(b)
										Secton
			 30.2"Services are provided under a plan of care established by
			 and approved by a physician"  to Section 30.3 "under the care of a physician"
			 ; and
(c)
										Section 40
			 "Covered services under a qualifying home health
			 plan of care" 
			 to Section 50.3 "medical
			 social
										services" .
(4)
									
									Comply with all applicable requirements for medicaid
			 providers in Chapter 5160-1 of the Administrative Code.
(5)
									
									Comply with all federal, state
			 and local laws and regulations as applicable.
(6)
									
									Have
			 back up staff available to provide services when the MCHHA's
			 regularly scheduled staff cannot or do not meet their obligation to provide
			 services.
(7)
									
									Submit written notification to the
			 
									individual at least thirty days prior to the last date
			 of service when terminating a service unless:
(a) The 
										individual's treating physician has discontinued home
			 health services;
(b) The treating
			 physician has been notified that goals have been met;
(c) The 
										individual
										
										no longer resides at their known place of
			 residence or their whereabouts are
			 unknown;
(d) The
			 
										individual or another person has harmed or threatened
			 to harm staff of the MCHHA
										;
(e) The 
										individual
			 requested that services be terminated; or
(f) The 
										individual
			 has been enrolled in a medicaid managed care plan (MCP).
(8)
									
									Contact the individual's medicaid MCP when
			 applicable to request prior authorization for home health and PDN
			 services.
(9)
									
									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.
(b) Time keeping records that indicate the
			 date and time span of the services provided during 
										each visit, and the
			 type of service provided.
(10)
									
									Obtain the completed and signed
			 
									ODM 07137
			 "Certificate of Medical Necessity for Home Health Services and
			 Private Duty Nursing Services" (rev. 7/2014), which
			 certifies the medical necessity for services in accordance with
			  rule
			 5160-12-01 or  rule 5160-12-02 of the Administrative Code.