Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-45 - Administered Waiver Service Providers › Section 5160-45-04 - Ohio department of medicaid (ODM) -administered waiver program: provider enrollment process

Current through all regulations passed and filed through July 1, 2024
(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
			  completes and submits a
			  provider application to ODM
			  in accordance with rule 5160-1-17 of the
			 Administrative Code.
(C) Upon
			 receipt of the  provider application,
			 ODM or its designee shall verify 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.
(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, 
								or applies for 
								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 rules 5160-1-
			 17.6and 5160-1- 17.7 of the Administrative
			 Code.