Ohio Administrative Code › Title 173 - Department of Aging › Chapter 173-39 - Certification of Community-Based Long-Term Care Service Providers › Section 173-39-02.7 - ODA provider certification: home medical equipment and supplies

Current through all regulations passed and filed through July 1, 2024
(A) "Home medical
			 equipment and supplies" (HME) means a service providing rented or purchased
			 home medical equipment and supplies to individuals to enable those individuals
			 to function safely in their homes with greater independence, thereby
			 eliminating the need for placement in a nursing facility.
HME is limited to equipment and supplies allowed under Chapter
				5160-10 of the Administrative Code, miscellaneous equipment and supplies,
				equipment repairs, and equipment and supplies not paid (in full or in part) by
				medicare, state plan medicaid, or another third-party payer.
(B) Requirements for ODA-certified providers
			 of home medical equipment and supplies:
(1)
			 General requirements: The agency provider shall comply with the requirements
			 for every ODA-certified agency provider in rule
			 173-39-02
			 of the Administrative Code and the non-agency provider shall comply with the
			 requirements for every ODA-certified agency provider in rule
			 173-39-02
			 of the Administrative Code.
(2)
			 Ongoing assistance: The provider shall provide professional, ongoing assistance
			 when needed to evaluate and adjust equipment and supplies delivered, and/or to
			 instruct the individual or the individual's caregiver in the use of equipment
			 and supplies.
(3) Repairs and
			 replacements: The provider shall assume liability for equipment warranties and
			 shall install, maintain, and/or replace any defective parts or items specified
			 in those warranties. Replacement items or parts for HME are not payable as
			 rental equipment.
(4) Billing:
(a) Before ODA's designee may authorize
			 equipment or supplies, the provider shall document the equipment and supplies
			 to be purchased were not covered (in full or in part) by medicare, state plan
			 medicaid, and any other third-party payer.
(b) The provider shall, in collaboration with
			 the 
										ODA's designee, ascertain and recoup any third-party
			 resource(s) available to the individual before billing ODA or its designee. ODA
			 or its designee may then pay the unpaid balance up to the lesser of the
			 provider's billed charge or the maximum allowable payment established in
			 the appendix  to rule 5160-1-06.1 of the Administrative
			 Code.
(c) The provider shall
			 
										provide the price for an item to be purchased or
			 rented to the ODA's designee no more than two
			 business days after the 
										ODA's designee's request. The provider shall
			 purchase, deliver, and install (as appropriate) the authorized item(s) before
			 
										billing ODA's designee. The billed amount for
			 each item shall not exceed the item rate authorized by
			 ODA's designee.
(5) Delivery and verification:
(a) The provider shall verify the successful
			 completion of each activity (i.e., delivery, installation, or education) it
			 provides using either an electronic or manual system and shall retain
			 
										records verifying the delivery of HME. Regardless of
			 the system used, the verification shall include the individual's name, date of
			 delivery, installation, or education, and itemization of each activity
			 completed.
(b) Delivery verification
			 methods: 
										The provider shall 
										verify the delivery of HME by
			 one of the following methods:
(i) A unique
			 identifier of the individual.
(ii)
			 If a provider uses a common carrier to deliver HME, the provider shall verify
			 the success of the delivery by using the method in paragraph (B)(5)(b)(i) of
			 this rule or by retaining the common carrier's tracking statement or returned
			 postage-paid delivery invoice.
(c) If a provider leaves
			 
										an HME item
			 outside the door of an individual's home, the provider shall contact the
			 individual by telephone at least once per month to alert them to any delivery
			 left outside the door to their home.
(d) The provider shall replace (at no cost to
			 the individual, ODA, or ODA's designee) any HME item lost or stolen between the
			 time of delivery and receipt by the individual.
(e) If a single visit by the provider
			 includes more than one HME activity, the provider may verify the success of all
			 the activities it provides by obtaining only one verification.
(f) The provider shall not verify an HME
			 activity was successfully provided with the signature of the provider, an
			 employee of the provider, or any other person with a financial interest in the
			 HME.