(5) In order to be a provider and submit a claim for reimbursement of waiver nursing services, the RN, or LPN at the direction of the RN, delivering the service must meet all of the following requirements:(a) Comply with all applicable rules set forth in Chapters 5160--46 of the Administrative Code.
(b) Request reimbursement for the provision of services in accordance with rule 5160-46-06 of the Administrative Code.
(G) If an individual is denied enrollment in the Ohio home care waiver program pursuant to paragraph (D) of this rule, or is disenrolled from the waiver pursuant to paragraph (E) or (F) of this rule, the individual shall be afforded notice and hearing rights in accordance with division 5101:6 of the Administrative Code.
of the Revised Code; (b) Services that require the skills of a psychiatric nurse; (c) Visits performed for the purpose of conducting an RN assessment as set forth in rule 5160-12-08 of the Administrative Code, including but not limited to an outcome and assessment information set (OASIS) assessment or any other assessment; (d) RN consultations as set forth in rule 5160-12-08 of the Administrative Code, including but not limited to, those performed by RNs for the sole purpose of directing LPNs in the performance of waiver nursing services or directing personal care aides or home health aides employed by a medicare-certified home health agency or otherwise accredited agency; (e) Visits performed for the sole purpose of meeting the supervisory requirements (including any visit) pursuant to paragraph (B)(6)(c) of this rule; (f) Visits performed for the sole purpose of meeting the home care attendant service RN visit requirements set forth in rules 5160-46-04.1 and 173-39- 02.24 of the Administrative Code; or (g) Services performed in excess of the number of hours approved pursuant to, and as specified on, the individual's all services plan.
(4) Waiver nursing services may be provided on the same day as, but not concurrently with, an RN assessment and/or an RN consultation as set forth in rule 5160-12-08 of the Administrative Code.
(5) The individual is under sixty years of age and resides in a medicaid-funded NF at the time of application.
(6) The individual is under sixty years of age, is determined by ODM to be eligible for the HOME choice ("Helping Ohioans Move, Expanding Choice") program in accordance with rule 5160-51-02 of the Administrative Code, and resides in a residential treatment facility as defined in rule 5160-51-01 of the Administrative Code, or an inpatient hospital setting.
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