5160-43-02 Specialized recovery services program individual eligibility and program enrollment.

 

 

 

 

 

PUBLIC HEARING NOTICE OHIO DEPARTMENT OF MEDICAID

 

DATE:                       May 16, 2016

TIME:                        11:00 AM

LOCATION:                         Lazarus Building, 50 West Town Street, Room A501 Columbus, Ohio 43215

 

 

Pursuant to Chapter 119. and section 5164.02 of the Revised Code, the director of the Ohio Department of Medicaid (ODM) gives notice of the Department's intent to file as new the rules identified below and of a public hearing thereon.

 

Rule 5160-43-01, entitled Specialized Recovery Services Program Definitions, is being proposed as new. This rule sets forth the definitions used in OAC Chapter 5160-43 regarding the Specialized Recovery Services Program.

 

Rule 5160-43-02, entitled Specialized Recovery Services Program Individual Eligibility, and Program Enrollment, is being proposed as new. This rule is being implemented to outline the criteria for eligibility and enrollment in the Specialized Recovery Services Program.  This rule includes hearing rights for individuals denied enrollment or who are dis-enrolled and includes an appendix which lists all qualifying diagnoses.

 

Rule 5160-43-03, entitled Specialized Recovery Services Program Individual Rights and Responsibilities, is being proposed as new. This rule describes an individual's rights and responsibilities once enrolled in the Specialized Recovery Services Program. This rule establishes certain expectations of the individual and what they can expect from their provider(s) while enrolled in the program.

 

Rule 5160-43-04, entitled Specialized Recovery Services Program Covered Services and Provider Requirements, is being proposed as new.  This rule sets forth the three home and community-based services (HCBS) that will be covered under the Specialized Recovery Services Program:  recovery management, peer recovery support and individualized placement and support - supported employment (IPS-SE). A service description and the provider requirements for each service are also included in this rule.

 

Rule 5160-43-05, entitled Specialized Recovery Services Program Provider Conditions  of Participation, is being proposed as new. This rule requires providers of specialized recovery services to maintain a professional relationship with individuals they serve. It provides a list of actions that must be accomplished by providers, as well as activities that are prohibited.

 

Rule 5160-43-06, entitled Specialized Recovery Services Program Incident Management System, is being proposed as new.  This rule details the procedures for incident notification and documentation requirements for ODM, its designees, providers, and

 

 

 

 

individuals enrolled in the program. In addition, it clarifies the terms incident, alert and provider occurrence.

Rule 5160-43-07, entitled Specialized Recovery Services Program Compliance: Provider Monitoring, Oversight, Structural Reviews and Investigations, is being proposed as new. This rule establishes the monitoring and oversight of service providers and contractors. It provides service providers with ODM's expectations around the process and procedures for monitoring and oversight including structural reviews and investigations.

Rule 5160-43-08, entitled Specialized Recovery Services Program Reimbursement Rates and Billing Procedures for Recovery Management, is being proposed as new. This rule establishes the $19.00 billing rate per 15 minute billing unit for recovery management services.

Rule 5160-43-09, entitled Specialized Recovery Services Program Criminal Record Checks for Providers, is being proposed as new. This rule implements the criminal records check requirements for all providers billing Medicaid for the provision of HCBS to individuals enrolled in the Specialized Recovery Services Program. It includes an appendix listing disqualifying offenses that may prohibit an individual from working in a position that involves providing HCBS and the exclusionary period for the offenses.

A copy of each of the proposed rules is available at the address listed below and without charge, to any person affected by the rules and at the county department of job and family services. The proposed rules are also available on the internet at  http://www.registerofohio.state.oh.us/. A public hearing on the proposed rules will be held at the date, time and location listed at the top of this notice. Either written or oral testimony will be taken at the public hearing. Additionally, written comments submitted or postmarked no later than the date of the public hearing will be treated as testimony.

Requests for a copy of the proposed rules or comments on the rules should be submitted by mail to the Ohio Department of Medicaid, Office of Legal Counsel, 50 West Town Street, 4th Floor, Columbus, Ohio 43218, by fax at [phone], or by e-mail at  [e-mail]. Comments received may be reviewed upon request.