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OAC 5160-12-05 — Reimbursement: home health services
OhioregulationOhio Department of Medicaid· effective 2024-01-01
What this rule requires your agency to do
- 1An MCHHA may be reimbursed for services to an individual residing in a facility/home only if it has written documentation from the facility/home stating the facility is not responsible for providing the same or similar services (para. (I)).(OAC 5160-12-05 — Reimbursement: home health services)
- 2An MCHHA must not be reimbursed for home health services that duplicate same or similar services already paid by Medicaid or another funding source (e.g., a facility already paid to provide personal care or nursing services) (para. (H)).(OAC 5160-12-05 — Reimbursement: home health services)
- 3Reimbursement for a home health visit is the lesser of the provider's billed charge or the Medicaid maximum rate, with each visit less than or equal to four hours (para. (C), (C)(1)).(OAC 5160-12-05 — Reimbursement: home health services)
- 4A telehealth visit must be indicated using place-of-service code "02" (para. (F)).(OAC 5160-12-05 — Reimbursement: home health services)
- 5An RN home health nursing visit must be billed using code G0299 and an LPN home health nursing visit using code G0300 (para. (G)).(OAC 5160-12-05 — Reimbursement: home health services)
Applies to: home health
Sets the base-rate/unit-rate reimbursement methodology for Medicaid home health visits, group-visit and telehealth billing, RN vs LPN billing codes, and — most importantly for compliance — prohibits reimbursement for services that duplicate same/similar services already paid by Medicaid or another funding source. Fills the anti-duplication / billing-integrity framework gap.
Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.