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OAC 5160-12-03.1 — Non-agency nurses and otherwise-accredited agencies: qualifications and requirements

OhioregulationOhio Department of Medicaid· effective 2015-07-01

What this rule requires your agency to do

  • 1An otherwise-accredited agency must have and maintain accreditation for home health, PDN, personal care, and support services from a CMS-approved national accreditation organization and execute a Medicaid provider agreement (para. (C)).(OAC 5160-12-03.1 — Non-agency nurses and otherwise-accredited agencies: qualifications and requirements)
  • 2A non-agency nurse must not be the parent, step-parent, foster parent, or legal guardian of an individual under eighteen, or the individual's spouse (para. (B)(3)).(OAC 5160-12-03.1 — Non-agency nurses and otherwise-accredited agencies: qualifications and requirements)
  • 3A non-agency nurse must meet all conditions of participation in paragraphs (C) and (D) of rule 5160-45-10 (para. (B)(4)).(OAC 5160-12-03.1 — Non-agency nurses and otherwise-accredited agencies: qualifications and requirements)
  • 4A non-agency nurse must be a registered nurse (or an LPN at the direction of an RN) practicing within the scope of his or her nursing license under R.C. Chapter 4723 as an independent provider (para. (B)(1)).(OAC 5160-12-03.1 — Non-agency nurses and otherwise-accredited agencies: qualifications and requirements)
  • 5Providers of PDN who also provide waiver services to a waiver-enrolled individual must comply with all applicable HCBS waiver rule requirements (para. (D)).(OAC 5160-12-03.1 — Non-agency nurses and otherwise-accredited agencies: qualifications and requirements)
  • 6A non-agency nurse must comply with the MCHHA requirements of rule 5160-12-03 except paragraphs (A), (B)(1), and (B)(6) of that rule (para. (B)(2)).(OAC 5160-12-03.1 — Non-agency nurses and otherwise-accredited agencies: qualifications and requirements)

Applies to: private duty nursing

Sets the licensure, provider-agreement, and conduct requirements for non-agency nurses and otherwise-accredited agencies to provide private duty nursing in Ohio Medicaid, including scope-of-practice, family-member prohibitions, and background/conditions-of-participation cross-references. Fills the independent-provider qualifications and family-caregiver-restriction framework gaps.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.