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OAC 5160-12-03 — Medicare certified home health agencies: qualifications and requirements

OhioregulationOhio Department of Medicaid· effective 2015-07-01

What this rule requires your agency to do

  • 1The MCHHA must maintain documentation on all aspects of services provided, including clinical records with all signed orders and time-keeping records showing date, time span, and type of service; all documentation must be complete before billing (para. (B)(9)).(OAC 5160-12-03 — Medicare certified home health agencies: qualifications and requirements)
  • 2The MCHHA must obtain the completed and signed ODM 07137 Certificate of Medical Necessity certifying medical necessity per rule 5160-12-01 or 5160-12-02 (para. (B)(10)).(OAC 5160-12-03 — Medicare certified home health agencies: qualifications and requirements)
  • 3The MCHHA must have back-up staff available to provide services when its regularly scheduled staff cannot or do not meet their obligation to provide services (para. (B)(6)).(OAC 5160-12-03 — Medicare certified home health agencies: qualifications and requirements)
  • 4The MCHHA must implement specified home health and PDN policy components from the Medicare Benefit Policy Manual, chapter seven (para. (B)(3)).(OAC 5160-12-03 — Medicare certified home health agencies: qualifications and requirements)
  • 5An MCHHA must be certified for Medicare participation by the Ohio Department of Health under OAC Chapter 3701-60 and meet the federal conditions of participation at 42 C.F.R. Part 484 (para. (B)(1)-(2)).(OAC 5160-12-03 — Medicare certified home health agencies: qualifications and requirements)
  • 6The MCHHA must submit written notification to the individual at least thirty days prior to the last date of service when terminating a service, except in the enumerated circumstances (para. (B)(7)).(OAC 5160-12-03 — Medicare certified home health agencies: qualifications and requirements)

Applies to: home health agency

Establishes the qualification and ongoing operational requirements for a Medicare-certified home health agency (MCHHA) to participate in Ohio Medicaid, including ODH certification, federal conditions of participation, back-up staffing, termination notice, documentation, and certificate-of-medical-necessity duties. Fills the agency conditions-of-participation, records, and service-termination framework gaps.

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