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Ohio's Medicaid State Plan

​Medicaid State Plan Services

​Administered by the Ohio Department of Medicaid, Ohio’s Medicaid State Plan services cover a wide range of needs, including doctor visits, prescriptions, medical equipment at home, dental and vision services, pregnancy care, and mental health services.

Visit the Medicaid.Ohio.gov for more information about the kinds of services, who can get services, or how to apply for Medicaid State Plan services. 

Medicaid Managed Care Plans

People accessing services through a Home and Community-based Services Waiver, like DODD's Level One, Individual Options, or Self-Empowered Life Funding waivers, can enroll in a Medicaid managed care plan, which offers benefits like

  • one permanent card, rather than a new paper card each month,
  • more health care providers in your network and help finding health care providers,
  • a dedicated toll-free number for questions and 24-hour nurse advice line,
  • health and wellness programs,
  • multiple ways to give feedback on the quality of the care you get,
  • and additional benefits like vision, dental, and transportation.

Enrollment in a managed care plan is completely optional. Your waiver services stay the same if you choose to use a managed care plan or not. Learn more about Medicaid managed care plans.


Medicaid Health Services At-A-Glance 

This tool may be useful for service and support administrators to understand available Medicaid State Plan services, eligibility requirements, and billing codes.


Ohio Medicaid State Plan: Home Health Services

Home Health Services

Available Services Eligible Providers Codes 



Eligibility Requirements

No Age Restriction

Medical Need

Physician’s Order

Face-to-Face Encounter Required

Services provided in any setting in which normal life activities take place: NO hospital/ICF/NF or setting where Medicaid payment made for service




Home Health Nursing

Home Health Aide Skilled therapies (OT, ST, PT)

Part-time intermittent equals 4 hrs or less/visit

No more than 8 hrs/day combined of nursing, aide, and/or therapies

No more than 14 hrs/week combined of nursing and/ or aide hours unless prior authorization from KePro

These services cannot be used for respite, habilitative care, or therapy maintenance care





Medicare-certified home health agencies only 




RN – G0299  
LPN – G0300  
Aide – G0156  
ST – G0153  
OT – G0152  
PT – G0151


 Home Health Services— 

Post-Hospital

Available Services

Eligible Providers

Codes


Eligibility Requirements


No Age Restriction


Medical Need

hospital admission and 3 day or longer hospital stay

Form 07137 completed and received by the home care agency

Skilled service at least once per week


Same service setting as state plan home health



Home Health Nursing  
Home Health Aide Skilled Therapies (OT, ST, PT)

Part-time intermittent equals 4 hrs or less/visit

No more than 8 hrs/day combined of nursing, aide and/or therapies

Allowed up to 28 hrs/week for 60 days from the date of hospital discharge. If discharged directly to skilled/rehab unit, those days must be included in the 60-day restriction

Not for maintenance, respite or habilitative care 



Medicare-certified home health agencies only 



HospitaRN – G0299  
LPN – G0300  
Aide – G0156   
ST – G0153   
OT – G0152   
PT – G0151l

Hospital discharge date is required for providers to bill for post-hospital services   



Home Health Services— HealthChek

Available Services Eligible Providers  Codes


Eligibility Requirements

Must be younger than 21

Medical Need

Face-to-Face Encounter Required

Skilled service at least once per week

Same service setting as state plan home health




Home Health Nursing  
Home Health Aide Skilled Therapies (OT, ST, PT)

Part-time intermittent equals 4 hrs or less/visit

BUT

Increased service available if requires more than 28 hrs per week/combined and/or longer than 60 days

Or more than 8 hrs/day of any home health service (nursing/aide/therapy), or more than 14 hrs/week of aide and nursing

Not for respite or habilitative care 



Medicare-certified home health agencies only 



RN – G0299  
LPN – G0300  
Aide – G0156   
ST – G0153   
OT – G0152   
PT – G0151  

and

U5 – HealthChek modifier  
must be used 


Ohio Medicaid State Plan: Registered Nursing Services 

Registered Nursing— Assessment 

Available Services

Eligible Providers

 Codes

Eligibility Requirements

No Age Restriction



Medicaid service performed as follow-up to orders written by the treating physician, involving a face-to-face interview and observation assessment completed by an RN prior to the start or change of services and/or change in person’s condition 



Performed by an RN

Completed in home or residence

Pertains to the assessment visit to initiate or update the plan of care

Prior-approval by county board (and DODD if PDN/ waiver nursing services

in place) for person on DODD-administered waiver required

Must be specified on individual service plan


T1001


Registered Nursing— Consultation 

Available Services Eligible Providers  Codes

Eligibility Requirements

No Age Restriction



Face-to-face or telephone contact between a directing RN and LPN when a person experiences a significant change that necessitates a change in the existing interventions the LPN must perform during a nursing service visit, and that will result in a change in the person’s plan of care 



Does not replace routine direction or supervision by an RN to an LPN where no significant change exists or does not necessitate a change in the LPN’s intervention or the person’s plan of care

Can be provided by Medicare-certified agency, other accredited agency, DODD-certified agency providing waiver nursing, and non-agency RNs



T1001 with the U9 modifier 


Ohio Medicaid State Plan: Private Duty Nursing Services 

Private Duty Nursing

Available Services Eligible Providers Code

Eligibility Requirements

No Age Restriction

Medical Need

Physician’s Orders

Face-to-Face Encounter Required 

Continuous Skilled Nursing

greater than 4-hr service episode for the individual

Individual SN authorization not to exceed 12 hrs/visit

There may be multiple visits or shifts within a single service episode.

Example: 16 continuous hrs equals one episode with two provider shifts

 

Cannot be used for 
habilitative care 



Private Duty Nursing—

Post-Hospital

Adults and Children

Available Services 

Eligible Providers


Codes


Eligibility Requirements

No Age Restriction

Medical Need

greater than or equal to 3-day hospital admission and stay

Physician’s Orders

Face-to-Face Encounter Required

Form 07137 Completed and Received by Nursing Provider

Hospital Discharge Date Required

Continuous Skilled Nursing

greater than 4-hr service episode for the individual

Individual SN authorization not to exceed 12 hrs/visit

Up to 56 hrs/week to be provided for: Up to 60 consecutive days post- hospital discharge – any skilled care/rehab stay immediately following hospital discharge must be included in the 60-day restriction

There may be multiple visits/shifts within a single service episode. Example: 16 continuous hrs equals one episode with two provider shifts

Must be used for acute care not for maintenance or habilitative care 

Medicare-certified agency

Other accredited home health agency

Non-agency RN/LPN

T1000 for ALL Provider

Types

T1000 TE – LPN visit T1000 TD – RN visit Modifier required for

RN/LPN visit

Hospital discharge date is required for providers to bill for post-hospital services