Ohio Administrative Code|Rule 5160-21-05 | Nurse home visiting services.

                                                
(A) Unless otherwise noted, any
		  limitations or requirements specified in the Revised Code or in agency 5160 of
		  the Administrative Code apply to services addressed in this rule.
(B) Definitions.
(1) "Advanced
			 practice registered nurse (APRN)" has the same meaning as in Chapter
			 4723-08 of the Administrative Code.
(2) "Registered
			 nurse (RN)" has the same meaning as in Chapter 4723. of the Revised
			 Code.
(3) "Eligible
			 provider" has the same meaning as in rule 5160-1-17 of the Administrative
			 Code.
(4) "Home
			 visiting" has the same meaning as in Chapter 3701-8 of the Administrative
			 Code.
(5) "Nurse home
			 visiting" is home visiting provided by an APRN or RN. Within the package
			 of home visiting services, emphasis is placed on the following services
			 performed within the scope of the practitioner:
(a) Prenatal visits;
(b) Postpartum visits;
(c) Training in pediatric care;
(d) Nursing examinations, which focus on assessment of
				social determinants of health, on education, and on emotional
				support;
(e) Health education;
(f) Maternal depression screening; and
(g) Lactation counseling.
(C) Providers.
(1) Rendering provider.
			 Medicaid payment may be made for a covered nurse home visiting service rendered
			 by an eligible provider.
(2) Billing
			 ("pay-to") provider. The following eligible providers may receive
			 medicaid payment for submitting a claim for a covered nurse home visiting
			 service:
(a) An ambulatory health care clinic as defined in Chapter
				5160-13 of the Administrative Code;
(b) A federally qualified health center
				(FQHC);
(c) A rural health clinic (RHC); or
(d) A professional medical group.
(D) Coverage.
(1) Payment may be made
			 only for a nurse home visiting service for which the following criteria are
			 met:
(a) The service is medically necessary in accordance with
				rule 5160-1-01 of the Administrative Code;
(b) The service is performed at the order of a practitioner
				in accordance with rule 5160-1-17 of the Administrative Code;
(c) The individual receiving the service has at least one
				of the following medically complex conditions that may put an individual at a
				high risk for preterm birth:
(i) Asthma;
(ii) Diabetes;
(iii) Cardiovascular
				  disease;
(iv) Substance use
				  disorder; or
(v) History of pre-term
				  birth; and
(d) The individual is not currently receiving another
				service that substantially duplicates a nurse home visiting
				service.
(2) No payment is made
			 for a separate evaluation and management service in addition to a nurse home
			 visiting service rendered by the same provider to the same individual on the
			 same day.
(E) Claim payment.
(1) For a covered nurse
			 home visiting service rendered by an FQHC or RHC, payment is made in accordance
			 with Chapter 5160-28 of the Administrative Code.
(2) For a covered nurse
			 home visiting service rendered at any other valid place of service, payment is
			 the lesser of the provider's submitted charge or the maximum amount
			 specified in appendix DD to rule 5160-1-60 of the Administrative
			 Code.


Last updated January 3, 2022 at 9:54 AM