This was distributed by DODD earlier this week. We checked to see if this process would take place when a provider added a service. It is highly likely that these pre-enrollment visits will take place when an existing providing adds a service, due to the high level of assessed risk.
Anita
From: Sue.Pairan@dodd.ohio.gov [mailto:Sue.Pairan@dodd.ohio.gov]
On Behalf Of Lori.Horvath@dodd.ohio.gov
Sent: Wednesday, September 09, 2015 12:08 PM
To: ssa-contacts@list.dodd.ohio.gov; cb-superintendents@list.dodd.ohio.gov; waiver-contacts@list.dodd.ohio.gov; Lori Stanfa <lstanfa@oacbdd.org>; Anita Allen <aallen@opra.org>; kathy@ohiowaivernetwork.com; Lyle, Deb <dlyle@graceworks.org>; MRench@stjosephhome.org;
cog-directors@list.dodd.ohio.gov
Subject: Pre-enrollment visits
Effective September 14, 2015, the Ohio Department of Medicaid will initiate the process of conducting site visits of the following agencies prior to enrolling them as Medicaid providers. These pre-enrollment visits are required under the Affordable Care Act for organizations that may pose a moderate to high risk of Medicaid fraud. The purpose of the visits is to ensure the agencies have the necessary infrastructure to conduct Medicaid business.
· Residential Respite (ALL) High
· Community Respite (ALL) High
· Adult Family Living (IO only) High
· Adult Foster Care (IO only) High
· Homemaker/Personal Care (IO and LV1) High
· Homemaker/Personal- Care Daily Billing Unit (IO only) High
· Community Inclusion – Personal Assistance (SELF only) High
· Community Inclusion – Transportation (SELF only) High
· Transportation (ALL) High
· Non-Medical Transportation (ALL) High
· Habilitation-Adult Day Support (ALL) High
· Habilitation-Vocational Habilitation (ALL) High
· Remote Monitoring (ALL) High
· Remote Monitoring Equipment (ALL) High
· Adaptive and Assistive Equipment (IO Only) High
· Specialized Medical Equipment (Level One) High
· Integrated Employment (SELF only) High
· Supported Employment Community (ALL) High
· Supported Employment Enclave (ALL) High
This new process may result in an additional 2-week delay from the time DODD refers the applicant to ODM for consideration and when the agency receives a Medicaid provider number. If any deficiencies are noted during the on-site visit, it may take even longer for a Medicaid number to be assigned.
Please remember that providers will not receive final approval letters from DODD until they receive Medicaid provider numbers. Until this process is complete, providers may not be added to PAWS.
Feel free to contact Jovon Loveless at Jovon.loveless@dodd.ohio.gov with any questions.
Thanks!
Lori Horvath