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Ohio Department of Medicaid (ODM) is pleased to announce the rollout of substantial reimbursement rate increases for home- and community-based services (HCBS), home health, and private duty nursing providers effective January 1, 2024. As part of Governor Mike DeWine’s commitment to making sure every Ohioan receives quality care, and with the support of the General Assembly and Centers for Medicare and Medicaid (CMS) approval, these rate increases will support providers as they continue delivering the highest level of care for Ohio’s residents.
The rate increases are historic in nature, totaling approximately $3.4 billion per year across a network of more than 200,000 active providers.
ODM updated the following HCBS rules for January 1, 2024:
- 5160-12-05 - Reimbursement: home health services.
- 5160-12-06 - Reimbursement: private duty nursing services.
- Please refer to the private duty nursing FAQ on the budget page of our website for additional information regarding changes to the “weighted first hour.”
- 5160-46-06 - Ohio home care waiver program: reimbursement rates and billing procedures.
- 5160-46-06.1 - Ohio home care waiver program: home care attendant services reimbursement rates and billing procedures.
- 5160-1-06.1 – HCBS waivers: PASSPORT.
- 5160-1-06.5 – HCBS waivers: assisted living.
- Chapter 5123-9 HCBS waivers.
The new rates apply to January 1, 2024, dates of service and beyond. ODM reimburses all services based on the date of service, not the date the provider bills the service. More information on these rate changes is available here: https://medicaid.ohio.gov/about-us/budget/budget. The rate increases do not apply to nurses employed by a community behavioral health agency; for information on those rate increases refer to the December 1, Medicaid BH Bulletin.
If you also supply these services through a contract with one of our managed care entities, please contact the plan with questions about how these rate changes may affect your contracted rate. Managed care entity provider hotlines are available here: https://medicaid.ohio.gov/resources-for-providers/managed-care/provider-mcp-resources.
For additional questions, providers can contact the ODM Integrated Helpdesk (IHD) at 800-686-1516 or IHD@medicaid.ohio.gov. Representatives are available 8 a.m.-4:30 p.m. Eastern time Monday - Friday.
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