You are a New or Current Provider
You and the Ohiohcp
Daily Keys to Provider Success
Success in the Ohiohcp is important because your work impacts so many consumers that are dependent on your help.
To be successful, you will:
1. Commit yourself to excellence, both professionally and personally.
2. Communicate effectively with consumers, the case manager and others.
3. Comply with personal care service instructions and show ability to perform skills requested by consumers or the case manager.
4. Be the provider on the consumer’s approved “All Services Plan.” The “All Service Plan” (ASP) is a document that defines the services you are to provide, the estimated amount of money those services should cost, the goal of the services and the other individuals and/or agencies that contribute to the health and safety of the consumer. You can find more instructions regarding the ASP at www.ohiohcp.org.
5. Comply with all monitoring requirements ordered by the program.
6. Keep and maintain copies of consumer’s current “All Services Plan” and keep copies of old ones.
7. Keep up to date with your continuing education requirement, and never stop learning to improve your skills.
8. Maintain a clinical record at each consumer’s residence AND keep a copy at their place of business or home (the information that the record must include is in OAC 5101:3-46-04, 5101:3-47-04 and 5101:3-50-04).
Your Ohiohcp "Top10" List
These are the 10 key points that you must understand as a provider in the Ohiohpc:
1. You are responsible for knowing and understanding the rules.
2. You are self-employed. You do not work for The Ohio Home Care Program, CareStar or the State of Ohio.
3. You must have prior approval on consumer’s “All Services Plan” (ASP). This is mandatory before you provide any service or submit any billing for service.
4. You are responsible for your billing. Please follow the ASP and assure that your billing is accurate and that it reflects the actual face-to-face services you have provided to a waiver consumer.
5. You must complete and submit a new “Bureau of Criminal Identification and Investigation” (BCII) background check every year.
6. You must have an annual face-to-face review with a Provider Monitor from the Ohiohcp. This is called a “Structural Review” and it is a requirement of the rules.
7. You are required to keep your contact information current. If you have a change of name, address, phone number or e-mail please notify Ohiohcp and CareStar. It is your responsibility to keep the State updated with such information.
8. You are responsible for paying all your earnings taxes. As a self-employed provider you must report your income earned in the Ohiohcp.
9. You must respond to requests from program officials. If you are contacted by personnel of the Ohiohcp or Ohio Department of Job and Family Services, you must respond in a timely manner. This includes telephone calls, e-mails, letters and face-to-face meetings.
10. You are very important to the success of the Home and Community Waiver Programs. Thousands of Ohio Citizens could not safely stay in their own homes without providers like you!
Working with the State
1. The State issues your Provider Number with a date that marks the day your number became effective. You MAY NOT bill the State for services provided prior to the effective date of your Provider Number. You may only bill for services provided after your effective date if those services have been authorized by the Case Manager and approved on the consumer’s “All Services Plan.”
2. Always have an “All Services Plan” before you provide/bill any Medicaid services.
3. Make sure that the consumer signs your time-slip upon completion of your visit. This acts as proof that the service was provided and it is necessary for Medicaid billing.
4. Remember that you are personally responsible for your Medicaid billing. If it is not accurate, you (not your billing agent) will be held accountable for repayment. Review your “Medicaid Remittance Advice” and understand what you are being paid for. If you don’t understand, call Provider Assistance or the Ohiohcp for clarification. Receiving more money than you should is considered “Medicaid Fraud.” This can be very serious!
Working with the Case Manager
1. Contact the Ohiohcp Case Manager if you have any concerns about a consumer or your responsibilities.
2. Only provide the services that are specified on the “All Services Plan.” If the consumer requests additional services or additional hours, contact the Case Manager.
3. Provide the Case Manager with necessary documentation regarding the completion of your BCII criminal background check.
4. Provide documentation that clearly shows the date of service delivery, personal care tasks performed or not performed, arrival and departure times and signatures of Non-Agency Providers and the consumer (or authorized representative).
5. The “progress notes” are signed and dated by the Non-Agency Provider. All communication with the Case Manager, treating physician and all members of the multidisciplinary team, and any unusual events during a visit must be documented clearly.
6. The “progress note” must contain the general condition of the consumer.
7. The Non-Agency Provider must develop a signed and dated “discharge summary” when services are no longer needed by the consumer.
8. Make records available to ODJFS or the Ohiohcp case manager upon request.
9. Do not begin service delivery until you receive Case Manager Approval and a copy of the “All Services Plan.” Provide services only as specified on the “All Services Plan.” Contact the Case Manager for approval before initiating any changes in the “All Services Plan.”
10. Adhere to the “consumer bill of rights” as presented by the Case Manager.
11. Report any violation of consumer rights to Case Manager and other appropriate agencies (e.g., Children’s Services) as soon as it is observed or witnessed.
12. Submit time sheets for the consumer to sign prior to submitting bills to ODJFS.
13. All Non-Agency Providers must assist the consumer in developing a back-up plan and activating back-up staffing for any and all canceled shifts.
14. All Non-Agency Providers must maintain a clinical record for each consumer. It should be stored in a manner that protects the confidentiality of the record. Non-Agency Providers must maintain the clinical records at their place of business, and maintain a copy in the consumer's residence. For the purposes of this rule, the place of business must be a location other than the consumer's residence. These records must be made available to ODJFS or the Case Manager upon request.
Working with the Program Management
1. If you have a change of name, address, phone number or e-mail please notify Provider Network Management and CareStar. It is your responsibility to keep the State updated with such information.
2. Make sure that you are available to attend provider training sessions. You need to understand the rules, proper billing procedures and your responsibilities.
3. ODJFS will send you notification and instruction by mail when it is time to have your annual BCII done. Failure to submit your annual BCII in the time allotted will result in your removal from any and all “All Service Plans,” and possibly the termination of your Provider Number. Please keep your contact information updated so you can be notified.
4. As a Non-Agency Provider, you will be required to participate in a “Structural Review” every year. This is due to the Ohio Revised Code 5101:3-12-30, which states that provider services have to be monitored on a regular basis. The purpose of the “Structural Review” visit is to review provider compliance with the Rules of the Ohiohcp. In accordance with this rule, the “Provider Management Services” division of Care Star, Inc. conducts site visits with every provider every year. Your participation in this review process is a requirement to continue in the program. Failure to comply may result in the suspension or termination of your Medicaid Provider agreement as outlined in Ohio Administrative Code 5101:3-1-17.6.
You will receive a letter from CareStar informing you of your Structural Review date and time. Be prepared to bring the following documents to your review:
1. All documentation for each specified consumer.
2. All Remittance Advice, Billing Records and Time Sheets as specified.
3. All of the “All Service Plans” for each specified consumer.
4. An Affidavit of Notarized Tax Payment for Federal, State and Local taxes.
5. Any other documentation that is related the review process.
6. A photo ID.
Working with the Incident Management, Investigation, & Response System (IMIRS)
Incident Management, Investigation, & Response System (IMIRS) is a team that investigates and reviews reported allegations that a provider is jeopardizing the health and safety of a consumer.
You and the Consumer
It's Up to You!
Your business is based on your relationship with the consumer. This means you can directly reap the benefits of good service, as it will increase your own reputation and value, not to mention your bank account. On the other hand, you can ruin your own business as a provider with unsatisfactory, irresponsible, unknowledgeable or unreliable service. It’s up to YOU!
Finding a New Consumer
Every day Case Managers throughout the state post listings of consumers in need of care and services. Click the Requests for Service/Help Needed link and pick the county in which you want a new case.
Securing a New Consumer
Because each consumer’s needs may be different, consider these issues for each one:
1. Be prepared for an interview with the consumer. Have a copy of your certifications, training, in-service, current background check and anything else that would help verify your qualifications.
2. Contact individuals and gain their permission before you identify them as a reference. Have complete names, addresses and phone numbers so that they are able to be contacted easily.
3. Do not be surprised or offended when a consumer asks to see evidence of your successful criminal background check. He or she is acting responsibly, and CareStar has encouraged all consumers to review background checks, references, etc.
4. Only agree to provide services that you are sure you can provide. Consider the hours, location and skills necessary before you agree to provider services for a consumer.
5. If you have been employed by an agency, you may have some type of “employee agreement” to consider. Some agencies have “non-compete clauses” or other forms of a contract that may limit which consumers you may serve. Find out about such limitations before you agree to provide services for a consumer.
Working with Your New Consumer
1. Keep your relationship with the consumer professional. Avoid becoming involved in the consumer’s personal and private issues and do not involve the consumer in such issues from your life. Do not borrow or lend money or property.
2. Be open and willing to receive additional training. A consumer may request that you attend CPR training, MR/DD workshops or classes in Behavior Modification. Such training will help you to serve them and others. Although Medicaid does not require that you have this training to become a Non-Agency Provider, a consumer or guardian may decide not to use your services without it.
3. If you transport the consumer, remember to obey all rules. You must be properly licensed and the vehicle must be insured. If your vehicle is unsafe or unreliable, do not agree to provide services that include transportation.
4. Do not share any consumer information with anyone that is not identified as a team member on the “All Services Plan.” This includes other Non-Agency Providers and consumers. Information that you gain about specific consumers while working as a Non-Agency Provider must be kept confidential.
5. Keep any documentation regarding consumers in a safe and secure place. Do not leave it unattended or unprotected in your car or around your house. It is very important that you be respectful of the consumer’s right to privacy.
6. Read the Ohiohcp rules! When you sign the Medicaid Provider Agreement, you are agreeing to follow these rules. Make sure that you understand your responsibilities.
Continuing Education and Training
Education is a key component to ensuring success in the Ohio Home Care program. As a provider, you must stay certified to remain active in the program. Below are links to current education offerings.
Authorized Training Schools- Classroom
Resources for Success
For more information on starting your business, visit:
The 1st Stop Business Connection - State of Ohio
A program sponsored by the Ohio Department of Development's Small Business Development Centers and the U.S. Small Business Administration. It provides FREE state-level information needed to get started or continue on your independent journey.
The Small Business Administration -(SBA) U.S. Government
The SBA provides small business counseling and training through a variety of programs and resource partners located strategically around the country.
The SCORE Association (Service Corps of Retired Executives) is a resource partner of the SBA. It is dedicated to entrepreneur education and the formation, growth and success of small businesses nationwide. There are more than 10,500 SCORE volunteers in 389 chapter locations that assist small businesses with business counseling and training. SCORE also operates an active online counseling initiative.
Small Business Development Centers (SBDC)
This training resource is a cooperative effort of the private sector, the educational community and federal, state and local governments. It is SBA's largest resource partner and an initiative that enhances economic development by providing small businesses with management and technical assistance. There are more than 1,100 SBDC lead and service centers located around the country.
Women's Business Centers (WBC)
Women's Business Centers represent a national network of more than 80 educational centers designed to assist women to start and grow small businesses. WBCs operate with the mission to level the playing field for women entrepreneurs, who still face unique obstacles in the world of business.
You are Ready for Success!
You have completed the last 3 steps to becoming a successful provider! CareStar and the Ohio Health Program wish you the best of luck with your business. If you have any questions left unanswered, or if you would like to leave any positive/negative feedback about the Ohiohcp, you can contact us here. Congratulations for taking the steps towards "Provider Success." You and your consumers will benefit from your hard work!
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