This rule sets forth the Ohio department of medicaid (ODM) payment for hospice services and care.
The service intensity add-on (SIA) payment shall be billed using code G0299 for the direct care provided in an in-person visit completed by an RN. The SIA payment shall be billed using code G0155 for the direct care provided during an in-person visit completed by a social worker.
The reimbursement rate for the SIA payment shall be equal to the continuous home care hourly rate converted into fifteen minute increments, up to a maximum of four hours (sixteen units) combined total per day for RN and social worker visits. Visits solely for the pronouncement of death shall not be counted for the service intensity addon payment.
The physician may be an employee of the hospice, a practitioner under contractual arrangement with the hospice, or an attending practitioner who is not an employee of the hospice but is an eligible medicaid provider. Separate payment cannot be made, however, for the following services:
Ohio Admin. Code 5160-56-06
Five Year Review (FYR) Dates: 10/1/2022
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.03
Prior Effective Dates: 05/01/1990, 05/15/1990, 05/16/1990, 12/01/1991, 04/01/1994, 09/26/2002, 01/01/2004, 04/01/2005, 03/02/2008, 02/01/2011, 04/01/2015, 10/01/2017, 06/12/2020