Independent Providers of Long-Term Services
Welcome to our Waiver Provider website page. As those servicing some of our most vulnerable Ohioan’s, Buckeye is committed to engaging in meaningful and effective ways to strengthen our partnership in service to these individuals. This page aims to present news, updates and specialty content that is unique and impactful to you. Be sure to bookmark this page to ensure easy future access.
Click on the link below to view our May 29, 2024, Waiver Provider Townhall. (video may begin as soon as the web page opens - if needed, scroll video back to hear from the beginning.
Coming Soon....NextGen MyCare Townhall & FAQs.
Assisted Living Memory Care
On January 2, 2024 changes were made to the tier structure in Assisted Living Waiver billing, including the addition for Assisted Living Facilities to become "certified" for memory care.
Prior billing included 3 level Tiers for rate reimbursement based upon the members needed care. Tier 1 (also U1) was the least amount of needed care and the lowest reimbursement. Level 2 (U2) and Level 3 (U3) could be used for higher care levels for members.
With the new changes that occurred January 2, 2024, there are now only 2 levels of care for billing/reimbursement. Tier 1 (U1) and Tier 3 (U3).
Tier 3 can only be used for Assisted Living facilities that have applied for Memory Care through ODA and have been approved. This certification is also to be listed on the facilities website.
Facilities which are approved for certified Memory Care through ODA, by meeting the requirements in the OAC, have the option to bill U1 or U3.
The additional requirement to be able to bill U3, requires the member to have a dementia diagnosis (or diagnosis under the dementia umbrella). The dementia diagnosis should be listed on the claim when facilities are billing under a U3.
Facilities that have not gone through certification and approval through ODA, are only able to bill U1. Tier 2 (U2) is no longer an option.
If you need additional information on submitting claims or reason for claims denial, Buckeye's Provider Services can be reached at 866-296-8731.
Buckeye Health Plan is excited to present our new provider publication Waiver Provider News (WPN). Each issue will be hot off the press information with the latest and current items you need to know. While the articles and information on this website page may change over time, the content in the newsletter will remain in this archive for future reference. We look forward to growing the WPN, and this website page, through your valuable review and input, ensuring they provide you value as a resource. .
Ohio Department of Medicaid has created ‘The PCG Match Portal’ for use by members, independent providers, HH agency providers, and case managers.
Who can use the PCG Match?
- Individuals receiving Ohio Home Care or MyCare Ohio Waiver Services and/or Medicaid State Plan Services.
- Independent Providers who are personal care aids, home care attendants, or nurses.
- Medicare-certified or otherwise accredited home health agency providers.
- Case managers supporting individuals on the Ohio Home Care or MyCare Ohio Waivers.
Ohio Department of Medicaid has created ‘The PCG Match Portal’ for use by members, independent providers, HH agency providers, and case managers.
Who can use the PCG Match?
- Individuals receiving Ohio Home Care or MyCare Ohio Waiver Services and/or Medicaid State Plan Services.
- Independent Providers who are personal care aids, home care attendants, or nurses.
- Medicare-certified or otherwise accredited home health agency providers.
- Case managers supporting individuals on the Ohio Home Care or MyCare Ohio Waivers.
Adult Day Service Transportation
- Guidance for Adult Day Service Transportation can be found in two places in the Ohio Administrative Code.
- 173-39-02.1 ODA provider certification: adult day service which allows providers to bill for transportation separately from the bundled ADS rate.
- 5160-46-04 Ohio home care waiver: definition of the covered services and provider requirements and specifications which does not allow for transportation to be billed separately and states that transportation is included in the bundled payments received for ADS.
- Beginning April 1st, 2024 Buckeye will follow the guidance for ADS transportation outlined in OAC rule 173-39-02.1 which allows ADS providers to bill separately for ADS transportation.
- A provider may transport each individual to and from the center and be reimbursed according to OAC rule 5160-1-06.1, Adult Day Transportation Round Trip.
- If a provider choses to render ADS transportation to a Waiver member, this service must be added to the member’s service plan by the member’s Case Manager or Waiver Service Coordinator and be authorized by Waiver Utilization Management prior to delivery of service.
- The provider will receive a separate authorization for ADS transportation.
Ohio Department of Medicaid has created ‘The PCG Match Portal’ for use by members, independent providers, HH agency providers, and case managers.
Who can use the PCG Match?
- Individuals receiving Ohio Home Care or MyCare Ohio Waiver Services and/or Medicaid State Plan Services.
- Independent Providers who are personal care aids, home care attendants, or nurses.
- Medicare-certified or otherwise accredited home health agency providers.
- Case managers supporting individuals on the Ohio Home Care or MyCare Ohio Waivers.
Ohio Department of Medicaid has created ‘The PCG Match Portal’ for use by members, independent providers, HH agency providers, and case managers.
Who can use the PCG Match?
- Individuals receiving Ohio Home Care or MyCare Ohio Waiver Services and/or Medicaid State Plan Services.
- Independent Providers who are personal care aids, home care attendants, or nurses.
- Medicare-certified or otherwise accredited home health agency providers.
- Case managers supporting individuals on the Ohio Home Care or MyCare Ohio Waivers.