Ohio - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Ohio Department of Aging (ODA) and the Ohio Department of Developmental Disabilities (DODD) certify providers for non-medical supervision and socialization under the PASSPORT, Individual Options, and Level One waivers, where these supports are typically billed as Personal Care or Homemaker/Personal Care (HPC) rather than a standalone Adult Companion service. Applicants must initiate all certification requests through the Ohio Medicaid Enterprise System (OMES) Provider Network Management (PNM) module using an active OH|ID.

Before an application is approved, agency and independent providers must undergo a pre-certification review conducted by the regional PASSPORT Administrative Agency (PAA) or the local County Board of Developmental Disabilities. Providers must also enroll in the Ohio Attorney General's Retained Applicant Fingerprint Database (Rapback) and implement the state's Electronic Visit Verification (EVV) system for in-home services.

1. Service Definition and Scope

Ohio does not currently maintain a distinct, standalone Medicaid waiver service titled "Adult Companion Services." Instead, non-medical supervision, socialization, and assistance that allow an adult to remain safely in the community are authorized and billed under Homemaker/Personal Care (HPC) in DODD waivers or Personal Care in ODA's PASSPORT waiver.

These services encompass supervision for health and safety, assistance with activities of daily living (ADLs), and socialization. They are delivered in the individual's home or community and must be explicitly detailed in the person-centered Individual Service Plan (ISP).

• Service Consolidation: Ohio absorbs companion-type supervision into Homemaker/Personal Care (HPC) or Personal Care service definitions.
• Target Population: Adults enrolled in the PASSPORT, Ohio Home Care, Individual Options, or Level One waivers.
• Delivery Setting: The individual's private residence or community settings, subject to HCBS settings rules (OAC 5160-44-01).
• Excluded Activities: Skilled nursing, medication administration (unless delegated), and services provided while the individual is hospitalized.
• Authorization: Services must be prior-authorized by the waiver case manager and listed in the ISP.

2. Regulatory and Oversight Agencies

Multiple state agencies collaborate to oversee HCBS providers in Ohio. The Ohio Department of Medicaid (ODM) holds the ultimate authority for the Medicaid program and manages the centralized enrollment portal.

Day-to-day certification and compliance are delegated to the Ohio Department of Aging (ODA) for older adults and the Department of Developmental Disabilities (DODD) for individuals with intellectual disabilities.

• Ohio Department of Medicaid (ODM): Administers the Medicaid program and the PNM module (https://medicaid.ohio.gov).
• Ohio Department of Aging (ODA): Certifies PASSPORT waiver providers (https://aging.ohio.gov).
• Ohio Department of Developmental Disabilities (DODD): Certifies HPC providers for IO and Level One waivers (https://dodd.ohio.gov).
• PASSPORT Administrative Agencies (PAAs): Regional entities that conduct ODA pre-certification reviews and manage local provider networks (https://aging.ohio.gov/find-services).
• County Boards of Developmental Disabilities: Conduct local oversight and ISP development for DODD waivers (https://dodd.ohio.gov/about-us/our-programs/county-boards).

3. Gatekeeping Prerequisites: Who Can Even Apply

Ohio requires all prospective Medicaid HCBS providers to establish a digital identity and clear preliminary background checks before submitting a formal application. Providers must create an OH|ID through the state's InnovateOhio Platform.

While Ohio does not use a Certificate of Need for HCBS companion/personal care, ODA explicitly requires applicants to consult with their local PASSPORT Administrative Agency (PAA) regarding geographic saturation levels, as certification does not guarantee client referrals.

• Digital Identity: Applicants must establish an OH|ID username and password to access the PNM module.
• Market Saturation Review: ODA requires providers to work with the local PAA to assess demand; PAAs may restrict new network additions if the area is oversaturated.
• Business Registration: Agency applicants must hold an active registration as a business entity with the Ohio Secretary of State.
• NPI Requirement: Applicants must obtain a National Provider Identifier (NPI) prior to enrollment.
• Rapback Enrollment: Providers must consent to and enroll in the Ohio Attorney General's Retained Applicant Fingerprint Database (Rapback).

4. Licensure and Certification Requirements

Non-medical personal care and companion-type services do not require a home health agency license from the Ohio Department of Health. Instead, they require HCBS Provider Certification from either ODA (under OAC 173-39-02) or DODD (under OAC 5123-2-09).

Certification requires demonstrating compliance with structural standards, including maintaining a physical business site (for agencies), establishing a table of organization, and passing a pre-certification structural review.

• Governing Rule (ODA): OAC 173-39-02 establishes the certification requirements for PASSPORT providers.
• Governing Rule (DODD): OAC 5123-2-09 establishes the certification requirements for DODD independent and agency providers.
• Application Fee: Agency applicants must pay a non-refundable Medicaid application fee (unless waived by Medicare/Medicaid enrollment elsewhere).
• Business Site: Agency providers must maintain a physical business site in Ohio from which to conduct operations.
• Pre-Certification Review: The PAA or DODD conducts an on-site or desk review within 45 days of a complete application.

5. Medicaid Provider Enrollment

All Medicaid provider enrollment in Ohio is centralized through the Provider Network Management (PNM) module. This system replaced the legacy MITS portal for enrollment and certification actions.

Once ODA or DODD approves the certification application within the PNM, ODM issues the final Medicaid Provider Agreement and assigns a Medicaid provider number.

• Enrollment Portal: Provider Network Management (PNM) module (https://ohpnm.omes.maximus.com).
• Provider Type: Enrolled as an HCBS Waiver Provider (specific specialty codes depend on ODA vs. DODD).
• Revalidation: Providers must revalidate their Medicaid enrollment every 3 to 5 years through the PNM.
• Managed Care Contracting: Providers serving MyCare Ohio members must separately contract with the regional MyCare managed care plans (e.g., Aetna, CareSource).
• Hold and Review: ODM subjects new providers to a hold and review process for initial claims under OAC 5160-1-27.2.

6. Staffing, Training and Background Checks

Direct care staff providing supervision and personal care must meet strict background and training standards before delivering services. Ohio law mandates both initial criminal records checks and continuous monitoring.

Staff must complete required training on the individual's specific needs, major unusual incidents (MUIs), and basic health and safety protocols.

• Criminal Background Check: Bureau of Criminal Identification and Investigation (BCII) check required for all direct care staff (OAC 173-9).
• Continuous Monitoring: Mandatory enrollment in the Rapback system for ongoing criminal record alerts.
• First Aid/CPR: Direct care workers must hold valid, in-person or hybrid First Aid and CPR certification.
• Annual Training: Staff must complete at least 8 hours of in-service or continuing education each calendar year.
• Exclusion Checks: Agencies must verify staff are not on the OIG List of Excluded Individuals/Entities (LEIE) or the Ohio Medicaid exclusion list.

7. Documentation, Policies and Records

Providers must maintain comprehensive administrative and client records. Ohio strictly enforces the use of Electronic Visit Verification (EVV) for all personal care and companion-type services delivered in the home.

Agencies must develop written policies covering incident reporting, grievance procedures, and compliance with HCBS settings rules.

• EVV Mandate: Providers must use the ODM-approved EVV system (Sandata) to record the start and end times of in-home visits (OAC 5160-32).
• Service Documentation: Records must align with the authorized Individual Service Plan (ISP) and include the date, time, and specific tasks performed.
• Incident Reporting: Mandatory reporting of Major Unusual Incidents (MUIs) or Adult Protective Services (APS) referrals for suspected abuse/neglect.
• Policy Requirements: Agencies must submit written policies on non-discrimination, HIPAA compliance, and worker's compensation during certification.
• Record Retention: All service and billing records must be retained for a minimum of six years.

8. Billing, Rates and Claims

Claims for HCBS waiver services are submitted through the Ohio Medicaid Enterprise System (OMES) or directly to the MyCare Ohio managed care plan, depending on the client's enrollment.

Rates for Personal Care and HPC are established by ODM and published in the provider fee schedules. Services are typically billed in 15-minute increments.

• Billing System: Claims are submitted via the OMES portal or through an approved clearinghouse.
• Billing Units: Services are generally billed in 15-minute units using specific HCPCS codes (e.g., T1019 for personal care).
• Rate Setting: Statewide fee schedules are published by ODM and DODD; providers cannot bill clients for the difference between the Medicaid rate and private rates.
• EVV Claims Matching: Claims submitted without matching EVV data will be denied by the OMES system.
• MyCare Ohio: Claims for dual-eligible individuals in MyCare regions must be routed to the specific managed care plan.

9. Approval Sequence and Timeline

The certification process involves multiple sequential steps across different state systems. Delays often occur if background checks are incomplete or if the applicant fails to respond to requests for additional information.

From initial PNM submission to final Medicaid provider agreement issuance, the process typically takes 60 to 90 days.

• Step 1: Create OH|ID and register business with the Secretary of State.
• Step 2: Submit the certification application and upload policies via the PNM module.
• Step 3: PAA or DODD conducts a desk review and schedules the pre-certification structural review (within 45 days).
• Step 4: Applicant corrects any deficiencies identified during the structural review (usually given 30 days).
• Step 5: ODA/DODD approves certification and ODM issues the Medicaid Provider Agreement.

10. Common Denials and Survey Findings

Applications are frequently denied or delayed due to administrative errors, such as failing to upload required policy documents or incomplete background checks.

During annual structural compliance reviews, providers are commonly cited for failing to maintain EVV compliance or lapsing in required staff training.

• Application Abandonment: Denials issued when applicants fail to submit requested missing components within 30 calendar days.
• Background Check Failures: Disqualifying offenses on BCII checks or failure to enroll in Rapback.
• EVV Non-Compliance: Post-certification citations for billing claims without corresponding EVV visit data.
• Training Lapses: Failure to maintain current CPR/First Aid certifications or complete the annual 8-hour continuing education requirement.
• Policy Deficiencies: Submitted policies do not meet the specific requirements of OAC 173-39-02 or OAC 5123-2-09.

11. Key Contacts and Resources

Providers must utilize official state portals and regional agency contacts to navigate the enrollment and compliance processes.

Help desks are available for the PNM module, EVV system, and specific waiver programs.

• PNM Portal: Ohio Medicaid Enterprise System Provider Network Management (https://ohpnm.omes.maximus.com).
• ODA Provider Certification: Ohio Department of Aging certification resources (https://aging.ohio.gov/wps/portal/gov/aging/agencies-and-service-providers/certification).
• DODD Provider Portal: Department of Developmental Disabilities provider resources (https://dodd.ohio.gov/providers).
• EVV Support: Sandata EVV help desk and ODM EVV resources (https://medicaid.ohio.gov/initiatives/mcd-initiatives/evv).
• PAA Directory: Local PASSPORT Administrative Agency contact list (https://aging.ohio.gov/find-services).

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