Ohio - Environmental Accessibility Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Environmental Accessibility Adaptations (EAA) in Ohio are licensed and certified primarily through the Ohio Department of Developmental Disabilities (DODD) under OAC 5123-9-23 and the Ohio Department of Aging (ODA) for waivers like PASSPORT and Ohio Home Care. Providers must enroll through the Ohio Medicaid Enterprise System's Provider Network Management (PNM) module.

Approval requires an active registration with the Ohio Secretary of State, compliance with local building codes, and the ability to submit itemized bids to county Service and Support Administrators (SSAs) or PASSPORT Administrative Agencies (PAAs). Providers must pass BCI/FBI background checks and pay a $688 Medicaid application fee to secure an active Medicaid provider number before bidding on authorized home modification projects.

1. Service Definition and Scope

Under Ohio Administrative Code 5123-9-23, Environmental Accessibility Adaptations are physical modifications to an individual's home necessary to ensure health, welfare, and safety, or to enable greater independence. These include ramps, grab-bars, widened doorways, and specialized electrical systems for medical equipment.

The service explicitly excludes modifications that add square footage, general utility upgrades like central air conditioning or roof repair, and modifications to residential facilities. All work must comply with state and local building codes and be identified in the individual service plan (ISP).

• Included Modifications: Ramps, roll-in showers, grab-bars, and doorway widening.
• Excluded Modifications: General utility improvements, square footage additions, and new home construction.
• Regulatory Standard: Must meet all applicable state and local building codes.
• Assessment Requirement: Must be determined necessary by the individual's team and documented in the ISP.

2. Regulatory and Oversight Agencies

Oversight is divided based on the waiver program funding the service. The Ohio Department of Developmental Disabilities (DODD) oversees EAA for the Individual Options, Level One, and SELF waivers, while the Ohio Department of Aging (ODA) and Ohio Department of Medicaid (ODM) oversee PASSPORT and the Ohio Home Care Waiver.

All provider enrollment applications are routed through the Provider Network Management (PNM) module, which interfaces with the respective state agencies for final certification.

• Ohio Department of Developmental Disabilities (DODD): Certifies providers for DD waivers (https://dodd.ohio.gov).
• Ohio Department of Aging (ODA): Certifies providers for PASSPORT and Assisted Living waivers (https://aging.ohio.gov).
• Ohio Department of Medicaid (ODM): Manages the overarching Medicaid program and Ohio Home Care Waiver (https://medicaid.ohio.gov).
• Provider Network Management (PNM): The central portal for all Ohio Medicaid provider enrollment (https://ohpnm.omes.maximus.com).

3. Gatekeeping Prerequisites: Who Can Even Apply

Ohio does not restrict EAA provider enrollment through a Certificate of Need, closed network, or competitive RFP process. Any qualified contractor or agency that meets the baseline business and background check requirements can apply for certification.

However, providers must be registered businesses in good standing with the Ohio Secretary of State and must possess the necessary local contractor licenses or trade certifications required by the municipalities where they operate. There is no mandatory affiliation with a designated network entity prior to application.

• Business Registration: Must hold an active registration certificate with the Ohio Secretary of State.
• Trade Licensure: Must hold applicable local contractor licenses or permits required by city or county building departments.
• Network Affiliation: None required; Ohio operates an open enrollment model for EAA providers.
• Need-Review Approvals: None required; no Certificate of Need applies to this service.

4. Licensure and Certification Requirements

Ohio does not issue a distinct EAA License. Instead, providers obtain Medicaid Certification for Environmental Accessibility Adaptations through DODD or ODA. Certification requires demonstrating compliance with OAC 5123-9-23 and submitting proof of business legitimacy.

Applicants must submit a W-9, proof of liability insurance, and sign a Non-Disclosure Statement. For ODA certification, providers must also submit the HCBS Settings Requirement Form to verify compliance with federal community-based setting rules.

• Certification Authority: DODD or ODA, depending on the target waiver population.
• Rule Citation: OAC 5123-9-23 for DODD EAA provider qualifications.
• Insurance: Proof of commercial general liability insurance is required.
• HCBS Settings Form: Required by ODA to ensure the provider complies with federal community integration rules.

5. Medicaid Provider Enrollment

All prospective EAA providers must apply through the Provider Network Management (PNM) module. The system requires an OH|ID for access and routes the application to the appropriate certifying agency (DODD or ODA) based on the selected provider type and specialties.

Agency applicants must pay a Medicaid application fee of $688, per OAC 5160-1-17.8, unless they have paid the fee to Medicare or another state's Medicaid program within the past two years.

• Enrollment Portal: Provider Network Management (PNM) module.
• Access Credential: OH|ID is required to log into the PNM system.
• Application Fee: $688 non-refundable fee for agency applicants.
• Fee Exemption: Waived if paid to Medicare or another state Medicaid program within the last two years (proof required).

6. Staffing, Training and Background Checks

EAA providers are typically general contractors, plumbers, or electricians. While they do not need clinical credentials, any staff or owners interacting with waiver participants must pass stringent background checks.

Owners must obtain a criminal record check from the Ohio Bureau of Criminal Identification and Investigation (BCI). If the applicant has lived outside Ohio in the past five years, an FBI background check is also mandatory.

• BCI Check: Required for each owner at the time of application, sent directly to ODA or DODD.
• FBI Check: Required if the applicant lived outside Ohio anytime in the past five years.
• Staff Qualifications: Must hold appropriate trade licenses (e.g., plumbing, electrical) if performing specialized work.
• Training: Must complete initial provider certification orientation and annual training as mandated by DODD or ODA.

7. Documentation, Policies and Records

Providers must maintain detailed service documentation to validate payment. Under OAC 5123-9-23, this includes the type, date, and place of service, the individual's Medicaid ID, and a description of the delivered services matching the ISP.

Before work begins, providers must submit itemized quotes detailing demolition, permit fees, materials (brand name and item number), and labor costs. All building permits and final inspection reports must be retained in the provider's records.

• Itemized Quotes: Must break down materials, labor, permit fees, and cleanup costs.
• Service Documentation: Must record date, place, Medicaid ID, and specific services delivered.
• Permits: Copies of all local building permits and final inspection approvals must be kept on file.
• Residency Proof: ODA requires documentation like a valid driver's license or tax form to prove Ohio residency for the past five years.

8. Billing, Rates and Claims

EAA is not billed at a standard hourly rate; it is reimbursed based on the approved bid amount authorized in the individual's service plan. The Service and Support Administrator (SSA) or PASSPORT care manager must secure at least two bids from certified providers whenever possible.

Claims are submitted through the PNM/OMES system after the work is completed and inspected. For individuals transitioning from an institution, the service cannot be billed until the date the individual leaves the facility and enrolls in the waiver.

• Reimbursement Model: Paid based on the specific, itemized bid approved by the state or case management agency.
• Bid Requirement: SSAs typically require at least two competing bids from certified providers.
• Billing Trigger: Work must be fully completed and pass local inspection before claims are submitted.
• Institutional Transitions: Billing is delayed until the individual officially discharges from the institution and enrolls in the waiver.

9. Approval Sequence and Timeline

The process begins with registering the business with the Ohio Secretary of State and obtaining an OH|ID. The provider then submits the application and $688 fee through the PNM module, uploading all required background checks and business documents.

The certifying agency (DODD or ODA) reviews the application. If approved, the provider receives a Medicaid provider number and is added to the directory, allowing SSAs and PAAs to request bids for home modification projects. The entire enrollment process typically takes 60 to 90 days.

• Step 1: Register business with the Ohio Secretary of State and obtain an OH|ID.
• Step 2: Complete BCI/FBI background checks using approved reason codes.
• Step 3: Submit application, documentation, and $688 fee via the PNM module.
• Step 4: Receive DODD/ODA certification and Medicaid provider number to begin bidding.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to missing background checks or failure to use the exact approved reason codes for BCI/FBI fingerprinting. Another common barrier is failing to upload the required HCBS Settings Requirement Form or proof of the $688 fee payment.

During audits or post-payment reviews, providers are often cited for failing to obtain necessary local building permits or for billing before the project is fully completed and inspected. Discrepancies between the approved itemized bid and the final billed amount also trigger recoupments.

• Background Check Errors: Using incorrect reason codes for BCI/FBI checks causes automatic application rejection.
• Missing Documentation: Failure to upload the Ohio Secretary of State certificate or W-9 in the PNM.
• Permit Violations: Completing structural modifications without required local building permits.
• Premature Billing: Submitting claims before the individual transitions out of an institutional setting.

11. Key Contacts and Resources

Prospective providers should utilize the Ohio Medicaid Enterprise System and the specific certifying agency's website for the most current rules, forms, and portal access. The Integrated Help Desk is the primary contact for PNM technical issues.

Local PASSPORT Administrative Agencies (PAAs) and County Boards of Developmental Disabilities are the primary sources for project referrals and bid requests once certified.

• Provider Network Management (PNM) Module: https://ohpnm.omes.maximus.com
• Ohio Department of Developmental Disabilities (DODD): https://dodd.ohio.gov
• Ohio Department of Aging (ODA): https://aging.ohio.gov
• ODM Integrated Help Desk: [email protected] or 800-686-1516 for PNM support.

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