Ohio - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Ohio, Home Health Services are licensed by the Ohio Department of Health (ODH) and enrolled for Medicaid reimbursement through the Ohio Department of Medicaid (ODM) Provider Network Management (PNM) module. The service provides intermittent skilled nursing, home health aide services, and skilled therapies to individuals in their homes, often requiring Medicare certification as a prerequisite for Medicaid enrollment.

The most significant structural precondition for providing skilled home health services in Ohio is that an agency must either be Medicare-certified, accredited by a CMS-approved national accreditation organization (such as ACHC, CHAP, or The Joint Commission), certified by the Ohio Department of Aging (ODA), or otherwise meet Medicare conditions of participation. Additionally, new applicants who were not providing direct care prior to September 30, 2021, must secure a $50,000 surety bond for a skilled license.

1. Service Definition and Scope

Ohio Administrative Code (OAC) 5160-12-01 defines "Home health services" as including home health nursing, home health aide services, and skilled therapies provided on a part-time or intermittent basis. Services must be ordered by a qualifying treating physician who documents a face-to-face encounter with the individual within 90 days prior to or 30 days following the start of care.

Intermittent care is defined as no more than a combined total of eight hours per day of home health nursing, home health aide, and skilled therapies, or up to 14 hours per week. Exceptions exist for post-hospital stays, allowing up to 28 hours per week for 60 days if the individual meets comparable level of care requirements.

• Service Components: Home health nursing, home health aide services, and skilled therapies.
• Intermittent Limit: Maximum of 8 hours per day or 14 hours per week combined.
• Post-Hospital Exception: Up to 28 hours per week for 60 days following an inpatient stay of 3 or more days.
• Physician Requirement: Must be ordered by a treating physician with a documented face-to-face encounter.
• Plan of Care: Services must be specified in a physician-signed plan of care or an approved person-centered services plan for waiver enrollees.

2. Regulatory and Oversight Agencies

The Ohio Department of Health (ODH) is the primary regulatory body responsible for licensing Home Health Agencies and recommending Medicare certification to the Centers for Medicare and Medicaid Services (CMS).

The Ohio Department of Medicaid (ODM) administers the Medicaid program, handles provider enrollment through the Provider Network Management (PNM) module, and establishes coverage and reimbursement rules.

• Licensing Agency: Ohio Department of Health (ODH) (https://odh.ohio.gov/know-our-programs/home-health-agencies/homehealthagencies)
• Medicaid Authority: Ohio Department of Medicaid (ODM) (https://medicaid.ohio.gov)
• Enrollment Portal: Provider Network Management (PNM) module (https://ohpnm.omes.maximus.com/OH_PNM_PROD/)
• Federal Oversight: Centers for Medicare and Medicaid Services (CMS) (https://www.cms.gov/)

3. Gatekeeping Prerequisites: Who Can Even Apply

Before applying for a Skilled Home Health Services license in Ohio, an agency must meet specific structural prerequisites outlined in Ohio Revised Code Chapter 3740. The applicant must provide evidence of Medicare certification, national accreditation (ACHC, CHAP, Joint Commission), ODA certification, or compliance with Medicare conditions of participation.

Furthermore, applicants who were not providing direct care on or immediately prior to September 30, 2021, are required to obtain a surety bond. For skilled home health services, this bond must be in the amount of $50,000.

• Certification/Accreditation Requirement: Must be Medicare-certified, nationally accredited, ODA-certified, or meet Medicare conditions of participation.
• Surety Bond (Skilled): $50,000 surety bond required for new applicants not operating prior to September 30, 2021.
• Surety Bond (Nonmedical): $20,000 surety bond required for nonmedical applicants not operating prior to September 30, 2021.
• Moratorium Note: ODM periodically implements enrollment moratoria for certain provider types; applicants must verify current open enrollment status.

4. Licensure and Certification Requirements

Agencies must apply to ODH for a Skilled Home Health Services license or a Nonmedical Home Health Services license. A skilled license allows the agency to also provide nonmedical services without a separate license.

The application requires a non-refundable fee and submission of the primary owner's fingerprint impression card. Licenses are renewed triennially.

• Application Fee: $250.00 non-refundable fee.
• License Types: Skilled Home Health Services and Nonmedical Home Health Services.
• Fingerprinting: Primary owner must submit a fingerprint impression card (not just a criminal record check) to ODH.
• Renewal Cycle: Triennial (every three years).
• Application Method: Electronic submission via the ODH Gateway (CertLicensure) or by mail.

5. Medicaid Provider Enrollment

Once licensed and (if applicable) Medicare-certified, agencies must enroll as Medicaid providers through the ODM Provider Network Management (PNM) module. Medicaid certification is administered by ODM.

Providers cannot claim reimbursement for services furnished prior to their official Medicaid approval date.

• Enrollment System: Ohio PNM portal.
• Provider Type: Medicare Certified Home Health Agency (MCHHA) or applicable waiver provider type.
• Prerequisite: ODH licensure and Medicare certification/approval.
• Effective Date: Billing is only permitted for services provided after the official approval date.

6. Staffing, Training and Background Checks

Home health agencies must ensure that all employees providing direct care undergo comprehensive background checks. The chief administrator must conduct a database review before employment and as required during employment.

Staff must meet the qualifications for their specific roles, such as registered nurses, licensed practical nurses, or home health aides, and operate under the supervision of a treating physician.

• Database Review: Required prior to employing any direct care staff, checking systems like the federal excluded parties list.
• Criminal Records Check: Required for direct care employees to ensure no disqualifying offenses under ORC 109.572.
• Supervision: Care must be under the supervision of a treating physician.
• Staff Qualifications: Must hold appropriate Ohio professional licenses or certifications for nursing and therapy.

7. Documentation, Policies and Records

Providers must maintain strict documentation, including a physician-signed plan of care and records of the required face-to-face encounter. For Medicaid reimbursement, services must be explicitly detailed in the plan of care.

For waiver enrollees, services must be documented on the person-centered services plan approved by ODM, ODA, or DODD.

• Face-to-Face Documentation: Must use form ODM 07137 for post-hospital or dually eligible individuals.
• Plan of Care: Must contain the physician's signature, credentials, and date.
• Waiver Documentation: Services must be on the approved person-centered services plan.
• Record Retention: Must comply with standard Medicaid record retention policies.

8. Billing, Rates and Claims

Home health services are billed to Ohio Medicaid based on the established fee schedule for nursing, aide, and therapy services. Services not specified in the plan of care are not reimbursable.

Providers must coordinate benefits, billing Medicare first for dually eligible individuals when applicable.

• Billing System: Claims are submitted through the PNM/MMIS system or to the applicable managed care plan.
• Prior Authorization: Required for services exceeding standard limits or as dictated by waiver plans.
• Dual Eligibles: Medicare must be billed prior to Medicaid for covered services.
• Managed Care: Must contract with and bill the individual's Medicaid managed care plan if enrolled.

9. Approval Sequence and Timeline

The approval process begins with obtaining the necessary accreditation or Medicare certification, followed by applying for the ODH license. The ODH application requires the $250 fee, surety bond (if applicable), and fingerprint cards.

After ODH licensure and CMS approval (for Medicare certification), the agency applies for Medicaid enrollment through the PNM portal. The entire process can take several months depending on accreditation and survey timelines.

• Step 1: Obtain accreditation or meet Medicare conditions of participation.
• Step 2: Submit ODH license application with fee, bond, and fingerprints.
• Step 3: Undergo ODH/CMS survey for Medicare certification.
• Step 4: Submit Medicaid enrollment application via PNM portal.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete documentation, such as failing to provide the correct surety bond amount or submitting a criminal background check instead of the required fingerprint impression card.

During surveys, common findings include inadequate documentation of the physician face-to-face encounter or providing services not explicitly authorized in the plan of care.

• Fingerprint Error: Submitting a background check report instead of the required fingerprint impression card.
• Bond Deficiency: Failure to secure the $50,000 (skilled) or $20,000 (nonmedical) surety bond if required.
• Documentation Lapses: Missing physician signatures or dates on the plan of care.
• Face-to-Face Missing: Lack of documented face-to-face encounter within the required 90/30 day window.

11. Key Contacts and Resources

Prospective providers should utilize the official state portals and contact numbers for guidance through the licensure and enrollment process.

The ODH Bureau of Regulatory Operations handles licensure and certification, while ODM manages Medicaid enrollment.

• ODH Home Health Licensure: https://odh.ohio.gov/know-our-programs/home-health-agencies/homehealthagencies
• ODM Provider Enrollment: https://medicaid.ohio.gov
• PNM Portal: https://ohpnm.omes.maximus.com/OH_PNM_PROD/
• Medicaid Enrollment Support: (877) 908-1746
• Ohio Attorney General Webcheck: https://www.ohioattorneygeneral.gov/Business/Services-for-Business/Webcheck

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