Ohio - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Ohio Department of Developmental Disabilities (DODD) certifies agencies and independent providers to deliver Home and Community-Based Services (HCBS) under the Individual Options, Level One, and SELF waivers. Prospective providers must first obtain an OH|ID and initiate the application through the Provider Network Management (PNM) module, which routes to the Provider Services Management (PSM) system for DODD review.

Approval requires designating a Director of Operations (DOO) and securing Bureau of Criminal Identification and Investigation (BCII) background checks before the state's 30-day application review window commences. Once DODD approves the certification, the Ohio Department of Medicaid (ODM) issues the final Medicaid provider number.

1. Service Definition and Scope

In Ohio, I/DD waiver services encompass a broad array of supports designed to keep individuals in community settings rather than Intermediate Care Facilities (ICFs/IID). These services are funded primarily through three waivers: the Individual Options (IO) Waiver, the Level One Waiver, and the Self-Empowered Life Funding (SELF) Waiver.

The service array includes Homemaker/Personal Care (HPC), Group Employment Support, Community Integration, and Supported Living. All waiver services provided must be medically necessary and authorized in the individual's person-centered service plan by the local county board of developmental disabilities.

• Individual Options (IO) Waiver: Comprehensive waiver offering extensive funding for services like Homemaker/Personal Care and Supported Living.
• Level One Waiver: Capped-funding waiver focused on personal care, adult day support, and employment services.
• SELF Waiver: Participant-directed waiver allowing individuals to manage their own services and budgets.
• Homemaker/Personal Care (HPC): Core service providing daily living assistance, billed in 15-minute units or daily rates.
• Group Employment Support: Service assisting individuals in finding and maintaining community employment.

2. Regulatory and Oversight Agencies

The Ohio Department of Developmental Disabilities (DODD) acts as the primary operating agency for I/DD waivers, handling provider certification, compliance, and rate setting. DODD operates under the delegated authority of the single state Medicaid agency.

The Ohio Department of Medicaid (ODM) retains ultimate authority over the Medicaid program, managing the Provider Network Management (PNM) module, issuing Medicaid provider numbers, and overseeing federal waiver compliance.

• Ohio Department of Developmental Disabilities (DODD): Certifies providers and manages daily waiver operations (https://dodd.ohio.gov).
• Ohio Department of Medicaid (ODM): Single state agency managing Medicaid enrollment and federal compliance (https://medicaid.ohio.gov).
• County Boards of Developmental Disabilities: Local entities responsible for level of care evaluations, service planning, and local provider authorization.
• Public Consulting Group (PCG): Contractor conducting pre- and post-enrollment on-site screening visits for ODM (https://ohiohcbs.pcgus.com).

3. Gatekeeping Prerequisites: Who Can Even Apply

Ohio requires prospective I/DD agency providers to establish a formal business structure and designate a qualified Director of Operations (DOO) before applying. The DOO must meet specific age and language requirements and pass a background check.

Crucially, DODD will not begin the 30-day review of a certification application until all supporting documents, including the BCII background check results, are received. If the application remains incomplete after 30 days of submission, it is closed, and the applicant must pay a new fee to reapply.

• Director of Operations (DOO): Must be at least 21 years old, able to read/write English, and responsible for day-to-day operations.
• OH|ID Account: Mandatory single sign-on credential required to access the PNM and PSM systems (https://ohid.ohio.gov).
• National Provider Identifier (NPI): Must be obtained from NPPES before initiating the Medicaid enrollment process.
• BCII Background Check: Must be initiated at a WebCheck location; results can take up to 45 days and gate the application review.
• OhioPays Registration: Providers must register as a Payee with the Office of Budget and Management to receive funds (https://ohiopays.ohio.gov).

4. Licensure and Certification Requirements

Agencies do not receive a traditional "license" to provide HCBS waiver services in Ohio; instead, they receive DODD Provider Certification. This certification is tied to specific services and is managed through the Provider Services Management (PSM) system.

Applicants select the specific services they intend to provide during the PSM application process. DODD reviews the application and, upon approval, issues a DODD contract number and forwards the file to ODM for final Medicaid enrollment.

• Provider Services Management (PSM): DODD's internal system for processing certification applications and renewals.
• Application Fee: Non-refundable fee required at the time of application submission in PSM.
• Service Selection: Providers must explicitly add each service (e.g., Group Employment Support) they wish to be certified for in PSM.
• Supplemental Application: DODD may issue this request via PSM if additional clarification is needed during the review.
• Certification Expiration: Certifications are typically valid for three years and require renewal through the PSM portal.

5. Medicaid Provider Enrollment

Medicaid enrollment is integrated with the DODD certification process via the Provider Network Management (PNM) module. Applicants start in PNM, are redirected to PSM for DODD certification, and then return to ODM's jurisdiction for final Medicaid approval.

Once DODD approves the certification, ODM conducts its own review, which may include an unannounced on-site screening visit by PCG. Upon final approval, ODM issues the Medicaid provider number.

• Provider Network Management (PNM) Module: The mandatory starting point for all Ohio Medicaid provider enrollments (https://ohpnm.omes.maximus.com/OH_PNM_PROD/Account/Login.aspx).
• Taxonomy Codes: Providers must use specific taxonomy codes aligned with DODD waiver services when applying for their NPI.
• On-Site Screening: PCG conducts unannounced site visits for certain provider types as required by OAC 5160-1-17.8.
• Medicaid Provider Agreement: The formal contract between the provider and ODM, executed upon final approval.
• Approval Letter: Sent via email, containing the DODD contract number, Medicaid provider number, and effective dates.

6. Staffing, Training and Background Checks

Ohio mandates strict background checks and training for all Direct Support Professionals (DSPs) and agency DOOs. Background checks must be processed through the Bureau of Criminal Identification and Investigation (BCII) using the WebCheck system.

Training requirements include initial and annual components, covering topics such as major unusual incidents (MUIs), individual rights, and CPR/First Aid. DODD provides the MyLearning portal to help providers meet some of these requirements.

• BCII WebCheck: Mandatory electronic fingerprinting for all DOOs and DSPs prior to providing services.
• RAPBACK Enrollment: Providers must enroll staff in the RAPBACK system for continuous criminal record monitoring.
• First Aid and CPR: All direct care staff must hold valid, in-person or blended certification before serving individuals.
• Initial Training: DSPs must complete DODD-specified training on rights, MUIs, and universal precautions.
• Medication Administration Certification: Required for any staff administering medications, involving specific DODD-approved coursework.

7. Documentation, Policies and Records

Certified agencies must maintain comprehensive administrative and client records to demonstrate compliance with OAC rules. This includes maintaining a current W-9, banking information, and detailed service delivery documentation.

Agencies must also have written policies covering incident reporting, behavioral support, and personnel management. The DOO is responsible for ensuring these records are available during compliance reviews.

• W-9 and Banking Info: Must match exactly when registering in the OhioPays system for electronic funds transfer.
• Service Documentation: Must include date, start/stop times, location, description of service, and DSP signature.
• MUI/UI Logs: Agencies must maintain logs of all Major Unusual Incidents and Unusual Incidents and report them to the county board.
• Personnel Files: Must contain proof of age, background checks, training certificates, and driver's license/insurance if transporting.
• DOO Change Notification: Agencies must report any change in the Director of Operations to DODD within 14 days.

8. Billing, Rates and Claims

Billing for DODD waiver services is conducted through the electronic Medicaid Billing System (eMBS), accessed via the provider's OH|ID account. Rates are established by DODD and ODM and are uniform statewide, though some services have add-ons for complex needs.

Payments are disbursed by the Office of Budget and Management (OBM) through the OhioPays system. Providers must ensure their OhioPays profile is active to avoid payment disruptions.

• eMBS (electronic Medicaid Billing System): The DODD portal used to submit claims for waiver services.
• OhioPays: The state system that issues actual electronic payments to providers (https://ohiopays.ohio.gov).
• Monthly Rate Calculator: Tool used by county boards to determine the funding authorization for HPC services.
• Prior Authorization: All billed services must match the authorization limits set in the individual's service plan.
• Claim Cycle: Claims are typically processed weekly, with payments deposited directly into the provider's registered bank account.

9. Approval Sequence and Timeline

The certification process is highly dependent on the provider's preparation. The formal 30-day DODD review period does not begin until all required documents, especially the BCII background check, are received and linked to the application.

Because BCII results can take up to 45 days, providers are advised to complete fingerprinting early. Once DODD approves, ODM's final enrollment and site visit process adds additional time before billing can commence.

• Step 1: Create OH|ID and register in OhioPays (10-14 days for Payee ID).
• Step 2: Complete BCII WebCheck background check (up to 45 days for results).
• Step 3: Submit application via PNM/PSM and pay fee.
• Step 4: DODD Application Review (30 days, starting only after all docs are received).
• Step 5: ODM Review and Site Visit (variable timeline post-DODD approval).

10. Common Denials and Survey Findings

Applications are frequently delayed or closed because providers fail to submit all required documentation within the 30-day window, most commonly due to delayed background checks or mismatched DOO information.

Post-enrollment, the DODD Office of Compliance conducts routine reviews. Common citations include missing DSP training records, inadequate service documentation, and failure to report MUIs within required timeframes.

• Application Closure: Occurs if the application remains incomplete 30 days after fee submission.
• Name Mismatches: Delays caused by abbreviating agency names or DOO names inconsistently across PSM and W-9 forms.
• Training Deficiencies: Compliance citations for DSPs lacking current CPR/First Aid or annual MUI training.
• Documentation Errors: Recoupment of funds due to missing start/stop times or missing DSP signatures on service logs.
• Unapproved Settings: Citations for providing services in locations that do not meet HCBS settings requirements.

11. Key Contacts and Resources

Providers must navigate multiple state systems and contractors. DODD Provider Certification staff handle the PSM application, while ODM manages the PNM portal and final Medicaid enrollment.

Local county boards of developmental disabilities are the primary contact for securing client authorizations once certified. Technical support for billing and payments is handled by OBM Shared Services.

• DODD Provider Certification: Reached via the 'Communicate' button in the PSM portal (https://dodd.ohio.gov/providers).
• ODM Provider Enrollment: Manages the PNM module and NPI requirements (https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-enrollment).
• OBM Shared Services: Handles OhioPays registration and payment issues ([email protected], 877-644-6771).
• PCG (Public Consulting Group): Conducts ODM required on-site screening visits (https://ohiohcbs.pcgus.com, 877-908-1746).
• DODD MyLearning: Portal for accessing required provider training and webinars (accessed via OH|ID).

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