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Ohio - Integrated Employment — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Ohio funds Individual Employment Support through the Department of Developmental Disabilities (DODD) Individual Options (IO), Level One, and SELF waivers. Providers must first obtain DODD agency or independent provider certification under Ohio Administrative Code (OAC) 5123-9-15 before applying for Medicaid enrollment through the Provider Network Management (PNM) module.

The service encompasses job development, placement, and on-site coaching to achieve competitive integrated employment at or above minimum wage. Applicants must demonstrate compliance with Ohio's Employment First initiative and federal HCBS settings rules prior to receiving authorization to bill for services.

1. Service Definition and Scope

In Ohio, the service is officially designated as Individual Employment Support under the DODD waiver system. It is designed to help individuals with developmental disabilities secure and maintain competitive integrated employment at prevailing wages.

The service includes job development, customized employment, and on-site job coaching. It is distinct from Group Employment Support and Adult Day Support, focusing exclusively on individualized, community-based employment outcomes.

2. Regulatory and Oversight Agencies

The Ohio Department of Developmental Disabilities (DODD) serves as the primary operating agency, responsible for provider certification, rule promulgation, and compliance monitoring. The Ohio Department of Medicaid (ODM) is the single state Medicaid agency overseeing the waivers and final provider enrollment.

Providers interact with both state agencies and local County Boards of Developmental Disabilities, which handle local service coordination and person-centered planning.

3. Gatekeeping Prerequisites: Who Can Even Apply

Ohio requires all HCBS waiver providers to obtain DODD certification before they can be enrolled as Medicaid providers. There is no standalone Medicaid enrollment for this service without prior DODD approval.

Additionally, providers must meet the HCBS Settings Rule requirements, demonstrating that their service delivery model is fully integrated into the community and not institutional in nature.

4. Licensure and Certification Requirements

Providers must apply for DODD certification via the Provider Network Management (PNM) system. The certification process requires demonstrating compliance with OAC 5123-9-15, which governs Individual Employment Support.

Agencies must submit organizational policies, proof of insurance, and designate a Director of Operations who meets specific experience and training criteria.

5. Medicaid Provider Enrollment

Once DODD certification is approved, the application automatically routes to the Ohio Department of Medicaid (ODM) for final enrollment. Providers do not submit a separate paper application to ODM.

Providers must sign a Medicaid Provider Agreement and complete revalidation every three to five years as mandated by CMS and ODM.

6. Staffing, Training and Background Checks

Direct support professionals (DSPs) providing Individual Employment Support must undergo rigorous background checks, including BCII and FBI fingerprinting, and checks against the DODD Abuser Registry.

Staff must complete DODD-approved initial training, including Employment First principles, and maintain annual continuing education.

7. Documentation, Policies and Records

Providers must maintain detailed service documentation that aligns with the individual's Person-Centered Service Plan (PCSP) developed by the County Board Service and Support Administrator (SSA).

Records must include start and stop times, specific activities performed, and progress toward competitive employment goals.

8. Billing, Rates and Claims

Billing for Individual Employment Support is processed through the DODD Electronic Medicaid Billing System (eMBS). Services are typically billed in 15-minute units.

Rates are established by DODD and ODM and are uniform statewide, though specific modifiers may apply based on the waiver or staff qualifications.

9. Approval Sequence and Timeline

The approval process begins with the submission of the DODD certification application through the PNM module. DODD reviews the application for completeness and compliance with OAC rules.

The entire process, from initial submission to final Medicaid enrollment, typically takes 60 to 90 days, depending on the completeness of the application and background check processing times.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete background checks, missing training certificates, or failure to demonstrate HCBS Settings Rule compliance.

During compliance surveys, common citations include inadequate service documentation, failure to follow the PCSP, and lapsed CPR/First Aid certifications.

11. Key Contacts and Resources

Providers should utilize the DODD Support Teams and the Integrated Help Desk for assistance with certification and billing questions.

The Ohio Employment First website provides additional resources and training materials for employment service providers.

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