Ohio - Skilled Respite Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Ohio Department of Medicaid (ODM) and the Ohio Department of Aging (ODA) fund skilled respite services through the Ohio Home Care Waiver (OHCW) and PASSPORT programs under Ohio Administrative Code (OAC) 5160-46-04 and 173-39-02.23. This service delivers short-term relief to primary caregivers by providing licensed nursing staff (RNs or LPNs) to individuals whose medical needs exceed the scope of personal care aides or unlicensed caregivers.

Approval requires agencies to hold active Medicare certification or Ohio Department of Health (ODH) Home Health Agency licensure before submitting a Medicaid provider application through the Provider Network Management (PNM) module. Applicants must also pay a non-refundable $688 application fee to ODA if applying to serve the PASSPORT population, unless they have paid a similar fee to Medicare or ODM within the past two years.

1. Service Definition and Scope

In Ohio, skilled respite is not licensed as a standalone service category; rather, it is authorized as Waiver Nursing Respite or Out-of-Home Respite delivered by licensed nurses under the state's HCBS waivers. The service provides temporary, substitute care for individuals with skilled nursing needs when their primary, unpaid caregiver is absent or needs relief.

Services can be delivered in the individual's home or in an approved out-of-home setting, such as a Medicaid-certified nursing facility. The scope of practice is strictly governed by the Ohio Board of Nursing, and all interventions must align with the individual's person-centered services plan.

• Target Population: Individuals enrolled in OHCW (age 59 and under) or PASSPORT (age 60+) meeting nursing facility level of care.
• Service Delivery: Must be performed by an RN or an LPN at the direction of an RN.
• Setting Limitations: Can be provided in the home or an approved out-of-home facility, subject to HCBS Settings Rule compliance.
• Duration Limits: Authorized strictly according to the hours specified in the individual's approved care plan.
• Exclusions: Cannot be billed concurrently with standard Waiver Nursing or Personal Care Services for the same individual.

2. Regulatory and Oversight Agencies

Oversight of skilled respite providers is divided among several state agencies depending on the waiver program and the provider's organizational structure. The Ohio Department of Medicaid (ODM) manages the overarching Medicaid program and the OHCW, while the Ohio Department of Aging (ODA) administers the PASSPORT waiver.

The Ohio Department of Health (ODH) surveys and licenses the home health agencies and nursing facilities that employ the nurses delivering this service. The Provider Network Management (PNM) module serves as the central hub for all Medicaid enrollment actions.

• Ohio Department of Medicaid (ODM): Administers OHCW and manages the PNM module (https://medicaid.ohio.gov/).
• Ohio Department of Aging (ODA): Certifies providers for the PASSPORT waiver (https://aging.ohio.gov/).
• Ohio Department of Health (ODH): Licenses Home Health Agencies and Nursing Facilities (https://odh.ohio.gov/).
• Provider Network Management (PNM): The mandatory portal for all Ohio Medicaid provider enrollment and credentialing (https://ohpnm.omes.maximus.com/).
• Ohio Board of Nursing: Regulates the scope of practice for RNs and LPNs delivering the skilled care (https://nursing.ohio.gov/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Ohio does not allow newly formed, unlicensed entities to enroll directly as skilled respite agencies. An applicant must first secure structural approvals that demonstrate clinical capacity and regulatory compliance.

Agency applicants must possess either active Medicare certification as a Home Health Agency or distinct licensure from the Ohio Department of Health. Additionally, ODA requires a specific application fee for PASSPORT certification, which acts as a financial gatekeeper.

• Licensure Prerequisite: Must hold active ODH Home Health Agency licensure or Medicare certification before Medicaid enrollment.
• Application Fee: A non-refundable $688 fee is required by ODA per OAC 5160-1-17.8, unless paid to Medicare/ODM in the last two years.
• NPI Requirement: Must obtain a National Provider Identifier (NPI) and register it with ODM prior to application.
• Secretary of State Registration: Must be actively registered and in good standing with the Ohio Secretary of State.
• HCBS Settings Compliance: Out-of-home respite settings must submit evidence demonstrating they do not have institutional qualities.

4. Licensure and Certification Requirements

Because skilled respite is a nursing service, agencies must comply with the Ohio Department of Health's regulations for Home Health Agencies or the specific certification standards for ODA/ODM waiver providers. This includes maintaining a clinical director and adhering to strict quality assurance protocols.

Providers must also meet the Conditions of Participation outlined in OAC 173-39-02 for ODA and OAC 5160-44-31 for ODM, which dictate administrative, clinical, and operational standards.

• Clinical Leadership: Agencies must employ a registered nurse to serve as the clinical director or nursing supervisor.
• OAC 173-39-02 Compliance: PASSPORT providers must meet all ODA Conditions of Participation.
• OAC 5160-44-31 Compliance: OHCW providers must adhere to ODM's specific provider requirements.
• Liability Insurance: Must maintain commercial general liability insurance of at least $1 million per occurrence.
• Physical Location: Must maintain a physical business office in Ohio or a border state.

5. Medicaid Provider Enrollment

All provider enrollment in Ohio is processed electronically through the Provider Network Management (PNM) module. Paper applications are not accepted. Applicants must first create an OH|ID to access the state's digital systems.

During enrollment, providers must select the appropriate provider type and specialty codes corresponding to Waiver Nursing and Respite services, and upload all prerequisite licenses, NPI documentation, and background checks.

• OH|ID Creation: The mandatory first step to access the PNM module and other state systems.
• PNM Module: The exclusive portal for submitting the Medicaid provider application.
• Provider Type Selection: Must select the specific agency or non-agency provider type applicable to HCBS waivers.
• Taxonomy Codes: Must align with the National Provider Identifier and Taxonomy Guidance issued by ODM.
• Revalidation: Providers must revalidate their Medicaid enrollment every five years through the PNM.

6. Staffing, Training and Background Checks

Direct care staff delivering skilled respite must hold active, unencumbered nursing licenses in Ohio. Agencies are responsible for verifying licensure status and ensuring staff complete all state-mandated training prior to client contact.

Ohio law mandates rigorous criminal background checks for all owners and direct care staff. These checks must be processed through the Bureau of Criminal Identification and Investigation (BCI) using specific reason codes.

• Nursing Licensure: Staff must hold an active RN or LPN license issued by the Ohio Board of Nursing.
• BCI Background Check: Required for all owners at application and all staff prior to hire, sent directly to ODA/ODM.
• FBI Background Check: Required if the individual has lived outside of Ohio at any time in the past five years.
• First Aid/CPR: All direct care staff must maintain active First Aid and CPR certification.
• Incident Management Training: Staff must complete training on Ohio's incident reporting rules (OAC 5160-44-05) before providing care.

7. Documentation, Policies and Records

Providers must maintain comprehensive policy manuals and clinical records that meet both ODH licensure standards and Medicaid waiver requirements. Documentation must support the medical necessity of the skilled respite and align with the person-centered services plan.

Records must be retained for a minimum of six years and be readily available for state surveyors or PASSPORT Administrative Agencies (PAAs) upon request.

• Person-Centered Plan: Services must be delivered and documented exactly as authorized in the individual's care plan.
• Clinical Notes: Nurses must document the date, start/stop times, interventions performed, and the individual's response for every shift.
• HCBS Settings Form: Out-of-home providers must print and upload the federal HCBS Settings Requirement Form with their application.
• Residency Proof: Owners must provide documentation (e.g., driver's license, tax form) proving Ohio residency for the past five years.
• Record Retention: All clinical and billing records must be securely maintained for at least six years.

8. Billing, Rates and Claims

Skilled respite claims are submitted through the PNM module or a clearinghouse to the Medicaid Management Information System (MMIS). Services are billed in 15-minute increments or per diem, depending on the specific waiver authorization.

Ohio mandates the use of Electronic Visit Verification (EVV) for all in-home nursing and personal care services. Providers must log the exact start and end times of each respite shift using the state-sponsored EVV system or an approved alternate vendor.

• EVV Mandate: In-home skilled respite requires GPS-enabled Electronic Visit Verification for every shift.
• Billing Increments: Typically billed in 15-minute units (e.g., T1005) as specified in the waiver appendix.
• Prior Authorization: Claims will deny if the service is not prior-authorized by the case manager in the MMIS.
• Rate Setting: Rates are established by ODM and published in the provider fee schedules on the ODM website.
• Claim Submission: Must be submitted electronically via the PNM module or an EDI clearinghouse.

9. Approval Sequence and Timeline

The approval process is sequential and cannot be expedited. An agency must first establish its corporate entity, obtain an NPI, and secure ODH licensure or Medicare certification, which can take 6 to 12 months.

Once the prerequisite license is active, the provider submits the Medicaid application via the PNM module. ODA or ODM review typically takes 30 to 90 days, culminating in a pre-certification review or desk audit before the Medicaid ID is issued.

• Phase 1: Corporate formation, NPI registration, and Secretary of State filing (1-2 weeks).
• Phase 2: ODH Home Health Agency licensure or Medicare certification (6-12 months).
• Phase 3: OH|ID creation and PNM module application submission (1-2 weeks).
• Phase 4: Background check processing and ODA/ODM application review (30-90 days).
• Phase 5: Pre-certification review and issuance of the active Medicaid Provider ID.

10. Common Denials and Survey Findings

Applications are frequently rejected at the gate due to administrative errors, such as using the wrong BCI reason code or failing to upload proof of the $688 application fee. Incomplete OH|ID profiles also cause significant delays.

During post-enrollment surveys, the most common citations involve failure to utilize the EVV system correctly, missing clinical signatures on nursing notes, and delivering services outside the authorized hours on the person-centered plan.

• Background Check Errors: Using an unapproved BCI/FBI reason code results in immediate application rejection.
• Fee Documentation: Failure to upload proof of the $688 ODA application fee or valid exemption.
• EVV Non-Compliance: Surveyors frequently cite agencies for missing or manually entered EVV data.
• Plan Deviations: Billing for respite hours that exceed the case manager's prior authorization.
• Lapsed Training: Failure to maintain current CPR/First Aid or annual incident management training in staff files.

11. Key Contacts and Resources

Providers must utilize the official state portals and guidance documents to navigate the enrollment and compliance landscape. The PNM module is the primary interface for all application and billing activities.

For waiver-specific questions, providers should contact the ODM provider assistance line or their regional PASSPORT Administrative Agency (PAA).

• Ohio Department of Medicaid (ODM): https://medicaid.ohio.gov/
• Ohio Department of Aging (ODA): https://aging.ohio.gov/
• Provider Network Management (PNM) Portal: https://ohpnm.omes.maximus.com/
• Ohio Department of Health (ODH): https://odh.ohio.gov/
• Ohio Administrative Code (OAC): https://codes.ohio.gov/

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