Provider Oversight

PCG conducts periodic reviews of all Ohio Home Care Waiver and Transitions II Aging Carve-Out Waiver providers.  All ODM-administered waiver providers are subject to announced or unannounced structural reviews.


All ODM-administered waiver agency providers that are not certified by Medicare or another accrediting organization must have a biennial structural review. This includes all providers that perform specialty services (out of home respite, respite, home modifications, home-delivered meals, etc.) would be reviewed every other year. The first biennial structural review must occur no later than one year after the date on which the provider first furnishes billable waiver services.

 

All ODM-administered waiver non-agency providers must participate in structural reviews annually.
All ODM-administered waiver providers may participate in a structural review when there are health or welfare issues involving the provider and an ODM-administered individual on a waiver program or for any other provider performance issue.


Structural reviews are face-to-face meetings between PCG and the provider, which include review of the provider’s documentation and supporting evidence to ensure:

  • The provider’s compliance with the Ohio Administrative Rules for provider performance for the delivery of the services.
  • The provider’s adherence to providing and billing for services authorized according to each individual’s All Services Plan for the waiver.
  • Review of the clinical documentation to support reimbursement of services.
  • The provider is educated about the rule violations found during the face-to-face review and about any rules changes.

The Structural Review is also a form of provider oversight to ensure the provider has billed according to the services authorized on the individual’s All Services Plan, and maintained documentation to support the appropriate reimbursement of services.   If, during the course of a structural review, PCG identifies rule violations or other non-compliance, PCG may require the provider to submit a Plan of Correction. 

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Contact Us

For more information about Public Consulting Group and how we can assist you in delivering or receiving Home and Community Based Waiver Services, please contact us at the following:

Ohio HCBS
155 East Broad Street 8th Floor Columbus, OH 43215
Phone: 877-908-1746
Fax: 614-386-1344
E-mail: ohiohcbs@pcgus.com