Billing

Individuals Residing in An Institution

By November 2, 2023January 12th, 2024No Comments

Under the TCM Rule 5160-48-01 “Institution” means a nursing facility, an intermediate care facility for individuals with intellectual disabilities (ICF/IID), a state-operated intermediate care facility for individuals with intellectual disabilities (ICF/IID) or a medical institution.

Activities performed on behalf of an eligible individual residing in an institution are not billable for Medicaid TCM reimbursement except for the last one hundred eighty (180) consecutive days of residence when the activities are related to moving the eligible individual from an institution to a non-institutional community setting.

Rule 5160-48-01:

Medicaid coverage of targeted case management services provided to individuals with developmental disabilities.

https://codes.ohio.gov/ohio-administrative-code/rule-5160-48- 01#:~:text=The%20number%20of%20units%20that,is%20eight%20or%20greater% 20minutes

If you have questions about anything TCM-related, please contact us at TCMTeam@medicaidbillingsolutions.com.