MedicaidAdministrativeMedium impact
5160-45-11 - ODM-administered waiver programs: exclusionary periods for disqualifying offenses; certificates; and pardons. (Amend/Final File)
Ohio Medicaid·OH·Specialty Services
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Ohio Department of Medicaid has updated Rule 5160-45-11 regarding exclusionary periods for disqualifying offenses in ODM-administered waiver programs, affecting provider eligibility and certification requirements. This amendment updates the criteria for pardons and certificates related to background check disqualifications for waiver program participation.
Action Required
Before January 1, 2026: Billing team and credentialing staff must review provider eligibility for Ohio Medicaid waiver programs (home care, transitions DD, transitions carve-out). Verify all participating providers meet updated background check requirements and obtain necessary certificates or pardons as specified in the amended rule. Update provider enrollment records and documentation to ensure compliance with new exclusionary period criteria.