MedicaidCoverageMedium impact
5160-4-02.3 - Exception for certain services provided by residents. (Amend/Original File)
Ohio Medicaid·OH·Medical Policy
Effective date
Oct 13, 2026
We identified it
Sep 12, 2026
Summary
Ohio Medicaid (5160-4-02.3) has amended its policy on exceptions for certain services provided by residents. The policy file date is 09/11/2026 with an effective date of 10/13/2026, but the actual policy content detailing what services are affected and what exceptions apply is not included in the provided document. Your billing team cannot implement this change without accessing the full rule body text.
Action Required
By October 13, 2026: Billing team must obtain and review the complete rule body for 5160-4-02.3 from the Ohio Department of Medicaid (contact Tommi Potter at 614-752-3877). Identify which resident-provided services are affected by the exception and update billing system logic, billing guides, and encounter forms accordingly. Determine if prior authorization, documentation, or coding changes are required. Do not bill affected services until the full policy text is reviewed and implemented. Failure to comply may result in claim denials for Ohio Medicaid beneficiaries.