11/01/2024

Ohio Medicaid Revised Oxygen Rule Goes into Effect on November 4

OAMES and ODM have been reviewing several DMEPOS policies over the past year as part of the State's five-year rule review requirement for all state regulations. One policy, Ohio Administrative Code 5160-10-13, DMEPOS oxygen rule, has been finalized and will be implemented on Monday, November 4.  

After several meetings between the association and ODM, OAMES testified in support of the proposed rule at the agency's public hearing on September 16.

The rule has now been officially approved by the Joint Committee on Agency Rule Review and will be effective 11/04/24. 

Click here for a copy of the revised “final” rule.

During the Medicaid presentation at OAMES Annual Meeting & Exhibition on October 16, Mark Rogers, ODM DME Administrator, highlighted some of the major changes to the oxygen rule which include:

• “Group III criteria” is introduced to designate indicators of the medical necessity of oxygen. Examples include cluster headaches or illnesses for which a public health emergency is declared.
• CMN ODM form 01909 has been updated.
• “Sleep study” has been corrected to “respiratory study”.
• The exclusion of payment for both a stationary oxygen concentrator and a portable oxygen concentrator has been removed.

OAMES would like to thank ODM’s Bureau of Health Plan Policy, Non-Institutional Policy section staff, Mark Rogers, Dennis Frazier, and Ryan Spindler, for their collaboration over the past year working closely with OAMES leadership on the oxygen rule making positive changes for this important Medicaid benefit. The association looks forward to continuing discussions with the Department on other DMEPOS rules as they move through the review process in the months ahead.