Medicaid Incident Management Requirements Proposed Rule Changes (5160-44-05)

The Ohio Department of Medicaid (ODM) has introduced a new draft rule, OAC 5160-44-05, to establish consistent incident management requirements across Medicaid programs, including OhioRISE, managed care, home and community-based services (HCBS), and the Specialized Recovery Services (SRS) program. The rule outlines expectations for documenting, reporting, and responding to incidents that may negatively affect a Medicaid recipient’s health or welfare.

The Ohio Council submitted comments submitted during the public comment period, which was open from May 3 to May 16, 2025, which raised concerns about the broad application of HCBS waiver-based requirements. Applying these standards across the general Medicaid population could create regulatory confusion, increase administrative burden, and duplicate existing reporting practices. Several definitions, such as restraint, seclusion, and restrictive intervention, differ from current behavioral health regulations and may lead to compliance conflicts. Additional concerns were noted about classifying clinically appropriate safety supports as reportable incidents.

Recommendations focused on aligning key definitions with OhioMHAS rules, limiting reporting requirements to clinically significant events, and tailoring the rule’s application to populations at higher risk. Standardizing thresholds, timelines, and terminology across programs would help improve clarity, reduce duplication, and support provider compliance.

The Ohio Council will continue to monitor the rulemaking process and keep members informed as developments occur.