Ohio Medicaid Provider Site Visits

Behavioral health provider organizations are required to revalidate with Medicaid every 5 years. Provider Types 84 and 95 are considered moderate risk providers, and this requires a site visit to complete the revalidation process. The Ohio Department of Medicaid (ODM), contracts with Public Consulting Group (PCG) to complete site visits on their behalf. For revalidation purposes, PCG will contact organizations to schedule a site visit, which may be conducted either virtually or onsite. Please be responsive to PCG when they contact you. PCG should send you materials to prepare for the visit in advance. Below are examples of what you should receive:

Some organizations have been told by PCG staff that background checks are required annually. However, the annual background check requirement is specific to the providers of specific services outlined in the PCG informational flyer linked above. Note that it specifically lists Ohio Administrative Code (OAC) 5160-45- 07, (OAC) 5123-2-02 and/ or (OAC) 4766- 3-13. It does not apply to BH providers, unless you are also a waiver services provider, DD provider or Ambulette provider. Although background checks are not required annually, provider exclusion list checks are recommended at regular intervals as outlined in 5160.1.17.8, paragraph D(1). It is best practice to check these lists regularly as anyone listed is not able to be employed by a Medicaid provider.

In addition to site visits for revalidation purposes. ODM also conducts unannounced site visits as a requirement to limit fraud and ensure program compliance. These site visits are typically conducted by PCG as well.