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Compliance and Oversight
Common Questions about Compliance & Oversight
Compliance and Oversight

A structural review is a monitoring activity completed by ODM's Oversight Contractor per OAC 5160-45-06.

You need to notify the Case Manager and the individual.  In the case of an emergency or unplanned absence, the provider shall immediately activate the back-up plan per the individual's Person-centered Plan.  OAC 44-31 (8).

An incident is an alleged, suspected or actual event that is not consistent with the routine care of, and/or service delivery to an individual per OAC 5160-44-05.

Providers are monitored through the structural review and incident processes.

Yes if ODM or it's designee requests it.  OAC 5160-45-06

Public Consulting Group (PCG) is the Ohio Department of Medicaid's designee that conducts Provider Oversight for the State of Ohio. PCG also provides training for providers regarding incident reporting, tracking, and resolution. An “incident” is an alleged, suspected or actual event that is not consistent with the routine care of, and/or service delivery to, an individual enrolled on an ODM waiver. More information is available at: http://ohiohcbs.pcgus.com/TrainingMaterials/

You can also reach PCG at 1-877-908-1746.

PCG reviews provider applications, conducts Onsite Visits, Incident Investigations and Structural Reviews for ODM-Administered Waiver services.

Phone: 877-908-1746
Fax: 614-386-1344
E-mail: ohiohcbs@pcgus.com