Fidelity Request Form

Consistent with the Ohio Department of Medicaid’s (ODM) rules to promote high-quality service, the IHBT Fidelity Tool was developed to ensure compliance with IHBT service delivery standards. Providers choosing to bill services under Medicaid’s IHBT bundled rate must be certified.

Certification assures minimum fidelity standards are being met, consistent with the ODM and OhioMHAS IHBT rule. The Fidelity Tool consists of 17 fidelity standards, with ratings measured on a 1-5 scale.

Each rating of 5 indicates best practice for that standard. Minimum fidelity is achieved between ratings 3, 4 and 5 which are highlighted within each standard.

  • Fidelity review of each IHBT program with passing scores required to bill Medicaid
  • 12 items that measure fidelity to the IHBT standards (see handout)
  • Contact Kimberlyn Meyer ( to schedule fidelity review

Request Fidelity Review

Selection of the review date takes into consideration naturally occurring/scheduled opportunities at the organization (e.g. team meeting where IHBT team members, supervisors, and managers will be present or available).