3701-43-03 Standards and procedures for determining eligibility of physician providers.

(A) The director shall apply the standards and procedures prescribed by this rule in reviewing and making determinations concerning applications by physicians to be providers for the program for medically handicapped children.

(B) To be approved as a provider, a physician shall:

(1) Be licensed to practice allopathic medicine or osteopathic medicine in the state of Ohio or the state in which the physician's practice is located, if the physician will be providing services outside Ohio;

(2) Meet the following certification requirements:

(a) All physicians shall be certified by a certifying board of the "American Board of Medical Specialities" or a certifying board of the "American Osteopathic Association";

(b) To be designated as a subspecialist, a physician shall be certified in the relevant subspecialty by a certifying board of the "American Board of Medical Specialties" or a certifying board of the "American Osteopathic Association." If the applicable board does not certify physicians in the relevant subspecialty, the director may designate a physician as a subspecialist based upon significant advanced postgraduate training in the area. The director may consult with one or more members of the medical advisory council or with other individuals with expertise in the area in determining whether a physician has significant advanced postgraduate training;

(3) Meet the following practice requirements:

(a) Possession of skill and experience in the treatment of children or adolescents with handicapping conditions, as determined by the director. In making this determination, the director may consult with one or more members of the medical advisory council or with other individuals with expertise in the area; and

(b) Actively providing at the time of application, treatment to children with medically eligible conditions or adults with cystic fibrosis; and

(4) Maintain privileges on the staff of a hospital that is approved under rule 3701-43-04 of the Administrative Code; or have arrangements with physicians who are approved under this chapter to admit children needing inpatient care to a hospital that is approved under rule 3701-43-04 of the Administrative Code for inpatient care.

(C) A physician who does not meet the requirements of paragraph (B)(2)(b) of this rule may be designated as a subspecialist on a provisional basis for up to five years if the physician is certified in pediatrics by a certifying board of the "American Board of Medical Specialties" or a certifying board of the "American Osteopathic Association."

(D) In accordance with paragraph (D) of rule 3701-43-02 of the Administrative Code, the director shall determine the scope of services that each physician provider is approved to provide. The director may consult with one or more members of the medical advisory council or with other individuals with expertise in the area in determining the appropriate scope of services. The scope of services that a physician is approved to provide may be limited by:

(1) The physician's specialty and, if applicable, subspecialty designation;

(2) The scope of services that a hospital of whose staff the physician is a member is approved to provide; and

(3) The director's determination as to the skill and experience of the physician in treating particular handicapping conditions.

(E) The director may approve a physician who does not meet the standards prescribed by paragraph (B)(3) or (B)(4) of this rule as a limited provider. The director may consult with one or more members of the medical advisory council or with other individuals with expertise in the area concerning approval of physicians under this paragraph. Limitations on service provision may include, but are not limited to, the age of the recipients to be treated, specific handicapping conditions to be treated and types of services to be provided.

(F) Physician provider applicants shall:

(1) Complete and sign a physician application on a form prescribed by the director;

(2) Comply with the procedures prescribed by rule 3701-43-02 of the Administrative Code; and

(3) Submit two letters of reference that attest to the physician's skill in caring for children with special health care needs. One letter must be from a pediatrician and one letter must be from a member of the physician's specialty.

Effective: 01/16/2014
R.C. 119.032 review dates: 11/01/2013 and 10/28/2018
Promulgated Under: 119.03
Statutory Authority: 3701.021
Rule Amplifies: 3701.021 , 3701.022 , 3701.023
Prior Effective Dates: 1/1/1975, 6/12/82, 1/2/89, 5/20/91, 10/9/93, 12/1/01, 10/13/03, 9/1/08