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Ohio Laws and Rules
(A) The bureau shall establish minimum credentialing criteria for providers to qualify for participation in the HPP. Providers must meet all licensing, certification, or accreditation requirements necessary to provide services in Ohio. A provider licensed, certified or accredited pursuant to the equivalent law of another state shall qualify as a provider under this rule in that state.
(B) The minimum credentials for a provider, where applicable based upon the type of provider, are as follows. The provider shall:
(1) Be currently licensed to practice, as applicable, without disciplinary restrictions that affect the provider’s ability to treat patients, that compromise patient care, or that are related to chemical dependency or substance abuse.
(2) Meet other general certification requirements for the specific provider type, as provided in paragraph (C) of this rule.
(3) Possess a current and unrestricted drug enforcement agency registration, unless it is not required by the provider’s discipline and scope of practice.
(4) Be currently eligible for participation in medicare, medicaid or the Ohio workers’ compensation system.
(5) Not have a history of a felony conviction in any jurisdiction, a conviction under a federal controlled substance act, a conviction for an act involving dishonesty, fraud, or misrepresentation, a conviction for a misdemeanor committed in the course of practice, or court supervised intervention or treatment in lieu of conviction pursuant to section 2951.041 of the Revised Code or the equivalent law of another state.
(6) Provide proof of and maintain adequate, current professional malpractice and liability insurance. The bureau shall establish the appropriate amount of such insurance coverage for each provider type. In establishing the appropriate amount of insurance coverage for out of state providers, the bureau may consider the regulations or the community standards of the provider’s state of practice.
(7) Provide documentation of the provider’s malpractice history for the previous five years.
(8) Not have any outstanding provider overpayment or other indebtedness to the bureau which has been certified to the attorney general for collection.
(9) Provide proof of and maintain workers’ compensation coverage to the extent required under Ohio law or the equivalent law of another state, as applicable.
(10) Not have been excluded or removed from participation in other health plans for cause, or have lost hospital privileges for cause.
(C) The following minimum credentials apply to the providers listed below as provided in this rule.
(1) Ambulance, ambulette, or air ambulance service: license from Ohio medical transportation board if private; medicare participation if government/public.
(2) Ambulatory surgical center: license from Ohio department of health and medicare participation.
(3) Athletic trainer: license from Ohio occupational therapy, physical therapy, and athletic trainer board.
(4) Audiologist: license from Ohio board of speech-language pathology and audiology.
(5) Alcohol and drug counseling clinic: certified by Ohio department of alcohol and drug addiction services to administer outpatient counseling.
(6) Dentist: license from Ohio state dental board.
(7) Dialysis center: license from Ohio department of health and medicare participation.
(8) Durable medical equipment supplier, excludes orthotics, prosthetics and pedorthics state vendors license, medicare participation, or joint commission on accreditation of healthcare organization (JCAHO) accreditation.
(9) Ergonomist: certification for certified professional ergonomist (CPE), certified human factors professional (CHFP), associate ergonomics professional (AEP), associate human factors professional (AHFP), certified ergonomics associate (CEA), certified safety professional (CSP) with “ergonomics specialist” designation, certified industrial ergonomist (CIE), certified industrial hygienist (CIH), assistive technology practitioner (ATP), or rehabilitation engineering technologist (RET).
(10) Hearing aid dealer: license from Ohio hearing aid dealers and fitters licensing board.
(11) Home health agency: medicare participation, joint commission on accreditation of healthcare organization (JCAHO) accreditation, or community health accreditation program (CHAP) accreditation.
(12) Hospital: approved by the centers for medicare and medicaid services (CMS) for medicare, title XVIII of the Social Security Act; obtained national accreditation (joint commission on accreditation of healthcare organization (JCAHO), or American osteopathic association healthcare facilities accreditation program (HFAP), or commission on accreditation of rehabilitation facilities (CARF) for rehabilitation hospitals).
(13) Licensed social worker or licensed independent social worker (LSW) or (LISW): license from Ohio counselor and social worker board.
(14) Laboratory: valid licensing from clinical laboratory improvement amendment (CLIA).
(15) Massage therapist: certified by Ohio state medical board.
(16) Non-physician acupuncturist: certificate of registration from Ohio state medical board.
(17) Certified registered nurse anesthetist (CRNA): certified by national council on certification of nurse anesthetists or other certifying agency recognized by the Ohio board of nursing.
(18) Certified nurse practitioner: certified by American nurses credentialing center or other certifying agency recognized by the Ohio board of nursing.
(19) Clinical nurse specialist: certified by American nurses credentialing center or other certifying agency recognized by the Ohio board of nursing.
(20) Nursing home: license from Ohio department of health.
(21) Occupational therapist: license from Ohio occupational therapy, physical therapy, and athletic trainer board.
(22) Optician: license from Ohio optical dispensers board.
(23) Optometrist: license from Ohio board of optometry.
(24) Orthotist, prosthetist or pedorthist: license from Ohio state board of orthotics, prosthetics and pedorthics.
(25) Physical therapist: license from Ohio occupational therapy, physical therapy, and athletic trainer board.
(26) Physician assistant: certified by national commission on certification of physician assistants and certified by Ohio state medical board.
(27) Physician (M.D. or D.O.): license from Ohio state medical board.
(28) Chiropractic physician (D.C.): license from Ohio state chiropractic board.
(29) Podiatric physician (D.P.M.): license from Ohio state medical board.
(30) Licensed professional clinical counselor (LPCC) or licensed professional counselor (LPC): license from Ohio counselor and social worker board.
(31) Psychologist: license from Ohio state board of psychology
(32) Radiology services (free-standing) state licensing, registration or accreditation: (mobile) state, county or city registration, or medicare participation or medicaid certification.
(33) Residential care/assisted living facility: license from Ohio department of health.
(34) Speech pathologist: license from Ohio board of speech pathology and audiology.
(35) Traumatic brain injury (TBI) program: CARF accreditation for brain injury services (acute or post-acute).
(36) Vocational rehabilitation case managers: certification for occupational health nursing (COHN), certified rehabilitation counselor (CRC), certified disability management specialist (CDMS), certified vocational evaluator (CVE), certified rehabilitation nurse (CRRN), or certified case manager (CCM).
(37) Vocational rehabilitation case management interns:
(a) Vocational rehabilitation case management may be provided by a bureau-certified intern. An intern is a non-credentialed individual who provides vocational case management services and is supervised by a credentialed vocational case manager, as identified in paragraph (C)(36) of this rule.
(b) To become eligible for bureau certification and provide service as an intern, the intern must:
(i) Enroll with the bureau as an intern.
(ii) Qualify to take one of the examinations to become credentialed, as identified in paragraph (C)(36) of this rule.
(c) Bureau certification of vocational rehabilitation case management interns shall be for a period of four years.
(d) Vocational rehabilitation case management interns may not be recertified for additional four-year periods.
(38) Comprehensive pain management services program: (free standing) CARF accreditation; (hospital based) CARF or JCAHO accreditation.
(39) Occupational rehabilitation programs: CARF accreditation.
Effective: 04/01/2007
R.C. 119.032 review dates: 03/01/2009
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.121, 4121.44, 4121.441, 4123.66
Prior Effective Dates: 2/16/96; 1/15/99; 3/29/02; 7/14/03; 9/12/04