Chapter 4761:1-6 Certificate of Registration

4761:1-6-01 Qualifications to obtain a certificate of registration.

(A) An applicant applying for registration as an HME service provider must file an application with the board, on forms provided by the board.

(B) The applicant shall pay a fee prescribed by the board in accordance with rule 4761:1-8-01 of the Administrative Code.

(C) The applicant shall be accredited by the joint commission on accreditation of healthcare organizations or another national accrediting body recognized by the board in accordance with rule 4761:1-4-01 of the Administrative Code.

R.C. 119.032 review dates: 07/12/2013 and 03/31/2018
Promulgated Under: 119.03
Statutory Authority: 4752.17(A)(11)
Rule Amplifies: 4752.12(A)
Prior Effective Dates: 05/23/2005, 03/31/2008

4761:1-6-02 Application form requirements to apply for a certificate of registration.

The application form for an HME services provider certificate of registration shall minimally include the following:

(A) The name of the HME sevices provider (including the name of all legal owners or corporate names used by the applicant) .

(B) The mailing address or corporate mailing address, if different than the physical mailing address of the location of the HME services provider.

(C) The legal name of the HME services provider.

(D) The physical mailing address of the location of the HME service provider .

(E) The telephone number of the HME service provider, including the number to be contacted in an emergency situation which is monitored twenty-four hours per day, seven days per week .

(F) The name of a person authorized to legally sign on behalf of the HME services provider as a representative agent, if different than the legal owner of the HME services provider, including the last four digits of the person's social security number and date of birth.

(G) The name of a person serving as the manager of the physical location of the HME services provider, if different that the person authorized to legally sign on behalf of the HME services provider, including the last four digits of the person's social security number and date of birth.

(H) The names of shareholders, members, or partners owning five percent interest or more in the HME services provider business, including the last four digits of the social security numbers for each person listed.

(I) The email address for the owner or authorized representative for the HME services provider.

(J) The Ohio medicaid number, federal medicare number, and federal tax identification number for the HME services provider.

(K) A list of the HME to be stored, repaired, leased or sold from this business location .

(L) A brief description of the HME provider's office location, including square footage of the facility .

(M) Name of the national accrediting body that issued the accreditation on which the application is based .

(N) The applicant's accreditation number and the expiration date of the accreditation.

(O) A complete certificate of accreditation form, verifying current accreditation with an organization recognized under rule 4761:1-4-01 of the Administrative Code.

(P) List of other licenses or registrations held by the HME services provider, including, but not limited to, the federal food and drug administration number, federal department of transportation number, and Ohio pharmacy board license number.

(Q) The HME services provider's response to the following practice questions:

(1) How long has the HME services provider been renting, selling, delivering, installing, maintaining, replacing or demonstrating HME to Ohio citizens?

(2) Has the HME services provider ever been denied a license, certification, or registration as an HME services provider in any state, for any reason?

(3) Has any license or accreditation associated with the practice of HME ever been revoked, suspended, or conditionally approved?

(4) Has the HME services provider ever violated any provision of the Ohio Revised Code, including providing HME services to Ohio citizens without a license or certificate of registration?

(R) An attestation, signed and dated by the person authorized to legally represent the HME services provider, affirming the thruthfulness of the application and the information contained therein, including compliance with federal, state licensure and regulatory requirements, standards, and compliance with continuing education requirements.

Effective: 11/05/2013
R.C. 119.032 review dates: 07/12/2013 and 03/31/2018
Promulgated Under: 119.03
Statutory Authority: 4752.17(A)(2) , 4752.17(A)(11)
Rule Amplifies: 4752.12(A) , 4752.17(A)(2)
Prior Effective Dates: 05/23/2005, 03/31/2008

4761:1-6-03 License and certificate of registration issuance and display.

(A) If the board finds that the applicant meets the qualifications for issuance of a license or a certificate of registration pursuant to Chapter 4752. of the Revised Code, and division level 4761:1 of the Administrative Code. the board shall issue a license or certificate of registration to the applicant. The initial license or certificate of registration shall be effective on the date it is approved by the board or its designee. A wall certificate and identification card shall be mailed to the facility as proof that the license or certificate of registration is current and valid. The license or certificate of registration is valid only for the facility named in the application.

(B) The license or certificate of registration issued is valid from the day it is issued until the thirtieth day of June. Thereafter, a license or certificate of registration is valid only if it is renewed in accordance with section 4752.13 of the Revised Code biennially on or before the thirtieth day of June.

(C) The wall certificate shall be signed by the board president and/or executive director of the board and shall include the name of the licensee or registrant, name of the facility, if different than the name of the licensee or registrant, address of the facility, and date on which the license or registration was initially issued. The wall certificate shall be posted in the place of business in a location that is readily visible to all clients or customers of the business.

(D) The identification card shall be issued with the initial license or certificate of registration wall certificate and upon the approval of any subsequent renewal application required under rules 4761:1-7-01 and 4761:1-7-02 of the Administrative Code. The identification card shall be signed by the board president and/or executive director of the board and shall include the name of the licensee or registrant, name of the facility, if different than the name of the licensee or registrant, address of the facility, date on which the license or certificate of registration is effective for the current biennial renewal period, and the date the license or certificate of registration expires.

R.C. 119.032 review dates: 05/06/2010 and 05/06/2015
Promulgated Under: 119.03
Statutory Authority: 4752.17(A)(2)
Rule Amplifies: 4752.05(d) , 4752.12(B) , 4752.17(A)(2)
Prior Effective Dates: 05/23/2005, 05/24/2006, 07/15/2007, 03/31/2008

4761:1-6-04 Failure to file a complete application for a certificate of registration.

(A) Certificate of registration applications for HME services providers must include a complete application and proof of meeting all requirements under rules 4761:1-6-014761:1-6-02 of the Administrative Code. Applications that are incomplete will be held open for ninety days following notification of incomplete requirements by regular mail. After sixty days, a final notice of incomplete application will be mailed by certified mail, return-receipt requested. If, by the end of the ninety day period, the application remains incomplete, it will be considered abandoned. After ninety days, if desired, the applicant must submit a new application, including fee.

R.C. 119.032 review dates: 05/06/2010 and 05/06/2015
Promulgated Under: 119.03
Statutory Authority: 4752.17(A)(11)
Rule Amplifies: 4752.17(a)(h)
Prior Effective Dates: 07/15/2007