The following terms as used in Chapter 5101:3-16 of the Administrative Code are defined as follows:
(A) An "alternative payment clinic" is an outpatient health facility (OHF), federally qualified health center (FQHC), or rural health clinic (RHC). Medicaid providers may be enrolled as only one type of alternative payment clinic.
(B) "Billable services" for RHCs are services identified in rule 5101:3-16-02 of the Administrative Code and provided in accordance with Chapter 5101:3-16 of the Administrative Code.
(C) A "federally qualified health center (FQHC)" is defined in accordance with rule 5101:3-28-01 of the Administrative Code.
(D) An "outpatient health facility (OHF)" is defined in accordance with rule 5101:3-29-01 of the Administrative Code.
(E) A "rural health clinic (RHC)" is a clinic certified by the Ohio department of health (ODH) as meeting the conditions of certification for rural health clinics under Title XVIII of the Social Security Act (medicare).
(1) Requirements for RHCs are listed in 42 C.F.R. part 491, effective October 1, 2005.
(2) The centers for medicare and medicaid services (CMS) deems that RHCs approved for medicare participation meet the standards for certification under medicaid.
(F) An "encounter" is defined as a face-to-face contact between a patient and provider(s) of covered services, except for transportation services. Encounters involving more than one health professional for the same unit of service, and multiple interactions with the same health professional, that take place on the same day and at a single location constitute a single encounter, except when the patient, after the first interaction, suffers illness or injury requiring additional diagnosis or treatment. Encounters shall be documented in the patient health record.
(G) "Nurse practitioner" means a an advanced practice nurse, as defined in accordance with rule 5101:3-8-20 of the Administrative Code.
(H) "Physician assistant" is defined in accordance with rule 5101:3-4-03 of the Administrative Code.
(I) "Nurse-midwife" is an advanced practice nurse, as defined in rule 5101:3-8-20 of the Administrative Code.
(J) A "clinical social worker" means an individual who:
(1) Possesses a master's or doctoral degree in social work;
(2) After obtaining such degree has performed at least two years of supervised clinical social work; and
(3) Is licensed to practice as a "licensed independent social worker" in accordance with division (B) of section 4757.27 of the Revised Code or as a "licensed social worker" in accordance with division (A) of section 4757.28 of the Revised Code and who is supervised by a licensed independent social worker, psychologist or physician.
(K) A "clinical psychologist" means an individual who:
(1) Holds a doctoral degree in psychology from a program in clinical psychology of an educational institution that is accredited by an organization recognized by the "Council on Post-Secondary Accreditation";
(2) Is licensed in accordance with division (B) of section 4732.10 of the Revised Code; and
(3) Possesses two years of supervised clinical experience, at least one of which is postdegree.
(L) "Physician supervision" is defined in accordance with rule 5101:3-4-02 of the Administrative Code. For the purposes of Chapter 5101:3-16 of the Administrative Code, physician supervision also includes:
(1) Medical direction for the RHC's health care activities and consultation for, and medical supervision of, the health care staff;
(2) In conjunction with the physician's assistant and/or nurse practitioner member(s), developing, executing, and periodically reviewing the RHC's written policies and the services provided to federal program patients;
(3) Periodic reviews of the RHC's patient records, provision of medical orders, and provision of medical care services to patients of the clinic; and
(4) Attendance, for sufficient periods of time, at least once in every two-week period (except in extraordinary circumstances), to provide the medical direction, medical care services, consultation and supervision described in paragraph (J)(1)(M)(1) of this rule, and availability, through direct telecommunication for consultation, for assistance with medical emergencies, or patient referral. The extraordinary circumstances are documented in the records of the RHC.
R.C. 119.032 review dates: 03/30/2006 and 07/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01, 5111.02, 5111.021
Prior Effective Dates: 4/1/80, 6/1/91, 7/1/01