5101:3-8-01 Eligible providers of limited practitioner services.

(A) Individuals licensed under state of Ohio law to practice a limited branch of medical or remedial care are eligible to participate in the medicaid program within the scope of that limited practice as defined by state law, provided that the individual is authorized by the rules of the department to be a provider for those services, and holds a currently valid provider agreement. (Reference Chapter 5101:3-1 of the Administrative Code for an explanation of conditions for a provider agreement.)

(B) Providers of limited practitioner services may form or enter into a professional medical group in accordance with the provisions set forth in rule 5101:3-1-17 of the Administrative Code. The professional medical group may bill for practitioner services performed by limited practitioners who are a part of the medical professional medical group.

(C) Providers of limited medical/remedial care thus eligible include:

(1) Individual chiropractor licensed under Chapter 4734. of the Revised Code for medicaid-covered services within the scope of his or her practice as defined by state law.

(2) Individual physical therapist licensed under sections 4755.40 to 4755.56 of the Revised Code for medicaid-covered services within the scope of his or her practice as defined by state law. The provider must also be a participant under the medicare program and must maintain an independent practice as defined and determined under medicare.

(3) Individual occupational therapist licensed under sections 4755.04 to 4755.13 of the Revised Code for medicaid-covered services within the scope of his or her practice as defined by state law. The provider must also be a participant under the medicare program and must maintain an independent practice as defined and determined under medicare.

(4) Individual mechanotherapist licensed under section 4731.15.1 of the Revised Code for medicaid-covered services within the scope of his or her practice as defined by state law.

(5) Individual psychologist licensed under Chapter 4732. of the Revised Code for medicaid-covered services within the scope of his or her practice as defined by state law. The provider must also be a participant under medicare.

(D) Eligible providers of physical therapy, occupational therapy, and psychology services may also include the following Ohio medicaid providers:

(1) Fee-for-service ambulatory health care clinics as defined in Chapter 5101: 3-13 of the Administrative Code;

(2) Rural health clinics as defined in Chapter 5101:3-16 of the Administrative Code;

(3) Outpatient health facilities as defined in Chapter 5101:3-29 of the Administrative Code;

(4) Federally qualified health centers as defined in Chapter 5101:3-28 of the Administrative Code;

(5) Hospitals as defined in Chapter 5101: 3-2 of the Administrative Code; and

(E) The provider types listed in paragraphs (D)(1), (D)(2), and (D)(4) of this rule may also be eligible to provide chiropractic services.

Effective: 08/02/2011
R.C. 119.032 review dates: 09/20/2010 and 08/01/2016
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021 , 5111.029
Prior Effective Dates: 4/7/77, 9/19/77, 12/21/77, 7/1/02, 1/1/08