5101:3-8-21 Advanced practice nurses: eligible Ohio medicaid providers.

(A) A certified nurse practitioner approved under section 4723.42 of the Revised Code is eligible to become an Ohio medicaid provider as an individual nurse practitioner upon the execution of an Ohio medicaid provider agreement if both of the following are met:

(1) The certified nurse practitioner holds a valid certificate of authority issued by the Ohio board of nursing in accordance with section 4723.42 of the Revised Code.

(2) The certified nurse practitioner is certified by a national certifying organization approved by the Ohio board of nursing as at least one of the following:

(a) An adult nurse practitioner;

(b) A family nurse practitioner;

(c) A pediatric nurse practitioner;

(d) An obstetrical-gynecological/women's health care nurse practitioner;

(e) A neonatal nurse practitioner;

(f) A gerontological nurse practitioner;

(g) An acute care nurse practitioner;

(h) A psychiatric nurse practitioner; or

(i) A palliative care nurse practitioner.

(B) A clinical nurse specialist approved under section 4723.42 of the Revised Code is eligible to become an Ohio medicaid provider as an individual clinical nurse specialist upon execution of an Ohio medicaid provider agreement if both of the following are met:

(1) The clinical nurse specialist holds a valid certificate of authority issued by the Ohio board of nursing in accordance with section 4723.42 of the Revised Code.

(2) The clinical nurse specialist is certified by a national certifying organization approved by the Ohio board of nursing as at least one of the following:

(a) An oncology clinical nurse specialist;

(b) A clinical nurse specialist in adult health;

(c) A gerontological clinical nurse specialist;

(d) A psychiatric clinical nurse specialist;

(e) A palliative care nurse specialist;

(f) An acute care clinical nurse specialist; or

(g) A pediatric clinical nurse specialist.

(C) Clinical nurse specialists and certified nurse practitioners not meeting the criteria in paragraphs (A)(1) and (A)(2) or paragraphs (B)(1) and (B)(2) of this rule, as applicable, are not eligible for enrollment as a provider in the medicaid program.

(D) A certified nurse midwife approved under section 4723.42 of the Revised Code is eligible to become an Ohio medicaid provider as an individual nurse midwife upon execution of an Ohio medicaid provider agreement if all of the following are met:

(1) The certified nurse midwife holds a valid certificate of authority issued by the Ohio board of nursing in accordance with section 4723.42 of the Revised Code.

(2) The certified nurse midwife has completed an accredited course of study.

(3) The certified nurse midwife is certified by the American college of nurse-midwives, the American midwifery certification board, or the American college of nurse midwives certification council.

(E) An advanced practice nurse group is eligible to enroll in the medicaid program if it meets the criteria as a professional medical group as defined in paragraph (C) of rule 5101:3-1-17 of the Administrative Code.

(F) Advanced practice nurses enrolled in the medicaid program may be members of any physician group practice enrolled in the Ohio medicaid program.

(G) Out-of-state advanced practice nurses providing services to Ohio medicaid recipients must be licensed, certified, or authorized as required by the state in which the recipient is located at the time the service is provided. In addition, out-of-state advanced practice nurses must meet the provisions of rule 5101:3-1-11 of the Administrative Code addressing out-of-state coverage.

(H) Any advanced practice nurse practicing in Ohio who applies to become a medicaid provider must be authorized by the Ohio board of nursing to practice as an advanced practice nurse in accordance with sections 4723.41 and 4723.42 of the Revised Code.

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
Prior Effective Dates: 3/1/94 (Emer), 5/12/94, 5/1/97, 6/1/02, 1/1/08