Rule 4123-6-02.2 | Provider access to the HPP - provider certification criteria.
(A) The bureau will establish minimum criteria for provider certification. 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 qualifies as a provider under this rule in that state. However, a provider is ineligible to participate in the health partnership program if:
(1) The state of Ohio has denied the provider's application for a professional license or the provider's professional license in Ohio is under revocation or suspension; or
(2) The provider's professional license is subject to disciplinary restrictions that affect the provider's ability to treat patients or that compromise patient care.
(B) The minimum criteria 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 or that compromise patient care.
(2) Meet other general certification criteria for the specific provider type, as provided in paragraph (C) of this rule.
(3) Not be currently excluded from participation in medicare or Ohio medicaid for cause.
(4) Not be currently ineligible to participate in the health partnership program due to the provider having been convicted of or pleaded guilty to a criminal offense as set forth in the appendix to this rule.
(5) Attest to and maintain professional malpractice and liability insurance, and provide proof of such coverage to BWC upon request.
(6) Provide documentation of the provider's malpractice history for the previous five years.
(7) Not have any outstanding provider overpayment or other indebtedness to the bureau which has been certified to the attorney general for collection.
(8) Maintain workers' compensation coverage to the extent required under Ohio law or the equivalent law of another state, as applicable, and provide proof of such coverage to BWC upon request.
(9) Not have been excluded or removed from participation in other health plans for cause.
(10) Not have lost hospital privileges for cause.
(C) The following minimum credentials apply to the providers listed below as provided in this rule.
(1) Adult day care facility: Ohio department of aging PASSPORT adult day care provider agreement.
(2) Alcohol and drug counseling clinic: certified by Ohio department of mental health and addiction services.
(3) Ambulance, ambulette, or air ambulance service: license from Ohio state board of emergency medical, fire, and transportation services if private; approved for medicare by the centers for medicare and medicaid services (CMS) if government/public.
(4) Ambulatory surgical center: license from Ohio department of health and approved for medicare by CMS.
(5) Anesthesiologist assistant: license from Ohio state medical board.
(6) Athletic trainer: license from Ohio occupational therapy, physical therapy, and athletic trainers board.
(7) Audiologist: license from Ohio state speech and hearing professionals board.
(8) Certified nurse practitioner: license from Ohio board of nursing and certified by American nurses credentialing center or other certifying agency approved by the Ohio board of nursing.
(9) Certified registered nurse anesthetist (CRNA): license from Ohio board of nursing and certified by national council on certification of nurse anesthetists or other certifying agency approved by the Ohio board of nursing.
(10) Certified shoe retailer: certified or accredited by American board for certification in orthotics, prosthetics and pedorthics or board of certification/accreditation.
(11) Chiropractic physician (D.C.): license from Ohio state chiropractic board.
(12) Clinical nurse specialist: license from Ohio board of nursing and certified by American nurses credentialing center or other certifying agency approved by the Ohio board of nursing.
(13) Comprehensive pain management services program: (free standing) commission on accreditation of rehabilitation facilities CARF accreditation; (hospital based) CARF or joint commission accreditation.
(14) Dentist: license from Ohio state dental board.
(15) Dialysis center: license from Ohio department of health and approved for medicare by CMS or a deeming organization approved by CMS.
(16) Durable medical equipment supplier (excludes orthotics, prosthetics and pedorthics): approved for medicare by CMS and state of Ohio board of pharmacy home medical equipment certificate of registration.
(17) Employment specialist:
(a)
(i) Certification for American board of vocational experts (ABVE), certified rehabilitation counselor (CRC), certified case manager (CCM), certified employment support professional (CESP), certification for individual placement and support (CIPS), global career development facilitator (GCDF), associate certified coach (ACC), professional certified coach (PCC), master certified coach (MCC), certified disability management specialist (CDMS), or CARF accreditation for employment and community services in job development or employment supports; or
(ii) Evidence of completion of three or more courses, seminars or workshops prior to application for certification, totaling a minimum of eighty hours and approved by the bureau or by an entity offering a certification referenced in paragraph (C)(17)(a)(i) of this rule, in at least two of the following domain areas: job development, job placement, and career and lifestyle development; vocational consultation and services for employers; professional roles and practices, ethics, and utilization of community resources; or
(iii) Evidence of bureau reimbursement to the provider for job placement, job development, job seeking skills training, job club, and/or job coaching services to injured workers for dates of service beginning not less than eighteen months prior to April 1, 2014. However, if the provider has been certified pursuant to this provision and the provider's certification subsequently lapses, the provider must thereafter meet the criteria of paragraph (B)(17)(a)(i) or (B)(17)(a)(ii) of this rule for certification or recertification.
(b) Employment specialists certified pursuant to paragraph (C)(17)(a)(ii) or (C)(17)(a)(iii) of this rule must complete thirty hours of continuing education, including three hours of ethics, every three years to maintain certification under this rule.
(18) 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).
(19) Hearing aid dealer: license from Ohio state speech and hearing professionals board.
(20) Home health agency: license from Ohio department of health, and approved for medicare by CMS or a deeming organization approved by CMS.
(21) Hospice: license from Ohio department of health, and approved for medicare by CMS.
(22) Hospital: license from Ohio department of health no later than September 30, 2024, and approved for medicare by CMS or a deeming organization approved by CMS, or obtained CARF accreditation for rehabilitation hospitals. The following facility types are eligible to be credentialed and certified as hospitals: short-term general and specialty hospitals; long-term care hospitals; rehabilitation hospitals; and psychiatric hospitals; hospital (provider) based urgent care facilities or clinics as designated on the hospital's medicare cost report.
(23) Independent diagnostic testing facility (IDTF): approved for medicare by CMS.
(24) Laboratory: valid clinical laboratory improvement amendments (CLIA) certificate.
(25) Licensed professional clinical counselor (LPCC) or licensed professional counselor (LPC): license from Ohio counselor, social worker, and marriage and family therapist board.
(26) Licensed social worker (LSW) or licensed independent social worker (LISW): license from Ohio counselor, social worker, and marriage and family therapist board.
(27) Massage therapist: license from Ohio state medical board.
(28) Non-physician acupuncturist: license to practice acupuncture or certificate to practice as an oriental medicine practitioner from Ohio state medical board.
(29) Nursing home: license from Ohio department of health or approved for medicare by CMS.
(30) Ocularist: license from Ohio state vision professionals board.
(31) Occupational rehabilitation-comprehensive programs (work hardening): CARF accreditation.
(32) Occupational therapist: license from Ohio occupational therapy, physical therapy, and athletic trainers board.
(33) Optician: license from Ohio state vision professionals board.
(34) Optometrist: license from Ohio state vision professionals board.
(35) Orthotist, prosthetist or pedorthist: license from Ohio occupational therapy, physical therapy, and athletic trainers board.
(36) Physical therapist: license from Ohio occupational therapy, physical therapy, and athletic trainers board.
(37) Physician (M.D. or D.O.): license from Ohio state medical board.
(38) Physician assistant: certified by national commission on certification of physician assistants and license from Ohio state medical board.
(39) Podiatric physician (D.P.M.): license from Ohio state medical board.
(40) Psychologist: license from Ohio state board of psychology.
(41) Radiology services (free-standing) registration from the Ohio department of health and approved for medicare by CMS or a deeming organization approved by CMS.
(42) Residential care/assisted living facility: license from Ohio department of health.
(43) Sleep laboratory: certified by the American academy of sleep medicine and approved for medicare by CMS or a deeming organization approved by CMS.
(44) Speech-language pathologist: license from Ohio state speech and hearing professionals board.
(45) Traumatic brain injury (TBI) program: CARF accreditation for brain injury services (acute or post-acute).
(46) Urgent care facility (free standing): approved for medicare by CMS.
(47) Vocational rehabilitation case managers: certification for ABVE, occupational health nursing (COHN(S)), CRC, CDMS, certified vocational evaluator (CVE), certified rehabilitation nurse (CRRN), or CCM.
(48) 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)(47) 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)(47) 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 cannot be recertified for additional four-year periods.
Last updated April 15, 2024 at 8:31 AM
Supplemental Information
Amplifies: 4121.12, 4121.121, 4121.44, 4121.441, 4123.66
Five Year Review Date: 5/1/2025
Prior Effective Dates: 2/16/1996, 1/15/1999, 3/29/2002, 7/14/2003, 9/12/2004, 4/1/2007, 2/1/2010, 12/11/2012, 4/1/2014, 12/3/2015, 2/15/2018, 9/1/2020