Rule 5160-1-80 | Substitute practitioners (locum tenens).
(1) "Practitioner," for purposes of this rule, is a collective term for the following professionals:
(a) Doctor of medicine or osteopathy;
(b) Advanced practice registered nurse;
(e) Podiatrist; or
(2) "Regular practitioner" is a practitioner enrolled in the Ohio medicaid program who regularly takes care of an individual's health care needs.
(3) "Substitute practitioner" is a practitioner who generally does not maintain an individual practice and who works in place of a regular practitioner when the regular practitioner is absent;
(B) Coverage and limitations. Payment may be made for services rendered by a substitute practitioner only when the following conditions are met:
(1) Both the regular practitioner and the substitute practitioner are professionals listed in paragraph (A)(1) of this rule;
(2) The regular practitioner is expected to be absent for a period of not longer than sixty days unless there are extenuating circumstances (e.g., active duty in the armed forces, pregnancy, extended illness);
(3) The substitute practitioner has the status of an independent contractor rather than of an employee;
(4) The substitute practitioner meets the applicable provider screening requirements described in rule 5160-1-17.8 of the Administrative Code;
(5) The substitute practitioner has not been sanctioned under medicare, medicaid, or Title XX and is not otherwise prohibited from providing services to medicare, medicaid, or Title XX beneficiaries; and
(6) The substitute practitioner receives payment from the regular practitioner as a fixed amount per diem or on a similar fee-for-time basis.
Last updated October 2, 2023 at 8:23 AM