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Ohio Administrative Code (Last Updated: January 12, 2021) |
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5160 Medicaid |
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Chapter5160-27. Community Mental Health Agency Services |
5160-27-01. Eligible provider for behavioral health services
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(A) An "eligible behavioral health provider" for purposes of this chapter is a provider of a mental health or substance use disorder treatment service covered in agency 5160 of the Administrative Code and is one of the following:
(1) An entity meeting the certification requirements set forth in section 5119.36 of the Revised Code and Chapters 5122-24 to 5122-29 and Chapter 5160-1 of the Administrative Code and providing mental health or substance use disorder treatment services.
(2) An entity furnishing mental health and/or substance use disorder services operating in a bordering state and meeting the requirements set forth in rule 5160-1-11 of the Administrative Code. The entity must be an eligible and enrolled provider with the state medicaid agency in the state where the entity operates.
(3) Physician, or physician assistant, licensed by the state of Ohio medical board and practicing according to agency 4731 and agency 4730 of the Administrative Code respectively and Chapter 5160-4 of the Administrative Code, or a clinical nurse specialist or certified nurse practitioner, licensed by the Ohio board of nursing and practicing according to agency 4723 of the Administrative Code. The practitioner must be an employee or an independent contractor of an entity meeting the requirements set forth in paragraph (A)(1) or (A)(2) of this rule.
(4) Registered nurse or licensed practical nurse licensed by the Ohio board of nursing and practicing according to agency 4723 of the Administrative Code. The nurse must be an employee or an independent contractor of an entity meeting the requirements set forth in paragraph (A)(1) or (A)(2) of this rule. A registered nurse or licensed practical nurse must work under an order authorized by one of the practitioners listed in paragraph (A)(3) of this rule, except when a registered nurse performs a nursing regimen in accordance with section 4723.01 of the Revised Code or rule 5160-27-11 of the Administrative Code.
(5) A licensed practitioner meeting the requirements stated in rule 5160-8-05 of the Administrative Code and is an employee or an independent contractor of an entity meeting the requirements set forth in paragraph (A)(1) or (A)(2) of this rule.
(6) An unlicensed practitioner meeting the following requirements as applicable:
(a) An unlicensed practitioner providing mental health services who holds a valid high school diploma or equivalent and has both work experience and training related to the service(s) being provided, and is an employee or an independent contractor of an entity meeting the requirements set forth in paragraph (A)(1) or (A)(2) of this rule. These practitioners must operate under the general supervision of one of the practitioners listed in paragraphs (E)(1) to (E)(10) of this rule, in accordance with paragraph (D)(2)(b) of rule 5160-8-05 of the Administrative Code.
(b) An unlicensed practitioner providing substance use disorder services must operate under the general supervision, in accordance with paragraph (D)(2)(b) of rule 5160-8-05 of the Administrative Code, of one of the practitioners listed in paragraphs (E)(1) to (E)(10) of this rule, be an employee or an independent contractor of an entity meeting the requirements set forth in paragraph (A)(1) or (A)(2) of this rule, and be one of the following provider types:
(i) A chemical dependency counselor assistant certified by the Ohio chemical dependency professionals board and practicing according to rule 5160-8-05 of the Administrative Code.
(ii) A peer recovery supporter meeting all of the following requirements:
(a) Certified as a peer recovery supporter by the Ohio department of mental health and addiction services.
(b) Be eighteen years of age or older and have a high school diploma or equivalent.
(iii) A care management specialist meeting the following requirements:
(a) Be eighteen years of age or older and have a high school diploma or equivalent.
(b) Have an understanding of substance use disorder treatment and recovery including how to engage a person in treatment and recovery.
(c) Have an understanding of health care systems, social service systems, and the criminal justice system.
(B) All practitioners shall practice within their professional scope of practice.
(C) Supervisors shall ensure that individuals whom they supervise meet the appropriate education and training qualifications for the service(s) they render.
(D) Provider agencies shall have an active provider agreement with the Ohio department of medicaid.
(E) The following practitioners shall have an active provider agreement with the Ohio department of medicaid:
(1) Physician.
(2) Physician assistant.
(3) Certified nurse practitioner.
(4) Clinical nurse specialist.
(5) Psychologist.
(6) Board licensed school psychologist.
(7) Licensed independent social worker.
(8) Licensed professional clinical counselor.
(9) Licensed independent marriage and family therapist.
(10) Licensed independent chemical dependency counselor.
(11) Licensed practical nurse.
(12) Registered nurse.
(F) An eligible provider meeting the requirements set forth in paragraph (A)(1) or (A)(2) of this rule must ensure that all contact information for their business including all physical locations where services are rendered are listed correctly in the medicaid information technology system (MITS) and updated within thirty days of any change in operations.