5160-28-03.3. Cost-based clinics: RHC services, co-payments, and limitations  


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  • (A) A rural health clinic (RHC) may be paid on a per-visit basis for providing any of the following services:

    (1) Services that are rendered by a physician, physician assistant, or advanced practice registered nurse employed by or otherwise compensated by the RHC;

    (2) Mental or behavioral health services, including therapy and testing, that meet one of the following criteria:

    (a) They are provided by a clinical psychologist or advanced practice registered nurse certified by a national organization in the specialty of psychiatry; or

    (b) They are provided by a clinical social worker, professional counselor, or professional clinical counselor;

    (3) Services provided under supervision that would be covered if they were rendered by a physician or an advanced practice registered nurse; or

    (4) Visiting nurse services if four conditions are satisfied:

    (a) The service site is located in an area in which the United States secretary of health and human services (HHS) has determined that there is a shortage of home health agencies;

    (b) The services are furnished by either a registered nurse or a licensed practical nurse employed by or under contract with the RHC;

    (c) The services are furnished to a homebound individual; and

    (d) The services are furnished under a written plan of treatment that is established by a supervising physician of the RHC or a physician, physician assistant, or advanced practice registered nurse, is signed by a supervising physician of the RHC or a physician, physician assistant, or advanced practice registered nurse, and is reviewed at least every sixty days by a supervising physician of the RHC.

    (B) An RHC may be required to enroll separately in medicaid as another type of provider and to use a non-RHC medicaid provider number in order to receive separate payment for a service or supply that cannot be claimed as an RHC service under paragraph (A) of this rule.

    (C) Co-payments may be established in accordance with rule 5160-1-09 of the Administrative Code for services rendered by an RHC. Co-payments for services rendered to managed care enrollees are applied in accordance with Chapter 5160-26 of the Administrative Code.

Replaces: 5160-16-02, part of 5160-16-03


Effective: 10/1/2016
Five Year Review (FYR) Dates: 10/01/2021
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.20, 5164.02
Prior Effective Dates: 04/01/1980, 06/01/1991, 07/01/2001, 08/01/2001, 07/01/2006