4123-6-02.2 Provider access to the HPP - provider credentialing criteria.

 

 

 

4123-6-02.2                 Provider access to the HPP - provider credentialing criteria.

 

 

 

(A)   The bureau shall establish minimum credentialing criteria for providers to qualify for participation in the HPP. 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 shall qualify as a provider under this rule in that state.

 

(B)    The minimum credentials 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, or that are related to chemical dependency or substance abuse.

 

(2)   Meet other general certification requirements for the specific provider type, as provided in paragraph (C) of this rule.

 

(3)   Possess a current and unrestricted drug enforcement agency registration, unless it is not required by the provider's discipline and scope of practice.

 

(4)     Be currently eligible for participation in medicare, medicaid or the Ohio workers' compensation system.

 

(5)   Not have a history of a felony conviction in any jurisdiction, a conviction under a federal controlled substance act, a conviction for an act involving dishonesty, fraud, or misrepresentation, a conviction for a misdemeanor committed in the course of practice, or court supervised intervention or treatment in lieu of conviction pursuant to section 2951.041 of the Revised Code or the equivalent law of another state.

 

(6)    Provide proof of and maintain adequate, current professional malpractice and liability insurance. The bureau shall establish the appropriate amount of such insurance coverage for each provider type. In establishing the appropriate amount of insurance coverage for out of state providers, the bureau may consider the regulations or the community standards of the provider's state of practice.

 

(7)    Provide documentation of the provider's malpractice history for the previous five years.

 

(8)    Not have any outstanding provider overpayment or other indebtedness to the bureau which has been certified to the attorney general for collection.

 

 

(9) Provide proof of and maintain workers' compensation coverage to the extent required under Ohio law or the equivalent law of another state, as applicable.

(10) Not have been excluded or removed from participation in other health plans for cause, or have lost hospital privileges for cause.

(C)   The following minimum credentials apply to the providers listed below as provided in this rule.

(1)    Air Ambulance, ambulette, or air ambulance, transport operator service: FAA pilot license; air ambulance, treating attendant: certified paramedic with basic life support training license from Ohio medical transportation board if private; medicare participation if government/public.

(2)       Ambulance service: license from state ambulance board or medicare certification Ambulatory surgical center: license from Ohio department of health and medicare participation.

(3)    Ambulatory surgical facility: license from Ohio department of health Athletic trainer: license from Ohio occupational therapy, physical therapy, and athletic trainer board.

(4)    Athletic trainer: licensed by the Ohio occupational therapy, physical therapy, and athletic trainer board Audiologist: license from Ohio board of speech-language pathology and audiology.

(5)     Audiologist: license from state board of speech pathology and audiology; CCC-A certificate of clinical competence in audiology Alcohol and drug counseling clinic: certified by Ohio department of alcohol and drug addiction services to administer outpatient counseling.

(6)     Alcohol and drug counseling clinic: certified with the state department of alcohol and drug addiction services to administer outpatient counseling Dentist: license from Ohio state dental board.

(7)      Dialysis center: license from Ohio department of health and medicare certification participation.

(8)      Durable medical equipment supplier, excludes orthotics, prosthetics and pedorthics state vendors license, medicare certification participation, or joint commission on accreditation of healthcare organization ("JCAHO") accreditation.

(9)    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).

(10)   Hearing aid dealer: license required by state from Ohio hearing aid dealers and fitters licensing board.

(11)   Home health agency: medicare certification participation, joint commission on accreditation of healthcare organization (JCAHO) accreditation, or community health accreditation program (CHAP) accreditation.

(12)   Hospital: approved by health care financing administration (HCFA) the centers for medicare and medicaid services (CMS) for medicare, title XVIII of the Social Security Act; obtained national accreditation (joint commission on accreditation of healthcare organization (JCAHO), or American osteopathic association (AOA) accreditation healthcare facilities accreditation program (HFAP), or commission on accreditation of rehabilitation facilities (CARF) for rehabilitation hospitals).

(13)    Independent Licensed social worker or licensed independent social worker (ISW) (LSW) or (LISW): licensed by the license from Ohio counselor and social worker board.

(14)   Laboratory: valid licensing from clinical laboratory improvement amendment (CLIA); acceptable error rates.

(15)   Massage therapist: certified by the Ohio state medical board.

(16)    Non-physician acupuncturist: certificate of registration from the Ohio state medical board.

(17)   Certified registered nurse anesthetist (CRNA): certified by the national council on certification of nurse anesthetists or other certifying agency recognized by the state nursing Ohio board of nursing.

(18)    Certified nurse practitioner: certified by the American nurses credentialing center or other certifying agency recognized by the state nursing Ohio board

of nursing.

(19)   Clinical nurse specialist: certified by the American nurses credentialing center or other certifying agency recognized by the state nursing Ohio board of nursing.

(20)   Nursing home: medicaid certification or state license from Ohio department of health.

(21)      Occupational therapist: licensed by the license from Ohio occupational therapy, physical therapy, and athletic trainer board.

(22)   Optician: licensed by the state license from Ohio optical dispensers board.

(23)   Optometrist: must be a doctor of optometry, licensed by the state license from Ohio board of optometry; therapeutic certification to prescribe drugs (if applicable to practice).

(24)    Orthotist, prosthetist or pedorthist: licensed by the license from Ohio state board of orthotics, prosthetics and pedorthics.

(25)      Physical therapist: licensed by license from Ohio occupational therapy, physical therapy, and athletic trainer board.

(26)    Physician assistant: certified by the national commission on certification of

physician assistants, and certified by state medical board.

certificate of registration from Ohio

(27) Physician (M.D. or D.O.): license from Ohio state medical board.

(28) Chiropractic physician (D.C.): license from Ohio state chiropractic board.

(29) Podiatric physician (D.P.M.): license from Ohio state medical board.

(27)(30) Professional Licensed professional clinical counselor (PCC) or (LPCC) or licensed professional counselor (LPC): licensed by the license from Ohio counselor and social worker board.

(28)(31) Professional counselor (PC) or (LPC): licensed by the Ohio counselor and social worker board Psychologist: license from Ohio state board of psychology.

(29)(32) Radiology services (free-standing) state licensing, registration or accreditation; (mobile) state, county or city registration, or medicare participation or medicaid certification.

(30)(33)  Residential  care/assisted  living  facility:  medicaid  certification  or  state license from Ohio department of health.

(31) Social worker (SW) or (LSW): licensed by the Ohio counselor and social worker board.

(32)(34)  Speech  pathologist:  licensed  by  the  state license from Ohio board of speech pathology and audiology.

(33)(35)  Traumatic  brain  injury  (TBI)  program:  CARF  accreditation  for  brain injury services (acute or post-acute).

(34)(36) Vocational/medical rehabilitation case managers: certification for occupational health nursing (COHN(S)), certified rehabilitation counselor (CRC), or certified disability management specialist (CDMS), certified vocational evaluator (CVE), certified rehabilitation nurse (CRRN), or certified case manager (CCM).

(35)(37) 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)(34)(36) 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)(34) (36) 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 may not be recertified for additional four-year periods.

(36)(38) Comprehensive pain management services program category one or two: (free standing) CARF accreditation or compliance with rule 4123-6-02.21 of the Administrative Code; (hospital based) CARF or JCAHO accreditation.

(37)(39)  Occupational  rehabilitation  programs  category  one  or  two:  CARF accreditation.

Effective:	04/01/2007
R.C. 119.032 review dates:	03/01/2009
CERTIFIED ELECTRONICALLY
Certification
03/19/2007
Date
Promulgated Under:	119.03
Statutory Authority:	4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Rule Amplifies: Prior Effective Dates:	4121.121, 4121.44, 4121.441, 4123.66 2/16/96; 1/15/99; 3/29/02; 7/14/03; 9/12/04