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

 

 

 

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

 

 

 

(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:                                                             10/01/2016

Five Year Review (FYR) Dates:                         10/01/2021

CERTIFIED ELECTRONICALLY
Certification
09/19/2016
Date
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