Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-11 - Independent Laboratory and X-Ray Services
Section 5160-11-31 - Independent diagnostic testing facility (IDTF) services
Universal Citation: OH Admin Code 5160-11-31
Current through all regulations passed and filed through September 16, 2024
(A) Providers.
(1)
An entity may enroll in medicaid as an independent
diagnostic testing facility (IDTF) only if it meets the following
criteria:
(a)
It
meets all standards set forth in and provide services in accordance with
42 C.F.R.
410.33 (October 1, 2020);
(b)
It takes the
following measures to establish accountability:
(i)
It ensures that
each supervising practitioner attests in writing, at the time of the initial
application and at each renewal of the Ohio medicaid provider agreement, that
one of two statements is true:
(a)
The practitioner owns the facility, in whole or in
part, and employs the operating personnel; or
(b)
The practitioner
works for the facility either as an employee (full-time or part-time) or under
contract and has responsibilities that include checking the procedure and
quality control manuals; observing the performance of operators or technicians;
verifying that the equipment and personnel meet applicable conditions for
federal, state, and local licensure and registration; and ensuring that safe
operating procedures and quality control procedures are used;
(ii)
It
maintains and updates procedure and quality control manuals;
and
(iii)
It keeps all records of quality control must be kept
for the period of time specified in rule
5160-1-17.2 of the
Administrative Code; and
(c)
It performs only
procedures that are not subject to the "Clinical Laboratory Improvement
Amendments of 1988" (CLIA, Pub. L. No. 100-578,
42 U.S.C.
263a as in effect on January 1,
2021).
(2)
An entity that owns both an IDTF and an independent
laboratory should enroll them as discrete Ohio medicaid
providers.
(3)
An entity may enroll in medicaid as a mammography
supplier (a facility or an entity established solely for the provision of
mammography services) only if it meets the following criteria:
(a)
It participates
in medicaid as an IDTF; and
(b)
It complies with
the conditions set forth in
42
C.F.R. 410.34 (October 1,
2020).
(B) Coverage. Provisions affecting payment for radiology services are set forth in rule 5160-4-25 of the Administrative Code.
(C) Claim payment.
(1)
No separate
payment is made to an IDTF that performs a procedure in a hospital setting.
Instead, the provider makes payment arrangements directly with the
participating hospital.
(2)
For a covered global radiology procedure and its
professional and technical components, the medicaid maximum payment amounts are
indicated in appendix DD to rule
5160-1-60 of the Administrative
Code.
Replaces: 5160-11- 03.3, part of 5160-11-01, part of 5160-11-02, part of 5160-11-09
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