Current through all regulations passed and filed through September 16, 2024
(A)
Unless otherwise
noted, any limitations or requirements specified in the Revised Code or in
agency 5160 of the Administrative Code apply to services addressed in this
rule.
(B)
This rule does not apply to federally qualified health
centers (FQHCs) nor to rural health clinics (RHCs), policies for which are set
forth in Chapter 5160-28 of the Administrative Code.
(C)
Definition.
"Clinic" is an entity that meets all of the following criteria:
(1)
It renders
healthcare services on an outpatient basis under the direction of a physician
or dentist.
(2)
It operates from a fixed location, a specifically
designed mobile unit, or both.
(3)
It is
freestanding administratively, organizationally, and financially independent of
an institution such as a hospital or long-term care facility. It may be
physically located in a hospital or long-term care facility so long as it
remains independent.
(4)
It does not provide overnight
accommodations.
(D)
The following
entities that meet the definition of a clinic may enroll with the Ohio
department of medicaid (ODM) as a clinic provider:
(1)
A dialysis
center, defined as a "dialysis facility" in
42 C.F.R.
494.10 (October 1, 2022), that meets the
following criteria:
(a)
It is recognized by medicare as a dialysis
facility;
(b)
It operates in accordance with Chapter 3701-83 of the
Administrative Code or, if it is located outside of Ohio, operates in
accordance with its respective state's authority; and
(c)
It provides
services in accordance with rule
5160-13-02 of the Administrative
Code;
(2)
A family planning clinic that meets the following
criteria:
(a)
It is a public or nonprofit organization;
(b)
It complies with
federal guidelines set forth in 42 C.F.R. Part 59 (October 1,
2022);
(c)
It is qualified to receive funding for pregnancy
prevention services through Title X of the Public Health Services Act;
and
(d)
It provides pregnancy prevention services in accordance
with Chapter 5160-21 of the Administrative Code;
(3)
An outpatient
rehabilitation clinic that delivers rehabilitation services at a
medicare-certified rehabilitation agency, defined in
42 C.F.R.
485.703 (October 1, 2022), or at a
medicare-certified comprehensive outpatient rehabilitation facility (CORF),
defined in 42 C.F.R.
485.51 (October 1, 2022);
(4)
A primary care
clinic that meets either of the following criteria:
(a)
It receives state
or federal grant funds for the provision of health services; or
(b)
It is an
accredited provider of primary care services as recognized by one of the
following entities:
(i)
The joint commission;
(ii)
The
accreditation association for ambulatory health care (AAAHC);
(iii)
The healthcare
facilities accreditation program of the American osteopathic association (AOA);
or
(iv)
The community health accreditation program
(CHAP);
(5)
A professional
dental school clinic associated with an accredited dental
school;
(6)
A professional optometry school clinic associated with
an accredited optometry school;
(7)
A public health
department clinic that meets the following criteria:
(a)
It has legal
status as a local health department created by a city health district, a
general health district, or a combined health district in accordance with
Chapter 3709. of the Revised Code; and
(b)
It meets the
standards set forth under the authority of section
3701.342 of the Revised Code;
or
(8)
A speech-language-audiology clinic that specializes in
and provides speech, language, or audiology services delivered by professionals
who meet the American speech-language-hearing association (ASHA) certification
standards as determined by ASHA.
(E)
Payment for a
covered service furnished in a clinic is made in accordance with the chapter or
rule of agency 5160 of the Administrative Code that pertains to that
service.
Replaces: 5160-13-01
