Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-4 - Physician Services
Section 5160-4-02 - Healthcare services provided under supervision
Universal Citation: OH Admin Code 5160-4-02
Current through all regulations passed and filed through March 18, 2024
(A) Definitions that apply to this rule.
(1) "Independent
practitioner" is a practitioner who, under Ohio law, may provide
healthcare services without
supervision.
(2) "Non-independent
practitioner" is a practitioner who, under Ohio law, may provide
healthcare services only with
supervision.
(3) "Supervision" is a
collective term encompassing two types of professional oversight:
(a) A practitioner providing direct
supervision is present in the practice setting, although not necessarily in the
same room, and is immediately available to provide assistance and direction
throughout the provision of services. Neither availability by telephone nor
presence nearby outside the practice setting constitutes direct
supervision.
(b) A practitioner
providing general supervision is available, although not necessarily present in
the practice setting, to provide assistance and direction throughout the
provision of services. A practitioner who is not physically present
has the capability to provide
immediate consultation by communications device and can travel to the practice
setting quickly in case of emergency.
(B) Coverage. Payment may be made to the following practitioners only if the specified services are provided and the indicated conditions are met.
(1)
An independent practitioner, for a
service provided by a non-independent practitioner under general
supervision:
(a) The
non-independent practitioner functions in one of the following capacities:
(i) An employee of the supervising
independent practitioner or of the practice in which the supervising
independent practitioner participates; or
(ii) An independent contractor engaged by the
supervising independent practitioner through a written agreement;
(b) The professional control
exercised by the supervising independent practitioner or the practice of the
supervising independent practitioner is the same for both employees and
independent contractors; and
(c)
The service was provided in connection with a covered
healthcare service that represents an expense to the
practice of the supervising independent practitioner.
(2)
An independent practitioner, for a
service provided by a non-independent practitioner under direct supervision:
(a)
All of the
conditions specified in paragraph (B)(1) of this rule are met;
and
(b)
Either of the following conditions is met:
(i)
The supervising independent practitioner personally rendered a professional
service to initiate the course of treatment, to which the service performed by
the non-independent practitioner is incidental; or
(ii) The supervising
independent practitioner rendered subsequent services at a frequency indicating
continued participation in the management of the course of treatment.
(C) Constraints and limitations.
(1) Services provided by
an independent
practitioner who is employed by or under contract with
another independent practitioner are not subject to the supervision provisions
set forth in this rule.
(2) Nothing
in this rule constitutes an exemption either from the
fundamental principle that services rendered
are
within a practitioner's scope of licensure or practice or from any supervision
standard established in law, regulation, statute, or
rule.
(3) No separate payment
is
made for a professional service provided in a
nursing facility (NF), skilled nursing facility (SNF),
intermediate care facility for individuals with intellectual disabilities
(ICFIID), inpatient hospital, outpatient hospital, or hospital emergency
department by a non-independent practitioner employed by the
facility
or hospital, even if an independent practitioner ordered the service.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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