Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-8 - Therapeutic and Diagnostic Services
Section 5160-8-31 - Skilled therapy: providers
Universal Citation: OH Admin Code 5160-8-31
Current through all regulations passed and filed through September 16, 2024
(A) Rendering providers.
(1)
Independently practicing skilled therapists either must participate in the
medicare program or, if they limit their practice to pediatric treatment and do
not serve medicare beneficiaries, must meet all other requirements for medicare
participation.
(2)
The following eligible providers may render a physical
therapy service:
(a)
A physical therapist;
(b)
A physical
therapist assistant who is licensed to provide the particular service and who
provides the service to only one person at a time under the supervision of an
eligible provider;
(c)
A physical therapy student who is completing an
internship, if the following conditions are met:
(i)
The service is
provided under the supervision of the eligible provider responsible for the
patient's therapy;
(ii)
The eligible provider responsible for the patient's
therapy has face-to-face contact with the patient during provision of the
service;
(iii)
The eligible provider responsible for the patient's
therapy keeps on file official documentation of the internship, including the
beginning and ending dates; and
(iv)
The eligible
provider responsible for the patient's therapy includes in the patient's
medical record documentation that appropriate service was provided under
supervision, that the eligible provider checked and updated the medical record
at least once a week, and that all requirements for payment were met;
or
(d)
A mechanotherapist.
(3)
The following
eligible providers may render an occupational therapy service:
(a)
An occupational
therapist;
(b)
An occupational therapy assistant who is licensed to
provide the particular service and who provides the service to only one person
at a time under the supervision of an eligible provider; or
(c)
An occupational
therapy student who is completing an internship, if the following conditions
are met:
(i)
The service is provided under the supervision of the eligible provider
responsible for the patient's therapy;
(ii)
The eligible
provider responsible for the patient's therapy has face-to-face contact with
the patient during provision of the service;
(iii)
The eligible
provider responsible for the patient's therapy keeps on file official
documentation of the internship, including the beginning and ending dates;
and
(iv)
The eligible provider responsible for the patient's
therapy includes in the patient's medical record documentation that appropriate
service was provided under supervision, that the eligible provider checked and
updated the medical record at least once a week, and that all requirements for
payment were met.
(4)
The following
eligible providers may render a speech-language pathology service:
(a)
A
speech-language pathologist;
(b)
A
speech-language pathology aide who is licensed to provide the particular
service and who provides the service to only one person at a time under the
supervision of an eligible provider;
(c)
A
speech-language pathology student who is completing an internship, if the
following conditions are met:
(i)
The service is provided under the supervision of the
eligible provider responsible for the patient's therapy;
(ii)
The eligible
provider responsible for the patient's therapy has face-to-face contact with
the patient during provision of the service;
(iii)
The eligible
provider responsible for the patient's therapy keeps on file official
documentation of the internship, including the beginning and ending dates;
and
(iv)
The eligible provider responsible for the patient's
therapy includes in the patient's medical record documentation that appropriate
service was provided under supervision, that the eligible provider checked and
updated the medical record at least once a week, and that all requirements for
payment were met; or
(d)
A person holding
a conditional license to practice speech-language pathology, if the eligible
provider supervising the professional experience keeps on file a copy of the
conditionally-licensed speech-language pathologist's plan of supervised
professional experience, required by section
4753.071 of the Revised
Code.
(5)
The following eligible providers may render an
audiology service:
(a)
An audiologist;
(b)
An audiology
aide who is licensed to provide the particular service and who provides the
service to only one person at a time under the supervision of an eligible
provider;
(c)
An audiology student who is completing an internship,
if the following conditions are met:
(i)
The student
provides the service under the supervision of the eligible provider responsible
for the patient's therapy;
(ii)
The eligible
provider responsible for the patient's therapy has face-to-face contact with
the patient during provision of the service;
(iii)
The eligible
provider responsible for the patient's therapy keeps on file official
documentation of the internship, including the beginning and ending dates;
and
(iv)
The eligible provider responsible for the patient's
therapy includes in the patient's medical record documentation that appropriate
service was provided under supervision, that the eligible provider checked and
updated the medical record at least once a week, and that all requirements for
payment were met; or
(d)
An audiology
student who is completing an externship, if the following conditions are
met:
(i)
The
service is provided under the supervision of the eligible provider responsible
for the patient's therapy; and
(ii)
The eligible
provider responsible for the patient's therapy keeps on file official
documentation of the externship, including the beginning and ending
dates.
(B) Billing ("pay-to") providers.
(1)
The following eligible providers may receive medicaid
payment for submitting a claim for a skilled therapy service on behalf of a
rendering provider:
(a)
A hospital, rules for which are set forth in Chapter
5160-2 of the Administrative Code;
(b)
A provider of
physician services, rules for whom are set forth in Chapter 5160-4 of the
Administrative Code;
(c)
A professional medical group;
(d)
An ambulatory
health care clinic, rules for which are set forth in Chapter 5160-13 of the
Administrative Code;
(e)
A rural health clinic, rules for which are set forth
in Chapter 5160-16 of the Administrative Code;
(f)
A federally
qualified health center, rules for which are set forth in Chapter 5160-28 of
the Administrative Code; or
(g)
An outpatient
health facility, rules for which are set forth in Chapter 5160-29 of the
Administrative Code.
(2)
The following
eligible providers may receive medicaid payment either for rendering a skilled
therapy service themselves or for submitting a claim for a skilled therapy
service on behalf of a rendering provider:
(a)
A skilled
therapist; or
(b)
A mechanotherapist.
Replaces: Part of 5160-8-01, part of 5160-8-02, part of 5160-8-03, part of 5160-34- 01.2
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