4123-6-022 Provider access to the HPP - provider credentialing criteria

(A) The bureau shall establish minimum credentialing criteria for providers to qualify for participation in the HPP. Providers must meet all licensing, certification, or accreditation requirements necessary to provide services in Ohio. A provider licensed, certified or accredited pursuant to the equivalent law of another state shall qualify as a provider under this rule in that state.

(B) The minimum credentials for a provider, where applicable based upon the type of provider, are as follows. The provider must:
(1) Be currently licensed to practice, as applicable.
(2) Meet other general certification requirements for the specific provider type, as provided in paragraph (C) of this rule.
(3) Possess a current and valid Drug Enforcement Agency registration, unless it is not required by the provider's discipline and scope of practice.
(4) Not have a previous administrative termination from participation in Medicare, Medicaid or the Ohio workers' compensation system.
(5) Not have a felony conviction in any jurisdiction, a conviction under a federal controlled substance act, or a conviction for an act involving dishonesty, fraud, or misrepresentation.
(6) Provide proof of adequate, current professional malpractice and liability insurance.

(C) The following minimum credentials apply to the providers listed below as provided in this rule.
(1) Air ambulance, transport operator: FAA pilot license; air ambulance, treating attendant: certified paramedic with basic life support training.
(2) Ambulance service: license from state ambulance board; certified in paramedic training in, at least, basic life support.
(3) Ambulatory surgical facility: license from Ohio Department of Health.
(4) Audiologist: license from state board of speech pathology and audiology; CCC-A certificate of clinical competence in audiology.
(5) Alcohol and drug counseling clinic: certified with the state Department of Alcohol and Drug Addiction Services to administer outpatient counseling.
(6) Dialysis center: Medicare certification.
(7) Durable medical equipment supplier, excludes orthotics and prosthetics: proof of being able to service the medical equipment supplied.
(8) Hearing aid dealer: license required by state hearing aid dealers and fitters board.
(9) Home health agency: Medicare certification.
(10) Hospital: approved by Health Care Financing Administration (HCFA) for Medicare, title XVIII of the Social Security Act; obtained national accreditation (Joint Commission on Accreditation of Health Care Organization (JCAHO), or American Osteopathic Association (AOA) accreditation, or Commission on Accreditation of Rehabilitation Facilities (CARF) for rehabilitation hospitals).
(11) Laboratory: valid licensing from clinical laboratory improvement amendment (CLIA); acceptable error rates.
(12) Certified registered nurse anesthetist (CRNA): certified by the American Association of Nurse Anesthetists (AANA).
(13) Nursing home: Medicaid certification.
(14) Occupational therapist: licensed by the Ohio occupational therapy, physical therapy, and athletic trainer board.
(15) Optician: licensed by the state optical dispensers board.
(16) Optometrist: must be a doctor of optometry, licensed by the state board of optometry; therapeutic certification to prescribe drugs (if applicable to practice).
(17) Orthotist: custom-fit BOC certification or other applicable credentials; custom-fit and custom-fabricated ABC certification in orthotics.
(18) Pharmacy: licensed by the Ohio state board of pharmacy; electronic point of sale eligibility.
(19) Physical therapist: licensed by Ohio occupational therapy, physical therapy, and athletic trainer board.
(20) Prosthetist: ABC certification in prosthetics.
(21) Radiology services (free-standing): state licensing; accreditation.
(22) Speech pathologist: licensed by the state board of speech pathology and audiology.
(23) Traumatic brain injury (TBI) program: CARF accreditation for brain injury services (acute or post-acute).
(24) Vocational/medical case managers: certification for occupational health nursing (COHN(S)), certified rehabilitation counselor (CRC), or certified insurance rehabilitation specialist (CIRS), certified vocational evaluator (CVE) or certified rehabilitation nurse (CRRN), or intern for such classifications as provided by the bureau.
(25) Comprehensive pain management services program category one or two: CARF accreditation.
(26) Occupational rehabilitation programs category one or two: CARF accreditation.

Effective date: Feb. 16, 1996