Ohio Admin. Code 4123-6-02.2 - Provider access to the HPP - provider certification criteria
(A) The bureau
shall establish minimum criteria for provider certification. 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. However, if an
individual
a provider will be ineligible to
participate in the health partnership program if:
(1)
The state of Ohio
has denied the provider's application for a professional license or the
provider's professional license in Ohio is under revocation or suspension;
or
(2)
The provider's professional license
is under revocation or suspension in any state,
or is subject to disciplinary restrictions in any state that affect the provider's ability to
treat patients or that compromise patient care, the
provider shall be ineligible to participate in the health partnership
program.
(B)
The minimum criteria for a provider, where applicable based upon the type of
provider, are as follows. The provider shall:
(1) Be currently licensed to practice, as
applicable, without disciplinary restrictions that affect the provider's
ability to treat patients or that compromise patient care, including, but not limited to, disciplinary restrictions
related to chemical dependency or substance abuse.
(2) Meet other general certification
requirements for the specific provider type, as provided in paragraph (C) of
this rule.
(3) Possess a current
and unrestricted drug enforcement agency registration, unless it is not
required by the provider's discipline and scope of practice.
(4) Not be currently excluded from
participation in medicare or Ohio medicaid for
cause.
(5) Not
have a history of a felony conviction in any
jurisdiction, a conviction under a federal controlled substance act, a
conviction for an act involving dishonesty, fraud, or misrepresentation, a
conviction for a misdemeanor committed in the course of practice or involving
moral turpitude, or court supervised intervention or treatment in lieu of
conviction pursuant to section 2951.041 of the Revised Code or the equivalent
law of another state
be currently ineligible
to participate in the health partnership program due to the provider having
been convicted of or pleaded guilty to a criminal offense as set forth in the
appendix to this rule .
(6)
Attest to and maintain adequate, current
professional malpractice and liability insurance, and provide proof of such
coverage to BWC upon request. The bureau shall
establish the appropriate amount of such insurance coverage for each provider
type. In establishing the appropriate amount of insurance coverage for out of
state providers, the bureau may consider the regulations or the community
standards of the provider's state of practice.
(7) Provide documentation of the provider's
malpractice history for the previous five years.
(8) Not have any outstanding provider
overpayment or other indebtedness to the bureau which has been certified to the
attorney general for collection.
(9) Provide proof of and maintain workers'
compensation coverage to the extent required under Ohio law or the equivalent
law of another state, as applicable.
(10) Not have been excluded or removed from
participation in other health plans for cause,
.
or
(11)
Not have
lost hospital privileges for cause.
(C) The following minimum credentials apply
to the providers listed below as provided in this rule.
(46)
(45)
Traumatic brain injury (TBI) program: CARF accreditation for brain injury
services (acute or post-acute).
(47)
(46) Urgent care
facility (free standing): approved by the centers
for medicare and medicaid services (CMS) for medicare.
(48)
(47) Vocational
rehabilitation case managers: certification for American board of vocational experts (ABVE), occupational health nursing (COHN(S)),
certified rehabilitation counselor
(CRC), certified disability management specialist
(CDMS), certified vocational
evaluator (CVE), certified rehabilitation nurse (CRRN), or
certified case manager (CCM).
(49)
(48) Vocational
rehabilitation case management interns:
(1) Adult day care facility: Ohio department
of aging PASSPORT adult day care provider agreement.
(2) Alcohol and drug counseling clinic:
certified by Ohio department of mental health and addiction services.
(3) Ambulance, ambulette, or air ambulance
service: license from Ohio medical transportation board if private; approved by
the centers for medicare and medicaid services (CMS) for medicare if
government/public.
(4) Ambulatory
surgical center: license from Ohio department of health and approved by
the centers for medicare and medicaid services
(CMS) for medicare.
(5) Anesthesiologist assistant:
certificate of registration
license from Ohio state medical board.
(6) Athletic trainer: license from Ohio
occupational therapy, physical therapy, and athletic trainers board.
(7) Audiologist: license from Ohio state
speech and hearing professionals board.
(8) Certified nurse practitioner: license
from Ohio board of nursing and certified by American nurses credentialing
center or other certifying agency approved by the Ohio board of nursing.
(9) Certified registered nurse
anesthetist (CRNA): license from Ohio board of nursing and certified by
national council on certification of nurse anesthetists or other certifying
agency approved by the Ohio board of nursing.
(10) Certified shoe retailer: certified by
pedorthic footwear association.
(11) Chiropractic physician (D.C.): license
from Ohio state chiropractic board.
(12) Clinical nurse specialist: license from
Ohio board of nursing and certified by American nurses credentialing center or
other certifying agency approved by the Ohio board of nursing.
(13) Comprehensive pain management services
program: (free standing) commission on accreditation of
rehabilitation facilities CARF accreditation; (hospital based) CARF or
joint commission accreditation.
(14) Dentist: license from Ohio state dental
board.
(15) Dialysis center:
license from Ohio department of health and approved by
the centers for medicare and medicaid services
(CMS) for medicare
or an accrediting organization approved by
CMS .
(16) Durable medical
equipment supplier (excludes orthotics, prosthetics and pedorthics): approved
by the centers for medicare and medicaid services
(CMS) for medicare and state of
Ohio board of pharmacy home medical equipment certificate of
registration.
(17) Employment
specialist (may provide job placement, job
development, job seeking skills training, job club, and job coach services
only):
(a)
(i) Certification for American board of
vocational experts (ABVE), certified rehabilitation counselor (CRC), certified
case manager (CCM), certified employment support
professional (CESP), certification for individual placement and support
(CIPS), global career development facilitator (GCDF), associate certified
coach (ACC), professional certified coach (PCC), master certified coach (MCC),
certified disability management specialist (CDMS), or
commission on accreditation of rehabilitation
facilities (CARF) accreditation
for employment and community services in job development or employment
supports; or
(ii) Evidence of
completion of three or more courses, seminars or workshops prior to application
for certification, totaling a minimum of eighty hours and approved by the
bureau or by an entity offering a certification referenced in paragraph
(C)(17)(a)(i) of this rule, in at least two of the following domain areas: job
development, job placement, and career and lifestyle development; vocational
consultation and services for employers; professional roles and practices,
ethics, and utilization of community resources; or
(iii) Evidence of bureau reimbursement to the
provider for job placement, job development, job seeking skills training, job
club, and/or job coaching services to injured workers for dates of service
beginning not less than eighteen months prior to April 1, 2014.
However, if the provider has been certified pursuant to
this provision and the provider's certification subsequently lapses, the
provider must thereafter meet the criteria of paragraph (B)(17)(a)(i) or
paragraph (B)(17)(a)(ii) of this rule for certification or
recertification.
(b) Employment specialists certified pursuant
to paragraph (C)(17)(a)(ii) or (C) (17)(a)(iii) of this rule must complete
twenty
thirty
hours of continuing education, including three hours of ethics, every
two
three
years to maintain certification under this rule.
(18) Ergonomist: certification for certified
professional ergonomist (CPE), certified human factors professional (CHFP),
associate ergonomics professional (AEP), associate human factors professional
(AHFP), certified ergonomics associate (CEA), certified safety professional
(CSP) with "ergonomics specialist" designation, certified industrial ergonomist
(CIE), certified industrial hygienist (CIH), assistive technology practitioner
(ATP), or rehabilitation engineering technologist (RET).
(19) Hearing aid dealer: license from Ohio
state speech and hearing professionals board.
(20) Home health agency: approved by
the centers for medicare and medicaid services
(CMS) for medicare, joint commission accreditation, or community health
accreditation program (CHAP) accreditation, or
accreditation through an
accrediting organization
that has been granted deeming authority
approved by the
centers for medicare and medicaid services (CMS).
(21)
Hospice: license from Ohio department of health, and approved by
the centers for medicare and medicaid services
(CMS) for medicare or medicaid
certification.
(22) Hospital:
approved by the centers for medicare and medicaid
services (CMS) for medicare
or an accrediting organization approved by CMS,
or obtained national
CARF accreditation (joint commission accreditation, or American osteopathic
association healthcare facilities accreditation program (HFAP), or commission
on accreditation of rehabilitation facilities (CARF) for
rehabilitation hospitals). The following
facility types shall be credentialed and certified as hospitals: short-term
general and specialty hospitals; long-term care hospitals; rehabilitation
hospitals; psychiatric hospitals; hospital (provider) based urgent care
facilities or clinics as designated on the hospital's medicare cost
report.
(23) Independent diagnostic
testing facility (IDTF): approved by the centers for
medicare and medicaid services (CMS) for medicare.
(24) Laboratory: valid clinical laboratory
improvement amendments (CLIA) certificate.
(25) Licensed professional clinical counselor
(LPCC) or licensed professional counselor (LPC): license from Ohio counselor,
social worker, and marriage and family therapist board.
(26) Licensed social worker (LSW) or licensed
independent social worker (LISW): license from Ohio counselor, social worker,
and marriage and family therapist board.
(27) Massage therapist:
certified by
license from Ohio state medical board.
(28) Non-physician acupuncturist:
certificate
license to practice acupuncture or certificate to
practice as an oriental medicine practitioner from Ohio state medical
board.
(29) Nursing home: license
from Ohio department of health or approved by the
centers for medicare and medicaid services (CMS) for medicare.
(30) Ocularist: license from Ohio state
vision professionals board.
(31)
Occupational rehabilitation-comprehensive programs (work hardening): CARF
accreditation.
(32) Occupational
therapist: license from Ohio occupational therapy, physical therapy, and
athletic trainers board.
(33)
Optician: license from Ohio state vision professionals board.
(34) Optometrist: license from Ohio state
vision professionals board.
(35)
Orthotist, prosthetist or pedorthist: license from Ohio occupational therapy,
physical therapy, and athletic trainers board.
(36) Physical therapist: license from Ohio
occupational therapy, physical therapy, and athletic trainers board.
(37) Physician (M.D. or D.O.): license from
Ohio state medical board.
(38)
Physician assistant: certified by national commission on certification of
physician assistants and license from Ohio state
medical board.
(39) Podiatric
physician (D.P.M.): license from Ohio state medical board.
(40) Psychologist: license from Ohio state
board of psychology.
(41) Radiology
services (free-standing) state licensing,
registration or accreditation; (mobile) state, county or city
registration
license or registration from the
Ohio department of health, or joint commission accreditation , or approved
by the centers for medicare and medicaid services
(CMS) for medicare or medicaid
certification.
(42) Residential
care/assisted living facility: license from Ohio department of
health.
(43) Sleep laboratory:
certified by the American academy of sleep medicine and approved by
the centers for medicare and medicaid services
(CMS) for medicare
or an accrediting organization approved by
CMS .
(44) Speech-language
pathologist: license from Ohio state speech and hearing professionals board.
(45) Telemedicine: telemedicine
certificate from Ohio state medical board.
(a)
Vocational rehabilitation case management may be provided by a bureau certified
intern. An intern is a non-credentialed individual who provides vocational case
management services and is supervised by a credentialed vocational case
manager, as identified in paragraph (C)(48)
(47) of this
rule.
(b) To become eligible for
bureau certification and provide service as an intern, the intern must:
(i) Enroll with the bureau as an
intern.
(ii) Qualify to take one of
the examinations to become credentialed, as identified in paragraph (C)(48)
(47) of this
rule.
(c) Bureau
certification of vocational rehabilitation case management interns shall be for
a period of four years.
(d)
Vocational rehabilitation case management interns may not be recertified for
additional four-year periods.
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441, 4123.66
Prior Effective Dates: 02/16/1996, 01/15/1999, 03/29/2002, 07/14/2003, 09/12/2004, 04/01/2007, 02/01/2010, 12/11/2012, 04/01/2014, 12/03/2015, 02/15/2018
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(A) The bureau shall establish minimum criteria for provider certification . 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. However, if an individual a provider will be ineligible to participate in the health partnership program if:
(1) The state of Ohio has denied the provider 's application for a professional license or the provider 's professional license in Ohio is under revocation or suspension; or
(2) The provider 's professional license is under revocation or suspension in any state, or is subject to disciplinary restrictions in any state that affect the provider 's ability to treat patients or that compromise patient care, the provider shall be ineligible to participate in the health partnership program.
(B) The minimum criteria for a provider , where applicable based upon the type of provider , are as follows. The provider shall:
(1) Be currently licensed to practice, as applicable, without disciplinary restrictions that affect the provider 's ability to treat patients or that compromise patient care, including, but not limited to, disciplinary restrictions related to chemical dependency or substance abuse.
(2) Meet other general certification requirements for the specific provider type, as provided in paragraph (C) of this rule.
(3) Possess a current and unrestricted drug enforcement agency registration, unless it is not required by the provider 's discipline and scope of practice.
(4) Not be currently excluded from participation in medicare or Ohio medicaid for cause.
(5) Not have a history of a felony conviction in any jurisdiction, a conviction under a federal controlled substance act, a conviction for an act involving dishonesty, fraud, or misrepresentation, a conviction for a misdemeanor committed in the course of practice or involving moral turpitude, or court supervised intervention or treatment in lieu of conviction pursuant to section 2951.041 of the Revised Code or the equivalent law of another state be currently ineligible to participate in the health partnership program due to the provider having been convicted of or pleaded guilty to a criminal offense as set forth in the appendix to this rule .
(6) Attest to and maintain adequate, current professional malpractice and liability insurance, and provide proof of such coverage to BWC upon request. The bureau shall establish the appropriate amount of such insurance coverage for each provider type. In establishing the appropriate amount of insurance coverage for out of state providers, the bureau may consider the regulations or the community standards of the provider 's state of practice.
(7) Provide documentation of the provider 's malpractice history for the previous five years.
(8) Not have any outstanding provider overpayment or other indebtedness to the bureau which has been certified to the attorney general for collection.
(9) Provide proof of and maintain workers' compensation coverage to the extent required under Ohio law or the equivalent law of another state, as applicable.
(10) Not have been excluded or removed from participation in other health plans for cause, . or
(11) Not have lost hospital privileges for cause.
(C) The following minimum credentials apply to the providers listed below as provided in this rule. (46) (45) Traumatic brain injury (TBI) program: CARF accreditation for brain injury services (acute or post-acute). (47) (46) Urgent care facility (free standing): approved by the centers for medicare and medicaid services (CMS) for medicare. (48) (47) Vocational rehabilitation case managers: certification for American board of vocational experts (ABVE), occupational health nursing (COHN(S)), certified rehabilitation counselor (CRC), certified disability management specialist (CDMS), certified vocational evaluator (CVE), certified rehabilitation nurse (CRRN), or certified case manager (CCM). (49) (48) Vocational rehabilitation case management interns:
(1) Adult day care facility: Ohio department of aging PASSPORT adult day care provider agreement.
(2) Alcohol and drug counseling clinic: certified by Ohio department of mental health and addiction services.
(3) Ambulance, ambulette, or air ambulance service: license from Ohio medical transportation board if private; approved by the centers for medicare and medicaid services (CMS) for medicare if government/public.
(4) Ambulatory surgical center: license from Ohio department of health and approved by the centers for medicare and medicaid services (CMS) for medicare.
(5) Anesthesiologist assistant: certificate of registration license from Ohio state medical board.
(6) Athletic trainer: license from Ohio occupational therapy, physical therapy, and athletic trainers board.
(7) Audiologist: license from Ohio state speech and hearing professionals board.
(8) Certified nurse practitioner : license from Ohio board of nursing and certified by American nurses credentialing center or other certifying agency approved by the Ohio board of nursing.
(9) Certified registered nurse anesthetist (CRNA): license from Ohio board of nursing and certified by national council on certification of nurse anesthetists or other certifying agency approved by the Ohio board of nursing.
(10) Certified shoe retailer: certified by pedorthic footwear association.
(11) Chiropractic physician (D.C.): license from Ohio state chiropractic board.
(12) Clinical nurse specialist: license from Ohio board of nursing and certified by American nurses credentialing center or other certifying agency approved by the Ohio board of nursing.
(13) Comprehensive pain management services program: (free standing) commission on accreditation of rehabilitation facilities CARF accreditation; (hospital based) CARF or joint commission accreditation.
(14) Dentist: license from Ohio state dental board.
(15) Dialysis center: license from Ohio department of health and approved by the centers for medicare and medicaid services (CMS) for medicare or an accrediting organization approved by CMS .
(16) Durable medical equipment supplier (excludes orthotics, prosthetics and pedorthics): approved by the centers for medicare and medicaid services (CMS) for medicare and state of Ohio board of pharmacy home medical equipment certificate of registration.
(17) Employment specialist (may provide job placement, job development, job seeking skills training, job club, and job coach services only):
(a)
(i) Certification for American board of vocational experts (ABVE), certified rehabilitation counselor (CRC), certified case manager (CCM), certified employment support professional (CESP), certification for individual placement and support (CIPS), global career development facilitator (GCDF), associate certified coach (ACC), professional certified coach (PCC), master certified coach (MCC), certified disability management specialist (CDMS), or commission on accreditation of rehabilitation facilities (CARF) accreditation for employment and community services in job development or employment supports; or
(ii) Evidence of completion of three or more courses, seminars or workshops prior to application for certification , totaling a minimum of eighty hours and approved by the bureau or by an entity offering a certification referenced in paragraph (C)(17)(a)(i) of this rule, in at least two of the following domain areas: job development, job placement, and career and lifestyle development; vocational consultation and services for employers; professional roles and practices, ethics, and utilization of community resources; or
(iii) Evidence of bureau reimbursement to the provider for job placement, job development, job seeking skills training, job club, and/or job coaching services to injured workers for dates of service beginning not less than eighteen months prior to April 1, 2014. However, if the provider has been certified pursuant to this provision and the provider 's certification subsequently lapses, the provider must thereafter meet the criteria of paragraph (B)(17)(a)(i) or paragraph (B)(17)(a)(ii) of this rule for certification or recertification.
(b) Employment specialists certified pursuant to paragraph (C)(17)(a)(ii) or (C) (17)(a)(iii) of this rule must complete twenty thirty hours of continuing education, including three hours of ethics, every two three years to maintain certification under this rule.
(18) Ergonomist: certification for certified professional ergonomist (CPE), certified human factors professional (CHFP), associate ergonomics professional (AEP), associate human factors professional (AHFP), certified ergonomics associate (CEA), certified safety professional (CSP) with "ergonomics specialist" designation, certified industrial ergonomist (CIE), certified industrial hygienist (CIH), assistive technology practitioner (ATP), or rehabilitation engineering technologist (RET).
(19) Hearing aid dealer: license from Ohio state speech and hearing professionals board.
(20) Home health agency: approved by the centers for medicare and medicaid services (CMS) for medicare, joint commission accreditation, or community health accreditation program (CHAP) accreditation, or accreditation through an accrediting organization that has been granted deeming authority approved by the centers for medicare and medicaid services (CMS).
(21) Hospice: license from Ohio department of health, and approved by the centers for medicare and medicaid services (CMS) for medicare or medicaid certification .
(22) Hospital : approved by the centers for medicare and medicaid services (CMS) for medicare or an accrediting organization approved by CMS, or obtained national CARF accreditation (joint commission accreditation, or American osteopathic association healthcare facilities accreditation program (HFAP), or commission on accreditation of rehabilitation facilities (CARF) for rehabilitation hospital s). The following facility types shall be credentialed and certified as hospitals: short-term general and specialty hospitals; long-term care hospitals; rehabilitation hospitals; psychiatric hospitals; hospital (provider ) based urgent care facilities or clinics as designated on the hospital's medicare cost report.
(23) Independent diagnostic testing facility (IDTF): approved by the centers for medicare and medicaid services (CMS) for medicare.
(24) Laboratory: valid clinical laboratory improvement amendments (CLIA) certificate.
(25) Licensed professional clinical counselor (LPCC) or licensed professional counselor (LPC): license from Ohio counselor, social worker, and marriage and family therapist board.
(26) Licensed social worker (LSW) or licensed independent social worker (LISW): license from Ohio counselor, social worker, and marriage and family therapist board.
(27) Massage therapist: certified by license from Ohio state medical board.
(28) Non-physician acupuncturist: certificate license to practice acupuncture or certificate to practice as an oriental medicine practitioner from Ohio state medical board.
(29) Nursing home: license from Ohio department of health or approved by the centers for medicare and medicaid services (CMS) for medicare.
(30) Ocularist: license from Ohio state vision professionals board.
(31) Occupational rehabilitation-comprehensive programs (work hardening): CARF accreditation.
(32) Occupational therapist: license from Ohio occupational therapy, physical therapy, and athletic trainers board.
(33) Optician: license from Ohio state vision professionals board.
(34) Optometrist: license from Ohio state vision professionals board.
(35) Orthotist, prosthetist or pedorthist: license from Ohio occupational therapy, physical therapy, and athletic trainers board.
(36) Physical therapist: license from Ohio occupational therapy, physical therapy, and athletic trainers board.
(37) Physician (M.D. or D.O.): license from Ohio state medical board.
(38) Physician assistant: certified by national commission on certification of physician assistants and license from Ohio state medical board.
(39) Podiatric physician (D.P.M.): license from Ohio state medical board.
(40) Psychologist: license from Ohio state board of psychology.
(41) Radiology services (free-standing) state licensing, registration or accreditation; (mobile) state, county or city registration license or registration from the Ohio department of health, or joint commission accreditation , or approved by the centers for medicare and medicaid services (CMS) for medicare or medicaid certification .
(42) Residential care/assisted living facility: license from Ohio department of health.
(43) Sleep laboratory: certified by the American academy of sleep medicine and approved by the centers for medicare and medicaid services (CMS) for medicare or an accrediting organization approved by CMS .
(44) Speech-language pathologist: license from Ohio state speech and hearing professionals board.
(45) Telemedicine: telemedicine certificate from Ohio state medical board.
(a) Vocational rehabilitation case management may be provided by a bureau certified intern. An intern is a non-credentialed individual who provides vocational case management services and is supervised by a credentialed vocational case manager, as identified in paragraph (C)(48) (47) of this rule.
(b) To become eligible for bureau certification and provide service as an intern, the intern must:
(i) Enroll with the bureau as an intern.
(ii) Qualify to take one of the examinations to become credentialed, as identified in paragraph (C)(48) (47) of this rule.
(c) Bureau certification of vocational rehabilitation case management interns shall be for a period of four years.
(d) Vocational rehabilitation case management interns may not be recertified for additional four-year periods.
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441, 4123.66
Prior Effective Dates: 02/16/1996, 01/15/1999, 03/29/2002, 07/14/2003, 09/12/2004, 04/01/2007, 02/01/2010, 12/11/2012, 04/01/2014, 12/03/2015, 02/15/2018