Ohio Admin. Code 5160-8-52 - Services provided by a pharmacist
(A) Definition. "Pharmacist" has the same
meaning as in Chapter 4729:1-1 of the Administrative Code.
(B) Providers. An individual pharmacist may
enroll in medicaid as a pharmacist provider.
(C) Coverage.
(1) Payment may be made only for a pharmacist
service for which the following criteria are met:
(a) The service is within a pharmacist's
scope of practice;
(b) The service
is medically necessary in accordance with rule
5160-1-01
of the Administrative Code;
(c) For
a service rendered by prescription, the pharmacist provider obtains an order
issued by a practitioner having appropriate prescriptive authority and
maintains supporting documentation; and
(d) The service is rendered for one of the
following purposes:
(i) Managing medication
therapy under a consulting agreement with a prescribing practitioner pursuant
to section
4729.39
of the Revised Code;
(ii)
Administering immunizations in accordance with section
4729.41 of
the Revised Code; or
(iii)
Administering medications in accordance with section
4729.45
of the Revised Code.
(2) Nothing in this rule precludes a medicaid
managed care organization described in Chapters 5160-26 and 5160-58 of the
Administrative Code from paying pharmacists for additional purposes, within
scope of practice, including care management services that are rendered by a
pharmacist without a consult agreement.
(3) Payment may be made for covered
telehealth services in accordance with rule
5160-1-18 of the
Administrative Code.
(4) Services
may be rendered through a standing order or protocol as described in Chapter
4729. of the Revised Code.
(D) Claim payment.
(1) For a covered pharmacist service rendered
at a federally qualified health center (FQHC) or rural health clinic (RHC),
payment as an FQHC medical service or an RHC medical service is made in
accordance with Chapter 5160-28 of the Administrative Code.
(2) For a covered immunization, injection of
medication, or provider-administered pharmaceutical, payment is made in
accordance with rule
5160-4-12
of the Administrative Code.
(3) For
all other covered pharmacist services, payment is the lesser of the submitted
charge or eighty-five per cent of the medicaid maximum amount specified in
appendix DD to rule
5160-1-60 of the
Administrative Code.
(4) No separate
payment will be made for pharmacist services provided in an inpatient or
outpatient hospital, emergency department, or inpatient psychiatric facility
place of service.
Notes
Promulgated Under: 119.03
Authorized By: 5164.02
Amplifies: 5164.02
Five Year Review Date: 1/17/2021
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