Section 5160-8-31 - Skilled therapy: providers(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(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: (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
Ohio Admin. Code 5160-8-31
Effective: 10/1/2018
Five Year Review (FYR) Dates: 6/26/2018
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.03, 5164.02, 5164.06, 5164.70
Prior Effective Dates: 04/07/1977, 09/19/1977, 12/21/1977, 12/30/1977, 07/01/2002, 01/01/2008, 08/02/2011, 01/01/2014