Section 5160-1-80 - Substitute practitioners (locum tenens)(A) Definitions. (1) "Practitioner," for purposes of this rule, is a collective term for the following professionals: (a) Doctor of medicine or osteopathy;(b) Advanced practice registered nurse;(2) "Regular practitioner" is a practitioner enrolled in the Ohio medicaid program who regularly takes care of an individual's health care needs.(3) "Substitute practitioner" is a practitioner who generally does not maintain an individual practice and who works in place of a regular practitioner when the regular practitioner is absent; (B) Coverage and limitations. Payment may be made for services rendered by a substitute practitioner only when the following conditions are met:(1) Both the regular practitioner and the substitute practitioner are professionals listed in paragraph (A)(1) of this rule;(2) The regular practitioner is expected to be absent for a period of not longer than sixty days unless there are extenuating circumstances (e.g., active duty in the armed forces, pregnancy, extended illness);(3) The substitute practitioner has the status of an independent contractor rather than of an employee;(4) The substitute practitioner meets the applicable provider screening requirements described in rule 5160-1-17.8 of the Administrative Code;(5) The substitute practitioner has not been sanctioned under medicare, medicaid, or Title XX and is not otherwise prohibited from providing services to medicare, medicaid, or Title XX beneficiaries; and(6) The substitute practitioner receives payment from the regular practitioner as a fixed amount per diem or on a similar fee-for-time basis. Ohio Admin. Code 5160-1-80
Effective: 10/1/2023
Five Year Review (FYR) Dates: 7/14/2023 and 10/01/2028
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 10/01/2018, 01/01/2020