Ohio Admin. Code 3701-43-02 - Standards and procedures for determining eligibility of providers
(A) The director
shall apply the standards and procedures prescribed by this rule and by rules
3701-43-03 to
3701-43-08 and
3701-43-13 of the Administrative
Code for the purposes of reviewing the applications of provider applicants and
for making determinations as to whether these applicants are eligible
providers.
(1) For the purposes of this
chapter "provider applicant " means a health care professional, hospital ,
medical equipment supplier or other individual, group or agency that makes
application to become a provider , as defined in paragraph (P) of rule
3701-43-01 of the Administrative
Code.
(2) Subject to the
termination provisions prescribed by rule
3701-43-10 of the Administrative
Code, anyone who is a provider for the program for medically handicapped
children or adults with cystic fibrosis on the effective date of this rule is
not required to apply for approval under this rule and shall be considered a
provider for the purposes of this chapter .
(B) In addition to meeting the standards
prescribed by the applicable provisions of this chapter , a provider applicant
shall meet the following requirements to be eligible to be a provider :
(1) Participate as a provider in the Ohio
medicaid program , if providers of the same type as the provider applicant may
be medicaid providers;
(2) Be
located in Ohio, except that the director may approve a provider applicant
located outside Ohio who meets the standards prescribed in the applicable
provisions of this chapter for the purpose of providing diagnostic or treatment
services or goods :
(a) Not available in Ohio;
or
(b) For recipients for whom
travel to obtain comparable services within Ohio would present undue financial
or transportation hardship.
The
(3) Submit a
provider application on a form prescribed by the director , which shall be
completed in full and shall include any additional information required by
applicable provisions of this chapter ;
(4) The provider applicant shall submit any
additional information requested by the director for purposes of determining
whether the applicant meets the standards for eligibility to be a provider no
later than sixty days after the date of the director 's request; and
(5) Sign a provider agreement on a form
prescribed by the director .
(C) If the director determines that the
provider applicant meets all applicable eligibility standards and the other
applicable provisions of this chapter , the director shall approve the applicant
as a provider . Except as provided in rule
3701-43-22 of the Administrative
Code, if the director determines that a provider applicant does not meet the
standards for eligibility or has not complied with any of the procedural
requirements prescribed by this rule or other applicable rules of this chapter ,
the director shall not approve the applicant as a provider .
(D) For each provider , the director shall
specify the scope of services or goods the provider is approved to provide. The
director shall determine the scope of goods or services based upon:
(1) Applicable statutes and rules for
licensure of the provider ;
(2) The
scope of goods or services normally furnished by the provider ;
(3) The provider 's specialty, skill and
experience or other factors specified in applicable provisions of this chapter .
Upon request by a
(E) The
director shall notify a provider applicant in writing of approval or
disapproval under paragraph (C) of this rule within thirty days after
completion of all application procedures. A notice of approval also shall state
the scope of goods or services the provider is approved to provide, as
determined under paragraph (D) of this rule, and the effective date of
approval. The effective date of approval shall be the first day of the month in
which the provider applicant complied with all applicable requirements for
interviews and submission of additional documentation. A notice of disapproval
shall state the reasons for disapproval.
(F) A provider applicant whose application
has been disapproved may request reconsideration of the application by the
director by submitting a written request for reconsideration and any written
materials that the provider applicant wishes to be considered so that they are
received by the director no later than forty-five days after the date on the
notice of disapproval issued under paragraph (E) of this rule. The director may
request additional information, which the provider applicant shall submit so
that it is received by the director no later than forty-five days after the
date on the request. The director shall issue a written decision on
reconsideration within forty-five days after receipt of the request or any
requested additional information.
Notes
Promulgated Under: 119.03
Statutory Authority: 3701.021
Rule Amplifies: 3701.021, 3701.022, 3701.023, 3701.023
Prior Effective Dates: 1/2/1989, 12/1/01, 09/01/08
R.C. 119.032 review dates: 05/23/2008 and 09/01/2013
Promulgated Under: 119.03
Statutory Authority: 3701.021
Rule Amplifies: 3701.021, 3701.022, 3701.023
Prior Effective Dates: 1/2/1989, 12/1/01
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