(A) The director shall apply the standards
and procedures prescribed by this rule in reviewing and making determinations
concerning applications by physicians to be providers for the program for
medically handicapped children.
(B)
To be approved as a provider, a physician shall:
(1) Be licensed to practice allopathic
medicine or osteopathic medicine in the state of Ohio or the state in which the
physician's practice is located, if the physician will be providing services
outside Ohio;
(2) Meet the
following certification requirements:
(a) All
physicians shall be certified by a certifying board of the "American Board of
Medical Specialities" or a certifying board of the "American Osteopathic
Association";
(b) To be designated
as a subspecialist, a physician shall be certified in the relevant subspecialty
by a certifying board of the "American Board of Medical Specialties" or a
certifying board of the "American Osteopathic Association." If the applicable
board does not certify physicians in the relevant subspecialty, the director
may designate a physician as a subspecialist based upon significant advanced
postgraduate training in the area. The director may consult with one or more
members of the medical advisory council or with other individuals with
expertise in the area in determining whether a physician has significant
advanced postgraduate training;
(3) Meet the following practice requirements:
(a) Possession of skill and experience in the
treatment of children or adolescents with handicapping conditions, as
determined by the director. In making this determination, the director may
consult with one or more members of the medical advisory council or with other
individuals with expertise in the area; and
(b) Actively providing at the time of
application, treatment to children with medically eligible conditions or adults
with cystic fibrosis; and
(4) Maintain privileges on the staff of a
hospital that is approved under rule
3701-43-04 of the Administrative
Code; or have arrangements with physicians who are approved under this chapter
to admit children needing inpatient care to a hospital that is approved under
rule
3701-43-04 of the Administrative
Code for inpatient care.
(C) A physician who does not meet the
requirements of paragraph (B)(2)(b) of this rule may be designated as a
subspecialist on a provisional basis for up to five years if the physician
is certified in pediatrics by a certifying board of the
"American Board of Medical Specialties" or a certifying board of the "American
Osteopathic Association."meets the following
requirements:
The physician is certified in
pediatrics by a certifying board of the "American Board of Medical Specialties"
or a certifying board of the "American Osteopathic
Association";
(2) The physician provides a letter
from the chair of the sub-specialty fellowship training program verifying that
the physician has successfully completed the program and evaluating the degree
of skill and experience in the sub-specialty area the physician has
attained;
(3) The physician provides a letter
from the chief of services of the sub-specialty area at a hospital as defined
in paragraph (A) of rule 3701-43-04 oftheAdministrative Code verifying that the
physician has staff privileges.
Physicians who have been designated
as subspecialists under this paragraph shall have that designation withdrawn if
they do not provide documentation that they meet the requirements of paragraph
(B)(2)(b) within five years of the date on which they received provisional
approval as subspecialists under this paragraph. Withdrawal of the designation
as a subspecialist is automatic at the end of the five year period and is not
subject to appeal.
(D) In accordance with paragraph (D) of rule
3701-43-02 of the Administrative
Code, the director shall determine the scope of services that each physician
provider is approved to provide. The director may consult with one or more
members of the medical advisory council or with other individuals with
expertise in the area in determining the appropriate scope of services. The
scope of services that a physician is approved to provide may be limited by:
(1) The physician's specialty and, if
applicable, subspecialty designation;
(2) The scope of services that a hospital of
whose staff the physician is a member is approved to provide; and
(3) The director's determination as to the
skill and experience of the physician in treating particular handicapping
conditions.
(E) The
director may approve a physician who does not meet the standards prescribed by
paragraph (B)(3) or (B)(4) of this rule as a limited provider. The director may
consult with one or more members of the medical advisory council or with other
individuals with expertise in the area concerning approval of physicians under
this paragraph. Limitations on service provision may include, but are not
limited to, the age of the recipients to be treated, specific handicapping
conditions to be treated and types of services to be provided.
(F) Physician provider applicants shall:
(1) Complete and sign a physician application
on a form prescribed by the director;
(2) Comply with the procedures prescribed by
rule
3701-43-02 of the Administrative
Code; and
(3) Submit two letters of
reference that attest to the physician's skill in caring for children with
special health care needs. One letter must be from a pediatrician and one
letter must be from a member of the physician's specialty.
Notes
Ohio Admin. Code
3701-43-03
Effective:
1/16/2014
R.C.
119.032 review dates:
11/01/2013 and
10/28/2018
Promulgated
Under: 119.03
Statutory
Authority: 3701.021
Rule
Amplifies: 3701.021,
3701.022,
3701.023
Prior
Effective Dates: 1/1/1975, 6/12/82, 1/2/89, 5/20/91, 10/9/93, 12/1/01,
10/13/03, 9/1/08
