Ohio Admin. Code 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;
(c) Dentist;
(d) Optometrist;
(e) Podiatrist; or
(f) Chiropractor.
(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.
(1) Payment may be made for services rendered by a substitute practitioner only when the following conditions are met:
(a) Both the regular practitioner and the substitute practitioner are professionals listed in paragraph (A)(1) of this rule;
(b) 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);
(c) The substitute practitioner has the status of an independent contractor rather than of an employee;
(d) The substitute practitioner can pass meets the applicable provider screening requirements described in rule 5160-1-17.8 of the Administrative Code; and
(e) 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
(e)(f) The substitute practitioner receives payment from the regular practitioner as a fixed amount per diem or on a similar fee-for-time basis.
(2) Payment cannot be made for services rendered by a substitute practitioner when the regular practitioner is a member of a professional medical group or professional dental group.

Payment for a substitute practitioner is not available if a regular practitioner is a member of a practice arrangement involving more than one practitioner of the same scope or specialty.

Notes

Ohio Admin. Code 5160-1-80
Effective: 1/1/2020
Five Year Review (FYR) Dates: 10/1/2023
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 10/01/2018

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