Ohio Admin. Code 5160-28-02 - FQHC and RHC services: conditions affecting medicaid provider participation
(A)
Unless otherwise noted, any stipulations or limitations
specified in the Revised Code or in agency 5160 of the Administrative Code
apply to services rendered by a federally qualified health center (FQHC) or
rural health clinic (RHC). Provisions of other rules in agency 5160 of the
Administrative Code that concern coordination of benefits apply to payment for
FQHC and RHC services.
(B)
Responsibilities of an FQHC.
(1)
When it enrolls
or changes its enrollment (e.g., adds a service), an FQHC submits to the Ohio
department of medicaid (ODM) a copy of a notice of authorization or notice of
look-alike designation it has received from the federal health resources and
services administration (HRSA). In particular, two pieces of documentation are
needed:
(a)
Confirmation that the FQHC satisfies HRSA criteria for
providing the PPS services it plans to render (either new services or services
added through a change in scope); and
(b)
A list of the
services approved by HRSA for the FQHC to perform at any of its
sites.
(2)
Each FQHC site obtains and uses its own medicaid
provider number. No FQHC site is allowed to use the provider number of another
FQHC site, even if the two share the same parent organization.
(3)
The
responsibility of an FQHC to pay a health professional for performing a service
is described in a written agreement between the FQHC and the health
professional.
(4)
An FQHC notifies ODM in writing not later than ninety
days after any permanent decrease in its scope of service.
(C)
Medicaid payment cannot be made before the date listed on the FQHC HRSA notice
or before the RHC certification date.
(D)
No provider can
be simultaneously enrolled in medicaid as both an FQHC and an RHC.
Replaces: 5160-28-02
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 04/01/1980, 11/10/1983, 10/01/1987, 04/18/1988, 04/10/1991, 06/01/1991, 07/01/2001, 08/01/2001, 10/25/2001, 11/01/2001, 03/01/2002, 05/01/2005, 07/01/2006, 07/01/2009, 10/01/2016
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