Ohio Admin. Code 5160-8-30 - Skilled therapy: scope and definitions
(A)
Rules
5160-8-31
to
5160-8-34
of the Administrative Code set forth provisions governing payment for skilled
therapies as non-institutional professional services. Provisions governing
payment for skilled therapies as the following service types are set forth in
the indicated part of the Administrative Code:
(1)
Hospital
services, Chapter 5160-2;
(2)
Nursing facility services, Chapter
5160-3;
(3)
Home health services, Chapter 5160-12;
(4)
Clinic services
rendered by the following providers:
(a)
Fee-for-service ambulatory health care clinics,
Chapter 5160-13;
(b)
Rural health clinics, Chapter 5160-16;
(c)
Federally
qualified health centers, Chapter 5160-28; or
(d)
Outpatient
health facilities, Chapter 5160-29;
(5)
Medicaid school
program services, Chapter 5160-35; and
(6)
Intermediate
care facility services, Chapter 5123:2-7.
(B)
The following
definitions apply to rules
5160-8-31
to
5160-8-34
of the Administrative Code:
(1)
"Audiologist " is a person who holds a valid license as
an audiologist under Chapter 4753. of the Revised Code.
(2)
"Audiology aide "
is a person who holds a valid license as an audiology aide under Chapter 4753.
of the Revised Code.
(3)
"Developmental services" are skilled therapy services
rendered, in accordance with developmental milestones established by the
American academy of pediatrics, to enable individuals younger than seven years
of age to attain a level of age-appropriate functionality that they have not
yet achieved but are expected to achieve.
(4)
"Developmental
disability " has the same meaning as in section
5123.01 of the Revised
Code.
(5)
"Eligible provider " has the same meaning as in rule
5160-1-17 of
the Administrative Code.
(6)
"Maintenance services" are skilled therapy services
rendered to individuals for the purpose of maintaining but not improving
functionality.
(7)
"Mechanotherapist " is a person who holds a valid
license as a mechanotherapist under Chapter 4731. of the Revised Code and works
within the scope of practice defined by state law.
(8)
"Non-institutional setting " is a location that is not a hospital or long-term
care facility and that is appropriate to the delivery of skilled therapy
services. Examples include but are not limited to practitioners' offices,
clinics, licensed child day care centers, adult day care centers, and public
facilities such as community centers.
(9)
"Occupational
therapist " is a person who holds a valid license as an occupational therapist
under Chapter 4755. of the Revised Code and works within the scope of practice
defined by state law.
(10)
"Occupational therapy " has the same meaning as in
section 4755.04 of the Revised
Code.
(11)
"Occupational therapy assistant" is a person who holds
a valid license as an occupational therapy assistant under Chapter 4755. of the
Revised Code.
(12)
"Physical therapist " is a person who holds a valid
license as a physical therapist under Chapter 4755. of the Revised Code and
works within the scope of practice defined by state law.
(13)
"Physical
therapist assistant" is a person who holds a valid license as a physical
therapist assistant under Chapter 4755. of the Revised Code.
(14)
"Physical
therapy " has the same meaning as in section
4755.40 of the Revised
Code.
(15)
"Rehabilitative services" are skilled therapy services
rendered to individuals for the purpose of improving
functionality.
(16)
"Skilled therapist " is a collective term encompassing
physical therapist , occupational therapist , speech-language pathologist, and
audiologist .
(17)
"Skilled therapy " is a collective term encompassing
physical therapy , occupational therapy , speech-language pathology, and
audiology.
(18)
"Speech-language pathologist " is a person who holds a
valid license as a speech-language pathologist under Chapter 4753. of the
Revised Code.
(19)
"Speech-language pathology aide " is a person who holds
a valid license as a speech-language pathology aide under Chapter 4753. of the
Revised Code.
(20)
"Standardized test " is a diagnostic tool or procedure
that has a standardized administration and scoring process, the results of
which can be compared to an appropriate normative sample. Standardized tests
must be norm-referenced, age-appropriate, and specific to areas of
deficit.
(21)
"Supplemental test " is a non-diagnostic screening or
criterion-referenced tool that is used to provide further documentation of
deficits and to corroborate the results of a standardized test . A supplemental
test may not be used in place of a standardized test .
Replaces: Part of 5160-34- 01.1, part of 5160-34- 01.2
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.03, 5164.70, 5164.06, 5164.02
Prior Effective Dates: 01/01/2008, 01/01/2014
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(A) Rules 5160-8-31 to 5160-8-34 of the Administrative Code set forth provisions governing payment for skilled therapies as non-institutional professional services. Provisions governing payment for skilled therapies as the following service types are set forth in the indicated part of the Administrative Code:
(1) Hospital services, Chapter 5160-2;
(2) Nursing facility services, Chapter 5160-3;
(3) Home health services, Chapter 5160-12;
(4) Clinic services rendered by the following providers:
(a) Fee-for-service ambulatory health care clinics, Chapter 5160-13;
(b) Rural health clinics, Chapter 5160-16;
(c) Federally qualified health centers, Chapter 5160-28; or
(d) Outpatient health facilities, Chapter 5160-29;
(5) Medicaid school program services, Chapter 5160-35; and
(6) Intermediate care facility services, Chapter 5123:2-7.
(B) The following definitions apply to rules 5160-8-31 to 5160-8-34 of the Administrative Code:
(1) "Audiologist" is a person who holds a valid license as an audiologist under Chapter 4753. of the Revised Code.
(2) "Audiology aide" is a person who holds a valid license as an audiology aide under Chapter 4753. of the Revised Code.
(3) "Developmental services" are skilled therapy services rendered, in accordance with developmental milestones established by the American academy of pediatrics, to enable individuals younger than seven years of age to attain a level of age-appropriate functionality that they have not yet achieved but are expected to achieve.
(4) "Developmental disability" has the same meaning as in section 5123.01 of the Revised Code.
(5) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code.
(6) "Maintenance services" are skilled therapy services rendered to individuals for the purpose of maintaining but not improving functionality.
(7) "Mechanotherapist" is a person who holds a valid license as a mechanotherapist under Chapter 4731. of the Revised Code and works within the scope of practice defined by state law.
(8) "Non-institutional setting" is a location that is not a hospital or long-term care facility and that is appropriate to the delivery of skilled therapy services. Examples include but are not limited to practitioners' offices, clinics, licensed child day care centers, adult day care centers, and public facilities such as community centers.
(9) "Occupational therapist" is a person who holds a valid license as an occupational therapist under Chapter 4755. of the Revised Code and works within the scope of practice defined by state law.
(10) "Occupational therapy" has the same meaning as in section 4755.04 of the Revised Code.
(11) "Occupational therapy assistant" is a person who holds a valid license as an occupational therapy assistant under Chapter 4755. of the Revised Code.
(12) "Physical therapist" is a person who holds a valid license as a physical therapist under Chapter 4755. of the Revised Code and works within the scope of practice defined by state law.
(13) "Physical therapist assistant" is a person who holds a valid license as a physical therapist assistant under Chapter 4755. of the Revised Code.
(14) "Physical therapy" has the same meaning as in section 4755.40 of the Revised Code.
(15) "Rehabilitative services" are skilled therapy services rendered to individuals for the purpose of improving functionality.
(16) "Skilled therapist" is a collective term encompassing physical therapist, occupational therapist, speech-language pathologist, and audiologist.
(17) "Skilled therapy" is a collective term encompassing physical therapy, occupational therapy, speech-language pathology, and audiology.
(18) "Speech-language pathologist" is a person who holds a valid license as a speech-language pathologist under Chapter 4753. of the Revised Code.
(19) "Speech-language pathology aide" is a person who holds a valid license as a speech-language pathology aide under Chapter 4753. of the Revised Code.
(20) "Standardized test" is a diagnostic tool or procedure that has a standardized administration and scoring process, the results of which can be compared to an appropriate normative sample. Standardized tests must be norm-referenced, age-appropriate, and specific to areas of deficit.
(21) "Supplemental test" is a non-diagnostic screening or criterion-referenced tool that is used to provide further documentation of deficits and to corroborate the results of a standardized test. A supplemental test may not be used in place of a standardized test.
Replaces: Part of 5160-34- 01.1, part of 5160-34- 01.2
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.03, 5164.70, 5164.06, 5164.02
Prior Effective Dates: 01/01/2008, 01/01/2014