Ohio Administrative Code|Rule 5160-35-01 | Definitions.

                                                
(A) For the purposes of Chapter 5160-35 of the Administrative
		  Code, the following terms are defined as:
(1) At the direction of: communication of
			 a plan of care to a licensed practical nurse by a licensed physician or
			 registered nurse who is acting within the scope of his or her practice under
			 Ohio law for the provision of nursing services by the licensed practical
			 nurse.
(2) Clinical setting: for the purpose of
			 counseling and social work roles, a location in the school, or a location for
			 which the medicaid school program provider has contracted for the delivery of
			 services, where the child's confidentiality can be maintained when a
			 service is being rendered.
(3) Community school: a public school,
			 independent of any school district, established in accordance with Chapter
			 3314. of the Revised Code that is part of the state's program of
			 education.
(4) Common procedural terminology (CPT):
			 also known as current procedural terminology, is a list of descriptive terms
			 and identifying codes, as published by the American medical association (AMA)
			 for reporting medical services and procedures performed.
(5) Direct service costs: costs
			 associated with salaries, benefits, and contract compensation for individuals
			 and entities delivering services to an eligible child, services as defined in
			 rule 5160-35-05 of the Administrative Code and as defined in paragraph (B)(2)
			 of rule 5160-35-06 of the Administrative Code.
(6) Eligible child: a student for whom
			 medicaid reimbursement may be sought through the medicaid school program who is
			 enrolled in an entity defined in paragraph (B)(1) of rule 5160-35-02 of the
			 Administrative Code, who is between the age of three to twenty-one, and has an
			 individualized education program in which is indicated services that are
			 allowable under medicaid.
(7) Healthcare common procedure coding
			 system (HCPCS): is a uniform method for health care providers and medical
			 suppliers to report professional services, procedures and
			 supplies.
(8) The individualized education program
			 (IEP) is as defined in section 3323.011 of the Revised Code.
(9)  Licensed practitioner of the healing
			 arts: for purposes of these rules, includes the qualified practitioners
			 delineated in rule 5160-35-05 of the Administrative Code.
(10) Local education agency: school
			 districts of the state as defined in sections 3311.01 to 3311.05 of the Revised
			 Code.
(11) Medicaid authorized prescriber: a
			 physician (M.D. or D.O.), podiatrist, dentist, or advanced practice nurse
			 working within his or her scope of practice as defined by state
			 law.
(12) Medicaid school
			 program authorized referrer: is a licensed practitioner of the healing arts who
			 refers for services under the medicaid school component of the medicaid program
			 as set forth in section 5162.366 of the Revised Code.
(13) Medical home: a physician, physician
			 group practice, or an advanced practice nurse with a current medicaid provider
			 agreement, or a provider with a contract with an Ohio medicaid managed care
			 plan. This provider serves as an ongoing source of primary and preventive care
			 and provides assistance with care coordination for the patient.
(14) Medically necessary: skilled services
			 recommended by a qualified licensed practitioner in accordance with rules
			 5160-35-05 and 5160-35-06 of the Administrative Code who is acting within the
			 scope of his or her licensure that meet the requirements in rule 5160-1-01 of
			 the Administrative Code and meet general principles regarding reimbursement for
			 medicaid covered services found in rule 5160-1-02 of the Administrative Code.
			 For the purpose of the medicaid school program, it is recognized that medically
			 necessary services are those education related identified in the individualized
			 education program (IEP) that meet medicaid reimbursement
			 requirements.
(15) Medicaid school program (MSP): is as
			 set forth in Chapter 5160-35 of the Administrative Code.
(16) MSP provider: educational entity that
			 meets the qualifications delineated in rule 5160-35-02 of the Administrative
			 Code.
(17) Other costs: costs for
			 service-related activities for which there is no CPT or HCPCS code and for
			 which claiming is not possible by the MSP provider due to medicaid rule
			 restrictions; administrative claiming, equipment, supplies, indirect costs, and
			 billing fees.
(18) Skilled services: services of such
			 complexity and sophistication that the service can be safely and effectively
			 performed only by or under the supervision of a licensed practitioner of the
			 healing arts practicing within the scope of their licensure. Skilled services
			 do not include services provided by persons not licensed in accordance with the
			 Ohio Revised Code.
(19) State school: school under the
			 control and supervision of the state board of education established for
			 students who are deaf or blind as defined by section 3325.01 of the Revised
			 Code.
(20)  Supervision: is as defined in rules
			 4753-7-02, 4755-27-01, 4755-27-02, 4755-27-04, and 4755-7-04 of the
			 Administrative Code.
(21) Telehealth: is the
			 direct delivery of health care services to a patient via secure, synchronous,
			 interactive, real-time electronic communication comprised of both audio and
			 video elements in accordance with rule 5160-1-18 of the Administrative Code.
			 Practitioners must act within their scope of practice and in accordance with
			 their licensure agreements.