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Ohio Administrative Code (Last Updated: January 12, 2021) |
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4123 Bureau of Workers' Compensation |
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Chapter4123-6. Health Partnership Program |
| 4123-6-01. Definitions |
| 4123-6-01.1. Applicability of medical rules |
| 4123-6-01.2. [Effective 1/1/2021] Provisional treatment reimbursement approval - pilot program |
| 4123-6-02. Provider access to the HPP - generally |
| 4123-6-02.1. Rescinded |
| 4123-6-02.2. Provider access to the HPP - provider certification criteria |
| 4123-6-02.21. Provider access to the HPP - non-certified provider enrollment |
| 4123-6-02.22. Provider access to the HPP - ambulatory surgical center arthroplasty center requirements |
| 4123-6-02.3. Provider access to the HPP - provider application and certification criteria |
| 4123-6-02.4. Provider access to the HPP - provider and recertification |
| 4123-6-02.5. Provider access to the HPP - provider not certified |
| 4123-6-02.51. Provider access to the HPP - Denial of provider, entity or MCO enrollment/certification based on criminal conviction or civil action |
| 4123-6-02.6. Provider access to the HPP - selection by an MCO |
| 4123-6-02.7. Provider access to the HPP - provider decertification procedures |
| 4123-6-02.8. Provider requirement to notify of injury |
| 4123-6-02.9. Provider access to the HPP - provider marketing |
| 4123-6-03. MCO participation in the HPP - generally [RESCINDED] |
| 4123-6-03.2. MCO participation in the HPP - MCO application for certification or recertification |
| 4123-6-03.3. MCO participation in the HPP - MCO participation based on MCO capacity [RESCINDED] |
| 4123-6-03.4. MCO participation in the HPP - MCO certification |
| 4123-6-03.6. MCO participation in the HPP - administrator's authority to terminate MCO contracts [RESCINDED] |
| 4123-6-03.7. MCO participation in the HPP - bureau's authority to decertify, to refuse to certify or recertify an MCO |
| 4123-6-03.8. MCO participation in the HPP - marketing of services by MCO. [RESCINDED] |
| 4123-6-03.9. MCO participation in the HPP - MCO disclosure of relationship |
| 4123-6-03.10. Conflict of interest |
| 4123-6-04. MCO scope of services - generally [RESCINDED] |
| 4123-6-04.2. MCO scope of services - management of medical treatment of provider selected by employee [RESCINDED] |
| 4123-6-04.3. MCO scope of services - MCO medical management and claims management assistance |
| 4123-6-04.4. MCO scope of services - fee bill review and audit process |
| 4123-6-04.5. MCO scope of services - bureau claims management |
| 4123-6-04.6. Return to work assessment |
| 4123-6-05.1. Employer access to the HPP - MCO advertising and solicitation [RESCINDED] |
| 4123-6-05.2. Employer access to the HPP - employer enrollment and selection of MCO |
| 4123-6-05.3. Employer access to the HPP; certain solicitation practices by MCOs prohibited |
| 4123-6-05.4. Employer access to the HPP; payment for referrals prohibited |
| 4123-6-06. Employee access to the HPP - generally [RESCINDED] |
| 4123-6-06.1. Employee access to medical services - education by MCO and employer |
| 4123-6-06.2. Employee access to the HPP - employee choice of provider |
| 4123-6-06.3. Employee access to the HPP - application of rules to claims [RESCINDED] |
| 4123-6-07. Services and supplies never covered |
| 4123-6-08. Bureau fee schedule |
| 4123-6-09. Payment during adjudication of claim [RESCINDED] |
| 4123-6-10. Payment to providers |
| 4123-6-11. Payment to bureau certified provider [RESCINDED] |
| 4123-6-12. Payment to non-bureau certified provider [RESCINDED] |
| 4123-6-13. Payment to MCOs [RESCINDED] |
| 4123-6-14. MCO bill submission to bureau |
| 4123-6-14.1. Records to be retained by MCO |
| 4123-6-15. Confidentiality of records |
| 4123-6-16. Alternative dispute resolution for HPP medical issues |
| 4123-6-16.1. HPP medical treatment guidelines |
| 4123-6-16.2. Medical treatment reimbursement requests |
| 4123-6-16.3. Reimbursement of retroactive medical treatment reimbursement requests |
| 4123-6-17. Bureau refusal to certify or recertify, action to decertify a provider or MCO - standards and procedures for adjudication hearings |
| 4123-6-18. Data gathering and reporting |
| 4123-6-19. Remain at work services |
| 4123-6-20. Obligation to submit medical documentation and reports |
| 4123-6-20.1. Charges for copies of medical reports |
| 4123-6-21. Payment for outpatient medication |
| 4123-6-21.1. Payment for outpatient medication by self-insuring employer |
| 4123-6-21.2. Pharmacy and therapeutics committee |
| 4123-6-21.3. Outpatient medication formulary |
| 4123-6-21.4. Coordinated services program |
| 4123-6-21.5. Standard dose tapering schedules |
| 4123-6-21.6. `First fill of outpatient medications |
| 4123-6-21.7. Reimbursement of opioids in the treatment of pain for a work related injury or occupational disease |
| 4123-6-21.8. Reimbursement for services to assist in the discontinuation of medications |
| 4123-6-22. Stakeholders' health care quality assurance advisory committee |
| 4123-6-23. Jurisdictional principles applicable to payment of bills for medical services rendered by health care providers |
| 4123-6-24. Treatment necessary due to an industrial injury or occupational disease [RESCINDED] |
| 4123-6-25. Payment for medical supplies and services |
| 4123-6-26. Claimant reimbursement |
| 4123-6-27. Treatment by more than one physician |
| 4123-6-28. Treatment of more than one condition or to more than one part of the body [RESCINDED] |
| 4123-6-29. Request for information by the treating provider |
| 4123-6-30. Payment for physical medicine |
| 4123-6-31. Payment for miscellaneous medical services and supplies |
| 4123-6-32. Payment for lumbar fusion surgery |
| 4123-6-33. Payment for health and behavior assessment and intervention services |
| 4123-6-34. Payment for treatment of concussion injuries |
| 4123-6-35. Payment for hearing aids [RESCINDED] |
| 4123-6-36. Payment for shoes, braces, and other orthotic devices [RESCINDED] |
| 4123-6-37. Payment of hospital bills |
| 4123-6-37.1. Payment of hospital inpatient services |
| 4123-6-37.2. Payment of hospital outpatient services |
| 4123-6-37.3. Payment of ambulatory surgical center services |
| 4123-6-38. Payment for home health nursing services |
| 4123-6-38.1. Payment for nursing and caregiver services provided by persons other than home health agency employees |
| 4123-6-38.2. Payment of nursing home and residential care/assisted living services |
| 4123-6-39. Payment for prosthetic device or other artificial appliances |
| 4123-6-40. Payment of claimant travel expenses |
| 4123-6-41. No legal relationship between the industrial commission or bureau and a health care provider |
| 4123-6-43. Payment for transcutaneous electrical nerve stimulators and neuromuscular electrical stimulators |
| 4123-6-44. Bureau fees for provider services rendered by in-state and out-of-state providers |
| 4123-6-45. Audit of providers' patient and billing related records |
| 4123-6-45.1. Records to be retained by provider |
| 4123-6-46. Standardized or negotiated payment rates for services or supplies |
| 4123-6-50. Self-insured employer participation in the QHP system; reporting requirements for non-participating employers [RESCINDED] |
| 4123-6-51. Employer participation in the QHP system - bureau certification of QHPs |
| 4123-6-52. Employer participation in the QHP system - bureau recertification of QHPs |
| 4123-6-53. Employer participation in the QHP system - QHP quality assurance program required |
| 4123-6-54. Employer participation in the QHP system - QHP certification application |
| 4123-6-55. Employer participation in the QHP system - bureau's authority to decertify, to refuse to certify or recertify a QHP |
| 4123-6-56. Employee access to the QHP system - choice and change of provider [RESCINDED] |
| 4123-6-57. Provider access to the QHP system - generally [RESCINDED] |
| 4123-6-58. Provider access to the QHP system - provider participation in QHP system and other related health care program not linked |
| 4123-6-59. Provider access to the QHP system - QHP provider selection |
| 4123-6-60. Provider access to the QHP system - medical record keeping [RESCINDED] |
| 4123-6-61. Payment in the QHP system - employer responsibility - generally [RESCINDED] |
| 4123-6-62. Payment in the QHP system - balance billing prohibited [RESCINDED] |
| 4123-6-63. Payment in the QHP system - application of bureau fee schedule in the QHP system [RESCINDED] |
| 4123-6-64. Payment in the QHP system - vendor payment to providers [RESCINDED] |
| 4123-6-65. Payment in the QHP system - employer payment to vendor that provides medical management and cost containment services and/or QHPs |
| 4123-6-66. Payment in the QHP system - authorization and payment for initial emergency medical treatment [RESCINDED] |
| 4123-6-67. Payment in the QHP system - payment to providers in states that border Ohio [RESCINDED] |
| 4123-6-68. Providers in states that do not border Ohio - QHP freedom to negotiate; restriction on provider charges to employee [RESCINDED] |
| 4123-6-69. QHP dispute resolution process |
| 4123-6-70. Evaluation of the QHP system by the bureau; reporting requirements by employers and QHPs |
| 4123-6-71. Initial report of an injury and reporting requirements by providers and employees in the QHP system [RESCINDED] |
| 4123-6-72. Confidentiality |
| 4123-6-73. Bureau requirement to develop information describing rights under the QHP system [RESCINDED] |