4123-6-21.3 Outpatient medication formulary.

 

NOTICE OF PUBLIC HEARING

 

The Ohio Bureau of Workers' Compensation will hold a public hearing on Monday, November 21, 2016, at 1:00 p.m., in Room 1, Level 2, 30 West Spring Street, Columbus, Ohio 43215, to consider the following:

 

Amendment of the following rules for the purposes as shown below:

 

4123-6-21    Payment for outpatient medication.

4123-6-21.1 Payment for outpatient medication by self-insuring employer.

 

The Bureau is proposing to amend this rule to update the agency's prescription reimbursement model to better reflect pricing in the current marketplace, revise coverage and reimbursement of compounded prescriptions and implement coverage changes to various formulary medications.

 

4123-6-21.3 Outpatient medication formulary.

 

The Bureau proposes to revise the formulary appendix to this rule by amending coverage to the opioid drug class and 50 drug products listed in the formulary. These recommended changes are the result of recommendations from the Bureau's Pharmacy & Therapeutics Committee (P&T) Committee as well as a general clean up of the formulary appendix.

These revisions reflect the Bureau's dedication to providing for appropriate care while ensuring the safety of our injured workers. The committee's recommendations resulted from consideration of current literature, accepted treatment guidelines and best clinical practice as well as FDA and information.

 

4123-6-37.1 Payment of hospital impatient services.

 

This rule establishes the fees to be paid by BWC to providers of inpatient hospital services for injured workers. The proposed changes are:

Adopt Medicare final rule including but not limited to: Update to the national standardized amount

MS-DRG changes, ICD-10 update, and relative weight updates Quality and value related programs including new initiatives

Modify current Payment Adjustment Factor (PAF) to reflect the statewide reimbursement to cost benchmark of 114%

112.7% for MS-DRG services 175.4% for outlier services

 

 

The full and complete text of the proposed rules is available at the Register of Ohio (http://www.registerofohio.state.oh.us) and is on file in the office of the Secretary of State (180 East Broad Street, 15th Floor, Columbus, Ohio), the Legislative  Service Commission (77 South High Street, 9th Floor, Columbus, Ohio), the office of the Joint Committee on Agency Rule Review (77 South High Street, Concourse Level, Columbus,

 

 

 

 

 

Ohio), the Bureau of Workers' Compensation, Legal Operations (30 West Spring Street, 26th Floor, Columbus, Ohio), the Bureau of Workers' Compensation (30 West Spring Street, Columbus, Ohio, 1st Floor, Hearing Rooms), and all service offices of the Bureau.

All interested parties will be given an opportunity to be heard. Any interested party unable to attend the public hearing may submit written comments to the undersigned prior to the public hearing at [e-mail].

THE OHIO BUREAU OF WORKERS' COMPENSATION

Tom Sico

Assistant General Counsel, BWC 30 West Spring Street, L-26 Columbus, Ohio 43215-2256

[phone]