4123-6-02.2 Provider access to the HPP - provider credentialing criteria.

 

 

 

Rule Summary and Fiscal Analysis (Part A)

 

Bureau of Workers' Compensation

Agency Name

 

Aniko Nagy

Division                                                                  Contact

 

30 W. Spring St. Columbus OH 43215-0000                614-466-3293

Agency Mailing Address (Plus Zip)                                       Phone                     Fax

 

[e-mail]

Email

 

 

 

4123-6-02.2

Rule Number

AMENDMENT

TYPE of rule filing

Rule Title/Tag Line              Provider access to the HPP - provider credentialing criteria.

RULE SUMMARY

1.  Is the rule being filed for five year review (FYR)? Yes

2.  Are you proposing this rule as a result of recent legislation? No

3.  Statute prescribing the procedure in accordance with the agency is required to adopt the rule: 119.03

4.  Statute(s) authorizing agency to adopt the rule: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05

5.  Statute(s) the rule, as filed, amplifies or implements: 4121.12, 4121.121, 4121.44, 4121.441, 4123.66

6.  State the reason(s) for proposing (i.e., why are you filing,) this rule:

Pursuant to R.C. 119.032, state agencies are required to review all agency rules every five years to determine whether to amend the rules, rescind the rules, or continue the rules without change.

7.  If the rule is an AMENDMENT, then summarize the changes and the content

of the proposed rule; If the rule type is RESCISSION, NEW or NO CHANGE, then summarize the content of the rule:

This rule establishes minimum criteria for Bureau provider certification. The changes to this rule will require for Bureau certification that providers not be currently excluded from participation in Medicare or Medicaid. Further changes add certified shoe retailer as a Bureau certified provider type.

8.  If the rule incorporates a text or other material by reference and the agency claims the incorporation by reference is exempt from compliance with sections

121.71 to 121.74 of the Revised Code because the text or other material is generally available to persons who reasonably can be expected to be affected by the rule, provide an explanation of how the text or other material is generally available to those persons:

This response left blank because filer specified online that the rule does not incorporate a text or other material by reference.

9.  If the rule incorporates a text or other material by reference, and it was infeasible for the agency to file the text or other material electronically, provide an explanation of why filing the text or other material electronically was infeasible:

This response left blank because filer specified online that the rule does not incorporate a text or other material by reference.

10.  If the rule is being rescinded and incorporates a text or other material by reference, and it was infeasible for the agency to file the text or other material, provide an explanation of why filing the text or other material was infeasible:

Not Applicable.

11.  If revising or refiling this rule, identify changes made from the previously filed version of this rule; if none, please state so. If applicable, indicate each specific paragraph of the rule that has been modified:

The Bureau is refiling this rule to delete the amendment of paragraph (C)(16) of this rule, after considering feedback from The Surety & Fidelity Association of America, requiring DME providers who are not participating in medicare obtaining a bond.

12.  Five Year Review (FYR) Date: 8/26/2015

(If the rule is not exempt and you answered NO to question No. 1, provide the scheduled review date. If you answered YES to No. 1, the review date for this rule is the filing date.)

NOTE: If the rule is not exempt at the time of final filing, two dates are required: the current review date plus a date not to exceed 5 years from the effective date for Amended rules or a date not to exceed 5 years from the review date for No Change rules.

FISCAL ANALYSIS

13.  Estimate the total amount by which this proposed rule would increase / decrease either revenues / expenditures for the agency during the current biennium (in dollars): Explain the net impact of the proposed changes to the budget of your agency/department.

This will have no impact on revenues or expenditures. 0.00

n/a

14.  Identify the appropriation (by line item etc.) that authorizes each expenditure necessitated by the proposed rule:

n/a

15.  Provide a summary of the estimated cost of compliance with the rule to all directly affected persons. When appropriate, please include the source for your information/estimated costs, e.g. industry, CFR, internal/agency:

The potential impact to providers would be in the form of license fees or educational costs that a provider may incur to comply with the certification requirements of the rule.

The exact cost unknown at this time as the rule provides flexibility in the manner in which a provider can meet the certification criteria of this rule. The minimum criteria set forth in the regulation reflect criteria employed by other health care payers, i.e. Medicare and Medicaid, and therefore would not be a new requirement for providers participating in those systems.

16.  Does this rule have a fiscal effect on school districts, counties, townships, or municipal corporations? No

17.  Does this rule deal with environmental protection or contain a component dealing with environmental protection as defined in R. C. 121.39? No

S.B. 2 (129th General Assembly) Questions

18.  Has this rule been filed with the Common Sense Initiative Office pursuant to

R.C. 121.82? Yes

19.  Specific to this rule, answer the following:

A.) Does this rule require a license, permit, or any other prior authorization to engage in or operate a line of business? Yes

The proposed rule establishes minimum credentialing criteria for Bureau provider certification, which involves certification requirements for providers to qualify to participate in the Health Partnership Program in providing services to injured workers.

B.) Does this rule impose a criminal penalty, a civil penalty, or another sanction, or create a cause of action, for failure to comply with its terms? Yes

A provider who fails to meet the minimum credentialing criteria set forth in the rule is ineligible to participate in the health partnership program.

C.) Does this rule require specific expenditures or the report of information as a condition of compliance? No