4123-6-02.5 Provider access to the HPP - provider not certified.

 

 

 

4123-6-02.5                 Provider access to the HPP - provider not certified.

 

 

 

(A)     A provider not certified or recertified shall cure any defects in the provider application and agreement or recertification application and agreement within thirty days of notice by the bureau.

 

(B)  The administrator of the bureau of workers' compensation, pursuant to rule 4123-6-17 of the Administrative Code, may refuse to certify or recertify or may decertify a provider where the provider has failed to comply with the workers' compensation statutes or rules, or the terms of the provider application and agreement or recertification application and agreement.

 

(C)   Notwithstanding paragraph (B) of this rule, in any case where the administrator finds a serious danger to the public health and safety and sets forth specific reasons for such findings, or , in the case of an individual provider, the bureau receives notice from the appropriate state licensing board that the provider's professional license has been revoked or suspended, or the provider is convicted of or pleads guilty to a violation of sections 2913.48 or 2923.31 to 2923.36 if the Revised Code or any other criminal offense related to the delivery of or billing for health care benefits, the administrator may immediately revoke or suspend the certification of a provider. The order shall be final unless the provider, within seven days of such order, requests a hearing before the administrator where the provider shall show cause why the order should not be final. The order of the administrator shall remain in force during the pendency of the show cause hearing. other than a hospital, in accordance with section 4121.443 of the Revised Code, if the bureau determines any of the following apply to the provider:

 

(1)The professional license, certification, or registration held by the provider to practice the provider's profession has been revoked or suspended for an indefinite period of time or for a period of more than thirty days, subsequent to the provider's certification to participate in the health partnership program.

 

(2)The provider has been convicted of or has pleaded guilty to a violation of section 2913.48 or sections 2923.31 to 2923.36 of the Revised Code or has been convicted of or pleaded guilty to any other criminal offense related to the delivery of or billing for health care services.

 

(3)The bureau determines, by clear and convincing evidence, that the continued participation by the provider in the health partnership program presents a danger of immediate and serious harm to claimants.

 

(D)    The administrator may impose disciplinary sanctions upon a provider where the provider has failed to comply with the workers' compensation statutes or rules governing providers or the terms of the provider application and agreement or recertification application and agreement. The administrator may impose a disciplinary sanctions without an adjudication order under rule 4123-6-17 of the

 

 

Administrative Code. In imposing a disciplinary sanction against a provider the administrator may consider, but is not limited to, suspending all reimbursements to a provider.

Effective:                                                             11/13/2015

Five Year Review (FYR) Dates:                         08/26/2015 and 08/25/2020

CERTIFIED ELECTRONICALLY

Certification

11/02/2015

Date

Promulgated Under:                           119.03

Statutory Authority:                           4121.12, 4121.121, 4121.30, 4121.31, 4121.44,

4121.441, 4121.443, 4123.05

Rule Amplifies:                                  4121.12, 4121.121, 4121.44, 4121.441, 4121.443

Prior Effective Dates:                         2/16/96, 1/15/99, 3/29/02, 2/14/05, 2/1/10