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

 

Tom Sico

Division                                                                  Contact

 

30 West Spring St. L26 Columbus OH 43215-0000	614-466-6600	614-466-9384
Agency Mailing Address (Plus Zip)	Phone	Fax

 

 

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 consistent with the requirements of the RC 119.032 review? No

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, 4123.05

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

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

To make changes to the rules for provider credentialing in the Bureau's Health Partnership Program.

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:

The proposed rule changes add several new credentialing criteria for providers for

eligibility for the Health Partnership Program. The provider must:

Be currently licensed to practice without disciplinary restrictions that are related to chemical dependency or substance abuse;

Not have a history of court supervised intervention or treatment in lieu of conviction pursuant to section 2951.041 of the Revised Code or the equivalent law of another state;

Provide proof of and maintain adequate, current professional malpractice and liability insurance, as determined by the bureau;

Provide proof of and maintain workers' compensation coverage to the extent required under Ohio law or the equivalent law of another state, as applicable;

Not have been excluded or removed from participation in other health plans for cause, or have lost hospital privileges for cause;

The proposed rule also adds a training requirement for vocational rehabilitation case managers and interns, clarifies that only CARF accredited chronic pain programs shall be eligible for certification, changes several references from "Medicare certification" to "Medicare participation" and the "Health Care Financing Administration" to the "Centers for Medicare & Medicaid Services" to reflect changes in terminology, adds specific criteria for several provider types, including dentists, physicians, chiropractic physicians, and podiatric physicians, and makes additional minor changes.

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:

Paragraphs (B)(11) to (B)(13) of the prior filed version of the rule have been deleted. These paragraphs related to provider credentials and excluded from the Health Partnership Program providers who had a pattern or practice (more than three documented instances) of failing to comply with bureau administrative procedures and requirements set forth in the bureau's provider billing and reimbursement manual; failing to comply with vocational rehabilitation case management procedures and requirements as set forth in the bureau's provider billing and reimbursement manual; or failing to submit medical documentation, upon request, as required by rule 4123-6-20 of the Administrative Code and the bureau's provider billing and reimbursement manual.

The revised rule also clarifies some of the provider credentials under Paragraph (C) of the rule in Paragraph (C)(1), Ambulance services; (C)(2), Ambulatory surgical centers; (C)(12), Hospitals; (C)(26), Physician assistants; (C)(31), Social workers; and (C)(38), Comprehensive pain management services programs.

12. 119.032 Rule Review Date: 3/1/2009

(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:

N/A

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