4123-6-37.2 Payment of hospital outpatient services.

 

 

NOTICE OF PUBLIC HEARING

 

The Ohio Bureau of Workers' Compensation will hold a public hearing on Tuesday, June 29, 2010, at 2:00 p.m., in Room 1, 2nd Floor, 30 West Spring Street, Columbus, Ohio 43215, to consider the following:

 

Rescinding and creating a new rule with the same number the following rule for the purpose as shown below:

 

4123-6-37.2    Payment of hospital outpatient services.

 

The rule is amended to update the methodology for the payment of hospital outpatient services for workers' compensation claims.

 

This rule outline reimbursement for hospital outpatient services, starting January 1, 2011 or after, unless an MCO has negotiated a different payment rate with a hospital pursuant to rule 4123-6-10 of the Administrative Code. BWC's current hospital outpatient services reimbursement rule is based on a cost-plus methodology with a cap, utilizing outpatient cost-to-charge ratios (CCR) from Ohio Medicaid as the basis for determining the cost of hospital outpatient services.

 

BWC is proposing to move from this retrospective cost-plus reimbursement methodology to a prospective payment methodology for hospital outpatient services for 2011, based on a modified version of Medicare's Outpatient Prospective Payment System (OPPS). BWC is recommending the following changes to OAC 4123-6-37.2: adoption of a modified OPPS methodology for hospital outpatient reimbursement methodology; adoption of payment adjustment factors to be used with modified OPPS; modification to OPPS 'hold harmless' calculation; and, modification to payment for children's hospitals.

 

 

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.

 

THE OHIO BUREAU OF WORKERS' COMPENSATION

 

 

Tom Sico

 

 

 

 

 

Assistant General Counsel

Bureau of Workers' Compensation 30 West Spring Street, L-26 Columbus, Ohio 43215-2256

[phone]