4123-6-16.2 Medical treatment reimbursement requests.

 

 

 

NOTICE OF PUBLIC HEARING

 

The Ohio Bureau of Workers' Compensation will hold a public hearing on Thursday, September 14, 2006, at 10:00 a.m., in Room G, 3rd Floor, 30 West Spring Street, Columbus, Ohio 43215, to consider the following:

 

Adoption of the following rules:

 

4123-6-02.21      Provider access to the HPP - non-certified provider enrollment.

4123-6-02.51             Provider  access  to  the  HPP  --  Denial  of  provider,  entity  or  MCO certification based on criminal conviction or civil action.

4123-6-16.2         Medical treatment reimbursement requests. 4123-7-03  Payment for medical supplies and services.

 

Amendment of the following rules:

 

4123-6-02.2         Provider access to the HPP - provider credentialing criteria. 4123-6-02.9  Provider access to the HPP - provider marketing.

4123-6-16            Dispute resolution for HPP medical issues. 4123-6-25      Payment for medical supplies and services.

 

Rescission of the following rules:

 

4123-6-02.21      Provider access to the HPP - chronic pain program requirements.

4123-7-03                  Criteria used for the determination of the amount to be paid for medical services rendered by licensed practitioners.

 

The HPP provider credentialing rules were first promulgated in 1996, prior to the implementation of the HPP in 1997. The rules were amended in 2002 to more specifically spell out the provider recredentialing and recertification process, make both the initial certification and recertification process a one-step process, add specific minimum criteria for certification of non-CARF accredited chronic pain management programs, and address inappropriate marketing of injured workers by certified providers.

The proposed rule changes add several quality-oriented criteria to the provider certification criteria, and rescind the non-CARF accredited chronic pain program certification criteria rule and replace it with a rule regarding enrollment of eligible non- certified providers and non-provider types to receive payment for goods and services rendered to injured workers.

The proposed rule changes also add a new rule that would allow BWC to decertify (or refuse to certify or recertify) providers or MCOs who are owned by (more than 5%) or who have one or more officers, directors, partners, members, or managing employees who have a felony conviction, etc., and to terminate any agreement with and cease reimbursement to a person, provider, managed care organization, or owner as provided by to newly-enacted Ohio Revised Code section 4121.444.

 

 

 

 

 

Finally, the proposed rule changes add a provider solicitation "anti-kickback" provision to the current BWC certified provider marketing rule.

The existing Chapter 7 rule 4123-7-03, unchanged since 1978, is being rescinded and replaced with a new rule 4123-7-03 that mirrors the changes to the corresponding Chapter 6 rule 4123-6-25, so that the medical services provided to state-fund and self- insuring injured workers are equivalent.

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

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

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