Ohio Administrative Code
Title 4123 - Bureau of Workers' Compensation
Chapter 4123-6 - Health Partnership Program
- Section 4123-6-01 - Definitions
- Section 4123-6-01.1 - Applicability of medical rules
- Section 4123-6-01.2 - Provisional treatment reimbursement approval - pilot program
- Section 4123-6-02 - Provider access to the HPP - generally
- Section 4123-6-02.1 - Rescinded
- Section 4123-6-02.2 - Provider access to the HPP - provider certification criteria
- Section 4123-6-02.21 - Provider access to the HPP - non-certified provider enrollment
- Section 4123-6-02.22 - Provider access to the HPP - ambulatory surgical center arthroplasty center requirements
- Section 4123-6-02.3 - Provider access to the HPP - provider application and certification criteria
- Section 4123-6-02.4 - Provider access to the HPP - provider recertification
- Section 4123-6-02.5 - Provider access to the HPP - provider not certified
- Section 4123-6-02.51 - Provider access to the HPP - Denial of provider, entity or MCO enrollment or certification based on criminal conviction or civil action
- Section 4123-6-02.6 - Provider access to the HPP - selection by an MCO
- Section 4123-6-02.7 - Provider access to the HPP - provider decertification procedures
- Section 4123-6-02.8 - Provider requirement to notify of injury
- Section 4123-6-02.9 - Provider access to the HPP - provider marketing
- Section 4123-6-03 - MCO participation in the HPP - generally
- Section 4123-6-03.2 - MCO participation in the HPP - MCO application for certification or recertification
- Section 4123-6-03.3 - MCO participation in the HPP - MCO participation based on MCO capacity
- Section 4123-6-03.4 - MCO participation in the HPP - MCO certification
- Section 4123-6-03.6 - MCO participation in the HPP - administrator's authority to terminate MCO contracts
- Section 4123-6-03.7 - MCO participation in the HPP - bureau's authority to decertify, to refuse to certify or recertify an MCO
- Section 4123-6-03.8 - MCO participation in the HPP - marketing of services by MCO. [Rescinded]
- Section 4123-6-03.9 - MCO participation in the HPP - MCO disclosure of relationship
- Section 4123-6-03.10 - Conflict of interest
- Section 4123-6-04 - MCO scope of services - generally
- Section 4123-6-04.2 - MCO scope of services - management of medical treatment of provider selected by employee
- Section 4123-6-04.3 - MCO scope of services - MCO medical management and claims management assistance
- Section 4123-6-04.4 - MCO scope of services - fee bill review and audit process
- Section 4123-6-04.5 - MCO scope of services - bureau claims management
- Section 4123-6-04.6 - Return to work assessment
- Section 4123-6-05.1 - Employer access to the HPP - MCO advertising and solicitation
- Section 4123-6-05.2 - Employer access to the HPP - employer enrollment and selection of MCO
- Section 4123-6-05.3 - Employer access to the HPP - certain solicitation practices by MCOs prohibited
- Section 4123-6-05.4 - Employer access to the HPP - payment for referrals prohibited
- Section 4123-6-06 - Employee access to the HPP - generally
- Section 4123-6-06.1 - Employee access to medical services - education by MCO and employer
- Section 4123-6-06.2 - Injured worker access to the HPP - injured worker choice of provider
- Section 4123-6-06.3 - Employee access to the HPP - application of rules to claims
- Section 4123-6-07 - Services and supplies never covered
- Section 4123-6-08 - Bureau fee schedule
- Section 4123-6-09 - Payment during adjudication of claim
- Section 4123-6-10 - Payment to providers
- Section 4123-6-11 - Payment to bureau certified provider
- Section 4123-6-12 - Payment to non-bureau certified provider
- Section 4123-6-13 - Payment to MCOs
- Section 4123-6-14 - MCO bill submission to bureau
- Section 4123-6-14.1 - Records to be retained by MCO
- Section 4123-6-15 - Confidentiality of records
- Section 4123-6-16 - Alternative dispute resolution for HPP medical issues
- Section 4123-6-16.1 - HPP medical treatment guidelines
- Section 4123-6-16.2 - Medical treatment reimbursement requests
- Section 4123-6-16.2 - Medical treatment reimbursement requests
- Section 4123-6-16.3 - Reimbursement of retroactive medical treatment reimbursement requests
- Section 4123-6-17 - Bureau refusal to certify or recertify, action to decertify a provider, MCO, or QHP - standards and procedures for adjudication hearings
- Section 4123-6-18 - Data gathering and reporting
- Section 4123-6-19 - Remain at work services
- Section 4123-6-20 - Obligation to submit medical documentation and reports
- Section 4123-6-20.1 - Access to medical documentation
- Section 4123-6-21 - Payment for outpatient medication
- Section 4123-6-21.1 - Payment for outpatient medication by self-insuring employer
- Section 4123-6-21.2 - Pharmacy and therapeutics committee
- Section 4123-6-21.3 - Outpatient medication formulary
- Section 4123-6-21.4 - Coordinated services program
- Section 4123-6-21.5 - Standard dose tapering schedules
- Section 4123-6-21.6 - First fill of outpatient medications
- Section 4123-6-21.7 - Reimbursement of opioids in the treatment of pain for a work related injury or occupational disease
- Section 4123-6-21.8 - Reimbursement for services to assist in the discontinuation of medications
- Section 4123-6-22 - Stakeholders' health care quality assurance advisory committee
- Section 4123-6-23 - Jurisdictional principles applicable to payment of bills for medical services rendered by health care providers
- Section 4123-6-24 - Treatment necessary due to an industrial injury or occupational disease
- Section 4123-6-25 - Payment for medical supplies and services
- Section 4123-6-26 - Claimant reimbursement
- Section 4123-6-27 - Treatment by more than one physician
- Section 4123-6-28 - Treatment of more than one condition or to more than one part of the body
- Section 4123-6-29 - Request for information by the treating provider
- Section 4123-6-30 - Payment for physical medicine
- Section 4123-6-31 - Payment for miscellaneous medical services and supplies
- Section 4123-6-32 - Payment for lumbar fusion surgery
- Section 4123-6-33 - Payment for health and behavior assessment and intervention services
- Section 4123-6-34 - Payment for treatment of concussion injuries
- Section 4123-6-35 - Payment for spinal cord stimulator
- Section 4123-6-36 - Enhanced care program
- Section 4123-6-37 - Payment of hospital bills
- Section 4123-6-37.1 - Payment of hospital inpatient services
- Section 4123-6-37.2 - Payment of hospital outpatient services
- Section 4123-6-37.3 - Payment of ambulatory surgical center services
- Section 4123-6-38 - Payment for home health nursing services and home health aide services
- Section 4123-6-38.1 - Payment for nursing and caregiver services provided by persons other than home health agency employees
- Section 4123-6-38.2 - Payment of nursing home and residential care/assisted living services
- Section 4123-6-39 - Payment for prosthetic device or other artificial appliances
- Section 4123-6-40 - Payment of injured worker travel expenses
- Section 4123-6-41 - No legal relationship between the industrial commission or bureau and a health care provider
- Section 4123-6-42 - Interest on late payments for equipment, materials, goods, supplies or services in state insurance fund, public work relief employees' compensation fund, coal workers pneumoconiosis fund, and marine industry fund claims
- Section 4123-6-43 - Payment for transcutaneous electrical nerve stimulators and neuromuscular electrical stimulators
- Section 4123-6-44 - Bureau fees for provider services rendered by in-state and out-of- state providers
- Section 4123-6-45 - Audit of providers' patient and billing related records
- Section 4123-6-45.1 - Records to be retained by provider
- Section 4123-6-46 - Standardized or negotiated payment rates for services or supplies
- Section 4123-6-50 - Self-insured employer participation in the QHP system; reporting requirements for non-participating employers
- Section 4123-6-51 - Employer participation in the QHP system - bureau certification of QHPs
- Section 4123-6-52 - Employer participation in the QHP system - bureau recertification of QHPs
- Section 4123-6-53 - Employer participation in the QHP system - QHP quality assurance program required
- Section 4123-6-54 - Employer participation in the QHP system - QHP certification application
- Section 4123-6-55 - Employer participation in the QHP system - bureau's authority to decertify, to refuse to certify or recertify a QHP
- Section 4123-6-56 - Employee access to the QHP system - choice and change of provider
- Section 4123-6-57 - Provider access to the QHP system - generally
- Section 4123-6-58 - Provider access to the QHP system - provider participation in QHP system and other related health care program not linked
- Section 4123-6-59 - Provider access to the QHP system - QHP provider selection
- Section 4123-6-60 - Provider access to the QHP system - medical record keeping
- Section 4123-6-61 - Payment in the QHP system - employer responsibility - generally
- Section 4123-6-62 - Payment in the QHP system - balance billing prohibited
- Section 4123-6-63 - Payment in the QHP system - application of bureau fee schedule in the QHP system
- Section 4123-6-64 - Payment in the QHP system - vendor payment to providers
- Section 4123-6-65 - Payment in the QHP system - employer payment to vendor that provides medical management and cost containment services and/or QHPs
- Section 4123-6-66 - Payment in the QHP system - authorization and payment for initial emergency medical treatment
- Section 4123-6-67 - Payment in the QHP system - payment to providers in states that border Ohio
- Section 4123-6-68 - Providers in states that do not border Ohio - QHP freedom to negotiate; restriction on provider charges to employee
- Section 4123-6-69 - QHP dispute resolution process
- Section 4123-6-70 - Evaluation of the QHP system by the bureau; reporting requirements by employers and QHPs
- Section 4123-6-71 - Initial report of an injury and reporting requirements by providers and employees in the QHP system
- Section 4123-6-72 - Confidentiality
- Section 4123-6-73 - Bureau requirement to develop information describing rights under the QHP system
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