Ohio Administrative Code
Title 4123 - Bureau of Workers' Compensation
Chapter 4123-6 - Health Partnership Program
Section 4123-6-02.2 - Provider access to the HPP - provider certification criteria
Universal Citation: OH Admin Code 4123-6-02.2
Current through all regulations passed and filed through September 16, 2024
(A) The bureau will establish minimum criteria for provider certification. Providers must meet all licensing, certification, or accreditation requirements necessary to provide services in Ohio. A provider licensed, certified, or accredited pursuant to the equivalent law of another state qualifies as a provider under this rule in that state. However, a provider is ineligible to participate in the health partnership program if:
(1) The state of Ohio
has denied the provider's application for a professional license or the
provider's professional license in Ohio is under revocation or suspension;
or
(2) The provider's professional
license is subject to disciplinary restrictions that affect the provider's
ability to treat patients or that compromise patient care.
(B) The minimum criteria for a provider, where applicable based upon the type of provider, are as follows. The provider shall:
(1) Be currently licensed to practice,
as applicable, without disciplinary restrictions that affect the provider's
ability to treat patients or that compromise patient care.
(2) Meet other general certification
criteria for the specific provider type, as provided
in paragraph (C) of this rule.
(3)
Not be currently excluded from participation in medicare or Ohio medicaid for
cause.
(4) Not be currently
ineligible to participate in the health partnership program due to the provider
having been convicted of or pleaded guilty to a criminal offense as set forth
in the appendix to this rule.
(5) Attest to and
maintain professional malpractice and liability insurance, and provide proof of
such coverage to BWC upon request.
(6) Provide
documentation of the provider's malpractice history for the previous five
years.
(7) Not have any
outstanding provider overpayment or other indebtedness to the bureau which has
been certified to the attorney general for collection.
(8)
Maintain workers' compensation coverage to the extent
required under Ohio law or the equivalent law of another state, as
applicable, and provide proof of such coverage to BWC
upon request.
(9) Not have been
excluded or removed from participation in other health plans for
cause.
(10) Not have lost
hospital privileges for cause.
(C) The following minimum credentials apply to the providers listed below as provided in this rule.
(1) Adult day care facility: Ohio department
of aging PASSPORT adult day care provider agreement.
(2) Alcohol and drug counseling clinic:
certified by Ohio department of mental health and addiction services.
(3) Ambulance, ambulette, or air ambulance
service: license from Ohio
state board of emergency medical, fire,
and transportation services if private; approved for medicare by the centers for medicare and medicaid
services (CMS) if
government/public.
(4) Ambulatory
surgical center: license from Ohio department of health and approved
for medicare by CMS .
(5) Anesthesiologist assistant: license from
Ohio state medical board.
(6)
Athletic trainer: license from Ohio occupational therapy, physical therapy, and
athletic trainers board.
(7)
Audiologist: license from Ohio state speech and hearing professionals
board.
(8) Certified nurse
practitioner: license from Ohio board of nursing and certified by American
nurses credentialing center or other certifying agency approved by the Ohio
board of nursing.
(9) Certified
registered nurse anesthetist (CRNA): license from Ohio board of nursing and
certified by national council on certification of nurse anesthetists or other
certifying agency approved by the Ohio board of nursing.
(10) Certified shoe retailer: certified
or accredited by
American board for certification in orthotics,
prosthetics and pedorthics or board of
certification/accreditation.
(11) Chiropractic physician (D.C.): license
from Ohio state chiropractic board.
(12) Clinical nurse specialist: license from
Ohio board of nursing and certified by American nurses credentialing center or
other certifying agency approved by the Ohio board of nursing.
(13) Comprehensive pain management services
program: (free standing) commission on accreditation of rehabilitation
facilities CARF accreditation; (hospital based) CARF or joint commission
accreditation.
(14) Dentist:
license from Ohio state dental board.
(15) Dialysis center: license from Ohio
department of health and approved for medicare by
CMS or
a
deeming organization approved by CMS.
(16) Durable medical equipment supplier
(excludes orthotics, prosthetics and pedorthics): approved
for medicare by CMS and state of Ohio board of pharmacy
home medical equipment certificate of registration.
(17) Employment specialist:
(a)
(i)
Certification for American board of vocational experts (ABVE), certified
rehabilitation counselor (CRC), certified case manager (CCM), certified
employment support professional (CESP), certification for individual placement
and support (CIPS), global career development facilitator (GCDF), associate
certified coach (ACC), professional certified coach (PCC), master certified
coach (MCC), certified disability management specialist (CDMS), or CARF
accreditation for employment and community services in job development or
employment supports; or
(ii)
Evidence of completion of three or more courses, seminars or workshops prior to
application for certification, totaling a minimum of eighty hours and approved
by the bureau or by an entity offering a certification referenced in paragraph
(C)(17)(a)(i) of this rule, in at least two of the following domain areas: job
development, job placement, and career and lifestyle development; vocational
consultation and services for employers; professional roles and practices,
ethics, and utilization of community resources; or
(iii) Evidence of bureau reimbursement to the
provider for job placement, job development, job seeking skills training, job
club, and/or job coaching services to injured workers for dates of service
beginning not less than eighteen months prior to April 1, 2014. However, if the
provider has been certified pursuant to this provision and the provider's
certification subsequently lapses, the provider must thereafter meet the
criteria of paragraph (B)(17)(a)(i) or (B)(17)(a)(ii) of this rule for
certification or recertification.
(b) Employment specialists certified pursuant
to paragraph (C)(17)(a)(ii) or (C)(17)(a)(iii) of this rule must complete
thirty hours of continuing education, including three hours of ethics, every
three years to maintain certification under this rule.
(18) Ergonomist: certification for certified
professional ergonomist (CPE), certified human factors professional (CHFP),
associate ergonomics professional (AEP), associate human factors professional
(AHFP), certified ergonomics associate (CEA), certified safety professional
(CSP) with "ergonomics specialist" designation, certified industrial ergonomist
(CIE), certified industrial hygienist (CIH), assistive technology practitioner
(ATP), or rehabilitation engineering technologist (RET).
(19) Hearing aid dealer: license from Ohio
state speech and hearing professionals board.
(20) Home health agency:
license from Ohio department of health, and
approved for medicare by CMS
or
a
deeming organization approved by CMS.
(21) Hospice: license from Ohio department of
health, and approved for medicare by CMS
.
(22)
Hospital: license from Ohio department of health no
later than September 30, 2024, and approved for
medicare by CMS or
a
deeming organization approved by CMS, or obtained CARF accreditation for
rehabilitation hospitals. The following facility types
are eligible
to be credentialed and certified as hospitals: short-term general and
specialty hospitals; long-term care hospitals; rehabilitation hospitals;
and psychiatric hospitals; hospital (provider)
based urgent care facilities or clinics as designated on the hospital's
medicare cost report.
(23)
Independent diagnostic testing facility (IDTF): approved
for medicare by CMS .
(24) Laboratory: valid clinical laboratory
improvement amendments (CLIA) certificate.
(25) Licensed professional clinical counselor
(LPCC) or licensed professional counselor (LPC): license from Ohio counselor,
social worker, and marriage and family therapist board.
(26) Licensed social worker (LSW) or licensed
independent social worker (LISW): license from Ohio counselor, social worker,
and marriage and family therapist board.
(27) Massage therapist: license from Ohio
state medical board.
(28)
Non-physician acupuncturist: license to practice acupuncture or certificate to
practice as an oriental medicine practitioner from Ohio state medical
board.
(29) Nursing home: license
from Ohio department of health or approved for
medicare by CMS .
(30) Ocularist:
license from Ohio state vision professionals board.
(31) Occupational
rehabilitation-comprehensive programs (work hardening): CARF
accreditation.
(32) Occupational
therapist: license from Ohio occupational therapy, physical therapy, and
athletic trainers board.
(33)
Optician: license from Ohio state vision professionals board.
(34) Optometrist: license from Ohio state
vision professionals board.
(35)
Orthotist, prosthetist or pedorthist: license from Ohio occupational therapy,
physical therapy, and athletic trainers board.
(36) Physical therapist: license from Ohio
occupational therapy, physical therapy, and athletic trainers board.
(37) Physician (M.D. or D.O.): license from
Ohio state medical board.
(38)
Physician assistant: certified by national commission on certification of
physician assistants and license from Ohio state medical board.
(39) Podiatric physician (D.P.M.): license
from Ohio state medical board.
(40)
Psychologist: license from Ohio state board of psychology.
(41) Radiology services (free-standing)
registration from the Ohio
department of health
and approved
for medicare by CMS or
a deeming organization approved
by CMS.
(42) Residential
care/assisted living facility: license from Ohio department of
health.
(43) Sleep laboratory:
certified by the American academy of sleep medicine and approved
for medicare by CMS or
a deeming organization
approved by CMS.
(44)
Speech-language pathologist: license from Ohio state speech and hearing
professionals board.
(45) Traumatic
brain injury (TBI) program: CARF accreditation for brain injury services (acute
or post-acute).
(46) Urgent care
facility (free standing): approved for medicare
by CMS .
(47) Vocational rehabilitation case managers:
certification for ABVE, occupational health nursing (COHN(S)), CRC, CDMS,
certified vocational evaluator (CVE), certified rehabilitation nurse (CRRN), or
CCM.
(48) Vocational rehabilitation
case management interns:
(a) Vocational
rehabilitation case management may be provided by a bureau- certified intern.
An intern is a non-credentialed individual who provides vocational case
management services and is supervised by a credentialed vocational case
manager, as identified in paragraph (C)(47) of this rule.
(b) To become eligible for bureau
certification and provide service as an intern, the intern must:
(i) Enroll with the bureau as an
intern.
(ii) Qualify to take one of
the examinations to become credentialed, as identified in paragraph (C)(47) of
this rule.
(c) Bureau
certification of vocational rehabilitation case management interns shall be for
a period of four years.
(d)
Vocational rehabilitation case management interns
cannot be
recertified for additional four-year periods.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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