Ohio Admin. Code 4123-6-02.22 - Provider access to the HPP - ambulatory surgical center arthroplasty center requirements
(A) To be eligible for participation in the
HPP as an ambulatory surgical center arthroplasty center, an ambulatory
surgical center must comply with the following minimum criteria:
(1) The facility must be bureau certified as
an ambulatory surgical center under paragraph (C) of rule 4123-6-02.2 of the
Administrative Code.
(2) The
facility must have a formal joint replacement program which has been in place
for at least one year prior to the date of application, and must have performed
a minimum of ten arthroplasty procedures prior to the date of
application.
(3) The facility must
have a physician credentialing criteria policy which includes, at a minimum:
(a) A statement confirming any surgeon
performing the service for injured workers is board certified in a related
surgery specialty;
(b) A statement
confirming any surgeon performing this service for injured workers has
performed the procedure at the facility not less
than
within one year prior to the date
of application;
(c) A statement
confirming any surgeon performing the service for injured workers has admitting
privileges at a hospital within thirty miles of the facility or otherwise
closest hospital;
(d) The facility
recredentials surgeons at regular intervals.
(4) The facility must have a patient
selection criteria policy consistent with applicable standards of care which
includes, at a minimum:
(a) The patient is
American society of anesthesiologists (ASA) physical status I (normal healthy
patient) or II (patients with mild systemic disease);
(b) The patient is under sixty-five years of
age;
(c) The patient has a body
mass index which is not likely to affect surgical outcome;
(d) The patient has no co-morbid conditions
that would be likely to affect surgical outcome;
(e) The patient has one or more individuals
to assist with immediate post-surgical recovery care (home support).
(5) The facility must report
quality data measures to the centers for medicare and medicaid services (CMS)
under the ambulatory surgical center quality reporting (ASCQR)
program.
(6) The facility must have
an established protocol for tracking and reporting the following Ohio
association of ambulatory surgery center (OAASC) quality data measures:
(a) Number of extended stays past
midnight;
(b) Number of unexpected
complications;
(i) Vomiting which does not
respond to treatment;
(ii) Severe
pain not responding to treatment;
(iii) Excessive bleeding requiring return to
surgery or transfer;
(iv) Cardiac
or respiratory arrest;
(c) Number of other incidents in the
following areas:
(i) Medication
errors;
(ii) Medical device
errors;
(iii) Unintentional
retained foreign body;
(d) Post discharge complications;
(i) Infections (thirty days post-operative;
implants up to one year);
(ii)
Emergency room visit within forty-eight hours for related issue;
(7) The facility shall
list on its application the specific procedure(s) it is requesting bureau
certification to perform and receive reimbursement for under rule 4123-6-37.3
of the Administrative Code as an ambulatory surgical center arthroplasty
center.
(B) The bureau
is authorized to recredential and recertify a facility to participate in the
HPP as an ambulatory surgical center arthroplasty center in accordance with
rule
4123-6-02
of the Administrative Code.
(C)
The administrator may decertify, or refuse to certify or recertify the facility
as an ambulatory surgical center arthroplasty center, in accordance with rule
4123-6-17
of the Administrative Code and Chapter 119. of the Revised Code:
(1) If the facility has failed to meet or
maintain any of the requirements for bureau certification as an ambulatory
surgical center arthroplasty center set forth in paragraph (A) of this
rule;
(2) Upon the recommendation
of the bureau of workers' compensation stakeholders' health care quality
assurance advisory committee (HCQAAC) or other peer review committee
established by the bureau that injured worker safety would be compromised by
the continued participation of the facility as an ambulatory surgical center
arthroplasty center in the HPP; or
(3) As otherwise provided by this chapter of
the Administrative Code.
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441, 4123.66
Prior Effective Dates: 5/1/16
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(A) To be eligible for participation in the HPP as an ambulatory surgical center arthroplasty center, an ambulatory surgical center must comply with the following minimum criteria:
(1) The facility must be bureau certified as an ambulatory surgical center under paragraph (C) of rule 4123-6-02.2 of the Administrative Code.
(2) The facility must have a formal joint replacement program which has been in place for at least one year prior to the date of application, and must have performed a minimum of ten arthroplasty procedures prior to the date of application.
(3) The facility must have a physician credentialing criteria policy which includes, at a minimum:
(a) A statement confirming any surgeon performing the service for injured workers is board certified in a related surgery specialty;
(b) A statement confirming any surgeon performing this service for injured workers has performed the procedure at the facility not less than within one year prior to the date of application;
(c) A statement confirming any surgeon performing the service for injured workers has admitting privileges at a hospital within thirty miles of the facility or otherwise closest hospital ;
(d) The facility recredentials surgeons at regular intervals.
(4) The facility must have a patient selection criteria policy consistent with applicable standards of care which includes, at a minimum:
(a) The patient is American society of anesthesiologists (ASA) physical status I (normal healthy patient) or II (patients with mild systemic disease);
(b) The patient is under sixty-five years of age;
(c) The patient has a body mass index which is not likely to affect surgical outcome;
(d) The patient has no co-morbid conditions that would be likely to affect surgical outcome;
(e) The patient has one or more individuals to assist with immediate post-surgical recovery care (home support).
(5) The facility must report quality data measures to the centers for medicare and medicaid services (CMS) under the ambulatory surgical center quality reporting (ASCQR) program.
(6) The facility must have an established protocol for tracking and reporting the following Ohio association of ambulatory surgery center (OAASC) quality data measures:
(a) Number of extended stays past midnight;
(b) Number of unexpected complications;
(i) Vomiting which does not respond to treatment;
(ii) Severe pain not responding to treatment;
(iii) Excessive bleeding requiring return to surgery or transfer;
(iv) Cardiac or respiratory arrest;
(c) Number of other incidents in the following areas:
(i) Medication errors;
(ii) Medical device errors;
(iii) Unintentional retained foreign body;
(d) Post discharge complications;
(i) Infections (thirty days post-operative; implants up to one year);
(ii) Emergency room visit within forty-eight hours for related issue;
(7) The facility shall list on its application the specific procedure(s) it is requesting bureau certification to perform and receive reimbursement for under rule 4123-6-37.3 of the Administrative Code as an ambulatory surgical center arthroplasty center.
(B) The bureau is authorized to recredential and recertify a facility to participate in the HPP as an ambulatory surgical center arthroplasty center in accordance with rule 4123-6-02 of the Administrative Code.
(C) The administrator may decertify, or refuse to certify or recertify the facility as an ambulatory surgical center arthroplasty center, in accordance with rule 4123-6-17 of the Administrative Code and Chapter 119. of the Revised Code:
(1) If the facility has failed to meet or maintain any of the requirements for bureau certification as an ambulatory surgical center arthroplasty center set forth in paragraph (A) of this rule;
(2) Upon the recommendation of the bureau of workers' compensation stakeholders' health care quality assurance advisory committee (HCQAAC) or other peer review committee established by the bureau that injured worker safety would be compromised by the continued participation of the facility as an ambulatory surgical center arthroplasty center in the HPP ; or
(3) As otherwise provided by this chapter of the Administrative Code.
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441, 4123.66
Prior Effective Dates: 5/1/16