Ohio Admin. Code 4123-6-02.3 - Provider access to the HPP - provider application and certification criteria
(A) The bureau shall make available to each
provider a provider certification application and agreement or recertification
application and agreement, as applicable, which shall require the provider to
furnish documentation as provided in rule 4123-6-02.2 of the Administrative
Code.
(B) The provider application
and agreement or recertification application and agreement shall require the
provider to make statements that the provider is without impairments that would
interfere with the provider's ability to practice or that would jeopardize a
patient's health, and a statement that the application is without
misrepresentation, misstatement, or omission of a relevant fact or other acts
involving dishonesty, fraud, or deceit. The provider shall provide to the
bureau any additional documentation requested, and shall permit the bureau to
conduct a review of the provider's practice or facility. The provider shall
notify the bureau within thirty days of any change in the provider's
ownership as reported on the application and agreement,
or status regarding any of the credentialing criteria of paragraph (B) or
(C) of rule 4123-6-02.2 of the Administrative Code.
(C) The bureau shall review the application
and agreement and all documentation submitted by the provider. The bureau may
cross-check data with other governmental agencies or licensing bodies. The
bureau may refer provider certification and malpractice issues to the bureau's
stakeholders health care quality assurance advisory committee for review as
provided under rule
4123-6-22
of the Administrative Code.
(D) By
signing the provider application and agreement or recertification application
and agreement, the provider agrees to, and the bureau may refuse to certify or
recertify or may decertify a provider for failure to:
(10)
(11) Comply with the
workers' compensation statutes and rules and the terms of the provider
application and agreement or recertification application and
agreement.
(1) Provide health services that are
applicable to a work-related
work related injury, and not to substantially
engage in the practice of experimental modalities of treatment.
(2) Acknowledge and treat injured workers in
accordance with bureau recognized treatment guidelines.
(3) Acknowledge and treat injured workers in
accordance with the vocational rehabilitation hierarchy.
(4) Provide adequate on-call coverage for
patients.
(5) Utilize bureau
certified providers when making referrals to other providers.
(6) Timely schedule and treat injured workers
to facilitate a safe and prompt return to work.
(7) Release information from the national
practitioner data bank or the federation of state licensing boards. The bureau
may submit a report to the appropriate state licensing board or data bank as
required in the event the provider is decertified.
(8) Practice in a managed care environment
and adhere to MCO and bureau procedures and requirements concerning provider
compliance, outcome measurement data, peer review, quality assurance,
utilization review, bill submission, and dispute resolution.
(9) Adhere to the bureau's confidentiality
and sensitive data requirements, and use information obtained from the bureau
by means of electronic account access for the sole purpose of facilitating
treatment and no other purpose, including but not limited to engaging in
advertising or solicitation directed to injured workers.
(10)
Maintain
professionalism, integrity, and civility in the provision of services in the
HPP, including in all written and oral communications with the bureau, the
industrial commission, the MCO, injured workers, employers, and their
representatives.
(E) Upon
review and determination by the bureau that the provider has met bureau
credentialing requirements, the bureau shall certify or recertify the provider
as a bureau certified provider.
(F)
The bureau may enter into an addendum to a physician's provider certification
application and agreement or recertification application and agreement,
offering appropriate performance incentives to enhance physician proficiency in
patient care and navigation of the Ohio workers' compensation system, to
physicians who agree to:
(1) Perform enhanced
duties as the treatment team leader in the care of injured workers, as set
forth in the addendum, and
(2)
Enhanced provider outcome measurement.
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: 02/16/1996, 01/15/1999, 03/29/2002, 02/14/2005, 02/01/2010, 11/13/2015, 01/01/2018
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) The bureau shall make available to each provider a provider certification application and agreement or recertification application and agreement, as applicable, which shall require the provider to furnish documentation as provided in rule 4123-6-02.2 of the Administrative Code.
(B) The provider application and agreement or recertification application and agreement shall require the provider to make statements that the provider is without impairments that would interfere with the provider's ability to practice or that would jeopardize a patient's health, and a statement that the application is without misrepresentation, misstatement, or omission of a relevant fact or other acts involving dishonesty, fraud, or deceit. The provider shall provide to the bureau any additional documentation requested, and shall permit the bureau to conduct a review of the provider's practice or facility. The provider shall notify the bureau within thirty days of any change in the provider's ownership as reported on the application and agreement, or status regarding any of the credentialing criteria of paragraph (B) or (C) of rule 4123-6-02.2 of the Administrative Code.
(C) The bureau shall review the application and agreement and all documentation submitted by the provider . The bureau may cross-check data with other governmental agencies or licensing bodies. The bureau may refer provider certification and malpractice issues to the bureau's stakeholders health care quality assurance advisory committee for review as provided under rule 4123-6-22 of the Administrative Code.
(D) By signing the provider application and agreement or recertification application and agreement, the provider agrees to, and the bureau may refuse to certify or recertify or may decertify a provider for failure to: (10) (11) Comply with the workers' compensation statutes and rules and the terms of the provider application and agreement or recertification application and agreement.
(1) Provide health services that are applicable to a work-related work related injury , and not to substantially engage in the practice of experimental modalities of treatment.
(2) Acknowledge and treat injured workers in accordance with bureau recognized treatment guidelines .
(3) Acknowledge and treat injured workers in accordance with the vocational rehabilitation hierarchy.
(4) Provide adequate on-call coverage for patients.
(5) Utilize bureau certified providers when making referrals to other providers.
(6) Timely schedule and treat injured workers to facilitate a safe and prompt return to work.
(7) Release information from the national practitioner data bank or the federation of state licensing boards. The bureau may submit a report to the appropriate state licensing board or data bank as required in the event the provider is decertified.
(8) Practice in a managed care environment and adhere to MCO and bureau procedures and requirements concerning provider compliance, outcome measurement data, peer review, quality assurance, utilization review, bill submission, and dispute resolution .
(9) Adhere to the bureau's confidentiality and sensitive data requirements, and use information obtained from the bureau by means of electronic account access for the sole purpose of facilitating treatment and no other purpose, including but not limited to engaging in advertising or solicitation directed to injured workers.
(10) Maintain professionalism, integrity, and civility in the provision of services in the HPP , including in all written and oral communications with the bureau, the industrial commission, the MCO, injured workers, employers, and their representatives.
(E) Upon review and determination by the bureau that the provider has met bureau credentialing requirements, the bureau shall certify or recertify the provider as a bureau certified provider .
(F) The bureau may enter into an addendum to a physician 's provider certification application and agreement or recertification application and agreement, offering appropriate performance incentives to enhance physician proficiency in patient care and navigation of the Ohio workers' compensation system, to physicians who agree to:
(1) Perform enhanced duties as the treatment team leader in the care of injured workers, as set forth in the addendum, and
(2) Enhanced provider outcome measurement.
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: 02/16/1996, 01/15/1999, 03/29/2002, 02/14/2005, 02/01/2010, 11/13/2015, 01/01/2018