Ohio Admin. Code 4123-6-07 - Services and supplies never covered
The following services and supplies are never covered by, and shall not be authorized or reimbursed by, the bureau or MCO:
(A) Services and supplies that are never
covered pursuant to other bureau statutes or rules.
(B) The following services and supplies,
which are never considered to be durable medical equipment by the bureau:
(3)
(2) Home exercise
equipment, including but not limited to such equipment as treadmills and
exercise bikes;
(4)
(3) Home whirlpools, including built-in whirlpools and
pumps, portable hydrotherapy pools, jacuzzi tubs, portable saunas and spas,
non-portable hot tubs or whirlpools, and therasaunas.
(5)
(4)
Unsupervised physical reconditioning programs, including but not limited to memberships to or services
provided at a health club, YMCA, spa or nautilus facility, except when
the criteria have been met for an injured worker who is participating in a
vocational rehabilitation or remain at work program.
(1) Home furniture including, but not limited
to: reclining
(a)
Reclining
chairs, non-hospital beds, water beds, lounge beds
(such as adjust-a-sleep adjustable bed, craftmatic adjustable bed, electropedic
adjustable bed, simmons beautyrest adjustable bed). The bureau or MCO shall
reimburse for a seat lift mechanism when medically necessary and appropriate
for an injured worker who requires a mobility aid to stand from a seated
position due to physical limitations that are reasonably related to the
industrial injury (allowed conditions). However, the bureau or MCO shall not
reimburse for the chair (furniture)
(except for
the seat lift mechanism portion of a reclining chair) ;
(b)
Non-hospital
beds, (such as a water bed, adjust-a-sleep adjustable bed, craftmatic
adjustable bed, electropedic adjustable bed, simmons beautyrest adjustable
bed);
(c)
Hospital bed mattresses larger than a standard (eighty
inches long, thirty-six inches wide) size, except for bariatric hospital bed
mattresses.
(2) A mattress for a non-hospital
bed (including, but not limited to: tempurpedic, angelbed, memory foam
mattresses). Reimbursement for a hospital bed mattress is limited to a
twin/single size only. The bureau or MCO will not reimburse for a double, queen
or king size mattress for the purpose of accommodating two
people;
(C) Self-administered sympathetic
therapy/interferential therapy.
(D)
Prescription smoking deterrent drugs outside an approved smoking cessation
program, except when dispensed while the injured worker is admitted to a
hospital during an approved inpatient admission or during the course of an
outpatient visit in a hospital.
(E)
Drug screening of injured workers performed by employers or performed in the
emergency room at the time of injury at the request of the employer.
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, 4121.444
Prior Effective Dates: 12/11/2012, 11/13/2015
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.
The following services and supplies are never covered by, and shall not be authorized or reimbursed by, the bureau or
(A) Services and supplies that are never covered pursuant to other bureau statutes or rules.
(B) The following services and supplies, which are never considered to be durable medical equipment by the bureau: (3) (2) Home exercise equipment, including but not limited to such equipment as treadmills and exercise bikes; (4) (3) Home whirlpools, including built-in whirlpools and pumps, portable hydrotherapy pools, jacuzzi tubs, portable saunas and spas, non-portable hot tubs or whirlpools, and therasaunas. (5) (4) Unsupervised physical reconditioning programs, including but not limited to memberships to or services provided at a health club, YMCA, spa or nautilus facility, except when the criteria have been met for an injured worker who is participating in a vocational rehabilitation or remain at work program.
(1) Home furniture including, but not limited to: reclining
(a) Reclining chairs, non-hospital beds, water beds, lounge beds (such as adjust-a-sleep adjustable bed, craftmatic adjustable bed, electropedic adjustable bed, simmons beautyrest adjustable bed). The bureau or MCO shall reimburse for a seat lift mechanism when medically necessary and appropriate for an injured worker who requires a mobility aid to stand from a seated position due to physical limitations that are reasonably related to the industrial injury (allowed conditions). However, the bureau or MCO shall not reimburse for the chair (furniture) (except for the seat lift mechanism portion of a reclining chair) ;
(b) Non-hospital beds, (such as a water bed, adjust-a-sleep adjustable bed, craftmatic adjustable bed, electropedic adjustable bed, simmons beautyrest adjustable bed);
(c) Hospital bed mattresses larger than a standard (eighty inches long, thirty-six inches wide) size, except for bariatric hospital bed mattresses.
(2) A mattress for a non-
(C) Self-administered sympathetic therapy/interferential therapy.
(D) Prescription smoking deterrent drugs outside an approved smoking cessation program, except when dispensed while the injured worker is admitted to a hospital during an approved inpatient admission or during the course of an outpatient visit in a hospital .
(E) Drug screening of injured workers performed by employers or performed in the emergency room at the time of injury at the request of the employer.
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, 4121.444
Prior Effective Dates: 12/11/2012, 11/13/2015