The bureau of workers' compensation stakeholders' health care
quality assurance advisory committee (HCQAAC) was created to advise the
administrator, the chief of medical services, and the chief medical officer
with regard to medical quality issues. A list of medical providers, each
holding a professional license in good standing, who have
agreed to serve
expressed an interest in serving on the HCQAAC, and
who would add credibility and diversity to the mission and goals of the HCQAAC
shall be developed and maintained by the chief
medical officer
the bureau. Providers
may be nominated for inclusion on the list by provider associations and
organizations including but not limited to: deans of Ohio's allopathic and
osteopathic medical schools, deans of Ohio's colleges of pharmacy, deans of
Ohio's dental schools, the dean of the Ohio college of podiatric medicine, the
Ohio state medical association, the Ohio state osteopathic association, the
Ohio state chiropractic association, specialty board associations of Ohio, the
Ohio podiatric medical association, the Ohio psychological association, the
Ohio dental association, the Ohio pharmacists association, the Ohio hospital
association, the Ohio state medical board, the Ohio state chiropractic board,
the Ohio state psychology board, the Ohio state pharmacy board, and the Ohio
state dental board.
(A) The HCQAAC
shall consist of the bureau's chief medical officer, the chief of medical
services and not more than thirteen nor less than five voting members
representing the diverse group of providers that provide medical care to the
injured workers of Ohio as administrated through the bureau. The committee may
create any subcommittees that the committee determines are necessary to assist
the committee in performing its duties. Any subcommittee recommendations shall
be submitted to the HCQAAC committee.
(B) HCQAAC members must meet the following
requirements:
(1) Providers must be familiar
with issues relating to the treatment of injured workers in the Ohio workers'
compensation system.
(2) Providers
must possess significant clinical or administrative experience in health care
delivery, including but not limited to, medical quality assurance, disease
management, and utilization review.
(3) Providers must have experience with and
an understanding of the concepts of evidence based medicine as well as
contemporary best practices in their respective areas of practice.
(C) The appointing authority for
members of the HCQAAC shall be the administrator or the administrator's
designee(s), who shall appoint members of the HCQAAC from the list of qualified
providers developed and maintained by the
chief
medical officer
bureau. Terms of
membership for individual members of the HCQAAC shall be for one year.
Individuals may be reappointed to subsequent terms as determined by the
administrator. Vacated terms shall be filled in a like manner as for the full
term appointments and shall be for the remaining term of the vacated
member.
(D) The chief medical
officer of the bureau shall be the chairperson of the HCQAAC and shall provide
notice of meeting to the members and be responsible for the meeting agenda. In
addition, the chief medical officer and chief of medical services may be
self-designated as an ad hoc member of any subcommittees of the HCQAAC.
However, the chief of medical services
shall not
be
is not a voting member of the HCQAAC
or any subcommittee, and the chief medical officer
shall be
is a voting
member of the HCQAAC and any subcommittees only in the case of tie votes. The
bureau's medical director, the industrial
commission's medical
director
advisor, and one physician chosen by the MCOs may
participate in discussions; however, they
shall
are not
be voting members.
(E) The HCQAAC shall develop and establish
bylaws for the organization and operations of the committee and subcommittees,
subject to the requirements of this rule and approval by the administrator and
the chief medical officer.
(F) The
HCQAAC shall be responsible to respond to requests for
action
recommendation on any medical quality assurance issue
submitted by the bureau's administrator, chief of medical services, or chief
medical officer including
, but not limited
to:
(1) Review of medical treatment
guidelines referred to the bureau;
(2) Review of any of the bureau's policies
and procedures related to medical quality assurance issues;
(3) Review of any of the bureau's medical
providers' professional performance and conduct, including bureau certification
and malpractice issues.
The HCQAAC shall
perform
Any peer review
according to
conducted by the HCQAAC will be in accordance with
generally accepted standards of medical practice
.
and
The HQAAC
may recommend sanctions as well as decertification of any provider determined
to have consistently failed to meet
those
such standards
of
care. Any decertification or sanction of a provider by the bureau
pursuant to recommendation of the HCQAAC
shall
will be
conducted in accordance with rule
4123-6-17
of the Administrative Code;
(4)
Review of any of the bureau's managed care organizations' professional
performance and conduct regarding the management of medical services for the
bureau. This may include interfacing with any quality assurance committee of
any of the individual managed care organizations.
The HCQAAC may make such recommendations as it deems necessary
to address any medical quality assurance issue impacting the bureau.
(G) The HCQAAC shall
hold at least quarterly meetings. The HCQAAC and all subcommittees shall keep
written records of the agenda and minutes of each meeting
, which will be maintained by the bureau.
The records of all committees shall remain in the
custody of the chief medical officer.
(H) The HCQAAC shall submit an annual report
of its activities and recommendations to the administrator.
In addition to inclusion in the annual report, all
recommendations from the HCQAAC and subcommittees shall be submitted to the
chief medical officer in a timely fashion upon completion and approval by the
respective subcommittees and HCQAAC committee.
(I) Each member of the HCQAAC and its
respective subcommittees may be paid such fees as approved by the administrator
or administrator's designee. The expenses incurred by the HCQAAC and its
subcommittees and the fees of their members shall be paid in the same manner as
other administrative costs of the bureau.
Notes
Ohio Admin. Code 4123-6-22
Effective:
2/1/2022
Five Year Review (FYR) Dates:
11/12/2021 and
02/01/2027
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
Prior Effective Dates: 01/27/1997, 01/15/1999, 06/01/2005,
01/10/2011, 11/13/2015, 10/01/2016