Chapter 4123-6 - Health Partnership Program

Section 4123-6-01 - Definitions
Section 4123-6-01.1 - Applicability of medical rules
Section 4123-6-01.2 - Provisional treatment reimbursement approval - pilot program
Section 4123-6-02 - Provider access to the HPP - generally
Section 4123-6-02.1 - Rescinded
Section 4123-6-02.2 - Provider access to the HPP - provider certification criteria
Section 4123-6-02.21 - Provider access to the HPP - non-certified provider enrollment
Section 4123-6-02.22 - Provider access to the HPP - ambulatory surgical center arthroplasty center requirements
Section 4123-6-02.3 - Provider access to the HPP - provider application and certification criteria
Section 4123-6-02.4 - Provider access to the HPP - provider recertification
Section 4123-6-02.5 - Provider access to the HPP - provider not certified
Section 4123-6-02.51 - Provider access to the HPP - Denial of provider, entity or MCO enrollment or certification based on criminal conviction or civil action
Section 4123-6-02.6 - Provider access to the HPP - selection by an MCO
Section 4123-6-02.7 - Provider access to the HPP - provider decertification procedures
Section 4123-6-02.8 - Provider requirement to notify of injury
Section 4123-6-02.9 - Provider access to the HPP - provider marketing
Section 4123-6-03 - [Rescinded] MCO participation in the HPP - generally
Section 4123-6-03.2 - MCO participation in the HPP - MCO application for certification or recertification
Section 4123-6-03.3 - [Rescinded] MCO participation in the HPP - MCO participation based on MCO capacity
Section 4123-6-03.4 - MCO participation in the HPP - MCO certification
Section 4123-6-03.6 - [Rescinded] MCO participation in the HPP - administrator's authority to terminate MCO contracts
Section 4123-6-03.7 - MCO participation in the HPP - bureau's authority to decertify, to refuse to certify or recertify an MCO
Section 4123-6-03.8 - MCO participation in the HPP - marketing of services by MCO. [Rescinded]
Section 4123-6-03.9 - MCO participation in the HPP - MCO disclosure of relationship
Section 4123-6-03.10 - Conflict of interest
Section 4123-6-04 - [Rescinded] MCO scope of services - generally
Section 4123-6-04.2 - [Rescinded] MCO scope of services - management of medical treatment of provider selected by employee
Section 4123-6-04.3 - MCO scope of services - MCO medical management and claims management assistance
Section 4123-6-04.4 - [Rescinded] MCO scope of services - fee bill review and audit process
Section 4123-6-04.5 - MCO scope of services - bureau claims management
Section 4123-6-04.6 - Return to work assessment
Section 4123-6-05.1 - [Rescinded] Employer access to the HPP - MCO advertising and solicitation
Section 4123-6-05.2 - Employer access to the HPP - employer enrollment and selection of MCO
Section 4123-6-05.3 - Employer access to the HPP - certain solicitation practices by MCOs prohibited
Section 4123-6-05.4 - Employer access to the HPP - payment for referrals prohibited
Section 4123-6-06 - [Rescinded] Employee access to the HPP - generally
Section 4123-6-06.1 - [Rescinded] Employee access to medical services - education by MCO and employer
Section 4123-6-06.2 - Injured worker access to the HPP - injured worker choice of provider
Section 4123-6-06.3 - [Rescinded] Employee access to the HPP - application of rules to claims
Section 4123-6-07 - Services and supplies never covered
Section 4123-6-08 - Bureau fee schedule
Section 4123-6-09 - [Rescinded] Payment during adjudication of claim
Section 4123-6-10 - Payment to providers
Section 4123-6-11 - [Rescinded] Payment to bureau certified provider
Section 4123-6-12 - [Rescinded] Payment to non-bureau certified provider
Section 4123-6-13 - [Rescinded] Payment to MCOs
Section 4123-6-14 - MCO bill submission to bureau
Section 4123-6-14.1 - Records to be retained by MCO
Section 4123-6-15 - Confidentiality of records
Section 4123-6-16 - Alternative dispute resolution for HPP medical issues
Section 4123-6-16.1 - HPP medical treatment guidelines
Section 4123-6-16.2 - Medical treatment reimbursement requests
Section 4123-6-16.3 - Reimbursement of retroactive medical treatment reimbursement requests
Section 4123-6-17 - Bureau refusal to certify or recertify, action to decertify a provider, MCO, or QHP - standards and procedures for adjudication hearings
Section 4123-6-18 - Data gathering and reporting
Section 4123-6-19 - Remain at work services
Section 4123-6-20 - Obligation to submit medical documentation and reports
Section 4123-6-20.1 - Access to medical documentation
Section 4123-6-21 - Payment for outpatient medication
Section 4123-6-21.1 - Payment for outpatient medication by self-insuring employer
Section 4123-6-21.2 - Pharmacy and therapeutics committee
Section 4123-6-21.3 - Outpatient medication formulary
Section 4123-6-21.4 - Coordinated services program
Section 4123-6-21.5 - Standard dose tapering schedules
Section 4123-6-21.6 - First fill of outpatient medications
Section 4123-6-21.7 - Reimbursement of opioids in the treatment of pain for a work related injury or occupational disease
Section 4123-6-21.8 - Reimbursement for services to assist in the discontinuation of medications
Section 4123-6-22 - Stakeholders' health care quality assurance advisory committee
Section 4123-6-23 - [Rescinded] Jurisdictional principles applicable to payment of bills for medical services rendered by health care providers
Section 4123-6-24 - Treatment necessary due to an industrial injury or occupational disease
Section 4123-6-25 - Payment for medical supplies and services
Section 4123-6-26 - Claimant reimbursement
Section 4123-6-27 - Treatment by more than one physician
Section 4123-6-28 - Treatment of more than one condition or to more than one part of the body
Section 4123-6-29 - Request for information by the treating provider
Section 4123-6-30 - Payment for physical medicine
Section 4123-6-31 - Payment for miscellaneous medical services and supplies
Section 4123-6-32 - Payment for lumbar fusion surgery
Section 4123-6-33 - Payment for health and behavior assessment and intervention services
Section 4123-6-34 - Payment for treatment of concussion injuries
Section 4123-6-35 - Payment for spinal cord stimulator
Section 4123-6-36 - Enhanced care program
Section 4123-6-37 - Payment of hospital bills
Section 4123-6-37.1 - Payment of hospital inpatient services
Section 4123-6-37.2 - Payment of hospital outpatient services
Section 4123-6-37.3 - Payment of ambulatory surgical center services
Section 4123-6-38 - Payment for home health nursing services and home health aide services
Section 4123-6-38.1 - Payment for nursing and caregiver services provided by persons other than home health agency employees
Section 4123-6-38.2 - Payment of nursing home and residential care/assisted living services
Section 4123-6-39 - Payment for prosthetic device or other artificial appliances
Section 4123-6-40 - Payment of injured worker travel expenses
Section 4123-6-41 - No legal relationship between the industrial commission or bureau and a health care provider
Section 4123-6-42 - Interest on late payments for equipment, materials, goods, supplies or services in state insurance fund, public work relief employees' compensation fund, coal workers pneumoconiosis fund, and marine industry fund claims
Section 4123-6-43 - Payment for transcutaneous electrical nerve stimulators and neuromuscular electrical stimulators
Section 4123-6-44 - Bureau fees for provider services rendered by in-state and out-of- state providers
Section 4123-6-45 - Audit of providers' patient and billing related records
Section 4123-6-45.1 - Records to be retained by provider
Section 4123-6-46 - Standardized or negotiated payment rates for services or supplies
Section 4123-6-50 - [Rescinded] Self-insured employer participation in the QHP system; reporting requirements for non-participating employers
Section 4123-6-51 - Employer participation in the QHP system - bureau certification of QHPs
Section 4123-6-52 - Employer participation in the QHP system - bureau recertification of QHPs
Section 4123-6-53 - Employer participation in the QHP system - QHP quality assurance program required
Section 4123-6-54 - Employer participation in the QHP system - QHP certification application
Section 4123-6-55 - Employer participation in the QHP system - bureau's authority to decertify, to refuse to certify or recertify a QHP
Section 4123-6-56 - [Rescinded] Employee access to the QHP system - choice and change of provider
Section 4123-6-57 - [Rescinded] Provider access to the QHP system - generally
Section 4123-6-58 - Provider access to the QHP system - provider participation in QHP system and other related health care program not linked
Section 4123-6-59 - Provider access to the QHP system - QHP provider selection
Section 4123-6-60 - [Rescinded] Provider access to the QHP system - medical record keeping
Section 4123-6-61 - [Rescinded] Payment in the QHP system - employer responsibility - generally
Section 4123-6-62 - [Rescinded] Payment in the QHP system - balance billing prohibited
Section 4123-6-63 - [Rescinded] Payment in the QHP system - application of bureau fee schedule in the QHP system
Section 4123-6-64 - [Rescinded] Payment in the QHP system - vendor payment to providers
Section 4123-6-65 - Payment in the QHP system - employer payment to vendor that provides medical management and cost containment services and/or QHPs
Section 4123-6-66 - [Rescinded] Payment in the QHP system - authorization and payment for initial emergency medical treatment
Section 4123-6-67 - [Rescinded] Payment in the QHP system - payment to providers in states that border Ohio
Section 4123-6-68 - [Rescinded] Providers in states that do not border Ohio - QHP freedom to negotiate; restriction on provider charges to employee
Section 4123-6-69 - QHP dispute resolution process
Section 4123-6-70 - Evaluation of the QHP system by the bureau; reporting requirements by employers and QHPs
Section 4123-6-71 - [Rescinded] Initial report of an injury and reporting requirements by providers and employees in the QHP system
Section 4123-6-72 - Confidentiality
Section 4123-6-73 - [Rescinded] Bureau requirement to develop information describing rights under the QHP system