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:
(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;
(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.
(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
Ohio Admin. Code
4123-6-07
Effective:
4/1/2021
Five Year Review (FYR) Dates:
1/5/2021 and
08/01/2025
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
