Ohio Admin. Code 4123-6-37.3 - Payment of ambulatory surgical center services
Unless an MCO has negotiated a different payment rate with an
ambulatory surgical center pursuant to rule
4123-6-10 of the Administrative
Code, reimbursement for ambulatory surgical center services with a date of
service of May 1, 20252024 or after will be equal to the lesser of the
ambulatory surgical center's allowable billed charges or the fee schedule
amount indicated in the appendix to this rule, developed with provider and
employer input and effective May 1, 20252024.
Ambulatory surgical centers determined as of the effective date
of this rule by the centers for medicare and medicaid services (CMS) to not
meet quality measures for the calendar year 20252024 full
payment update under the CMS ambulatory surgical center quality reporting
(ASCQR) program, established by
42 U.S.C.
1395l as in effect as of the effective date
of this rule and 42 C.F.R. Part 416, Subpart H as published in the
October 1, 2024October
1, 2023 Code of Federal Regulations, will be subject to a two per cent
reduction to the BWC 20252024 ambulatory surgical center fee schedule
amounts indicated in the appendix to this rule.
However, if such an ambulatory surgical center, upon
reconsideration, is subsequently determined by CMS to meet quality measures for
the calendar year 20252024 full payment update under the CMS ASCQR
program, upon the ambulatory surgical center's request the ambulatory surgical
center will no longer be subject to the two per cent reduction, and the bureau
will adjust any bills for dates of service on or after the effective date of
this rule that were previously reduced pursuant to this rule.
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05, 4123.66
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441, 4123.66
Prior Effective Dates: 04/01/2009, 04/01/2010, 04/01/2011, 04/01/2012, 04/01/2013, 05/05/2014, 05/01/2015, 05/01/2016, 05/01/2017, 05/01/2018, 05/01/2019, 05/16/2020, 05/06/2021, 05/01/2022, 05/01/2023, 05/09/2024
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.
Unless an 2023 2024 or after will be equal to the lesser of the ambulatory surgical center's allowable billed charges or the fee schedule amount indicated in the appendix to this rule, developed with 2023 2024.
Ambulatory surgical centers determined as of the effective date of this rule by the centers for medicare and medicaid services (CMS) to not meet quality measures for the calendar year 2023 2024 full payment update under the CMS ambulatory surgical center quality reporting (ASCQR) program, established by 42 U.S.C. 1395l as in effect as of the effective date of this rule and 42 C.F.R. Part 416, Subpart H as published in the October 3, 2022 1, 2023 Code of Federal Regulations, will be subject to a two per cent reduction to the BWC 2023 2024 ambulatory surgical center fee schedule amounts indicated in the appendix to this rule.
However, if such an ambulatory surgical center, upon reconsideration, is subsequently determined by CMS to meet quality measures for the calendar year 2023 2024 full payment update under the CMS ASCQR program, upon the ambulatory surgical center's request the ambulatory surgical center will no longer be subject to the two per cent reduction, and the bureau will adjust any bills for dates of service on or after the effective date of this rule that were previously reduced pursuant to this rule.
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05, 4123.66
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441, 4123.66
Prior Effective Dates: 04/01/2009, 04/01/2010, 04/01/2011, 04/01/2012, 04/01/2013, 05/05/2014, 05/01/2015, 05/01/2016,05/01/2017, 05/01/2018, 05/01/2019, 05/16/2020, 05/06/2021, 05/01/2022, 05/01/2023