Chapter 4123-6 - Health Partnership Program

  1. § 4123-6-01 - Definitions
  2. § 4123-6-01.1 - Applicability of medical rules
  3. § 4123-6-01.2 - Provisional treatment reimbursement approval - pilot program
  4. § 4123-6-02 - Provider access to the HPP - generally
  5. § 4123-6-02.1 - Rescinded
  6. § 4123-6-02.2 - Provider access to the HPP - provider certification criteria
  7. § 4123-6-02.21 - Provider access to the HPP - non-certified provider enrollment
  8. § 4123-6-02.22 - Provider access to the HPP - ambulatory surgical center arthroplasty center requirements
  9. § 4123-6-02.3 - Provider access to the HPP - provider application and certification criteria
  10. § 4123-6-02.4 - Provider access to the HPP - provider recertification
  11. § 4123-6-02.5 - Provider access to the HPP - provider not certified
  12. § 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
  13. § 4123-6-02.6 - Provider access to the HPP - selection by an MCO
  14. § 4123-6-02.7 - Provider access to the HPP - provider decertification procedures
  15. § 4123-6-02.8 - Provider requirement to notify of injury
  16. § 4123-6-02.9 - Provider access to the HPP - provider marketing
  17. § 4123-6-03 - [Rescinded]MCO participation in the HPP - generally
  18. § 4123-6-03.2 - MCO participation in the HPP - MCO application for certification or recertification
  19. § 4123-6-03.3 - [Rescinded]MCO participation in the HPP - MCO participation based on MCO capacity
  20. § 4123-6-03.4 - MCO participation in the HPP - MCO certification
  21. § 4123-6-03.6 - [Rescinded]MCO participation in the HPP - administrator's authority to terminate MCO contracts
  22. § 4123-6-03.7 - MCO participation in the HPP - bureau's authority to decertify, to refuse to certify or recertify an MCO
  23. § 4123-6-03.8 - MCO participation in the HPP - marketing of services by MCO. [Rescinded]
  24. § 4123-6-03.9 - MCO participation in the HPP - MCO disclosure of relationship
  25. § 4123-6-03.10 - Conflict of interest
  26. § 4123-6-04 - [Rescinded]MCO scope of services - generally
  27. § 4123-6-04.2 - [Rescinded]MCO scope of services - management of medical treatment of provider selected by employee
  28. § 4123-6-04.3 - MCO scope of services - MCO medical management and claims management assistance
  29. § 4123-6-04.4 - [Rescinded]MCO scope of services - fee bill review and audit process
  30. § 4123-6-04.5 - MCO scope of services - bureau claims management
  31. § 4123-6-04.6 - Return to work assessment
  32. § 4123-6-05.1 - [Rescinded]Employer access to the HPP - MCO advertising and solicitation
  33. § 4123-6-05.2 - Employer access to the HPP - employer enrollment and selection of MCO
  34. § 4123-6-05.3 - Employer access to the HPP - certain solicitation practices by MCOs prohibited
  35. § 4123-6-05.4 - Employer access to the HPP - payment for referrals prohibited
  36. § 4123-6-06 - [Rescinded]Employee access to the HPP - generally
  37. § 4123-6-06.1 - [Rescinded]Employee access to medical services - education by MCO and employer
  38. § 4123-6-06.2 - Injured worker access to the HPP - injured worker choice of provider
  39. § 4123-6-06.3 - [Rescinded]Employee access to the HPP - application of rules to claims
  40. § 4123-6-07 - Services and supplies never covered
  41. § 4123-6-08 - Bureau fee schedule
  42. § 4123-6-09 - [Rescinded]Payment during adjudication of claim
  43. § 4123-6-10 - Payment to providers
  44. § 4123-6-11 - [Rescinded]Payment to bureau certified provider
  45. § 4123-6-12 - [Rescinded]Payment to non-bureau certified provider
  46. § 4123-6-13 - [Rescinded]Payment to MCOs
  47. § 4123-6-14 - MCO bill submission to bureau
  48. § 4123-6-14.1 - Records to be retained by MCO
  49. § 4123-6-15 - Confidentiality of records
  50. § 4123-6-16 - Alternative dispute resolution for HPP medical issues
  51. § 4123-6-16.1 - HPP medical treatment guidelines
  52. § 4123-6-16.2 - Medical treatment reimbursement requests
  53. § 4123-6-16.3 - Reimbursement of retroactive medical treatment reimbursement requests
  54. § 4123-6-17 - Bureau refusal to certify or recertify, action to decertify a provider or MCO - standards and procedures for adjudication hearings
  55. § 4123-6-18 - Data gathering and reporting
  56. § 4123-6-19 - Remain at work services
  57. § 4123-6-20 - Obligation to submit medical documentation and reports
  58. § 4123-6-20.1 - Access to medical documentation
  59. § 4123-6-21 - Payment for outpatient medication
  60. § 4123-6-21.1 - Payment for outpatient medication by self-insuring employer
  61. § 4123-6-21.2 - Pharmacy and therapeutics committee
  62. § 4123-6-21.3 - [Effective until8/1/2022]Outpatient medication formulary
  63. § 4123-6-21.3 - [Effective8/1/2022]Outpatient medication formulary, version 2
  64. § 4123-6-21.4 - Coordinated services program
  65. § 4123-6-21.5 - Standard dose tapering schedules
  66. § 4123-6-21.6 - [Effective until8/1/2022]`First fill of outpatient medications
  67. § 4123-6-21.6 - [Effective8/1/2022]First fill of outpatient medications, version 2
  68. § 4123-6-21.7 - Reimbursement of opioids in the treatment of pain for a work related injury or occupational disease
  69. § 4123-6-21.8 - Reimbursement for services to assist in the discontinuation of medications
  70. § 4123-6-22 - Stakeholders' health care quality assurance advisory committee
  71. § 4123-6-23 - [Rescinded]Jurisdictional principles applicable to payment of bills for medical services rendered by health care providers
  72. § 4123-6-24 - [Rescinded]Treatment necessary due to an industrial injury or occupational disease
  73. § 4123-6-25 - Payment for medical supplies and services
  74. § 4123-6-26 - Claimant reimbursement
  75. § 4123-6-27 - Treatment by more than one physician
  76. § 4123-6-28 - [Rescinded]Treatment of more than one condition or to more than one part of the body
  77. § 4123-6-29 - Request for information by the treating provider
  78. § 4123-6-30 - Payment for physical medicine
  79. § 4123-6-31 - Payment for miscellaneous medical services and supplies
  80. § 4123-6-32 - Payment for lumbar fusion surgery
  81. § 4123-6-33 - Payment for health and behavior assessment and intervention services
  82. § 4123-6-34 - Payment for treatment of concussion injuries
  83. § 4123-6-35 - [Rescinded]Payment for hearing aids
  84. § 4123-6-36 - [Rescinded]Payment for shoes, braces, and other orthotic devices
  85. § 4123-6-37 - Payment of hospital bills
  86. § 4123-6-37.1 - Payment of hospital inpatient services
  87. § 4123-6-37.2 - Payment of hospital outpatient services
  88. § 4123-6-37.3 - Payment of ambulatory surgical center services
  89. § 4123-6-38 - Payment for home health nursing services and home health aide services
  90. § 4123-6-38.1 - Payment for nursing and caregiver services provided by persons other than home health agency employees
  91. § 4123-6-38.2 - Payment of nursing home and residential care/assisted living services
  92. § 4123-6-39 - Payment for prosthetic device or other artificial appliances
  93. § 4123-6-40 - Payment of injured worker travel expenses
  94. § 4123-6-41 - No legal relationship between the industrial commission or bureau and a health care provider
  95. § 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
  96. § 4123-6-43 - Payment for transcutaneous electrical nerve stimulators and neuromuscular electrical stimulators
  97. § 4123-6-44 - Bureau fees for provider services rendered by in-state and out-of- state providers
  98. § 4123-6-45 - Audit of providers' patient and billing related records
  99. § 4123-6-45.1 - Records to be retained by provider
  100. § 4123-6-46 - Standardized or negotiated payment rates for services or supplies
  101. § 4123-6-50 - [Rescinded]Self-insured employer participation in the QHP system; reporting requirements for non-participating employers
  102. § 4123-6-51 - Employer participation in the QHP system - bureau certification of QHPs
  103. § 4123-6-52 - Employer participation in the QHP system - bureau recertification of QHPs
  104. § 4123-6-53 - Employer participation in the QHP system - QHP quality assurance program required
  105. § 4123-6-54 - Employer participation in the QHP system - QHP certification application
  106. § 4123-6-55 - Employer participation in the QHP system - bureau's authority to decertify, to refuse to certify or recertify a QHP
  107. § 4123-6-56 - [Rescinded]Employee access to the QHP system - choice and change of provider
  108. § 4123-6-57 - [Rescinded]Provider access to the QHP system - generally
  109. § 4123-6-58 - Provider access to the QHP system - provider participation in QHP system and other related health care program not linked
  110. § 4123-6-59 - Provider access to the QHP system - QHP provider selection
  111. § 4123-6-60 - [Rescinded]Provider access to the QHP system - medical record keeping
  112. § 4123-6-61 - [Rescinded]Payment in the QHP system - employer responsibility - generally
  113. § 4123-6-62 - [Rescinded]Payment in the QHP system - balance billing prohibited
  114. § 4123-6-63 - [Rescinded]Payment in the QHP system - application of bureau fee schedule in the QHP system
  115. § 4123-6-64 - [Rescinded]Payment in the QHP system - vendor payment to providers
  116. § 4123-6-65 - Payment in the QHP system - employer payment to vendor that provides medical management and cost containment services and/or QHPs
  117. § 4123-6-66 - [Rescinded]Payment in the QHP system - authorization and payment for initial emergency medical treatment
  118. § 4123-6-67 - [Rescinded]Payment in the QHP system - payment to providers in states that border Ohio
  119. § 4123-6-68 - [Rescinded]Providers in states that do not border Ohio - QHP freedom to negotiate; restriction on provider charges to employee
  120. § 4123-6-69 - QHP dispute resolution process
  121. § 4123-6-70 - Evaluation of the QHP system by the bureau; reporting requirements by employers and QHPs
  122. § 4123-6-71 - [Rescinded]Initial report of an injury and reporting requirements by providers and employees in the QHP system
  123. § 4123-6-72 - Confidentiality
  124. § 4123-6-73 - [Rescinded]Bureau requirement to develop information describing rights under the QHP system

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