Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-02.3 - Provider access to the HPP - provider application and certification criteria

Current through all regulations passed and filed through July 1, 2024
(A) The bureau shall make available to each
			 provider a provider certification application and agreement or recertification
			 application and agreement, as applicable, which shall require the provider to
			 furnish documentation as provided in rule 4123-6-02.2 of the Administrative
			 Code.
(B) The provider application
			 and agreement or recertification application and agreement shall require the
			 provider to make statements that the provider is without impairments that would
			 interfere with the provider's ability to practice or that would jeopardize a
			 patient's health, and a statement that the application is without
			 misrepresentation, misstatement, or omission of a relevant fact or other acts
			 involving dishonesty, fraud, or deceit. The provider shall provide to the
			 bureau any additional documentation requested, and shall permit the bureau to
			 conduct a review of the provider's practice or facility. The provider shall
			 notify the bureau within thirty days of any change in the provider's
			 ownership as reported on the application and agreement,
			 or status regarding any of the credentialing criteria of paragraph (B) or
			 (C) of rule 4123-6-02.2 of the Administrative Code.
(C) The bureau shall review the application
			 and agreement and all documentation submitted by the provider. The bureau may
			 cross-check data with other governmental agencies or licensing bodies. The
			 bureau may refer provider certification and malpractice issues to the bureau's
			 stakeholders health care quality assurance advisory committee for review as
			 provided under rule
			 4123-6-22
			 of the Administrative Code.
(D) By
			 signing the provider application and agreement or recertification application
			 and agreement, the provider agrees to, and the bureau may refuse to certify or
			 recertify or may decertify a provider for failure to:
(1) Provide health services that are
			 applicable to a 
									work related injury, and not to substantially
			 engage in the practice of experimental modalities of treatment.
(2) Acknowledge and treat injured workers in
			 accordance with bureau recognized treatment guidelines.
(3) Acknowledge and treat injured workers in
			 accordance with the vocational rehabilitation hierarchy.
(4) Provide adequate on-call coverage for
			 patients.
(5) Utilize bureau
			 certified providers when making referrals to other providers.
(6) Timely schedule and treat injured workers
			 to facilitate a safe and prompt return to work.
(7) Release information from the national
			 practitioner data bank or the federation of state licensing boards. The bureau
			 may submit a report to the appropriate state licensing board or data bank as
			 required in the event the provider is decertified.
(8) Practice in a managed care environment
			 and adhere to MCO and bureau procedures and requirements concerning provider
			 compliance, outcome measurement data, peer review, quality assurance,
			 utilization review, bill submission, and dispute resolution.
(9) Adhere to the bureau's confidentiality
			 and sensitive data requirements, and use information obtained from the bureau
			 by means of electronic account access for the sole purpose of facilitating
			 treatment and no other purpose, including but not limited to engaging in
			 advertising or solicitation directed to injured workers.
(10)
									Maintain
			 professionalism, integrity, and civility in the provision of services in the
			 HPP, including in all written and oral communications with the bureau, the
			 industrial commission, the MCO, injured workers, employers, and their
			 representatives.
(11) Comply with the
			 workers' compensation statutes and rules and the terms of the provider
			 application and agreement or recertification application and
			 agreement.