reglab/statecodes huggingface dataset:
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-43 - Payment for transcutaneous electrical nerve stimulators and neuromuscular electrical stimulators

Current through all regulations passed and filed through July 1, 2024
(A) Payment will be approved for a
			 transcutaneous electric nerve stimulator (TENS) unit for treatment of allowed
			 conditions in a claim  resulting
			 from an allowed 
								work related injury or occupational disease, as
			 provided in this rule.
(1) Prior
			 authorization is required for TENS units and supplies.
			 
									An
			 injured worker shall be provided only one TENS unit at a time. For each
			 TENS unit request approved, the unit shall be rented for a thirty day trial
			 period before purchase of the TENS unit. This trial period is to evaluate the
			 medical necessity and effectiveness of the TENS treatment. TENS treatment will
			 be discontinued at the end of the thirty day trial period
			  where the treatment has not proven to
			 be medically necessary or effective. Reimbursement of rental costs will be
			 considered only for that portion of the trial
			 period that the TENS unit was actually used 
									if treatment
			 was discontinued early. For each TENS unit
			 provided, payment shall be limited to necessary disposable or rechargeable
			 batteries, but not both.
(2) The
			 bureau shall apply all rental payments previously made to the purchase price of
			 the TENS unit. A TENS unit purchased and furnished to the
			 injured
			 worker is not the personal property of the injured
			 worker, but remains the property of the bureau or self-insuring employer.
			 The bureau or self-insuring employer reserves the right to reclaim and recover
			 the TENS unit from the 
									injured worker at the completion of the course of
			 TENS treatment. Once a TENS unit is purchased, the bureau or self-insuring
			 employer will reimburse for repair or replacement of the unit upon submission
			 of a request from the physician of record or treating provider that includes
			 medical documentation substantiating the continued medical necessity and
			 effectiveness of the unit.
(3) To
			 be eligible for reimbursement under this rule, the TENS unit must be prescribed
			 by a physician and furnished by a provider holding a current, valid, license or
			 certificate of registration from the state of
			 Ohio  board
			 of pharmacy to sell or rent home medical
			 equipment.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-44 - Bureau fees for provider services rendered by in-state and out-of- state providers

Current through all regulations passed and filed through July 1, 2024
Bureau fees for in-state or out-of-state providers will be
				established by the bureau. The bureau
				may establish different fees for in-state and out-of-state providers. The
				methods of payment may include rates based on resource based relative value
				scale (RBRVS), per cent of allowed charges, or usual, customary and reasonable
				fee maximas, as determined by the bureau. Rates will be reviewed at least annually by
				the bureau to determine the need for appropriate adjustment.
Payment for provider services will be made in accordance with
				rule
				4123-6-10 of
				the Administrative Code.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-45 - Audit of providers' patient and billing related records

Current through all regulations passed and filed through July 1, 2024
(A) Providers'
			 patient and billing related records, including but not limited to those records
			 described in rule 4123-6-45.1 of the Administrative Code, may be reviewed by
			 the bureau or the MCO to ensure workers are receiving proper and necessary
			 medical care, and to ensure compliance with the bureau's statutes, rules,
			 policies, and procedures.
(1) Based on
			 division (B)(15)(c) of section
			 4121.121
			 of the Revised Code, provider records may be reviewed before, during, or after
			 the delivery of services. Reviews may be random, with no unreasonable
			 infringement of provider rights, or may be for cause. Reviews may include the
			 utilization of statistical sampling methodologies and projections based upon
			 sample findings. Records reviews may be conducted at or away from the
			 provider's place of business.
(2)
			 Based on division (B)(15)(c) of section
			 4121.121
			 of the Revised Code, legible copies of providers' records may be requested.
			 Providers shall furnish copies of the requested records within thirty calendar
			 days of receipt of the request. The bureau shall establish a schedule for
			 payment of reasonable costs for copying records, which shall be published in
			 the health care provider billing and reimbursement manual.
(3) Original records shall not be removed
			 from the provider's premises, except upon court order or subpoena issued by the
			 bureau pursuant to section
			 4121.15
			 or
			 4123.08
			 of the Revised Code.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-45.1 - Records to be retained by provider

Current through all regulations passed and filed through July 1, 2024
(A) A health care provider shall create,
			 maintain, and retain sufficient records, papers, books, and documents in such
			 form to fully substantiate the delivery, value, necessity, and appropriateness
			 of goods and services provided to injured workers under the HPP or of
			 significant business transactions. The provider shall retain such records for a
			 minimum period of 
								five years from the date of payment for said
			 goods or services, or 
								five years from the date of referral to a
			 certified or non-certified provider, or until any initiated audit or
			 investigation is completed, whichever is longer. The provider shall create and
			 maintain the records at the time the goods or services are delivered or within
			 seven days from the date the service was rendered.
(B) The provider shall retain records
			 documenting the following minimum information concerning the goods or services
			 provided to injured workers:
(1) Date the
			 service was provided;
(2)
			 Description of service, treatment or product provided;
(3) Record of patient appointments, if
			 appropriate;
(4) Dates where
			 injured worker canceled or failed to appear for a scheduled examination,
			 treatment, or procedure;
(5)
			 Treatment plans;
(6) Subjective and
			 objective complaints, if the provider is the practitioner or physician of
			 record;
(7) Injured worker's
			 progress, if the provider is the practitioner or physician of record;
(8) Wholesale purchase records, if goods,
			 products, or prescriptions are delivered;
(9) Delivery records, if goods, products, or
			 prescriptions are delivered by way of a third party;
(10) The identity and qualifications of any
			 individual involved in the delivery of health care or billing for services to
			 injured workers on behalf of the provider billing for the services.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-46 - Standardized or negotiated payment rates for services or supplies

Current through all regulations passed and filed through July 1, 2024
(A) The bureau or
			 self-insuring employer may negotiate payment rates with health care providers
			 for services and supplies provided in the treatment of workers' compensation
			 claims.
(B) The bureau or
			 self-insuring employer may enter into volume-based or
			 optional-use contracts with medical providers for services including, but
			 not limited to, the purchase or rental of durable medical equipment and
			 supplies and catastrophic claim
			 services.
(C) The bureau or
			 self-insuring employer may inform injured workers of the availability of
			 services, supplies, or equipment from particular health care providers with
			 whom a contract for services or supplies, a negotiated payment rate for
			 services or supplies, or a contract for cost-effective payment levels or rates
			 has been entered into, so long as access to quality and convenient medical
			 services or supplies for injured workers is maintained.
Effective: 11/13/2015
Five Year
				Review (FYR) Dates: 08/26/2015 and
				08/25/2020
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,
				4123.651,
				4123.66
Prior
				Effective Dates: 2/12/97, 2/14/05,
				2/1/10
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-51 - Employer participation in the QHP system - bureau certification of QHPs

Current through all regulations passed and filed through July 1, 2024
(A) A health plan
			 that satisfies the QHP certification requirements of this chapter shall be
			 certified by the bureau as a QHP to manage medical treatment, direct care or
			 provide services or supplies to or on behalf of an employee for an injury or
			 occupational disease that is compensable under Chapter 4121., 4123., or 4131.
			 of the Revised Code.
(B) An
			 employer may establish a bureau certified QHP, that shall comply with the
			 thirteen standards set forth in divisions 
								(A)(1) to
			 (A)(13) of section 4121.442 of the Revised Code,
			 division 
								(P) of section
			 4121.44 of the Revised Code, and
			 rules
			 4123-6-53
			 and
			 4123-6-54
			 of the Administrative Code.
(C)
								The bureau 
								is authorized to recertify QHPs at
			 least every three years.
(D)
			 The bureau, at least annually, shall develop and make available information
			 that describes employer and employee rights under the QHP.
(E) The bureau shall continue to certify
			 health plans and shall periodically, at least annually, update its list of
			 certified QHPs.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-52 - Employer participation in the QHP system - bureau recertification of QHPs

Current through all regulations passed and filed through July 1, 2024
(A)
								 The bureau shall initiate the recertification process
			 by sending certified QHPs a recertification application, which must be
			 completed, signed and submitted to the bureau if the QHP wishes to be
			 considered for recertification.
(B)
								 Except as
			 otherwise provided in paragraph (E) of this rule, if the bureau receives a
			 completed and signed recertification application from a QHP, the QHP's
			 certification shall remain in effect until the bureau issues a final order
			 approving or denying the QHP's application for recertification.
(C)
								 If the bureau
			 does not receive a completed and signed recertification application from the
			 QHP within sixty days from the date of the notice sent in accordance with
			 paragraph (A) of this rule, the bureau shall send a second notice to the QHP
			 stating that the QHP has thirty days from the date of the second notice to
			 complete, sign and submit the recertification application to the bureau if the
			 QHP wishes to be considered for recertification.
(D)
								 If the bureau
			 does not receive a completed and signed recertification application from the
			 QHP within thirty days from the date of the notice sent in accordance with
			 paragraph (C) of this rule, the QHP's certification shall lapse. Such lapse of
			 certification is not an adjudication order and is not subject to appeal
			 pursuant to rule
			 4123-6-17
			 of the Administrative Code.
(E)
								 If the bureau
			 receives a completed and signed recertification application from a QHP after
			 the QHP's certification has lapsed pursuant to paragraph (D) of this rule, the
			 QHP's certification shall remain lapsed until the bureau issues a final order
			 approving or denying the QHP's application for recertification.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-53 - Employer participation in the QHP system - QHP quality assurance program required

Current through all regulations passed and filed through July 1, 2024
(A) Each QHP shall have a quality assurance
			 program that monitors the operation and measures the effectiveness of peer
			 review, utilization review, and dispute resolution within the QHP. Data
			 collected from the quality assurance program shall be used to assist an
			 employer in determining the quality, efficiency and effectiveness of the
			 employer's QHP and the QHP system in accordance with division
			 
								(A) of
			 section 4121.442 of the Revised
			 Code.
(B) Each quality assurance
			 program shall include a mechanism for monitoring and the methodology for
			 measuring and improving the QHP's compliance with each of the following eleven
			 elements:
(1) Peer review and evaluation of
			 clinical performance;
(2)
			 Credentialing and recredentialing and use of provider profiling;
(3) Utilization management to determine the
			 appropriateness of care;
(4)
			 Evaluation of employee and provider dispute resolution procedures and
			 outcomes;
(5) Evaluation of
			 outcomes of care based on clinical data;
(6) Procedures for remedial action for
			 inappropriate or substandard services;
(7) Evaluation of employee satisfaction with
			 the plan;
(8) Evaluation of
			 provider satisfaction with the plan;
(9) Evaluation of employer satisfaction with
			 the plan;
(10) Periodic evaluation
			 of medical records and office procedures; and
(11) Practice patterns compared to accepted
			 medical criteria.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-55 - Employer participation in the QHP system - bureau's authority to decertify, to refuse to certify or recertify a QHP

Current through all regulations passed and filed through July 1, 2024
(A) The bureau is authorized to decertify, to
			 refuse to certify or recertify a QHP from participation in the QHP
			 system.
(B) Should the bureau
			 determine that sufficient evidence exists that an employer or QHP has failed to
			 comply with applicable workers' compensation statutes or rules governing QHPs,
			 the bureau
								will take one of two courses of action:
(1) The bureau 
									will serve
			 written notice to the employer, employee representative and QHP
			  of the facts
			 and issues relating to the bureau's determination that the employer or QHP has
			 failed to comply with applicable workers' compensation statutes or rules
			 governing QHPs. Such notice 
									will set forth a period of time for the employer
			 or QHP to resolve or correct the problem. Failure of the employer or QHP to
			 resolve or correct the problem within the time period
			 
									will
			 result in  the bureau
			 serving notice to the employer and QHP in writing
			  of administrative action
			 that might result in a bureau determination to revoke certification, refusal to
			 certify or recertify, and the employer's and QHP's right to a hearing within
			 thirty days of the notice, if requested by the employer or QHP, pursuant to
			 rule 4123-6-17 of the Administrative
			 Code.
(2)
									Serve written
			 notice to the employer, employee representative and QHP
			  of
			 administrative action that might result in a bureau determination to revoke
			 certification, refusal to certify or recertify, and the employer's and QHP's
			 right to a hearing within thirty days of the notice, if requested by the
			 employer or QHP, pursuant to rule
			 4123-6-17 of the Administrative
			 Code.
(3) For the purpose of this
			 rule, "employee representative" does not include the employee's
			 attorney.
(4)
									The bureau will serve all notices pursuant to this rule
			 in accordance with section
			 119.05 of the Revised
			 Code.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-58 - Provider access to the QHP system - provider participation in QHP system and other related health care program not linked

Current through all regulations passed and filed through July 1, 2024
A QHP or vendor that provides medical management and cost
				containment services shall not require a provider to participate in a workers'
				compensation network of providers in order to maintain membership in a related
				health care program. If the QHP utilizes a leased
				provider network, the QHP shall not apply the discounted payment rates of the
				leased network to services rendered by the provider in the QHP unless the
				signed, written consent of the provider has been obtained.
Effective:
				2/1/2010
R.C. 119.032 review dates:
				11/17/2009 and
				11/01/2014
Promulgated
				Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31,
				4123.05
Rule Amplifies: 4121.121, 4121.44, 4121.441, 4121.442,
				4123.66
Prior Effective Dates: 9/5/96
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-59 - Provider access to the QHP system - QHP provider selection

Current through all regulations passed and filed through July 1, 2024
(A) An employer
			 that develops a QHP, a vendor within the QHP system, or a QHP shall develop and
			 implement standards of credentialing of providers in the QHP network that meet
			 but may exceed the bureau credentialing requirements in the HPP.
(B) An employer that develops a QHP may
			 selectively contract with providers or contract with a vendor that selectively
			 contracts with providers.
(C) Only
			 a bureau certified provider is eligible for selection by an employer that
			 develops a QHP, by a QHP as a QHP panel provider or by a vendor as a panel
			 provider to participate in the QHP system. A provider identified by a QHP for
			 inclusion in its panel of providers that is not a bureau certified provider may
			 be assisted by the QHP in applying for bureau provider credentialing and
			 certification.
(D) The bureau, an
			 employer, a QHP or a vendor shall not discriminate against any category of
			 health care provider when establishing categories of providers for
			 participation in the QHP system. However, an employer, a QHP or a vendor is not
			 required to accept or retain any individual provider in the QHP
			 system.
(E) The bureau, an
			 employer, a QHP and a vendor shall comply with state and federal laws
			 prohibiting discrimination based on race, color, religion, sex, age,
			 disability, military status as defined in section
			 4112.01 of the Revised
			 Code, national origin, ancestry, or
			  sexual orientation.
(F) A QHP shall include in its panel a
			 substantial number of the medical, professional, and pharmacy providers
			 currently being utilized by employees. A QHP may limit the number of providers
			 on its provider panel, but shall do so based upon objective data that
			 demonstrates that the fundamental needs of the employer and employees are met
			 based on reasonable standards such as historical claims data or other
			 geographic information approved by the bureau. In addition, a QHP shall include
			 in its application for QHP certification information including reasonable
			 patient access, the potential number of employees the QHP is applying to
			 service, and other performance criteria, without discrimination by provider
			 type. A QHP seeking QHP certification may select out-of-state providers as
			 members of the QHP panel.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-65 - Payment in the QHP system - employer payment to vendor that provides medical management and cost containment services and/or QHPs

Current through all regulations passed and filed through July 1, 2024
The bureau shall not interfere with nor impose restrictions
				upon an arrangement for payment negotiated between an employer and a vendor
				that provides medical management and cost containment services and/or a QHP
				under the QHP system, except that no financial arrangement between an employer
				and a vendor that provides medical management and cost containment services
				and/or a QHP shall incentivize a reduction in the quality of medical care
				received by an injured worker.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-70 - Evaluation of the QHP system by the bureau; reporting requirements by employers and QHPs

Current through all regulations passed and filed through July 1, 2024
(A)
			 To enhance the quality of the QHP system, and pursuant to division
			 
								(A)(9) of
			 section 4121.442 of the Revised
			 Code, the 
			 administrator  shall require employers and QHPs that participate
			 in the workers' compensation QHP system to report data to be
			 used by the administrator to
								measure
and perform comparison analyses of
				costs, quality, appropriateness of medical care, and effectiveness of medical
				care delivered by all components of the workers compensation system.
(B) The
			 bureau shall evaluate the effectiveness of the QHP system based on standardized
			 data and reporting requirements developed by the bureau.
(C) The bureau shall receive, define and
			 publish data elements and data collection techniques that meet the thirteen
			 standards set forth in divisions (A)(1) to (A)(13) of section
			 4121.442 of the Revised Code and
			 are necessary to evaluate the effectiveness of the QHP system. Performance
			 indicators used by the bureau to evaluate the effectiveness of the QHP system
			 may include, but shall not be limited to, the following: customer satisfaction;
			 system cost drivers; improvements in quality, and cost reductions.
Effective:
				2/1/2010
R.C. 119.032 review dates:
				11/17/2009 and
				11/01/2014
Promulgated
				Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31,
				4123.05
Rule Amplifies: 4121.121, 4121.44, 4121.441, 4121.442,
				4123.66
Prior Effective Dates: 9/5/96
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-6 - Health Partnership Program › Section 4123-6-72 - Confidentiality

Current through all regulations passed and filed through July 1, 2024
Subject to the requirements and protections contained in
				
								Ohio law
				pertaining to release of confidential and/or privileged information, in the
				course of medical management in the QHP system, confidential information may be
				exchanged among the bureau, the QHPs, an employer and its representative, an
				employee and his or her representative, and the provider. All parties providing
				or requiring such confidential information for use in the QHP system shall not
				provide or use such confidential information for any purpose other than to
				perform duties required under the QHP system, and shall prevent such
				information from further disclosure or use by unauthorized persons.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-10 - Accessing Confidential Personal Information › Section 4123-10-02 - Procedures for accessing confidential personal information

Current through all regulations passed and filed through July 1, 2024
For personal information systems,
				whether manual or computer systems, that contain confidential personal
				information, the bureau shall do the following:
(A)
								 Criteria for
			 accessing confidential personal information. Personal information systems of
			 the bureau are managed on a "need-to-know" basis whereby the information owner
			 determines the level of access required for an employee of the bureau to
			 fulfill his/her job duties. The determination of access to confidential
			 personal information shall be approved by the employee's supervisor and the
			 information owner prior to providing the employee with access to confidential
			 personal information within a personal information system. The bureau shall
			 establish procedures for determining a revision to an employee's access to
			 confidential personal information upon a change to that employee's job duties
			 including, but not limited to, transfer or termination. Whenever an employee's
			 job duties no longer require access to confidential personal information in a
			 personal information system, the employee's access to confidential personal
			 information shall be removed.
(B)
								 Individual's
			 request for a list of confidential personal information. Upon the signed
			 written request of any individual for a list of confidential personal
			 information about the individual maintained by the bureau, the bureau shall do
			 all of the following:
(1)
									 Verify the identity of the individual by a method that
			 provides safeguards commensurate with the risk associated with the confidential
			 personal information;
(2)
									 Provide to the individual the list of confidential
			 personal information that does not relate to an investigation about the
			 individual or is otherwise not excluded from the scope of Chapter 1347. of the
			 Revised Code; and
(3)
									 If all information relates to an investigation about
			 that individual, inform the individual that the bureau has no confidential
			 personal information about the individual that is responsive to the
			 individual's request.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-10 - Accessing Confidential Personal Information › Section 4123-10-03 - Valid reasons for accessing confidential personal information

Current through all regulations passed and filed through July 1, 2024
Pursuant to the requirements of division (B)(2) of section
				1347.15
				of the Revised Code, this rule contains a list of valid reasons, directly
				related to the bureau's exercise of its powers or duties, for which only
				employees of the bureau may access confidential personal information (CPI)
				regardless of whether the personal information system is a manual system or
				computer system:
(A) Performing the
			 following functions constitute valid reasons for authorized employees of the
			 bureau to access confidential personal information:
(1) Responding to a public records
			 request;
(2) Responding to a
			 request from an individual for the list of CPI the bureau maintains on that
			 individual;
(3) Administering a
			 constitutional provision or duty;
(4) Administering a statutory provision or
			 duty;
(5) Administering an
			 administrative rule provision or duty;
(6) Complying with any state or federal
			 program requirements;
(7)
			 Processing or payment of claims or otherwise administering a program with
			 individual participants or beneficiaries;
(8) Auditing purposes;
(9) Licensure [or permit, eligibility,
			 filing, etc.] processes;
(10)
			 Investigation or law enforcement purposes;
(11) Administrative hearings;
(12) Litigation, complying with an order of
			 the court, or subpoena;
(13) Human
			 resource matters (e.g., hiring, promotion, demotion, discharge, salary/
			 compensation issues, leave requests/issues, 
									timekeeping approvals/
			 issues);
(14) Complying with an
			 executive order or policy;
(15)
			 Complying with a bureau policy or a state administrative policy issued by the
			 department of administrative services, the office of budget and management or
			 other similar state agency; or
(16)
			 Complying with a collective bargaining agreement provision.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-10 - Accessing Confidential Personal Information › Section 4123-10-04 - Confidentiality statutes

Current through all regulations passed and filed through July 1, 2024
The following federal statutes or regulations or state statutes
				and administrative rules make personal information maintained by the bureau
				confidential and identify the confidential personal information within the
				scope of rules promulgated by the bureau in accordance with section
				1347.15 of the Revised
				Code:
(A) Social security numbers,
			 unless the individual was told that the number would be disclosed. See
			 5 U.S.C.
			 552a.
(B) Bureau of criminal investigation and
			 information criminal records check results. See section
			 4776.04 of the Revised
			 Code.
(C) Any information in
			 respect of any claim. Division (A) of section
			 4123.88 of the Revised Code
			 provides that no employee of the bureau "shall divulge any information in
			 respect of any claim or appeal which is or may be filed with a district or
			 staff hearing officer, the bureau, or commission to any person other than
			 members of the commission or to the superior of the employee except upon
			 authorization of the administrator of workers' compensation or a member of the
			 commission or upon authorization of the claimant or employer."
(D) Addresses and telephone numbers cannot be
			 divulged without authorization. See division (B) of section
			 4123.88 of the Revised
			 Code.
(E) Employer and third party
			 information, 
								payroll report, and child support / public assistance
			 information. See section
			 4123.27 of the Revised Code.
(1) Information submitted by the employer in
			 the payroll report (payroll, premium and number of
			 employees) and any other additional required information shall not be open to
			 the public.
(2) No person in the
			 employ of the bureau, except those who are authorized by the administrator of
			 workers' compensation, shall divulge any information secured by the person
			 while in the employ of the bureau in respect to the transactions, property,
			 claim files, records, or papers of the bureau or in respect to the business or
			 mechanical, chemical, or other industrial process of any company, firm,
			 corporation, person, association, partnership, or public utility to any person
			 other than the administrator or to the superior of such employee of the
			 bureau.
(3) The bureau can share
			 information with the Ohio department of job and family services or with the
			 auditor of state but will otherwise protect confidentiality of child support or
			 public assistance recipients.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-14 - Noncomplying Employer › Section 4123-14-01 - Non-complying employers within the meaning of the law

Current through all regulations passed and filed through July 1, 2024
(A) An employer, as
			 defined in division (B) of section
			 4123.01 of the Revised Code,
			 that either fails to establish or maintain industrial coverage, or fails to
			 make payments of premiums to the state insurance fund, as required by Chapter
			 4123. of the Revised Code and the rules of the industrial commission and the
			 bureau of workers' compensation, or fails to comply with the requirements for
			 self-insurance under section
			 4123.35 of the Revised Code and
			 the rules of the industrial commission or bureau of workers' compensation,
			 shall be regarded as a non-complying employer.
(B) An employer, as defined in division (B)
			 of section 
								
									4123.01
								 of the Revised
			 Code that, after a final adjudication, has failed to pay an obligation,
			 billing, account or assessment that is greater than one thousand dollars on or
			 before its due date, shall be regarded as a non-complying employer.
(1) For purposes of this rule, due date shall
			 be defined as sixty days after the invoice date of an obligation, billing,
			 account or assessment that is greater than one thousand dollars if no
			 administrative appeal as permitted by law is filed or sixty days following an administrative or
			 court order that has become final.
(2) Coverage will lapse if an obligation,
			 billing, account or assessment that is greater than one thousand dollars
			 remains unpaid as of the due date as defined in paragraph (B)(1) of this
			 rule.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-14 - Noncomplying Employer › Section 4123-14-03 - Requests for waiver of a default in the payment of premium, for approval of the original workers' compensation coverage retroactively, and for abatement of penalties

Current through all regulations passed and filed through July 1, 2024
(A) The administrator of the bureau of
			 workers' compensation, for good cause shown, may do any
			 of the following:
(1) Waive a default
			 in the payment of premium by an employer where workers' compensation coverage
			 has lapsed, if such a default is of less than sixty days duration. If such a
			 waiver is granted, workers' compensation coverage shall be reinstated
			 retroactively;
(2) Approve the
			 original workers' compensation coverage to take effect retroactively;
(3) Abate penalties imposed on employers for
			 failure to comply with the state of Ohio's workers' compensation
			 statutes.
(4) Waive penalties for
			 failure to file or pay amounts due under the annual payroll report.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-14 - Noncomplying Employer › Section 4123-14-04 - Procedures to recover from a non-complying employer the amount of money paid out of the state insurance fund for an industrial injury, occupational disease and/or death

Current through all regulations passed and filed through July 1, 2024
(A) Upon the filing of a workers'
			 compensation claim, naming a non-complying employer as the employer, the
			 attorney general's office shall prepare and the bureau shall file for record in the office of the county
			 recorder in any counties where the employer's property is located, if known, or
			 in any counties where the employer's business is located, an affidavit showing
			 the date on which the application for compensation or benefits was filed, the
			 name and address of the employer against whom it was filed, and the fact that
			 said employer has not complied with section
			 4123.35 of the Revised Code. A
			 copy of the application for compensation or benefits shall be filed with the
			 affidavit. The affidavit shall constitute a lien on employer's real property
			 and tangible personal property within each county where it was filed.
(B) The bureau shall notify the employer, by
			 mail and within the shortest time possible, of the filing of the application.
			 Such notice shall be accompanied by a copy of the application and a copy of the
			 affidavit, as described in paragraph (A) of this rule, and shall advise the
			 employer that unless it files a timely answer to the application, the claim
			 will be adjudicated upon the filed application.
(C) The employer, or its agent or attorney,
			 shall verify its answer. Upon filing of such answer, the bureau shall
			 immediately mail a copy of the answer to the employee. If the employee is
			 represented, the bureau shall mail a copy to the representative.
(D) The lien on employer's property, as
			 described in paragraph (A) of this rule, shall be cancelled under the following
			 circumstances:
(1) The employer has paid the
			 amount of all awards made by the commission and/ or the bureau;
(2) There was a final order of disallowance
			 of a claim;
(3) The employer has
			 filed a bond or other security in such an amount and with such a surety as the
			 bureau approves, conditioned on the employer's payment of all awards made by
			 the commission and/or the bureau. The bureau may, in its discretion, grant a
			 partial release of the lien, should this be necessary to facilitate the conduct
			 of the employer's business, provided a sufficient security remains to pay any
			 award that may be made in the claim;
(4) Settlement of employer's liability as
			 provided in rule
			 4123-14-05
			 of the Administrative Code;
(5) The
			 bureau, industrial commission, or court has determined that the employer
			 subject to the lien is not the employer of record in the claim.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-14 - Noncomplying Employer › Section 4123-14-05 - Settlement of liability of a non-complying employer

Current through all regulations passed and filed through July 1, 2024
(A) A non-complying employer may apply to the
			 administrator of the bureau of workers' compensation for settlement of its
			 liability to the state insurance fund. The request shall:
(1) Be 
									submitted
			 to the bureau by the employer concerned or by its duly authorized
			 representative. 
									The bureau may hold a request in
			 abeyance until it is properly completed, and the
			 applicant shall be notified accordingly;
(2) Clearly set forth the circumstances by
			 reason of which the proposed settlement is deemed desirable;
(3) Include, but not be limited to, the
			 following information:
(a) The size of
			 employer's business, including the number of employees;
(b) The location of the business, including
			 each state in which the business is located;
(c) The length of time the employer has been
			 in business;
(d) The nature and
			 type of the employer's business for the past five years;
(e) A copy of the employer's federal and
			 state income tax return for the past three years;
(f) A notarized financial statement of
			 current assets and liabilities;
(g)
			 A sworn statement to explain the reason for noncompliance with the "Ohio
			 Workers' Compensation Act";
(h) The
			 amount of the requested settlement; and
(i) Whether the employer is in business at
			 the present time and complying with the "Ohio Workers' Compensation
			 Act."
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-14 - Noncomplying Employer › Section 4123-14-06 - Bureau of workers' compensation adjudicating committee

Current through all regulations passed and filed through July 1, 2024
(A) The
			 administrator of the bureau of workers' compensation may delegate the authority
			 granted to the administrator under Chapters 4121., 4123., and 4131. of the
			 Revised Code and the rules adopted by the bureau of workers' compensation for
			 determining employer premium, assessment, or penalty obligations or
			 liabilities, eligibility for alternative premium plans or discount programs, or
			 other employer-related disputes or issues as may be authorized under the
			 workers' compensation statutes and rules. For this purpose, the administrator
			 may appoint an adjudicating committee to provide employers with hearings on
			 such matters referred by the administrator.
(1) An employer 
									may file with
			 the bureau a request for a hearing with the adjudicating committee
			  only after the
			 employer's request, protest, petition, or
			 application has been reviewed by the appropriate bureau business unit and only
			 after that business unit has 
									notified the employer 
									of the
			 bureau's initial decision regarding the employer's request, protest, petition,
			 or application.
(2) Unless a
			 different time is provided by the Revised Code or the Administrative Code for
			 such matter, an employer shall file a protest or appeal of the bureau's
			 decision on the request, protest, petition, or application within two years of
			 receipt of the bureau's determination.
(3) The employer shall state the specific
			 grounds or reasons for the protest or appeal of the bureau's determination, and
			  include supporting documentation. The
			 bureau may refuse to grant a hearing to the employer where the employer has
			 failed to state the specific grounds or reasons for the protest or appeal or
			 has failed to provide supporting documentation as required by this
			 rule.
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-15 - Code of Ethics › Section 4123-15-01 - Code of ethics, title and rules covering

Current through all regulations passed and filed through July 1, 2024
This rule and rules
				4123-15-02 to
				4123-15-04
				and
				4121-15-01
				to
				4121-15-04
				of the Administrative Code shall be titled, "Code of Ethics for
				 the Bureau of Workers'
				Compensation and the Industrial Commission of Ohio" and shall contain the code
				of ethics for employees of these agencies, including
				the members of the bureau of workers' compensation board of
				directors.
In addition to any civil or criminal penalties that may be
				provided by statute or rule, an employee who violates any of the provisions in
				the code of ethics shall be subject to discipline as provided in the employee
				handbook of the employee's agency.
Five Year Review (FYR) Dates:
				03/23/2017 and
				06/01/2020
Promulgated
				Under: 119.03
Statutory
				Authority: 4121.12,
				4121.121
Rule
				Amplifies: 4121.122
Prior
				Effective Dates: 1/1/78, 8/15/07,
				1/1/14
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-15 - Code of Ethics › Section 4123-15-02 - Policy

Current through all regulations passed and filed through July 1, 2024
(A) It is essential
			 that the public has confidence in the administration of the industrial
			 commission and the bureau of workers' compensation. This public confidence
			 depends in a large degree on whether the public trusts that employees of these
			 agencies are impartial, fair, and act only in the interest of the people,
			 uninfluenced by any consideration of self-interest, except those inherent in
			 the proper performance of their duties. Each employee, of whatever position,
			 should, therefore, maintain the highest standards of personal integrity, since
			 the public often judges the actions of an employee as reflecting the standards
			 of the employing agency.
(B) The
			 industrial commission and the bureau of workers' compensation are entrusted
			 with the collection and distribution of a large fund. Their employees must
			 respect this trust and should welcome public scrutiny of the way in which they
			 perform their duties in connection with the administration of this fund. They
			 should be willing to accept restrictions on their conduct that may not be
			 necessary of public employees in other agencies, who are not in similar
			 positions of trust. They must avoid not only impropriety, but the appearance of
			 impropriety.
Five Year Review (FYR) Dates:
				03/23/2017 and
				06/01/2020
Promulgated
				Under: 119.03
Statutory
				Authority: 4121.12,
				4121.121
Rule
				Amplifies: 4121.122
Prior
				Effective Dates: 1/1/78
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-15 - Code of Ethics › Section 4123-15-04 - Posting, distribution and employee acknowledgement and receipt

Current through all regulations passed and filed through July 1, 2024
(A) The code of
			 ethics for employees of the bureau of workers' compensation and industrial
			 commission shall be posted in a conspicuous place in every office of the bureau
			 and commission.
(B) A copy of this
			 code of ethics shall be distributed to each employee. After two weeks from such
			 receipt each employee will certify that the employee has received and read this
			 code. The certification shall be placed in the employee's personnel file.
Five Year Review (FYR) Dates:
				03/23/2017 and
				06/01/2020
Promulgated
				Under: 119.03
Statutory
				Authority: 4121.12,
				4121.121
Rule
				Amplifies: 4121.122
Prior
				Effective Dates: 1/1/78
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-15 - Code of Ethics › Section 4123-15-05 - Purpose: eliminating outside influence; producing impartiality in handling of claims and employer risk accounts and avoiding favoritism

Current through all regulations passed and filed through July 1, 2024
In accordance with division (C) of section
				4121.122 of the Revised Code and
				division (B)(12) of section
				4121.121 of the Revised Code,
				the rules numbered 4123-15-05 to 4123-15-09 and 4121-15-05 to 4121-15-09 of the
				Administrative Code are for the purpose of eliminating improper outside
				influence on employees of the bureau of workers' compensation and the
				industrial commission, producing an impartial workers' compensation claims and
				employer risk account handling process and avoiding favoritism in that
				process.
Effective: 6/10/2017
Five Year
				Review (FYR) Dates: 03/24/2017 and
				06/01/2020
Promulgated
				Under: 119.03
Statutory
				Authority: 4121.12,
				4121.121
Rule
				Amplifies: 4121.122
Prior
				Effective Dates: 1/1/78
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-15 - Code of Ethics › Section 4123-15-06 - Furnishing employees' code of ethics and rules on improper influence to representatives

Current through all regulations passed and filed through July 1, 2024
To the extent possible, all those who represent claimants or
				employers shall be furnished without charge with a copy of the "Code of Ethics
				 of the Bureau of Workers'
				Compensation and the Industrial Commission of Ohio" and with a copy of the
				rules concerning the elimination of outside influence, producing impartial
				claims and risk account handling, and avoiding favoritism in this process.
				Administrative Code rules shall also, to the extent possible, be furnished to
				employees or agents of those who represent claimants or employers and who may
				be permitted to inspect claims and employer risk files, or whose work requires
				personal contact with employees of the bureau or commission.
Five Year Review (FYR) Dates:
				03/23/2017 and
				06/01/2020
Promulgated
				Under: 119.03
Statutory
				Authority: 4121.12,
				4121.121
Rule
				Amplifies: 4121.122
Prior
				Effective Dates: 1/1/78, 1/1/14
Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-15 - Code of Ethics › Section 4123-15-07 - Representatives' responsibility relative to employees' code of ethics

Current through all regulations passed and filed through July 1, 2024
Representatives of claimants and employers as well as their
				employees and agents shall conduct their business with the employees of the
				bureau of workers' compensation, and the industrial commission in accordance
				with the highest moral principles and are expected to support the "Code of
				Ethics  of the Bureau of
				Workers' Compensation and the Industrial Commission of Ohio" by conduct that
				will not tempt employees of the bureau and commission to violate that code but
				will encourage them to fully observe it. Employees of the bureau and commission
				shall report to their immediate superior any activity which is, or appears to
				be, in violation of this rule, for further action by the administrator or by
				the industrial commission, as the case may be.
Five Year Review (FYR) Dates:
				03/23/2017 and
				06/01/2020
Promulgated
				Under: 119.03
Statutory
				Authority: 4121.12,
				4121.121
Rule
				Amplifies: 4121.122
Prior
				Effective Dates: 1/1/78, 8/15/07,
				1/1/14