REGULATORY ACTIVITY:

• Has posted notice of intent to review rule 4123-3-15 Claim Procedures Subsequent to Allowance; 4123-3-15.1 Dismissal of an application for the determination of percentage of permanent partial disability; and 4123-3-32 Temporary total examination.  To view the rules under consideration, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp
• Posted notice of intent to review a rule regarding payment for health and behavior assessment and intervention services. The posted notice is for rule 4123-6-33.  To review the posted rule, go to https://www.bwc.ohio.gov/downloads/blankpdf/OAC4123-6-33Proposed.pdf.
• Posted notice of intent to review rule 4123-3-15 Claims procedures after allowance.  To view the proposed rule, go to https://www.bwc.ohio.gov/downloads/blankpdf/OAC4123-3-15Proposed.pdf
• Posted notice of intent to review rule 4123-3-15.1 Dismissal of application for the determination of percentage of permanent partial disability.  To view the proposed rule, go to https://www.bwc.ohio.gov/downloads/blankpdf/OAC4123-3-15.1Proposed.pdf.
• Posted notice of intent to review rule 4123-3-32 Temporary total examinations. To view the proposed rule, go to https://www.bwc.ohio.gov/downloads/blankpdf/OAC4123-3-32Proposed.pdf.

FEE SCHEDULE NEWS:

• A new Inpatient fee schedule effective February 1, 2018 has been published.  The next expected update to the Inpatient schedule will be February 2019.

REGULATORY ACTIVITY:

• Has posted notice of a packet of rules being considered for review:

-Package Title: BWC Fee Schedule Rules -Rule Numbers: 4123-6-08 Bureau fee schedule. 4123-6-21.3 Outpatient medication formulary. 4123-6-37.2 Payment of hospital outpatient services. 4123-6-37.3 Payment of ambulatory surgical center services.

• To view the rules, go to: https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp
• Has posted notice of rule 4123-6-02.2 Provider access to the HPP - provider certification criteria being submitted to the BWC board of directors.  To view the rule submitted, go to: https://www.bwc.ohio.gov/downloads/blankpdf/OAC4123-6-02.2Proposed.pdf.

REGULATORY ACTIVITY:

• Has posted two rules for public comment.  Rule 4123-6-02.3 Provider Access to the HPP - provider application and certification criteria and Rule 4123-6-32 Payment for Lumbar Fusion Surgery have been posted and comments are due by November 20, 2017.
• Posted notice that Rule 4123-6-37.1 regarding Payment of hospital inpatient services is being considered for a review and amendment.
• Posted notice of intent to conduct a review of Rule 4123-3-35 Employer Handicap Reimbursement.
• Posted notice that rule 4123-3-08 Preparation and filing of applications for compensation and/or benefits is being considered for review.

REGULATORY ACTIVITY:

• The Ohio Bureau of Workers’ Compensation will hold a public hearing on Monday, August 14, 2017, at 1:00 p.m., in Room 1, Level 2, 30 West Spring Street, Columbus, Ohio 43215, to consider the following rule to: Amend, for the purpose shown below:  4123-6-21.3 Outpatient medication formulary.  The Bureau proposes to revise the formulary appendix to this rule by amending coverage to the opioid drug class and drug products listed in the formulary.  These recommended changes are the result of recommendations from the Bureau's Pharmacy & Therapeutics Committee (P&T) Committee as well as a general cleanup of the formulary appendix.
• The Ohio Bureau of Workers’ Compensation will hold a public hearing on Friday, August 4, 2017, at 2:00 p.m., in Room 1, Level 2, 30 West Spring Street, Columbus, Ohio 43215, to consider the following rule to:  Amend, for the purpose shown below: 4123-6-01.2 Provisional treatment reimbursement approval – pilot program.   Based on the success of the pilot program to date, the Bureau proposes that rule OAC 4123-6-01.2 be amended to extend the pilot program an additional two years, through June 30, 2019.
• The Ohio Bureau of Workers’ Compensation will hold a public hearing on Monday, August 14, 2017, at 1:00 p.m., in Room 1, Level 2, 30 West Spring Street, Columbus, Ohio 43215, to consider the following rule to:   Enact, for the purpose shown below:  4123-3-38 Surplus fund charge of qualified motor vehicle accident claims.  The proposed new rule provides that, in lieu of the traditional subrogation, the Bureau will charge the entire cost of the claim to the surplus fund if the employer can establish that the claim is based on a motor vehicle accident involving a third party, the third party is issued a citation for violation of any law or ordinance regulating the operation of a motor vehicle arising from the accident, and the third party has insurance that covers the claim.
• Ohio has posted notice of two rules that are going to be reviewed.  The two rules are 4123-6-02.3 Provider access to the HPP - provider application and certification and rule 4123-6-32 Payment for lumbar fusion surgery.   Comments may be submitted on this rule electronically the day 7/24/2017 12:00:00 AM. If you would like to comment on Rule Number: Provider application and certification criteria, please click HERE. The comment period will be open until 8/14/2017 12:00:00 AM

REGULATORY ACTIVITY:

• A rule in the category Workers' Compensation - Bureau of Workers' Compensation is being considered for review: -Rule Title: Provisional treatment reimbursement approval - pilot program. -Rule Number: 4123-6-01.2 -Proposed Action: Amended.
• Posted notice of five-year review of rule 4123-19 regarding self-insured risk providers.
• Has posted waiting for Common Sense Initiative Recommendations the Ohio Rule Number 4123-6-21.3 Outpatient medication formulary Appendix (formulary list of medications covered by the Ohio Bureau of Workers Compensations.  The proposals will become effective October 1.
• Published Chapter 4123-19-01 Definition: state risks, self-insuring risks Five Year Rule Review notice for review and comment.  The state is recommending no changes.

FEE SCHEDULE NEWS:

• The state has adopted changes to the ASC and outpatient fee schedule rates effective May 1, 2017. The next update is scheduled for May 2018.

REGULATORY ACTIVITY:

• Ohio has published final rule for rule 4123-6-02.5 Provider Access to the HPP- provider not certified.  The final rule was published on April 25, 2017.  The rule becomes effective on June 1, 2017.
• Ohio has published the final rule for Rule 4123-5-18 Medical proof for required for payment of compensation.  The final rule was published on April 25, 2017.  The rule becomes effective on June 1, 2017.
• Ohio has posted amendments to two rules.  The amended rules are 4123-15-09 Prohibition against unnecessary claim file possession and 4123-15-03 Standard of conduct.

REGULATORY ACTIVITY:

• Ohio has posted notice of three rule sets that are awaiting review.  The rules under consideration are the Marine Industry Fund Rules, 4123-17-16 Penalties late payment and reporting and 4123-17-16 Five-year rule review.
• Ohio has posted amendments to two rules.  The amended rules are 4123-15-09 Prohibition against unnecessary claim file possession and 4123-15-03 Standard of conduct.
• Ohio's ASC fee schedule becomes effective May 1, 2017.

REGULATORY ACTIVITY:

• Ohio has published notice of a rule package in the category Workers’ Compensation - Bureau of Workers’ Compensation is being considered for review:
  • Package Title: BWC - Pharmacy Rules
    Rule Numbers: 4123-6-21 Payment for outpatient medication.
    4123-6-21.1 Payment for outpatient medication by self-insuring employer.
    4123-6-21.2 Pharmacy and therapeutics committee.
• Ohio has published notice of a rule in the category Workers’ Compensation - Bureau of Workers’ Compensation is being considered for review:
  • Rule Title: Penalties: late payment and reporting.
    Rule Number: 4123-17-16
    Proposed Action: Amended
• Reminder: The Bureau has published three rules for comment.  Comments are due in by March 23, 2017.  The rules subject to comment are rules 4123-6-8 Bureau fee schedule; 4123-6-37.2 Payment of hospital outpatient services; and 4123-6-37.3. Payment of ambulatory surgical center services.
• Ohio has published a rule package in the category Workers’ Compensation - Bureau of Workers’ Compensation is being considered for review:
  • Package Title: Marine Industry Fund Rules
    Rule Numbers: 4123-20-01
    4123-20-02
    4123-20-03
    4123-20-04
    4123-20-05
    4123-20-06
    4123-20-07

REGULATORY ACTIVITY:

• A rule package in the category Workers’ Compensation - Bureau of Workers’ Compensation is being considered for review: Fee schedule and payments for medical services. -Rule Numbers: 4123-6-08 Bureau fee schedule; 4123-6-37.2 Payment for hospital outpatient services; 4123-6-37.3 Payment of ambulatory surgical center services.
• There are several proposed rules for comment. Two of the proposed rules address medical issues and the other rule addresses coverage.  The medical rules that have been proposed are 4123-5-18-Medical proof required for payment of compensation and 4123-6-02.5 Provider accesses to the HPP - Provider not certified.  The coverage rule that has been proposed is 4123-17-24 Other states coverage.  The state will receive public comment on these rules through COB February 16, 2017.

FEE SCHEDULE NEWS:

• The state has adopted a new Inpatient fee schedule with an effective date of February 1, 2017. The next expected update will be on February 1, 2018.
• A new medical fee schedule has been adopted as of January 1, 2017. The next scheduled update is for January 2018.
• The state has adopted changes to the ASC and Outpatient fee schedule rates effective May 1, 2016. The next update is scheduled for May 2017.

REGULATORY ACTIVITY:

• Ohio’s Bureau of Workers’ Compensation has posted notice of its intent to review several rules.  Among the rules awaiting Common Sense Initiative are 4123-3-23 Limitations on the filing fee bills; 4123-6-21 Payment for outpatient medication; 4123-6-21.1 Payment for outpatient medication by self-insuring employer; 4123-6-21.3 Outpatient medication formulary; and 4123-6-37.1 payment of hospital inpatient services.

LEGISLATIVE ACTIONS:

• House Bill 207
  Workers’ compensation claims involving motor vehicle accidents.  This legislation requires workers’ compensation claims to be charged to the Surplus Fund Account in lieu of to a state fund employer’s experience in certain circumstances when a claim is based on a motor vehicle accident involving a third party.  It allows a state fund employer who believes that a claim may qualify to be charged to the Surplus Fund Account under the act to file a request with the Administrator of Workers’ Compensation for a determination.   The legislation requires the Administrator to make the determination within 180 days after the Administrator receives the request and requires any amount collected by the Administrator through the subrogation process for compensation or benefits that were charged to the Surplus Fund Account to be credited to the Surplus Fund Account and not applied to an individual employer’s account.  The legislation eliminates the minimum number of employees required for a private sector employer or board of county commissioners to obtain self-insuring status under the Workers’ Compensation Law.  The legislation requires a self-insuring employer who resumes paying premiums to the state insurance fund to provide the Administrator with any information that the Administrator may require to develop a state fund experience modification factor.  The legislation requires, if a professional employer organization agreement is terminated, a self-insuring professional employer to provide the Administrator with information that the Administrator must use to develop a state fund experience modification factor for each client employer formerly subject to the agreement.  Workers’ compensation claims involving motor vehicle accidents charging experience for certain claims to the Surplus Fund Account  The act requires the Administrator of Workers’ Compensation, for workers’ compensation claims arising on or after July 1, 2017, to charge a state fund employer’s experience to the Surplus Fund Account created under continuing law within the State Insurance Fund and not to the employer’s experience for payments made in a workers’ compensation claim, if all of the following apply:
  • The claim is based on a motor vehicle accident involving a third party;
  • The third party is issued a citation for a violation of any law or ordinance regulating the motor vehicle’s operation arising from the accident on which the claim is based;
  • Either of the following circumstances apply to the claim:
    • Any form of insurance maintained by the third party covers the claim;
    • Uninsured or underinsured motorist coverage covers the claim.

        Effective Date August 31, 2016.