Effective: June 27, 2005
Latest Legislation: Senate Bill 124 - 126th General Assembly
(A) The administrator of workers' compensation shall develop standards for qualification of health care plans of the Ohio workers' compensation qualified health plan system to provide medical, surgical, nursing, drug, hospital, and rehabilitation services and supplies to an employee for an injury or occupational disease that is compensable under this chapter or Chapter 4123., 4127., or 4131. of the Revised Code. In adopting the standards, the administrator shall use nationally recognized accreditation standards. The standards the administrator adopts must provide that a qualified plan provides for all of the following:
(1) Criteria for selective contracting of health care providers;
(2) Adequate plan structure and financial stability;
(3) Procedures for the resolution of medical disputes between an employee and an employer, an employee and a provider, or an employer and a provider, prior to an appeal under section 4123.511 of the Revised Code;
(4) Authorize employees who are dissatisfied with the health care services of the employer's qualified plan and do not wish to obtain treatment under the provisions of this section, to request the administrator for referral to a health care provider in the bureau's health care partnership program. The administrator must refer all requesting employees into the health care partnership program.
(5) Does not discriminate against any category of health care provider;
(6) Provide a procedure for reporting injuries to the bureau of workers' compensation and to employers by providers within the qualified plan;
(7) Provide appropriate financial incentives to reduce service costs and utilization without sacrificing the quality of service;
(8) Provide adequate methods of peer review, utilization review, quality assurance, and dispute resolution to prevent and provide sanctions for inappropriate, excessive, or not medically necessary treatment;
(9) Provide a timely and accurate method of reporting to the administrator necessary information regarding medical and health care service and supply costs, quality, and utilization to enable the administrator to determine the effectiveness of the plan;
(10) Authorize necessary emergency medical treatment for an injury or occupational disease provided by a health care provider who is not a part of the qualified health care plan;
(11) Provide an employee the right to change health care providers within the qualified health care plan;
(12) Provide for standardized data and reporting requirements;
(13) Authorize necessary medical treatment for employees who work in Ohio but reside in another state.
(B) Health care plans that meet the approved qualified health plan standards shall be considered qualified plans and are eligible to become part of the Ohio workers' compensation qualified health plan system. Any employer or group of employers may provide medical, surgical, nursing, drug, hospital, and rehabilitation services and supplies to an employee for an injury or occupational disease that is compensable under this chapter or Chapter 4123., 4127., or 4131. of the Revised Code through a qualified health plan.
Structure Ohio Revised Code
Chapter 4121 | Industrial Commission; Bureau of Workers' Compensation
Section 4121.01 | Industrial Commission - Bureau of Workers' Compensation Definitions.
Section 4121.02 | Industrial Commission.
Section 4121.021 | Industrial Commission Operating Fund.
Section 4121.03 | Chairperson - Executive Director - Powers and Duties Generally.
Section 4121.04 | Industrial Commission Nominating Council - Initial Appointments - Challenges.
Section 4121.09 | Official Seal.
Section 4121.11 | Bureau Rules of Procedure.
Section 4121.12 | Workers' Compensation Board of Directors.
Section 4121.122 | Discipline of Commission and Bureau Employees.
Section 4121.123 | Workers' Compensation Board Nominating Committee.
Section 4121.125 | Monitoring Performance of System.
Section 4121.126 | Conflicts of Interest by Board Members or Bureau Employees.
Section 4121.127 | Transactions by Fiduciary Involving Conflict of Interest.
Section 4121.128 | Attorney General Legal Adviser of Board.
Section 4121.129 | Audit, Actuarial, and Investment Committees.
Section 4121.13 | Administrator of Workers' Compensation - Powers and Duties.
Section 4121.131 | Special Investigation Department Access to Crime Databases.
Section 4121.14 | Investigating Agent.
Section 4121.15 | Power to Administer Oaths, Issue Subpoenas, and Compel Attendance of Witnesses.
Section 4121.16 | Witness Attendance - Fees and Mileage.
Section 4121.17 | Examination of Place of Employment Upon Petition That Same Is Unsafe.
Section 4121.19 | Record of Proceedings.
Section 4121.20 | Depositions.
Section 4121.21 | Effective Date of Orders - Time for Compliance.
Section 4121.22 | Jurisdiction Over Places of Employment.
Section 4121.23 | Petition for Hearing by Employer.
Section 4121.24 | No Action to Vacate Allowed Until After Hearing.
Section 4121.25 | Action to Set Aside, Vacate, or Amend Order.
Section 4121.26 | Statement of Issues Not Adequately Considered - Stay of Proceedings.
Section 4121.27 | Exclusive Jurisdiction of Supreme Court.
Section 4121.28 | Order of Bureau of Workers' Compensation Not Stayed by Pendency of Action.
Section 4121.29 | Priority to Be Given Actions.
Section 4121.30 | Administrative Rules.
Section 4121.31 | Joint Adoption of Administrative Rules.
Section 4121.32 | Supplementing Rules With Operating Manuals.
Section 4121.34 | District Hearing Officers - Jurisdiction.
Section 4121.35 | Staff Hearing Officers - Jurisdiction.
Section 4121.36 | Industrial Commission Hearing Rules.
Section 4121.37 | Creation of Division of Safety and Hygiene.
Section 4121.38 | Impairment Evaluation.
Section 4121.39 | Administrator of Workers' Compensation - Powers and Duties.
Section 4121.40 | Service Directors - Investigators and Field Auditors - Duties.
Section 4121.42 | In-Service Training Programs.
Section 4121.43 | Compensation Payments.
Section 4121.441 | Health Care Partnership Program - Adoption of Rules.
Section 4121.442 | Health Care Quality Advisory Council.
Section 4121.443 | Summary Suspension.
Section 4121.444 | Obtaining Workers' Compensation Payments by Deception Prohibited.
Section 4121.446 | Selection of Managed Care Organizations.
Section 4121.447 | Data Security Agreement.
Section 4121.45 | Workers' Compensation Ombudsperson System.
Section 4121.47 | Violating Specific Safety Rule or Employee Welfare Legislation.
Section 4121.471 | Limitation on Action for Employer's Failure to Comply With Safety Rule.
Section 4121.50 | Rules to Implement Coordinated Services Program for Prescription Drug Abuse.
Section 4121.61 | Aiding Rehabilitation of Injured Workers.
Section 4121.62 | Contracts for Rendition of Rehabilitation Services.
Section 4121.63 | Living Maintenance Payments Paid to Claimants Agreeing to Rehabilitation.
Section 4121.65 | Employer May Furnish Rehabilitation Services.
Section 4121.68 | Compensation and Benefits to Rehabilitation Program Participants.
Section 4121.69 | Compensation of Professional, Administrative, and Managerial Employees.