Ohio Administrative Code Search

...(A) HPP. Except as provided in paragraphs (A)(7) and (A)(8) of this rule, reimbursement for hospital inpatient services with a discharge date of February 1, 2026 or after will be calculated as follows: (1) (a) Reimbursement for hospital inpatient services, other than outliers as defined in paragraph (A)(3) of this rule, services provided by hospitals subject to reimbursement under paragraph (A)(4) of this rule,...

...(A) HPP: Unless an MCO has negotiated a different payment rate with a hospital pursuant to rule 4123-6-10 of the Administrative Code, reimbursement for hospital outpatient services with a date of service of May 1, 2025 or after will be the applicable rate set forth in this rule as follows: (1) Except as otherwise provided in this rule, reimbursement for hospital outpatient services will be e...

...Unless an MCO has negotiated a different payment rate with an ambulatory surgical center pursuant to rule 4123-6-10 of the Administrative Code, reimbursement for ambulatory surgical center services with a date of service of May 1, 2023 or after will be equal to the lesser of the ambulatory surgical center's allowable billed charges or the fee schedule amount indicated in the appendix to this rule, developed...

...(A) For purposes of this rule: (1) "Amputee clinic" means an interdisciplinary group of professional providers led by a physician with a specialty in physical medicine and rehabilitation, orthopedic surgery or vascular surgery knowledgeable in the field of prosthetics and physical disabilities, comprised of members that may include a podiatrist, physical therapist, occupational therapist, kinesiotherapist, prosthet...

...For the purposes of administrative rules promulgated in accordance with section 1347.15 of the Revised Code, the following definitions apply: (A) "Access" as a noun means an opportunity to copy, view, or otherwise perceive whereas "access" as a verb means to copy, view, or otherwise perceive. (B) "Acquisition of a new computer system" means the purchase of a "computer system," as defined in this...

...(A) Chapter 4123-16 of the Administrative Code shall apply to all personal information systems maintained by the bureau unless exempted in paragraph (C) or (D) of this rule. (B) The bureau maintains a personal information system which it deposits or stores in a record center or stores in or has processed by a data center. The bureau does not maintain a personal information system belonging t...

...(A) The bureau shall take reasonable precautions to protect personal information in the system from unauthorized modification, destruction, or disclosure of personal information. In determining what is reasonable, consideration shall be given to the following: (1) The nature and vulnerability of the personal information. (2) The physical facilities where the personal information is maintained or used. (3) The need...

...(A) Responsibilities. (1) Whenever one employer succeeds another employer in the operation of a business in whole or in part, the successor shall notify the bureau of workers' compensation of the succession. (2) Pursuant to this rule, the bureau will provide to the parties to the transfer of experience the necessary forms and instructions to complete the transfer of the appropriate payrolls ...

...(A) Responsibilities. (1) Whenever one employer succeeds another employer in the operation of a business in whole or in part, the successor shall notify the bureau of the succession. (2) Pursuant to this rule, the bureau shall provide to the parties to the transfer of experience the necessary forms and instructions to complete the transfer of the appropriate payrolls and claims. The bureau shall...

...(A) Definitions. As used in this rule: (1) "Eligibility determination date" means the March first immediately preceding the policy year for which the EM is being calculated for private employers, and the September first immediately preceding the policy year for which the EM is being calculated for public employer taxing districts. (2) "Experience modification" or "EM" means the experience modif...

...(A) Definitions. As used in this rule: (1) "Experience modification" or "EM" means the experience modification as determined under rule 4123-17-03 of the Administrative Code. (2) "Eligibility determination date" means the March first immediately preceding the policy year for which the EM is being calculated for private employers, and the September first immediately preceding the policy year fo...

...(A) Definitions. As used in this rule: (1) "Experience modification" or "EM" means the experience modification as determined under rule 4123-17-03 of the Administrative Code. (2) "Eligibility determination date" means the March first immediately preceding the policy year for which the EM is being calculated for private employers, and the September first immediately preceding the policy year fo...

...In accordance with division (A)(1) of section 4123.29 of the Revised Code, the purpose of this rule is for the bureau of workers' compensation to conform the classifications of industries according to the categories the national council on compensation insurance (NCCI) establishes that are applicable to employers in Ohio. This rule is based upon "Rule 1, Classification Assignment," effective January 1, 2002...

...(A) An AEO or a PEO registered with the bureau of workers' compensation under rule 4123-17-15.2 of the Administrative Code may apply to pay compensation directly as a self-insuring employer. (1) The AEO or the PEO must meet all eligibility criteria set forth in section 4123.35 of the Revised Code. (a) The AEO or the PEO will provide five years of financial records as set forth in division (B...

...Disability relief, as permitted under section 4123.343 of the Revised Code and rule 4123-3-35 of the Administrative Code, will be applied to reducible claims costs as limited by the per-claim limit selected by the employer.

...(A) For purposes of this rule: (1) "Health risk factors" means physical and mental characteristics that can be modified, nearly always with much less cost compared to waiting for sickness and then attempting to treat the disease. (2) "Employer" or "employer" means a private state fund employer, a public employer taxing district, a marine industry fund employer, or a coal-workers' pneumoc...

...(A) Definitions. For the purposes of this rule, (1) "Local safety council" means an entity contracted with the bureau to provide a safety campaign in accordance with standards set forth by the superintendent of the division of safety and hygiene. (2) "Program year" means July first to June thirtieth, inclusive. (3) "Superintendent" means the superintendent of the division of safety and hygiene or the superintende...

...(A) Definitions. For the purposes of this rule, (1) "Local safety council" means an entity contracted with the bureau of workers' compensation to provide a safety campaign in accordance with standards set forth by the superintendent of the division of safety and hygiene. (2) "Program year" means July first to June thirtieth, inclusive. (3) "Superintendent" means the superintendent of the divis...

...(A) As used in this rule: (1) As defined in division (F)(3) of section 4123.34 of the Revised Code, "construction industry" includes any activity performed in connection with the erection, alteration, repair, replacement, renovation, installation, or demolition of any building, structure, highway, or bridge. The classification codes satisfying this definition are listed in paragraph (E) of this r...

...(A) As used in this rule: (1) As defined in division (F)(3) of section 4123.34 of the Revised Code, "construction industry" includes any activity performed in connection with the erection, alteration, repair, replacement, renovation, installation, or demolition of any building, structure, highway, or bridge. The manual classifications satisfying this definition are listed in paragraph (E) of this rule. (2) "Constru...

...(A) The administrator of workers' compensation shall offer a plan that groups employers for rating purposes. Individual employers shall retain their separate risk identity but shall be pooled and grouped for experience rating purposes only. (B) In establishing a group for group experience rating purposes, the sponsoring group organization or individual employers in the group must satisfy all of t...

...(A) The following certification requirements shall apply to all sponsoring organizations that seek to make application for either the group rating plan, as provided for in rule 4123-17-61 of the Administrative Code, or the group retrospective rating plan as provided in rule 4123-17-73 of the Administrative Code, known collectively as group programs. (B) The sponsoring organization must have been in existence for at ...

...This rule on termination and transfer of group experience rating shall apply at the group level after the bureau applies the applicable individual rules on transfer of experience. (A) A group formed for the purpose of group experience rating may not retroactively include experience in a plan, exclude experience from a plan, or voluntarily terminate a plan during the policy year. A change in the name of the group wil...

...This rule on termination and transfer of group experience rating shall apply at the group level after the bureau of workers' compensation applies the applicable individual rules on transfer of experience. (A) A group formed for the purpose of group experience rating may not retroactively include experience in a plan, exclude experience from a plan, or voluntarily terminate a plan during the policy ...

...(A) Definitions. As used in this rule: (1) "Coverage period" means the twelve month period beginning July first through June thirtieth for private employers, and January first through December thirty-first for public employers. The deductible selected by the employer will apply only to claims with a date of injury within the coverage period defined in the deductible agreement. (2) "Deductible" ...