Ohio Admin. Code 4123-6-02.22

Current through all regulations passed and filed through November 4, 2024

Section 4123-6-02.22 - Provider access to the HPP - ambulatory surgical center arthroplasty center requirements

(A) To be eligible for participation in the HPP as an ambulatory surgical center arthroplasty center, an ambulatory surgical center must :

(1) Be certified as an ambulatory surgical center under paragraph (C) of rule 4123-6-02.2 of the Administrative Code.

(2) Have a formal joint replacement program which has been in place for at least one year prior to the date of application, and have performed a minimum of ten arthroplasty procedures prior to the date of application.

(3) Have a physician credentialing criteria policy which includes, at a minimum:

(a) A statement confirming any surgeon performing the service for injured workers is board certified in a related surgery specialty;

(b) A statement confirming any surgeon performing this service for injured workers has performed the procedure at the facility within one year prior to the date of application;

(c) A statement confirming any surgeon performing the service for injured workers has admitting privileges at a hospital within thirty miles of the facility or otherwise closest hospital;

(d) The facility recredentials surgeons at regular intervals.

(4) Have a patient selection criteria policy for injured workers consistent with applicable standards of care which includes, at a minimum:

(a) The patient is American society of anesthesiologists (ASA) physical status I (normal healthy patient) or II (patients with mild systemic disease);

(b) The patient is under sixty-five years of age;

(c) The patient has a body mass index which is not likely to affect surgical outcome;

(d) The patient has no co-morbid conditions that would be likely to affect surgical outcome;

(e) The patient has one or more individuals to assist with immediate post- surgical recovery care (home support).

(5) Report quality data measures to the centers for medicare and medicaid services (CMS) under the ambulatory surgical center quality reporting (ASCQR) program.

(6) Have an established protocol for tracking and reporting the following Ohio association of ambulatory surgery center (OAASC) quality data measures:

(a) Number of extended stays past midnight;

(b) Number of unexpected complications;

(i) Vomiting which does not respond to treatment;

(ii) Severe pain not responding to treatment;

(iii) Excessive bleeding necessitating a return to surgery or transfer;

(iv) Cardiac or respiratory arrest;

(c) Number of other incidents in the following areas:

(i) Medication errors;

(ii) Medical device errors;

(iii) Unintentional retained foreign body;

(d) Post discharge complications;

(i) Infections (thirty days post-operative; implants up to one year);

(ii) Emergency room visit within forty-eight hours for related issue;

(7) List on its application the specific procedure(s) it is requesting bureau certification to perform and receive reimbursement for under rule 4123-6-37.3 of the Administrative Code as an ambulatory surgical center arthroplasty center.

(B) The bureau is authorized to recredential and recertify a facility to participate in the HPP as an ambulatory surgical center arthroplasty center in accordance with rule 4123-6-02 of the Administrative Code.

(C) The administrator may decertify, or refuse to certify or recertify the facility as an ambulatory surgical center arthroplasty center, in accordance with rule 4123-6-17 of the Administrative Code and Chapter 119. of the Revised Code:

(1) If the facility has failed to meet or maintain any of the criteria for bureau certification as an ambulatory surgical center arthroplasty center set forth in paragraph (A) of this rule;

(2) Upon the recommendation of the bureau of workers' compensation stakeholders' health care quality assurance advisory committee (HCQAAC) or other peer review committee established by the bureau that injured worker safety would be compromised by the continued participation of the facility as an ambulatory surgical center arthroplasty center in the HPP; or

(3) As otherwise provided by this chapter of the Administrative Code.

Ohio Admin. Code 4123-6-02.22

Effective: 4/15/2024
Five Year Review (FYR) Dates: 1/29/2024 and 08/01/2025
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441, 4123.66
Prior Effective Dates: 05/01/2016, 10/01/2016