COVID-19 Indoor Air Quality Assistance Program

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From:Sent:Subject:Ohio Bureau of Workers’ CompensationFriday, December 18, 2020Ohio BWC December 2020 Self-Insured NewsletterHaving trouble viewing this email? View it as a Web page.COVID-19 Indoor Air Quality AssistanceProgramThe COVID-19 Indoor Air Quality Assistance Program provides reimbursement to helpcover the costs of inspections, assessments, maintenance, and improvements to indoorheating, ventilation, and air conditioning (HVAC) systems. The goal is to control the spreadof COVID-19. It also provides reimbursement for secondary devices designed to destroybacteria, mold, and viruses. The following self-insuring employers are eligible for thisprogram: Nursing homes licensed by the Ohio Department of Health (ODH). Assisted living/residential care facilities licensed by ODH. Adult day centers that are Medicaid providers in the PASSPORT, Ohio Home Care,or MyCare Ohio waiver programs. Adult day support providers that are a Medicaid provider and have submitted aProvider Assurance Form to the Ohio Department of Developmental Disabilities(DODD).

Eligible expenses are those incurred in response to COVID-19 for the previously mentionedpurposes from March 1 to Dec. 30, 2020. The application form includes a list of eligibleexpenses.The U.S. Department of Treasury awarded these funds to the State of Ohio as federalfinancial assistance. The funding comes from the Coronavirus Aid, Relief, and EconomicSecurity Act (CARES) Act. Eligible employers may receive up to 15,000 for the durationof the program.Note: The deadline for employers to submit applications is Dec. 30, 2020.Specific information, including the application process, is available on our website. You canalso contact BWC’s Division of Safety & Hygiene at 1-800-644-6292 orgrants@bwc.state.oh.us.Prosthetics for Self-Insuring EmployersBWC is responsible for processing requests and payment for prosthetics on self-insuringemployers’ claims. While you should not approve C9 requests specifically for prostheticsand related equipment, you need to continue to manage the claim and treatment for therelated injuries.It is imperative that you submit the documentation listed below to BWC so we can expediteour responses to the C9s requesting prosthetic devices and/or supplies. You can fax theserecords to 1-866-366-8352 with the BWC claim number.The linked image cannot be displayed. The file may have been moved, renamed, or deleted. Verify that the link points to the correct file and location. A C9 dated and signed by an attending or consulting physician who has seen thepatient within the last six months. If you receive the C9 directly, please forward s upon receipt. Do notrespond to these requests. A detailed medical summary from an office visit from the provider who signed theC9 within six months of the request. The C9 should include the appropriate L codes for the requested device and/orsupplies. The L codes are available at https://hcpcs.codes/l-codes. The name of the prosthetic vendor requesting the device and/or supplies. The original operative report as well as any additional operative reports of anysurgical revisions that have been necessary throughout the life of the claim. Scheduled loss award and documentation.Once we approve the requests, we will address the following:

In some cases, as in accordance the Artificial Appliance Policy (OAC 4123-6-08), amultidisciplinary evaluation (MDE) will need to be scheduled with The Ohio StateUniversity Department of Rehabilitation. This exam will determine the necessity ofthe requested prosthetic device. The subject matter expert (SME) in prostheticswithin the CAT Department will assist the self-insuring case manager in schedulingthe exam and obtaining the exam summaries. We will require a detailed invoice from the prosthetic vendor with all appropriate Lcodes to include miscellaneous codes as well as pricing. (All miscellaneous codeswill require a detailed explanation as to why the miscellaneous codes are beingused as well as a manufacturer’s invoice before reimbursement can be considered).For any questions or concerns, feel free to reach out to James Landon RN, SMEProsthetics at james.l.14@bwc.state.oh.us or call at 614-440-4202.Rule ChangesPharmacy rules presented and approved by the Board of Directors.OAC 4123-6-21.1 (L) – Defines the time to address an authorization request forprescriptions to no more than three days. This is in line with BWC’s expectations, whileallowing employers to ensure the prescriptions are appropriate and to avoid delays forinjured workers to receive necessary medications.OAC 4123-6-21.1 (I) - Removes the requirement to obtain a drug utilization review beforeterminating certain prescriptions, including Oxycontin, which has been removed from BWC’sdrug formulary.Assessment Rule effective 12/1/2020OAC 4123-19-15(B)– Added the ability to offer a rebate to self-insuring employers who usethe bureau’s electronic payment and e-notification offeringsSelf-Insured Administrator and TPA RolesOne of the most important requirements for self-insuring employers is to assign anemployee to be the designated self-insured administrator. This employee must beknowledgeable about Ohio workers’ compensation requirements and able to makenecessary claim and administrative decisions. This role cannot be delegated to a broker orthird-party administrator. Self-insuring employers must notify BWC if the designated

administrator is changing. The newly assigned administrator must complete our onlineorientation program if they have less than one year of experience managing an Ohio selfinsured program.A self-insuring employer may retain a third-party administrator or other representative toassist in managing its workers’ compensation program, but the employer is ultimatelyresponsible for all actions taken by its representatives.You may assign the representatives to one of the following roles: Employer/risk representative (ERC): Authorized representative for risk and claimsrelated issues. Receives all correspondence. Claim management representative (CLM): Authorized rep for claims activity only.Receives claims related correspondence. Risk management representative (RISK): Authorized rep for risk related issues.Receives risk or policy administrative related correspondence.You may only assign one representative to each type, and the representative is assigned toall claims under the self-insured risk number regardless of the date of injury. We are notable to assign representatives for specific policy periods.You can update the representatives through your e-account login, or by completing aRequest to Add/Change or Terminate Permanent Authorization Form (AC-2) and submittingit to SIINQ@bwc.state.oh.us.You can authorize access for specific claims by completing an Employer AuthorizedRepresentative Form (R-1).When you have multiple representatives for different claim periods, you may considerassigning the current representative as the ERC, and the previous representative as theCLM rep. If you have more than two representatives, additional representatives will need tobe assigned to specific claims.2021 Compensation RatesThe Statewide Average Weekly Wage, or the maximum rate for compensation other thanpercentage of permanent partial awards, will be 1,019.00 for injuries occurring on or afterJan. 1, 2021. The minimum rate will be 339.67. The maximum percentage of permanentpartial awards will also be 339.67. The Disabled Workers’ Relief Fund (DWRF) entry levelwill be 401.81.

C 9 Treatment RequestsSelf-insuring employers must respond treatment requests within 10 days of receipt, or therequest will be considered approved. If a request is initially denied or pended to obtain anindependent medical exam or additional information is requested, the treatment requestshould be revisited upon receipt of the documentation.Important DatesJan 27, 2021:Assessments available online and mailed to employersMarch 1, 2021:SI 40 report and SI 40 backup detail report dueMarch 1, 2021:Assessment payments due (must use online payment method)Reporting Credits on SI 40 reportPlease only include credits for previously reported compensation on line 13 of thereport. You can report payments in claims overturned by an Industrial Commission or courtorder and subrogation recoveries received in 2020 for the compensation portion only. Thesubrogation amount must not exceed previously reported compensation. Do not reportreimbursements from excess insurance or recoveries for medical expenses. Also, besure to include supporting details for the credits on your backup report.Established in 1912, the Ohio Bureau of Workers’ Compensation is the exclusive provider ofworkers’ compensation insurance in Ohio and serves 249,000 public and private employers.With nearly 1,800 employees and assets of approximately 28 billion, BWC is one of thelargest state-run insurance systems in the United States. Our mission is to deliver

consistently excellent experiences for each BWC customer every day. For more, visitwww.bwc.ohio.gov.Stay Connected with Ohio Bureau of Workers' Compensation:SUBSCRIBER SERVICES:Manage Subscriptions HelpThis email was sent to Email Address using GovDelivery Communications Cloud, on behalf of: Ohio Bureau ofWorkers' Compensation · 30 W. Spring St. ·Columbus, OH 43215-2256

The COVID -19 Indoor Air Quality Assistance Program provides reimbursement to help cover the costs of inspections, assessments, maintenance, and improvements to indoor heating, ventilation, and air conditioning (HVAC) systems. The goal is to control the spread . codes to include miscellaneous codes as w

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