COVID-19 Indoor Air Quality Assistance Program
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 of COVID-19. It also provides reimbursement for secondary devices designed to destroy bacteria, mold, and viruses. The following self-insuring employers are eligible for this program:
- 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 a Provider Assurance Form to the Ohio Department of Developmental Disabilities (DODD).
Eligible expenses are those incurred in response to COVID-19 for the previously mentioned purposes from March 1 to Dec. 30, 2020. The application form includes a list of eligible expenses.
The U.S. Department of Treasury awarded these funds to the State of Ohio as federal financial assistance. The funding comes from the Coronavirus Aid, Relief, and Economic Security Act (CARES) Act. Eligible employers may receive up to $15,000 for the duration of 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 can also contact BWC’s Division of Safety & Hygiene at 1-800-644-6292 or grants@bwc.state.oh.us.
Prosthetics for Self-Insuring Employers
BWC is responsible for processing requests and payment for prosthetics on self-insuring employers’ claims. While you should not approve C9 requests specifically for prosthetics and related equipment, you need to continue to manage the claim and treatment for the related injuries.
It is imperative that you submit the documentation listed below to BWC so we can expedite our responses to the C9s requesting prosthetic devices and/or supplies. You can fax these records to 1-866-366-8352 with the BWC claim number.
- A C9 dated and signed by an attending or consulting physician who has seen the patient within the last six months. If you receive the C9 directly, please forward to BWC.CAT.Nurse.Referrals&Questions@bwc.state.oh.us upon receipt. Do not respond to these requests.
- A detailed medical summary from an office visit from the provider who signed the C9 within six months of the request.
- The C9 should include the appropriate L codes for the requested device and/or supplies. 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 any surgical 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), a multidisciplinary evaluation (MDE) will need to be scheduled with The Ohio State University Department of Rehabilitation. This exam will determine the necessity of the requested prosthetic device. The subject matter expert (SME) in prosthetics within the CAT Department will assist the self-insuring case manager in scheduling the exam and obtaining the exam summaries.
- We will require a detailed invoice from the prosthetic vendor with all appropriate L codes to include miscellaneous codes as well as pricing. (All miscellaneous codes will require a detailed explanation as to why the miscellaneous codes are being used 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, SME Prosthetics at james.l.14@bwc.state.oh.us or call at 614-440-4202.
Rule Changes
Pharmacy rules presented and approved by the Board of Directors.
OAC 4123-6-21.1 (L) – Defines the time to address an authorization request for prescriptions to no more than three days. This is in line with BWC’s expectations, while allowing employers to ensure the prescriptions are appropriate and to avoid delays for injured workers to receive necessary medications.
OAC 4123-6-21.1 (I) - Removes the requirement to obtain a drug utilization review before terminating certain prescriptions, including Oxycontin, which has been removed from BWC’s drug formulary.
Assessment Rule effective 12/1/2020
OAC 4123-19-15(B)– Added the ability to offer a rebate to self-insuring employers who use the bureau’s electronic payment and e-notification offerings
Self-Insured Administrator and TPA Roles
One of the most important requirements for self-insuring employers is to assign an employee to be the designated self-insured administrator. This employee must be knowledgeable about Ohio workers’ compensation requirements and able to make necessary claim and administrative decisions. This role cannot be delegated to a broker or third-party administrator. Self-insuring employers must notify BWC if the designated administrator is changing. The newly assigned administrator must complete our online orientation program if they have less than one year of experience managing an Ohio self-insured program.
A self-insuring employer may retain a third-party administrator or other representative to assist in managing its workers’ compensation program, but the employer is ultimately responsible 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 claims related 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 to all claims under the self-insured risk number regardless of the date of injury. We are not able to assign representatives for specific policy periods.
You can update the representatives through your e-account login, or by completing a Request to Add/Change or Terminate Permanent Authorization Form (AC-2) and submitting it to SIINQ@bwc.state.oh.us.
You can authorize access for specific claims by completing an Employer Authorized Representative Form (R-1).
When you have multiple representatives for different claim periods, you may consider assigning the current representative as the ERC, and the previous representative as the CLM rep. If you have more than two representatives, additional representatives will need to be assigned to specific claims.
2021 Compensation Rates
The Statewide Average Weekly Wage, or the maximum rate for compensation other than percentage of permanent partial awards, will be $1,019.00 for injuries occurring on or after Jan. 1, 2021. The minimum rate will be $339.67. The maximum percentage of permanent partial awards will also be $339.67. The Disabled Workers’ Relief Fund (DWRF) entry level will be $401.81.
C 9 Treatment Requests
Self-insuring employers must respond treatment requests within 10 days of receipt, or the request will be considered approved. If a request is initially denied or pended to obtain an independent medical exam or additional information is requested, the treatment request should be revisited upon receipt of the documentation.
Important Dates
Jan 27, 2021: Assessments available online and mailed to employers
March 1, 2021: SI 40 report and SI 40 backup detail report due
March 1, 2021: Assessment payments due (must use online payment method)
Reporting Credits on SI 40 report
Please only include credits for previously reported compensation on line 13 of the report. You can report payments in claims overturned by an Industrial Commission or court order and subrogation recoveries received in 2020 for the compensation portion only. The subrogation amount must not exceed previously reported compensation. Do not report reimbursements from excess insurance or recoveries for medical expenses. Also, be sure to include supporting details for the credits on your backup report.
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