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OhioBWC - Basics:  Health Parnership Program (HPP)

Health Partnership Program (HPP)

House Bill 107
House Bill (H.B.) 107, enacted Oct. 20, 1993, was one of a series of legislative reforms to the Ohio workers’ compensation system. Although a number of changes resulted from this legislation, one of the most significant was the requirement that a managed care system be established for state-funded and self-insured employers and their employees. This system took the form of the Health Partnership Program and the Qualified Health Plan. These programs and their supporting laws, rules and policies affect state-funded and self-insured employers and employees, respectively.

Managed Care Programs
Managed care is term applied to a widely-used health care model focusing on the proactive oversight and coordination of all medical services rendered to a patient. The Ohio workers’ compensation system implemented managed care in 1997 when the Health Partnership Program (HPP) and the Qualified Health Plan (QHP) were implemented. These programs, respectively, are used by state-fund and self-insured employers and their employees. HPP and QHP rely on employer-selected managed care organizations (MCOs), which are an integral part in medically managing injured worker claims.

Managed Care Organization (MCO) Managed Claim
A MCO managed claim is a workers’ compensation claim in which a MCO is responsible for its medical management, determination of reimbursement eligibility, payment of all medical bills, dispute resolution.

Managed Care Organization (MCO) Panel Provider
A MCO panel provider is a BWC-certified provider who has contracted with a MCO to be included in the MCO’s provider network (i.e., a panel).

Managed Care Organization (MCO) Standard Prior Authorization Table
To ensure consistent, quality care for all injured workers, BWC and the MCOs have established standardized prior authorization requirements. These requirements are described in the following MCO Standard Prior Authorization table. It is important to note that these requirements do not apply to self-insuring employer claims; therefore, contact these employers for their authorization guidelines.

Service Requirement
Physical medicine services, including chiropractic/osteopathic manipulative treatment and acupuncture PA
Consultations - Psychological/chronic pain program only PA
Dental PA
Diagnostic Testing PA (except basic X-rays which do not require PA)
DME PA if greater than $250 total cost of service, supply or device, rental or purchase
Home/auto/van modifications PA required from BWC
Home health agency services PA
Hospital inpatient treatment, including surgery and outpatient/ASC surgery PA for surgery from date of injury, if not emergency
Injections PA
Non-emergency ambulance services PA
Orthotic and prosthetic devices and/or repair PA greater than $250
Skilled Nursing Facility/Extended Care Facility PA
Vision services PA
Vocational rehabilitation - All vocational rehabilitation services, including remain at work, in or out of plan.

Note: PA not required for transitional work on-site therapy services provided by an OT or PT that fall under the presumptive authorization guidelines

Note: Occupational Rehabilitation (work hardening) require CARF accreditation
PA

Provider Network
A managed care organization's (MCO's) provider panel or network is a group of BWC-certified providers who have signed an agreement with the MCO. Providers may be on multiple networks or panels.



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