4123-6-04.3 MCO scope of services - MCO medical management and claims management assistance.

 

 

 

The Ohio Bureau of Workers' Compensation (BWC) will hold a public hearing on Wednesday, February 12, 2003, at 10:00 a.m., Training Room G, 3rd Floor, 30 West Spring  Street,  Columbus,  Ohio  43215,  to consider the following:

 

(1)  Amendment of the following rules of the BWC for the purpose as shown below:

 

4123-3-15          Claim procedures subsequent to allowance.

Would allow BWC to rule upon a request for subsequent action in a claim which has not had activity or a request for further action within a period in excess of 13 months  in the following situations: an employee seeks to have BWC/IC grant a new award, modify a previously-granted award, or settle the claim; an employee seeks to have BWC/IC secure the allowance of a disability/condition not previously considered, in which event the matter shall first be considered by the administrator; claimant dies and there is potential entitlement for accrued benefits or payment of medical bills, or the decedent's dependent(s) request  death benefits.

Provides that an MCO shall refer treatment requests to BWC for determination of causal relationship between original injury and current incident precipitating treatment requests when  supported  by medical evidence dated not more than 60 days prior to the request. If the treatment request is unsupported by valid medical evidence, MCO may dismiss the request without prejudice and referral to BWC. If the treatment request is adjudged in a final administrative/judicial determination to be related to the original injury, MCO may rule on the request; if the incident precipitating the treatment the request is adjudged as unrelated to original injury, MCO may dismiss request with prejudice.

4123-6-04.3 MCO scope of services -  MCO  medical  management  and  claims management  assistance.

Allows BWC, upon referral from MCO, to determine the causal relationship between the original injury and the current incident precipitating a medical treatment reimbursement request in a claim which has not had activity or a request for further action within a period in excess of 13 months.

4123-6-04.5        MCO scope of services - bureau claims management.

Allows BWC, upon referral from MCO, to determine the causal relationship between the original injury and the current incident precipitating a medical treatment reimbursement request in a claim which has not had activity or a request for further action within a period in excess of 13 months. Also states BWC will notify all parties and the MCO of its determination and that the employer or employee, or their representative, may appeal BWC's order to the IC, pursuant to section 4123.511 of the Revised Code.

 

The full and complete text of the proposed rules is available at the Register of Ohio (http://www.registerofohio.state.oh.us) and is on file in the office of the Secretary of State (180 East Broad Street, 15th Floor, Columbus, Ohio), the Legislative Service Commission (77 South High Street, 9th Floor, Columbus, Ohio), the office of the Joint Committee on Agency Rule Review (77 South High  Street, Concourse Level, Columbus, Ohio), the Bureau of Workers'  Compensation,  Legal  Operations  (30  West Spring Street, 26th Floor, Columbus, Ohio), the Bureau of Workers' Compensation (30 West Spring Street, Columbus, Ohio, 1st Floor, Hearing Rooms), and all service offices of the Bureau.

 

All interested parties will be given an opportunity to be heard. Any interested party unable to attend the public hearing may submit written comments to the undersigned prior to the public hearing.

 

THE OHIO BUREAU OF WORKERS' COMPENSATION

 

 

 

 

Tom Sico

Director, Legal Operations

Bureau of Workers' Compensation 30 West Spring Street, L-26 Columbus, Ohio 43215-2256

[phone]

 

 

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