4123-6-03.7 MCO participation in the HPP - bureau's authority to decertify, to refuse to certify or recertify an MCO.

 

 

 

4123-6-03.7                 MCO  participation  in  the  HPP  -  bureau's  authority  to decertify, to refuse to certify or recertify an MCO.

 

 

 

(A)   Should the administrator determine that sufficient evidence exists that an MCO has failed to comply with applicable workers' compensation statutes, rules governing MCOs, maintain any of the requirements set forth in division (F) of section 4121.44 of the Revised Code, or a provision to reasonably comply with or to perform in accordance with the terms of a contract between the bureau and the MCO entered into pursuant to division (B)(4) of section 4121.44 of the Revised Code, or for any other reason as set forth in rule 4123-6-03.6 of the Administrative Code has violated a rule adopted under section 4121.441 of the Revised Code, the administrator has the authority to decertify, or refuse to certify or recertify an MCO, in accordance with rule 4123-6-17 of the Administrative Code and Chapter 119. of the Revised Code.

 

(B)   In any case where the administrator finds a serious danger to the public health and safety and sets forth specific reasons for such findings, the administrator may immediately decertify an MCO.

 

(C)   Upon a final order of the administrator to decertify, or refuse to recertify an MCO, employees and employers shall not receive services from such MCO pursuant to the HPP.

 

(D)   Upon a final order of the administrator to decertify or refuse to recertify an MCO, any obligation of a provider to provide services under the HPP pursuant to a contract or agreement with such MCO shall be null and void.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4123-6-03.7                                                                                                                           2

Effective:                                                     06/09/2014

R.C. 119.032 review dates:                         02/01/2015

CERTIFIED ELECTRONICALLY

Certification

05/29/2014

Date

Promulgated Under:                           119.03

Statutory Authority:                           4121.12, 4121.121, 4121.30, 4121.31, 4123.05

Rule Amplifies:                                  4121.121, 4121.44, 4121.441, 4123.66

Prior Effective Dates:                         2/16/95, 1/1/99, 2/1/10