4123-6-03.9 MCO participation in the HPP - MCO disclosure of relationship.

 

 

 

4123-6-03.9                 MCO    participation    in    the    HPP    -    MCO     disclosure    of relationship.

 

 

 

If

 

(A)If

the managed care organization an MCO is affiliated with another individual,

corporation, or entity, as defined in rule 4123-6-05.1 of the Administrative Code, that has had or contemplates activities of any nature with the Ohio workers' compensation system and such relationship creates or presents either the opportunity for a conflict of interest or the appearance of a conflict of interest for the managed care organization and/or the other individual, corporation, or entity, the managed care organization MCO shall provide to the bureau a description of the resolution of such opportunity for or the appearance of a conflict of interest satisfactory to the bureau.

(B)For purposes of this rule, an individual, corporation, or entity is "affiliated with an MCO" when it:

(1)Owns, is owned by, or is under common ownership with an MCO, directly or indirectly through one or more intermediaries;

(2)Controls, is controlled by, or is under common control with an MCO, directly or indirectly through one or more intermediaries;

(3) Has a contractual or other business arrangement with an MCO;

(4)Has one or more owners, shareholders, partners, members, officers, directors or other persons who exercise operational or managerial control in common with the MCO.

4123-6-03.9                                                                                                                           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:                         2/16/96, 10/26/00, 2/1/10