Ohio Admin. Code 4123-6-03.9 - MCO participation in the HPP - MCO disclosure of relationship
(A) If an MCO is
affiliated with another individual, corporation, or entity that has had or
contemplates activities of any nature with the Ohio workers' compensation
system and such
including but not limited to third party administrators,
medical or vocational rehabilitation providers, professional employer
organizations, and/or transitional work developers:
(1)
To the extent
such relationship creates or presents either the opportunity for a
conflict of interest or preferential treatment or
the appearance of a conflict of interest or
preferential treatment for the managed care organization and/or the other
individual, corporation, or entity, the MCO shall provide to the bureau a
written description of the resolution of such
opportunity for or the appearance of a conflict of interest satisfactory to the
bureau; and shall disclose the potential conflict of
interest and its resolution to the employers and injured workers assigned to
the MCO .
(2)
The MCO and the other affiliated corporation or entity
shall implement complete separation of functions, offices, systems, and staff.
Complete separation of staff shall include, but not be limited to, medical and
vocational rehabilitation case management staff and marketing
staff.
(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.
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441
Prior Effective Dates: 2/16/96, 10/26/00, 2/1/10, 6/9/14
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(A) If an MCO is affiliated with another individual, corporation, or entity that has had or contemplates activities of any nature with the Ohio workers' compensation system and such including but not limited to third party administrators, medical or vocational rehabilitation providers, professional employer organizations, and/or transitional work developers:
(1) To the extent such relationship creates or presents either the opportunity for a conflict of interest or preferential treatment or the appearance of a conflict of interest or preferential treatment for the managed care organization and/or the other individual, corporation, or entity, the MCO shall provide to the bureau a written description of the resolution of such opportunity for or the appearance of a conflict of interest satisfactory to the bureau; and shall disclose the potential conflict of interest and its resolution to the employers and injured workers assigned to the MCO .
(2) The MCO and the other affiliated corporation or entity shall implement complete separation of functions, offices, systems, and staff. Complete separation of staff shall include, but not be limited to, medical and vocational rehabilitation case management staff and marketing staff.
(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 .
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441
Prior Effective Dates: 2/16/96, 10/26/00, 2/1/10, 6/9/14