Ohio Admin. Code 4123-6-05.2 - Employer access to the HPP - employer enrollment and selection of MCO
(A) An employer may
select any bureau certified MCO that has contracted with the bureau, and has
not been placed at capacity pursuant to the MCO contract, during an open
enrollment period as provided in this rule. The bureau shall develop a process
for verifying an employer's MCO selection.
(B) The bureau shall select an MCO for a
state fund employer that fails to select an MCO, as necessary.
(C) If an MCO merges into or is acquired by
another MCO, the bureau shall assign the employers formerly assigned to that
MCO to the surviving MCO.
(D) If
the administrator decertifies an MCO or terminates any agreement or contract
between the bureau and an MCO, the bureau shall randomly assign the employers
formerly assigned to the decertified or terminated MCO to all remaining,
eligible MCOs.
(E) Selection of an
MCO by an employer or selection by the bureau shall be until the next open
enrollment period. At the bureau's discretion or upon the employer's request,
the bureau may reassign an employer from the MCO if the bureau determines that
the reassignment is in the best interest of both the employer and the
MCO.
(F) Once the MCO has been
selected by either the employer or the bureau, the employer shall notify all
employees of the selection.
(G) The
bureau shall establish an open enrollment period during which time an employer
may change its selection of an MCO at least once every two years, but no more
than once in a year. The administrator may waive the
open enrollment period during a state of emergency or disaster declared by the
governor of Ohio or the president of the United States. During an open
enrollment period, an employer may:
(1)
Select a new MCO; or
(2) Continue
with the employer's current MCO. In such case, the employer is not required to
notify the bureau during the open enrollment period.
(H) The bureau shall maintain and make
available to employers electronically the list of all MCOs contracting with the
bureau, and shall provide adequate notice to employers in writing of the
deadline for new MCO selection.
(I)
An MCO may not refuse to accept an employer that has selected it or has been
assigned to it by the bureau, unless the MCO has placed itself at capacity
pursuant to the MCO contract.
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: 04/19/1996, 01/20/1998, 01/01/1999, 04/05/1999, 07/17/2000, 10/16/2008, 02/01/2010, 06/09/2014
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) An employer may select any bureau certified MCO that has contracted with the bureau, and has not been placed at capacity pursuant to the MCO contract, during an open enrollment period as provided in this rule. The bureau shall develop a process for verifying an employer's MCO selection.
(B) The bureau shall select an MCO for a state fund employer that fails to select an MCO , as necessary.
(C) If an MCO merges into or is acquired by another MCO , the bureau shall assign the employers formerly assigned to that MCO to the surviving MCO .
(D) If the administrator decertifies an MCO or terminates any agreement or contract between the bureau and an MCO , the bureau shall randomly assign the employers formerly assigned to the decertified or terminated MCO to all remaining, eligible MCOs.
(E) Selection of an MCO by an employer or selection by the bureau shall be until the next open enrollment period. At the bureau's discretion or upon the employer's request, the bureau may reassign an employer from the MCO if the bureau determines that the reassignment is in the best interest of both the employer and the MCO .
(F) Once the MCO has been selected by either the employer or the bureau, the employer shall notify all employees of the selection.
(G) The bureau shall establish an open enrollment period during which time an employer may change its selection of an MCO at least once every two years, but no more than once in a year. The administrator may waive the open enrollment period during a state of emergency or disaster declared by the governor of Ohio or the president of the United States. During an open enrollment period, an employer may:
(1) Select a new MCO ; or
(2) Continue with the employer's current MCO . In such case, the employer is not required to notify the bureau during the open enrollment period.
(H) The bureau shall maintain and make available to employers electronically the list of all MCOs contracting with the bureau, and shall provide adequate notice to employers in writing of the deadline for new MCO selection.
(I) An MCO may not refuse to accept an employer that has selected it or has been assigned to it by the bureau, unless the MCO has placed itself at capacity pursuant to the MCO contract.
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: 04/19/1996, 01/20/1998, 01/01/1999, 04/05/1999, 07/17/2000, 10/16/2008, 02/01/2010, 06/09/2014