Ohio Admin. Code 4123-6-55 - Employer participation in the QHP system - bureau's authority to decertify, to refuse to certify or recertify a QHP

(A) The bureau is authorized to decertify, to refuse to certify or recertify a QHP from participation in the QHP system.

(B) Should the bureau determine that sufficient evidence exists that an employer or QHP has failed to comply with applicable workers' compensation statutes or rules governing QHPs, the bureau, shall take one of two courses of action:

(1) The bureau shall notify the employer, employee representative and QHP in writing by certified mail of the facts and issues relating to the bureau's determination that the employer or QHP has failed to comply with applicable workers' compensation statutes or rules governing QHPs. Such notice shall set forth a period of time for the employer or QHP to resolve or correct the problem. Failure of the employer or QHP to resolve or correct the problem within the time period shall result in notification from the bureau to the employer and QHP in writing by certified mail of administrative action that might result in a bureau determination to revoke certification, refusal to certify or recertify, and the employer's and QHP's right to a hearing within thirty days of the notice, if requested by the employer or QHP, pursuant to rule 4123-6-17 of the Administrative Code.

(2) Notify the employer, employee representative and QHP in writing by certified mail of administrative action that might result in a bureau determination to revoke certification, refusal to certify or recertify, and the employer's and QHP's right to a hearing within thirty days of the notice, if requested by the employer or QHP, pursuant to rule 4123-6-17 of the Administrative Code.

(3) For the purpose of this rule, "employee representative" does not include the employee's attorney.

(C) Notwithstanding paragraph (B) of this rule, 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 revoke or suspend the certification of a QHP. The order shall be final unless the employer or QHP, within seven days of such order, requests a hearing before the administrator where the employer or QHP shall show cause why the order should not be final. The order of the administrator shall remain in force during the pendency of the show cause hearing.

(D) (C) Upon a final order of the administrator to decertify, refuse to recertify, or revoke or suspend the certification of a QHP, employees and employers shall not receive services from such QHP pursuant to the QHP system.

Notes

Ohio Admin. Code 4123-6-55

Effective: 11/13/2015
Five Year Review (FYR) Dates: 08/26/2015 and 08/25/2020
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4121.442, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441, 4121.442
Prior Effective Dates: 9/5/96, 2/1/10