The administrator of workers' compensation, with the advice and consent of the bureau of workers' compensation board of directors, has authority to approve contributions made to the state insurance fund by employers pursuant to sections 4121.121, 4123.39, and 4123.40 of the Revised Code. The administrator hereby sets rates per one hundred dollar unit of payroll to be effective July 1, 2015, applicable to the payroll reporting period July 1, 2015, through June 30, 2016, for public employer state (PES) agencies, including state universities and university hospitals, as indicated in the appendix to this rule.
For the purpose of the payment of costs to the managed care organizations (MCO) that manage the claims of state agencies, including state universities and university hospitals, the administrator hereby sets an additional contribution to the state insurance fund applicable to the payroll reporting period July 1, 2015, through June 30, 2016, for public employer state agencies, including state universities and university hospitals, as indicated in the appendix to this rule. After the end of fiscal year 2015, the bureau will compare the actual and collected costs to account for any overage or shortage in the costs collected. The bureau will apply any overages or shortages to the costs for the next policy year period. The resulting MCO cost rate will be a rate by agency as indicated in the appendix to this rule.
(A) A PES agency that is not currently participating in a settlement payment program may participate in the lump sum settlement (LSS) direct reimbursement rating and payment program. A PES agency participating in this program will have the LSS payments excluded from the bureau's rate calculation process.
(a) A PES agency shall make a three-year minimum commitment to the LSS direct reimbursement payment and rating program.
(b) The earliest beginning date of the LSS program is July 1, 2004.
(c) A PES agency shall notify the bureau of its desire to participate in the LSS direct reimbursement and payment program before the first day of the second month following any quarter ending date to be effective the following quarter. For example, if the PES agency chose to participate in the LSS program beginning April 1, 2015, the request must be submitted before February 1, 2015. The notification shall be made on the form provided by the bureau and signed by the PES agency's designee.
(d) A PES agency currently participating in a settlement program is not eligible to participate in the LSS direct reimbursement payment and rating program.
(2) LSS rate calculation.
(a) All LSS payments will be treated the same whether the result of a court-ordered settlement, an agency-negotiated settlement or any other type of settlement.
(b) Once a PES agency begins participating in the LSS direct reimbursement and rating program, all LSS payments will be excluded from the losses used to calculate the contribution rate for future policy years.
(c) When an agency terminates a LSS direct reimbursement and rating program, the contribution rate will include all LSS payments that were made by the bureau and not reimbursed by the PES agency.
(3) LSS reimbursement payments.
(a) A LSS will be billed in the next quarter following the date the LSS warrant was cashed. The October billing will include any lump sum settlement where the warrant was cashed in July, August or September; the January billing where the warrant was cashed in October, November or December; the April billing where the warrant was cashed in January, February or March; and the July billing where the warrant was cashed in April, May or June.
(b) The bureau will bill a structured settlement to the PES agency as the warrant is cashed.
(c) The PES agency shall pay the LSS quarterly bill within thirty days of the billing date.
(d) If the PES agency fails to pay a LSS quarterly bill within thirty days, the bureau will remove the PES agency from the LSS direct reimbursement rating and payment program and the bureau will include the outstanding LSS payments in the rate calculation.
(e) A PES agency may settle permanent total disability (PTD) and death benefit claims in which the present value was previously used in rate calculations.
PES agencies will not be billed for the settlement costs of PTD and death benefit claims in which the present value of both medical and indemnity costs was included in contribution rate calculations. These claims would likely be death benefit claims awarded before January 1, 2001 and PTD claims awarded before January 1, 1996.
For PTD claims awarded between January 1, 1996 and December 31, 2000 and where the present value of the future indemnity cost was previously included in the development of the agency's contribution rates, the bureau will include only the medical portion of the settlement amount in the quarterly billings.
(f) A PES agency shall file any dispute in writing, specifying the agency's objections to the billing, with the bureau's direct billing department. The filing of a dispute does not relieve or suspend the agency's obligation to pay the obligation. Questions concerning the rate calculations should be directed to the bureau's actuarial division.
(4) Change in status.
(a) When a PES agency combines with another PES agency, the succeeding agency's participation in this program will not be affected.
(b) A PES agency that is participating in a program and transfers a portion of its operations to another agency shall continue to participate in the program. Participation in this program by the agency to which the operations were transferred will not be affected.
(c) Where a PES agency participating in a LSS direct reimbursement rating and payment program becomes self-insured, the bureau will calculate a buyout and any obligations owed by the PES agency under the program will be included in the buyout.
(5) Terminating a LSS program.
(a) A PES agency may request, in writing, to terminate a LSS program after the three year minimum commitment period has been completed. The agency's participation in the program will automatically be renewed for another three years unless the written request is submitted.
(b) A PES agency shall submit a request to terminate a program before the first day of the second month of the quarter the three year commitment ends. For example, if the PES agency started participating in the LSS program or its participation was renewed for the policy year beginning July 1, 2012, the request must be submitted before May 1, 2015.
(c) Once a PES agency terminates a LSS program, the agency is no longer eligible to participate in this program.
Promulgated Under: 111.15
Statutory Authority: 4121.12, 4121.121
Rule Amplifies: 4121.12, 4123.39, 4123.40
Prior Effective Dates: 7/1/90, 7/1/91, 7/1/92, 7/1/93, 7/1/94, 7/1/95, 7/1/96, 7/1/97, 7/1/98, 7/1/99, 7/1/00, 7/1/01, 7/1/02, 7/1/03, 7/1/04, 7/1/05, 7/1/06, 7/1/07, 1/1/08, 7/1/08, 7/1/09, 7/1/10, 7/1/11, 7/1/12, 7/1/13, 7/1/14