4123-6-03.3 MCO participation in the HPP - MCO participation based on MCO capacity.

An MCO may request the bureau to limit employers from selecting the MCO or to limit the bureau from employer assignment by providing the bureau with written notice that it is at capacity and that it is unable to accept further employer selections or assignments as of the date identified in the notice. The request shall fully detail any and all reasons for the capacity limitation request, based on objective data, and it shall identify the counties where capacity will be limited. However, if the aggregate number of MCOs within a county does not meet bureau determined targets to adequately meet the needs of all employees and employers in that county, the bureau may deny the MCO's request and all MCOs certified in that county may be required to expand their capacity to meet the needs of all employees and employers in that county.

The bureau may declare an MCO ineligible to solicit or accept selection of the MCO by an employer or assignment of an employer to the MCO by the bureau by placing the MCO at capacity. The bureau shall base such determination on the failure by the MCO to meet predetermined performance criteria set forth in the MCO contract..

Effective: 02/01/2010
119.032 review dates: 11/17/2009 and 2/21/15
Promulgated Under: 119.03
Statutory Authority: RC 4121.12 , 4121.121 , 4121.30 , 4121.31 , 4123.05 , 4123.66
Rule Amplifies: RC 4121.121 , 4121.44 , 4121.441 , 4123.66
Prior Effective Dates: 2/16/96, 1/1/99