4123-6-03.6 MCO participation in the HPP - administrator's authority to terminate MCO contracts.

The administrator may terminate any MCO contract with the bureau if the administrator determines that it is in the best interest of the workers' compensation system to do so. The grounds for termination include, but are not limited to, the following:

(A) The MCO is insolvent.

(B) Any act of fraud or misrepresentation by an MCO of the amount or cost of services or supplies rendered or provided to any injured worker.

(C) Any act of fraud or misrepresentation by an MCO in reporting or submitting data to the bureau, including data that affects the bureau's calculation or determination of payment to the MCO.

(D) The MCO implements an unapproved change in its organizational structure or a material change in its operations.

(E) Decertification of the MCO.

(F) Failure of the MCO to comply with the workers' compensation statutes or rules governing MCOs.

(G) Substantial failure to perform on the part of the MCO in accordance with the terms and conditions of any contract or agreement between the MCO and the bureau.

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 , 4121.44 , 4121.441 , 4123.05 , 4123.66
Rule Amplifies: RC 4121.121 , 4121.44 , 4121.441 , 4123.66
Prior Effective Dates: 2/16/96, 1/1/99, 2/14/05