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Ohio Laws and Rules
(A) The bureau shall select an MCO for a state fund employer that fails to select an MCO, or is not solicited by an MCO.
(B) An employer with fixed work SITES in more than one county may select different MCOs certified to provide services in the counties where the employer maintains fixed work SITES.
(C) An MCO selected by an employer or employers shall provide a list of enrolled employers to the bureau.
(D) The bureau shall develop a process for verification of employer selection of an MCO.
(E) Selection of an MCO by an employer or selection by the bureau subject to paragraph (A) or (J) of this rule shall be until the next open enrollment period. 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 on behalf of an employer that has not made a selection, the employer shall notify all employees of the selection.
(G) Upon expiration of the employer enrollment period, an employer may:
(1) Select a new MCO pursuant to paragraphs (A) to (F) of this rule; or
(2) Continue with an MCO selected during the prior enrollment process. In such case, the employer is not required to notify the bureau during the enrollment process.
(H) Prior to the expiration of the MCO enrollment period, the bureau shall provide adequate notice to employers in writing of the pending deadline for new MCO selection.
(I) An MCO may not refuse to provide services to an employer once selected by that employer or assigned by the bureau, subject to the provisions of rule 4123-6-033 of the Administrative Code.
(J) If an employer selects more than one MCO in the same county, the bureau shall notify the employer in writing. The employer shall have fourteen days from date of written receipt of notification to select one MCO or an MCO will be assigned by the bureau.
(K) In the event of a decision by the administrator to decertify an MCO or to terminate any agreement or contract between the bureau and the MCO, immediately thereafter the bureau shall initiate an employer-MCO reassignment process. The bureau shall randomly assign those employers formerly assigned to the decertified or terminated MCO to all remaining, eligible MCOs for a period of thirty days. Upon expiration of the thirty day period, the employers affected by the decertification or termination shall have a fourteen day open enrollment period, during which they may select another MCO. In the absence of an employer’s selection of another MCO, the employer shall remain with the MCO to which it was randomly assigned.
(L) In the event of the merger or acquisition of an MCO, immediately thereafter the bureau shall assign those employers formerly assigned to that MCO to the merging or acquiring MCO for a period of thirty days. Upon expiration of the thirty day period, the employers affected by the merger or acquisition shall have a fourteen day open enrollment period, during which they may select another MCO. In the absence of an employer’s selection of another MCO, the employer shall remain with the merging or acquiring MCO.
R.C. 119.032 review dates: 10/27/2004 and 03/01/2009
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.121, 4121.44, 4121.441, 4123.66
Prior Effective Dates: 4/19/96, 1/20/98, 1/1/99, 4/5/99, 7/17/00