Ohio Administrative Code
Title 4123 - Bureau of Workers' Compensation
Chapter 4123-6 - Health Partnership Program
Section 4123-6-03.9 - MCO participation in the HPP - MCO disclosure of relationship
Universal Citation: OH Admin Code 4123-6-03.9
Current through all regulations passed and filed through September 16, 2024
(A) If an MCO is affiliated with another individual, corporation, or entity that has had or contemplates activities of any nature with the Ohio workers' compensation system including but not limited to third party administrators, medical or vocational rehabilitation providers, professional employer organizations, and/or transitional work developers:
(1)
To the extent
such relationship creates or presents either the opportunity for a
conflict of interest or preferential treatment or
the appearance of a conflict of interest or
preferential treatment for the managed care organization and/or the other
individual, corporation, or entity, the MCO shall provide to the bureau a
written description of the resolution of such
opportunity for or the appearance of a conflict of interest satisfactory to the
bureau; and shall disclose the potential conflict of
interest and its resolution to the employers and injured workers assigned to
the MCO.
(2)
The MCO and the other affiliated corporation or entity
shall implement complete separation of functions, offices, systems, and staff.
Complete separation of staff shall include, but not be limited to, medical and
vocational rehabilitation case management staff and marketing
staff.
(B) For purposes of this rule, an individual, corporation, or entity is "affiliated with an MCO" when it:
(1) Owns, is owned by,
or is under common ownership with an MCO, directly or indirectly through one or
more intermediaries;
(2) Controls,
is controlled by, or is under common control with an MCO, directly or
indirectly through one or more intermediaries;
(3) Has a contractual or other business
arrangement with an MCO;
(4) Has
one or more owners, shareholders, partners, members, officers, directors or
other persons who exercise operational or managerial control in common with the
MCO.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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