(A) The bureau is authorized to revoke certification, to refuse to certify or recertify an MCO from participation in the HPP.
(B) Should the bureau determine that sufficient evidence exists that an MCO has failed to comply with applicable workers' compensation statutes, rules governing MCOs, or a provision of a contract between the bureau and the MCO, the bureau, shall take one of two courses of action:
(1) The bureau shall notify the MCO in writing by certified mail of the facts and issues relating to the bureau's determination that the MCO has failed to comply with applicable workers' compensation statutes, rules governing MCOs, or a provision of a contract between the bureau and MCO, and set a period of time for the MCO to resolve or correct the problem. Failure of the MCO to resolve or correct the problem within the time period shall result in notification from the bureau to the MCO in writing by certified mail of administrative action that might result in a bureau determination to revoke certification, refusal to certify or recertify, and the MCO's right to a hearing within thirty days of the notice, if requested by the MCO, pursuant to rule 4123-6-17 of the Administrative Code.
(2) Notify the MCO in writing by certified mail of administrative action that might result in a bureau determination to revoke certification, refusal to certify or recertify, and the MCO's right to a hearing within thirty days of the notice, if requested by the MCO, pursuant to rule 4123-6-17 of the Administrative Code.
(C) Notwithstanding paragraph (B) of this rule, in any case where the administrator finds a serious danger to the public health and safety and sets forth specific reasons for such findings, the administrator may immediately revoke or suspend, or provisionally revoke or suspend, the certification of an MCO. The order shall be final unless the MCO, within seven days of such order, requests a hearing before the administrator where the MCO shall show cause why the order should not be final. The order of the administrator shall remain in force during the pendency of the show cause hearing.
(D) Upon a final order of the administrator to revoke certification of, refuse to recertify or suspend an MCO, employees and employers shall not receive services from such MCO pursuant to the HPP.
(E) Upon a final order of the administrator to revoke certification of or refuse to recertify an MCO, any obligation of a provider to provide services under the HPP pursuant to a contract or agreement with such MCO shall be null and void.
(F) Immediately after a final order of the administrator to revoke certification, or to refuse to recertify an MCO, the bureau may initiate an employer-MCO reassignment process. After initiation of the reassignment process, the employer affected by the decertification or refusal to recertify shall have thirty days to select another certified MCO. In the absence of an employer's selection of another MCO, the bureau is authorized to select and reassign another MCO to the employer.
Effective date: Feb. 16, 1996