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CLIENT ALERT: Ohio Managed Care Organization (MCO) Open Enrollment

Client Alert

Open Enrollment started April 30, and will continue through May 25, 2018, for your MCO (Managed Care Organization).  Every State Fund Ohio employer can select their MCO for the coming policy year.  The MCO is responsible for helping to manage Ohio Workers’ Compensation claim costs.  All State Fund employers will begin to receive correspondence urging them to select that particular MCO, or urging them not to make a switch.               

 

Legislation introduced in 1993, which eventually became law after amendments, made managed health care a part of the Ohio Workers’ Compensation system.  That system has evolved over the years, and MCOs now make initial decisions involving most medical management issues in state fund claims.  Their importance cannot be overstated, as the medical management often dictates the path a particular claim will take.  It would be a mistake for any State Fund Ohio employer to simply allow the “default” MCO manage their claims.  Instead, they should examine their MCO (every State Funded employer has one – and if the employer has not selected one, then one is selected for that employer at random), and decide whether they want to switch or keep their MCO.

 

The Ohio BWC provides helpful information for those looking for basic information (which can be found at https://www.bwc.ohio.gov/downloads/brochureware/brochures/MCOGuide.pdf).  Of course, anyone who wants to discuss their overall claims situation is free to contact Richard Williger, and I’d be happy to spend some time looking at their overall Experience.


NLRB Issues Final Rule on Joint-Employer Status

On October 26, 2023, the National Labor Relations Board (NLRB) issued its final rule on determining joint-employer status, departing from its prior 2020 standard. The final rule provides that two or more entities may be considered “joint employers” if each entity has an employment relationship with employees and if the entities share or codetermine one or more employees’ essential terms and conditions of employment. The final rule goes into effect on December 26, 2023, and will only be applied to cases filed after the effective date.

WEBINAR SERIES RECAP | Employment & Labor

BMD Partner and Co-Chair of the Employment & Labor Law Group, Bryan Meek, presented this four-part webinar series on trending topics in employment law.

Ohio Legalizes Recreational Marijuana; What’s Next for Ohio Employers?

Recent Changes to the No Surprises Act’s Federal IDR Process

Proposed changes to the No Surprises Act’s independent dispute resolution (IDR) process were recently issued by the Department of Health and Human Services, Department of Labor, Department of Treasury, and the Office of Personnel Management. The October 27, 2023, proposed rule overhauls the current Federal IDR process in an effort to create efficiencies and reduce delays relating to eligibility determinations and address feedback from interested parties and certified IDR entities.

What Inpatient Behavioral Health Providers Need to Know About ODM's New Draft Rule for Reimbursements

Ohio Department of Medicaid (ODM) recently released a draft rule that will transform how inpatient behavioral health services are reimbursed for some hospitals. ODM will migrate inpatient payments for behavioral health and substance use disorder services (BH/SUD) provided by freestanding psychiatric hospitals (FSPs) from the APR-DRG payment methodology to a per diem payment methodology derived from the APR-DRG system.