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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.


Corporate Transparency Act to be Re-evaluated

Recent federal rulings have impacted the enforceability of the Corporate Transparency Act (CTA), which took effect on January 1, 2024. While reporting requirements were briefly reinstated, FinCEN has now paused enforcement and is reevaluating the CTA. Businesses are no longer required to submit reports until further guidance is issued. For updates and legal counsel, contact BMD Member Blake Gerney.

Ohio Recovery Housing Operators Beware: House Bill 58 Seeks to Make Major Changes

Ohio House Bill 58 proposes significant changes to recovery housing oversight, granting ADAMH Boards authority to inspect and investigate recovery residences. The bill also introduces a Certificate of Need (CON) program, requiring state approval for major facility changes. OMHAS will assess applications based on cost, quality, accessibility, and financial feasibility. The bill also establishes a recovery housing residence fund to support inspections. For more information, contact BMD attorneys Daphne Kackloudis or Jordan Burdick.

January 2025 Notice of Proposed Rulemaking Brings Notable Changes to HIPAA Security Rule

In January 2025, the U.S. Department of Health and Human Services proposed amendments to the HIPAA Security Rule, aiming to enhance cybersecurity for covered entities (CEs) and business associates (BAs). Key changes include mandatory compliance audits, workforce training, vulnerability scans, and risk assessments. Comments on the proposed rule are due by March 7, 2025.

Corporate Transparency Act Effective Again

The federal judiciary has issued multiple rulings on the enforceability of the Corporate Transparency Act (CTA), which took effect on January 1, 2024. Previously, enforcement was halted nationwide due to litigation in Smith v. U.S. Department of the Treasury. However, on February 18th, the court lifted the stay, reinstating the CTA’s reporting requirements. Non-exempt entities now have until March 21, 2025, to comply. Businesses should act promptly to avoid civil penalties of $591 per day and potential criminal liability.

Status Update: Physician Noncompete Agreements in Ohio

Noncompete agreements remain enforceable in Ohio if they meet specific legal requirements. While the AMA and FTC have challenged these restrictions, courts continue to uphold reasonable noncompete provisions for physicians. Recent cases, like MetroHealth System v. Khandelwal, highlight how courts may modify overly restrictive agreements to balance employer interests with patient care. With ongoing legal challenges to the FTC’s proposed ban, Ohio physicians should consult a healthcare attorney before signing or challenging a noncompete agreement.