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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.


Ohio Department of Medicaid Proposes Changes to Dental Reimbursement and Coverage Rule

The Ohio Department of Medicaid is proposing amendments to Ohio Administrative Code. There will be a hearing on the proposed rule changes August 12, 2024.

Will Division II and III Athletic Programs Survive the New Era of College Athletics?

The potential reclassification of student-athletes as employees presents major financial challenges for Division II and III sports programs, which may struggle to afford the costs and could be forced to cut or eliminate non-revenue-generating sports. Recent legal rulings, including the Alston case and Johnson v. NCAA, have challenged the NCAA's amateurism model and prompted a need for innovative solutions to sustain these programs.

Corporate Transparency Act: Business Owners Must Act Now

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New Medicare Billing Rules: What MFTs, MHCs, and IOP Providers Need to Know

Starting January 1, 2024, Medicare began covering services provided to Medicare beneficiaries by marriage and family therapists, mental health counselors, and Intensive Outpatient Program (IOP) services. With this change, Medicare has become the primary payer for these services.

Chevron Doctrine No More: What the Supreme Court’s Ruling Means for Agency Authority

On June 28, 2024, the Supreme Court invalidated the Chevron doctrine, nearly 40 years after it first took effect.