Rule 4123-6-55 | Employer participation in the QHP system - bureau's authority to decertify, to refuse to certify or recertify a QHP.
(A) The bureau is authorized to decertify, to refuse to certify or recertify a QHP from participation in the QHP system.
(B) Should the bureau determine that sufficient evidence exists that an employer or QHP has failed to comply with applicable workers' compensation statutes or rules governing QHPs, the bureau will take one of two courses of action:
(1) The bureau will serve written notice to the employer, employee representative and QHP of the facts and issues relating to the bureau's determination that the employer or QHP has failed to comply with applicable workers' compensation statutes or rules governing QHPs. Such notice will set forth a period of time for the employer or QHP to resolve or correct the problem. Failure of the employer or QHP to resolve or correct the problem within the time period will result in the bureau serving notice to the employer and QHP in writing of administrative action that might result in a bureau determination to revoke certification, refusal to certify or recertify, and the employer's and QHP's right to a hearing within thirty days of the notice, if requested by the employer or QHP, pursuant to rule 4123-6-17 of the Administrative Code.
(2) Serve written notice to the employer, employee representative and QHP of administrative action that might result in a bureau determination to revoke certification, refusal to certify or recertify, and the employer's and QHP's right to a hearing within thirty days of the notice, if requested by the employer or QHP, pursuant to rule 4123-6-17 of the Administrative Code.
(3) For the purpose of this rule, "employee representative" does not include the employee's attorney.
(4) The bureau will serve all notices pursuant to this rule in accordance with section 119.05 of the Revised Code.
(C) Upon a final order of the administrator to decertify, refuse to recertify, or revoke or suspend the certification of a QHP, employees and employers cannot receive services from such QHP pursuant to the QHP system.
Last updated April 15, 2024 at 8:32 AM
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