Posted: August, 2001
Use of State Workers' Compensation Fund to Pay MCOs' Fees
Constitutional
Northwestern Ohio Building
& Const. Trades Council v. Conrad
(7/18/01), 92 Ohio St.3d 282.Issue: Can workers' compensation premiums be used to fund payments to MCOs?
Background: Northwestern Ohio Building and Construction Trades Council, an employer, filed a declaratory judgment suit claiming the payment of fees to MCOs from the state insurance fund violated Oh. Const. Art. II, Sec. 35. Court of Appeals found that the use of the state insurance fund to pay these fees was unconstitutional.
Decision: Supreme Court reverses (4-3).
Court says that the use of premium contributions from the state insurance fund for the payment of administrative and performance incentive fees to MCOs does not violate Article II, Section 35 of the Ohio Constitution. The Supreme Court ruled:
The use of premium contributions from the State Insurance Fund for the payment of administrative and performance incentive fees under Ohio Adm.Code 4123-6-13 to managed care organizations certified by the Bureau of Workers' Compensation under the Health Partnership Program does not violate Section 35, Article II of the Ohio Constitution.R.C. 4121.441 and O.A.C. 4123-6-13 do not specify the source of the administrative and performance payments. Court concludes that the BWC reasonably interpreted the statutory scheme when it decided to use the state insurance fund for these payments.
Court finds the use of these funds is constitutional because the medical management services performed by the MCOs are an integral part of the plan.
This information was provided courtesy
of the Ohio
Workers'
Compensation Bulletin. Click on the case name to
view this decision on
the Supreme Court's web site.