The Ohio Senate passed the state budget bill (House Bill 166 (HB166)) on June 20 and the bill will now go to a conference committee, where three members of the House and three members of the Senate will work to try to iron out the differences in the House and Senate versions of the bill prior to Sunday, June 30.
Three provisions that the Ohio Academy of Family Physicians (OAFP) and the House of Medicine have been following closely include:
- Price Transparency – The Senate replaced House language with a provision that requires a hospital, beginning January 1, 2020, and at the request of a patient or the patient’s representative, to provide a patient with a verbal or written cost estimate for scheduled services. The language specifies that the requirement does not apply if the patient is insured and the patient’s health plan issuer fails to supply the necessary information to the hospital within 48 hours of the hospital’s request. In addition, Senate language enumerates certain information that must be included in a cost estimate, requires a health plan issuer to provide to its covered persons estimates of the costs of health care services and procedures to at least the same extent it is required to do so by federal law, and prohibits the Superintendent of Insurance from enforcing this requirement. This language is a significant improvement over the House-passed language.
- Surprise billing – The Senate replaced House language with a provision that prohibits balanced billing for unanticipated out-of-network care and requires an insurer to reimburse an out-of-network provider for unanticipated out-of-network care when that care is performed at an in-network hospital. The Senate language defines “unanticipated out-of-network care” as health care services covered under a health benefit plan that are provided by an out-of-network provider when (1) the patient did not have the ability to request services from an in-network provider or (2) the services were emergency services. The language prohibits an insurer from requiring cost-sharing from a covered person for such services at a higher rate than the in-network cost sharing rate. The Senate language also requires the out-of-network provider to bill the insurer for the unanticipated out-of-network care, and requires the insurer, within 30 days, to either pay the billed amount or attempt to negotiate the reimbursement amount. Relative to negotiation, the bill:
- Specifies that, if the insurer and out-of-network provider fail to agree on a negotiated reimbursement within 60 days, either may initiate binding arbitration if the amount billed exceeds both (a) $700 and (b) 120% of the usual and customary amount for the service in question by filing a request with the Superintendent of Insurance.
- Prohibits an insurer from denying coverage in relation to a bill after arbitration on the bill has been initiated.
- Specifies procedures under which arbitration must be conducted, including (a) a requirement that the arbitrator decide within 30 days, (b) limiting the arbitrator’s decision to the insurer’s reimbursement offer or the provider’s billed amount, (c) specifying factors that the arbitrator must consider when making a decision, and (d) making the arbitrator’s decision binding on the parties.
Senate language is also a significant improvement over the House language (see“OAFP Signs on to Surprise Billing Letter” for additional information).
- Telemedicine – The Senate reinstated the original language from the governor’s version of the budget that requires coverage for telemedicine services on the same basis and to the same extent as in-person services. The Senate did add a provision that prohibits charging a facility fee to a telemedicine service.