Ohio has been inactive this term with legislation on healthcare price transparency, cost, or markets. Under a grant from the federal Centers for Medicare and Medicaid Services, the Governor’s Office of Health Transformation has submitted a state innovation plan that seeks to reform healthcare payment models by encouraging payment for value.
Ohio’s current regular legislative session runs from 1/2/2017 – 12/31/2017.
Recent Legislative Developments
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We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.
Transparency in Healthcare
- Ohio Rev. Code Ann. § 3727.33 through 40 requires hospitals to periodically submit information on certain inpatient and outpatient service measures and performance indicators regardless of who pays for the services. The information submitted pursuant to these sections is made available to the public on the internet by the Director of Health, with the stipulation that the information be presented in such a way so as to enable the public to compare the performance of hospitals.
- Ohio Rev. Code Ann. § 3727.42 requires that every hospital compile and make publically available (both in paper and online at no cost) a current price information list containing the usual and customary charges for the specified services, including the following: room and board, nursing care rates, the thirty most common radiological procedures, the thirty most common laboratory procedures, emergency room service rates, and operating room service rates, among others.
- Ohio Rev. Code Ann. § 4729.361 requires retail sellers of dangerous drugs to disclose price information regarding that drug verbally to all persons on the premises and by telephone to all persons maintaining a valid prescription.
- Ohio Rev. Code Ann. § 3963.03 specifies the required form of contracts between a health care provider and an insurer.
- Ohio Rev. Code Ann. § 3963.11 prohibits most-favored nation (MFN) clauses in a contract between a health insurance carrier and a health care provider. A most-favored nation clause is a type of contractual provision that requires that the provider give the health carrier a rate equal to or lower than the most favorable rate between the provider and any other health insurance carrier. A most-favored nation clause in a healthcare contract can prevent smaller insurance carriers with less market power from competing on price.
- Ohio Rev. Code Ann. 3702.11 et seq. prohibits health care providers from developing, relocating, or adding additional beds to a long-term care facility, except in specified circumstances, without the prior approval of the Department of Health through the state’s Certificate of Need process. A Certificate of Need regime aims to reduce healthcare overheard by reducing unnecessary or duplicative services, but can be anticompetitive by increasing regulatory barriers for new entrants.
- Ohio Rev. Code Ann. §§ 3923.02, 3923.021 requires that an insurer issuing a group or individual benefits plan obtain prior approval for forms and premium rates. Premium rates may be disapproved if the benefits provided are unreasonable in relation to the premium charged.
- Ohio Rev. Code Ann. § 3924.04 provides that subject to certain exceptions and variations, premium rates offered by a carrier “for a rating period for the same or similar coverage under a health benefit plan covering any small employer with similar case characteristics shall not vary from the applicable midpoint rate by more than forty percent.”
- Ohio Rev. Code Ann. § 3924.21 penalizes hospitals for charging more than the usual and customary charge by requiring them to refund to the beneficiary 15% of the overcharged amount if the beneficiary notifies the third-party payer of such overcharge 30 days after the making of a payment and the hospital is not able to show documentation that they were already in the process of correcting that error.
- On April 22, 2014, the Sixth Circuit affirmed the FTC administrative order requiring ProMedica Health System of Toledo, OH, to divest acquired hospital St. Luke’s. The FTC originally challenged the August 2010 merger in January 2011 on the basis that the transaction would adversely affect competition, in violation of the Clayton Act. ProMedica has stated that it will appeal the case to the U.S. Supreme Court.