Ohio

SUMMARY

Ohio has not yet introduced any legislation in the 2018 legislative term 

Ohio has been relatively inactive during the 2017 legislation on healthcare price transparency, cost, or markets. Ohio introduced bills that aimed at lowering prescription drug costs, increasing insurance plan transparency and providing universal healthcare coverage.  However none of these bills had bipartisan support and all failed in committee.

LEGISLATION/REGULATION

Legislative Calendar

Ohio’s current regular legislative session runs from January 2, 2018 until December 31, 2018.

 

Healthcare Transparency

SB 227 Requiring health insurers to release group plan information Authorizes a health plan issuer, beginning in 2019, to release the following to a requesting group policyholder: net claims data paid by month, monthly enrollment, the claims reserve amount, and, for claims over $10,000, the amount paid toward each claim, which claims are unpaid or outstanding, and claimant health condition. Dead. 

 

Healthcare Cost

HB 479 Disclose Drug Price Information To Patients  Seeks to reduce the administrative burden placed on pharmacists by Pharmacy Benefit Managers (PBMs), which act as third-party intermediaries between pharmacies and insurers. By requiring that patients are informed of the most affordable payment option for their prescriptions, PBMs or other administrators will be limited in the amount they may charge a patient. Referred to Committee.
SB 215  Create Ohio Pharmaceutical Assistance Program  Creates a pharmaceutical assistance program under the Ohio Department of Insurance.  The program creates three saving components including the Ohio supreme RX savings, Ohio veterans, and the Ohio bronze RX savings. To receive assistance from the program, the individual must be an Ohio state resident, is at least 65 years of age or disabled, and has an income lower than the state’s poverty line. Dead.

Healthcare Markets

HB 440 Provide Universal Healthcare Coverage to Ohioans  Creates the Ohio healthcare plan, which shall be administered by the Ohio health care agency under the direction of the Ohio health care board. The Ohio health care plan will provide universal and affordable health care coverage for all Ohio residents, consisting of a comprehensive benefit package that includes benefits for prescription drugs. Dead.

Key Statutes 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.

Healthcare Contracting

 

  • 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.

Healthcare Markets

  • 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.

FY 2018-2019 BUDGET Ohio enacts budgets on a two-year cycle, beginning July 1 of each odd-numbered year. Ohio’s new Biennial Budget will take effect on July 1, 2017 and is valid through June 30, 2019. To view Ohio’s FY 2018-2019 Budget, click here.   LITIGATION/ENFORCEMENT

  • 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.

  KEY RESOURCES Ohio Legislature Ohio Attorney General Ohio Department of Insurance Health Policy Institute of Ohio