Overview
Ohio lawmakers have made strides in healthcare price transparency in recent sessions despite previous setbacks. In 2021, the state eliminated surprise medical bills for HMO and PPO enrollees for emergency services provided by out-of-network professionals, facilities, and ground ambulance service providers, and non-emergency services provided by out-of-network professionals at in-network facilities. Also in 2021, the legislature enacted new law to allow small businesses to annually request employees’ de-identified enrollment and claims information from their health insurance provider—a move intended to strengthen businesses’ bargaining position with insurers.
Additionally, state legislators are considering new price transparency legislation that would require healthcare providers to give patients good-faith cost estimates in most circumstances in the wake of a 6th Circuit decision in 2020 that permanently enjoined the state from enforcing the Healthcare Price Transparency Law (HB 52). The 2015 law, which required providers to provide patients with a “good faith” cost estimate of non-emergency, elective health care services before beginning treatment, was challenged and halted by healthcare providers who argued its requirements are too broad and would delay patient care.
To promote access and healthcare cost savings, the state also requires coverage and cost-sharing parity for certain telehealth services, while lawmakers are considering additional legislation to expand these protections to additional healthcare services. Ohio’s Office of Health Transformation has also redesigned its state health care payment system in recent years to show providers how the cost and quality of their care compares to others in the state. Its system analyzes how much it costs a provider to treat an episode of care and to provide high-quality comprehensive primary care, which in turns helps generate cost savings and improve public health.
On the competition front, Ohio is one the few states that prohibits most-favored nation clauses in contracts between providers and insurers. Ohio’s merger review law requires nonprofit healthcare entities seeking to merge or consolidate to provide notice to the state’s attorney general, who may review and approve the transaction based on limited criteria including whether the parties fulfilled their fiduciary duties and whether the deal is fair or protects charitable assets. More notably, Ohio is the site of the high-profile FTC enforcement case against ProMedica Health System, which was challenged to divest St. Luke’s Hospital post-merger due to competition concerns in the Toledo area. The 6th Circuit ruling in favor of the FTC and Ohio attorney general sets important precedent for future healthcare merger challenges.
See below for an overview of Ohio state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/2/2023 - 12/31/2023 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 102 – Ohio
Introduced: 2019 Status: Inactive / Dead
Medicaid shall cover chiropractic services provided the chiropractor is appropriately licensed and is acting within scope-of-practice. A prior authorization requirement shall not be imposed on services.
HB 111 – Ohio
Introduced: 2017 Status: Enacted
Authorize nurses to compel mental health evaluations: Changes the scope of practice for certain advanced practice registered nurses and physician assistants.
HB 122 – Ohio
Introduced: 2021 Status: Enacted
Regards the provision of telehealth services. To establish and modify requirements regarding the provision of telehealth services.
HB 135 – Ohio
Introduced: 2021 Status: Inactive / Dead
Requires health insuring corporations and sickness and accident insurers to apply amounts paid by or on behalf of covered individuals toward cost-sharing requirements. Exempts situations where a generic version of a brand name drug exists, …
HB 153 – Ohio
Introduced: 2021 Status: Inactive / Dead
Prohibits health insurers from taking certain actions with respect to drugs during a health benefit plan year, including increasing cost-sharing, reducing coverage, and removing drugs from plan formularies.
HB 122 – Ohio
Introduced: 2021 Status: Enacted
Regards the provision of telehealth services. To establish and modify requirements regarding the provision of telehealth services.
HB 52 – Ohio
Introduced: 2015 Status: Enacted
[Enforcement suspended pending legal challenge] Healthcare Price Transparency Law: This law mandates providers to provide patients, before beginning treatment, with a “good faith” estimate of how much non-emergency, elective health care services would cost after …
Ohio Rev. Code § 109.34. Nonprofit health care entity proposing certain transactions to notify attorney general and obtain approval: Attorney General—Nonprofit Health Care Entity Transactions – Ohio
Introduced: Status: Enacted
A nonprofit health care entity proposing to enter into a transaction shall provide notice of the proposed transaction to the attorney general and obtain written approval of the transaction in accordance with this section.
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Ohio Rev. Code § 109.35. Approval or disapproval of proposed transactions: Attorney General—Nonprofit Health Care Entity – Ohio
Introduced: Status: Enacted
Not later than sixty days after receipt of a notice and other documents, the attorney general shall approve or disapprove the proposed transaction, except that the attorney general for good cause may extend this period …
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Ohio Rev. Code § 1345.01, 1345.02, 1345.03, & 1345.04 through 1345.13: Consumer Sales Practices – Ohio
Introduced: Status: Enacted
States that “no supplier shall commit an unconscionable act or practice in connection with a consumer transaction. Such an unconscionable act or practice by a supplier violates this section whether it occurs before, during, or …
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In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Ohio enacts budgets on a two-year cycle, beginning July 1 of each odd-numbered year. The biennial budget will take effect on July 1 and is valid through June 30 of the following odd-numbered year.
KEY RESOURCES
- Ohio Legislature
- Ohio Attorney General
- Ohio Department of Insurance
- Health Policy Institute of Ohio
- Ohio Office of Budget and Management