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.
Ohio Rev. Code § 1751.72. Policy, contract, or agreement containing a prior authorization requirement: Health Insuring Corporation Law – Ohio
Introduced: Status: Enacted
States that “If a policy, contract, or agreement issued by a health insuring corporation contains a prior authorization requirement, the department of medicaid or its designee, including a medicaid managed care organization, shall…“ follow specifications.
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Ohio Rev. Code § 2305.24. Information furnished to quality assurance or utilization committee to be confidential: Jurisdiction; Limitation of Actions—Utilization Committees – Ohio
Introduced: Status: Enacted
States that “any information, data, reports, or records made available to a quality assurance committee or utilization committee… are confidential and shall be used by the committee and the committee members only in the exercise …
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Ohio Rev. Code § 305.172. Health savings account program: Board of County Commissioners – Generally – Ohio
Introduced: Status: Enacted
States that the board of county commissioners of any county may establish and maintain a health savings account program.
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Ohio Rev. Code § 3901.11. Acquisition of stock of other insurers: Superintendent of Insurance – Ohio
Introduced: Status: Enacted
Any domestic insurer and any foreign or alien insurer authorized to do business in this state may retain, invest in, or acquire the whole or any part of the capital stock of any other insurer, …
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Ohio Rev. Code § 3902.30. Coverage for telemedicine services: Insurance Policies and Contracts – Ohio
Introduced: 2019 Status: Enacted
Provides a health benefit plan shall provide coverage for telemedicine services on the same basis and to the same extent that the plan provides coverage for the provision of in-person health care services.
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Community Hospitals and Wellness Centers v. State of Ohio – Ohio
District Court: Common Pleas Court of Williams County Status: Decided
Ohio’s Healthcare Price Transparency Law, passed in June 2015 (HB 52) by the Ohio Legislature, has been challenged by health care providers arguing that the …
State of Ohio v. OptumRx – Ohio
District Court: Ohio Court of Common Pleas (Franklin County) Status: Pending
On March 15, 2019, Ohio’s attorney general Dave Yost sued OptumRx in Ohio state court, claiming that between 2015 and 2018, the PBM failed to pass …
In the Matter of ProMedica Health System, Inc. – Ohio
District Court: United States of America Before The Federal Trade Commission Status: Decided
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 …
Medical Center at Elizabeth Place v. MedAmerica Health Systems et al. – Ohio
District Court: S.D. Ohio Status: Pending
In 2013, a Dayton physicians’ speciality hospital sued a group of larger hospitals, alleging a boycott conspiracy in violation of Section 1 of the Sherman …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
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