summary
Introduced
11/05/2019
11/05/2019
In Committee
12/09/2020
12/09/2020
Crossed Over
05/20/2020
05/20/2020
Passed
12/22/2020
12/22/2020
Dead
Signed/Enacted/Adopted
04/12/2021
04/12/2021
Introduced Session
133rd General Assembly
Bill Summary
To enact sections 3902.50, 3902.51, 3902.52, 3902.53, and 3902.54 of the Revised Code regarding out-of-network care.
AI Summary
This bill enacts new sections 3902.50 to 3902.54 of the Ohio Revised Code regarding out-of-network healthcare. Key provisions include:
1) Requiring health plan issuers to reimburse out-of-network providers for unanticipated out-of-network care provided at in-network facilities, emergency services provided at out-of-network emergency facilities or by out-of-network ambulances, and related clinical laboratory services. The reimbursement is based on a calculation involving the plan's in-network rates, usual and customary rates, or Medicare rates.
2) Prohibiting out-of-network providers, facilities, and ambulances from balance billing patients for the difference between the reimbursement and their charges in these situations.
3) Establishing an arbitration process for disputes between providers/facilities and health plan issuers over reimbursement amounts, with specific criteria for the arbitrator to consider in rendering a decision.
4) Providing that the new requirements apply to all health benefit plans regardless of their origination, issuance, delivery, renewal, or modification date, starting 9 months after the effective date of the law.
Committee Categories
Budget and Finance, Business and Industry
Sponsors (56)
Adam Holmes (R)*,
Brian Baldridge (R),
Richard Brown (D),
James Butler (R),
Sara Carruthers (R),
Jack Cera (D),
Randi Clites (D),
Hearcel Craig (D),
Jeffrey Crossman (D),
Tony DeVitis (R),
Jay Edwards (R),
John Eklund (R),
Teresa Fedor (D),
Haraz Ghanbari (R),
Timothy Ginter (R),
Doug Green (R),
David Greenspan (R),
Diane Grendell (R),
Bob Hackett (R),
Stephen Hambley (R),
Paula Hicks-Hudson (D),
Brett Hillyer (R),
Jay Hottinger (R),
Catherine Ingram (D),
Don Jones (R),
Laura Lanese (R),
George Lang (R),
Jeff LaRe (R),
Peggy Lehner (R),
David Leland (D),
Mary Lightbody (D),
Beth Liston (D),
Tina Maharath (D),
Gayle Manning (R),
Joe Miller (D),
Jessica Miranda (D),
Michael O'Brien (D),
Thomas Patton (R),
Rick Perales (R),
Tracy Richardson (R),
Phil Robinson (D),
Bill Roemer (R),
John Rogers (D),
Mark Romanchuk (R),
Bill Seitz (R),
Michael Sheehy (D),
J. Todd Smith (R),
Kent Smith (D),
Lisa Sobecki (D),
Dick Stein (R),
Bride Sweeney (D),
Terrence Upchurch (D),
Casey Weinstein (D),
Thomas West (D),
Shane Wilkin (R),
Sandra Williams (D),
Last Action
Senate Insurance and Financial Institutions A., 3rd Hearing, Proponent/Opponent/Interested Party (09:00 12/9/2020 Finance Hearing Room) (on 12/09/2020)
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