Quarterly Advocacy Update - July 2019

The Ohio Legislature is wrestling to resolve differences that have resulted in an interim budget, while at the same time dealing with several policy issues that will impact patients, doctors and the practice of medicine.

State budget - HB 166. The State’s interim budget expires on July 17th. There are many issues to be worked out between the competing House and Senate versions of the budget. The CMA has joined other physician organizations in the House of Medicine on these issues that are a part of the policy portion of the budget:

(1) Price Transparency- Physician groups are supporting the Senate adopted language rather than the House's approach: provisions that requires a hospital, beginning January 1, 2020, and on the request of a patient or the patient's representative, to provide a patient with a verbal or written cost estimate for scheduled services. Specifies that the requirement does not apply if the patient is insured and the patient's health plan issuer fails to supply the necessary information to the hospital within 48 hours of the hospital's request. Enumerates certain information that must be included in a cost estimate. Requires a health plan issuer to provide to its covered persons estimates of the costs of health care services and procedures to at least the same extent it is required to do so by federal law, and prohibits the Superintendent of Insurance from enforcing this requirement.

(2) Surprise billing- The Senate version replaces the House language with one that prohibits balanced billing for unanticipated out-of-network care and requires an insurer to reimburse an out-of-network provider for unanticipated out-of network care when that care is performed at an in-network hospital. Defines "unanticipated out-of-network care" as health care services covered under a health benefit plan that are provided by an out-of-network provider when (1) the patient did not have the ability to request services from an in-network provider or (2) the services were emergency services.

Prohibits an insurer from requiring cost-sharing from a covered person for such services at a higher rate than the in-network cost sharing rate.

Requires the out-of-network provider to bill the insurer for the unanticipated out-of-network care, and requires the insurer, within 30 days, to either pay the billed amount or attempt to negotiate the reimbursement amount. (1) Specifies that, if the insurer and out-of-network provider fail to agree on a negotiated reimbursement within 60 days, either may initiate binding arbitration if the amount billed exceeds both (a) $700 and (b) 120% of the usual and customary amount for the service in question by filing a request with the Superintendent of Insurance. (2) Prohibits an insurer from denying coverage in relation to a bill after arbitration on the bill has been initiated. (3) Specifies procedures under which arbitration must be conducted, including (a) a requirement that the arbitrator decide within 30 days, (b) limiting the arbitrator's decision to the insurer's reimbursement offer or the provider's billed amount, (c) specifying factors that the arbitrator must consider when making a decision, and (d)making the arbitrator's decision binding on the parties.

*We have put a lot of work into crafting this proposal and see it as a significant improvement to the house passed language. We have modeled the language off of what other states have done, such as New York and Texas and have been working with AMA and other national groups to craft the right proposal.

(3) Telemedicine- Adds back in the original language from the governor's version of the budget that requires coverage for telemedicine services on the same basis and to the same extent as in-person services. Unfortunately, the Senate did add a provision that prohibits charging a facility fee to a telemedicine service. While this is not a common occurrence, we have concerns with adding language that prohibits a potential reimbursement standard on policy that is strictly about coverage, not payment.

There are other issues and legislation outside of the budget bill. Here is a quick update on some of those items:

  • Immunizations: Based on decisions of the Public Policy Committee and feedback from the Loop, the CMA will be continuing its support of vaccination policies that best protect public health on various bills that may be receiving hearings

  • Health Education - HB 165 and Medicaid Support - HB 11:  per the decisions of physicians at the June CMA Public Policy Meeting, we have communicated our support to legislators for HB 165, sponsored by Rep. Liston, to establish health education standards in Ohio and also HB 11, providing Medicaid support for smoking cessation and dental services

  • APRN/CRNA scope of practice bills - for these issues, the CMA continues its support for protecting patients with a policy position of physician lead teams of healthcare provider. Negotiations/discussions and hearings are on-going.

  • A number of gun safety and fireworks issues have surfaced that CMA physicians are involved with from a public health perspective. The CMA will be communicating to the legislature as the issues receive legislative hearings and further attention.

One mention about a federal issue - Federal Disaster Preparedness Planning.  After much discussion and extended delays, Congress has passed, and the President has signed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019. This law provides key funding for disaster preparedness in our region that is coordinated by the Central Ohio Trauma System (COTS), a CMA affiliate organization.

On behalf of Dr. Stephanie Costa and Dr. Bill Cotton, Co-Chairs of the CMA's Public Policy Committee, please do not hesitate to be in touch if you have questions about any of these, or other, issues.

Find out more at columbusmedicalassociation.org/advocacy

AdvocacyMalcolm Porter