Ohio House Approves HB 125 with many amendments

The Ohio House of Representatives passed, by a vote of 91-5, House Bill 125 - the Healthcare Simplification Act, which was supported by the Academy of Medicine of Cleveland & Northern Ohio. The AMCNO lobbyists attended the interested party hearings on this legislation – a bill that was designed to provide remedies for many of the excessive administrative demands faced by doctors in their interactions with health plans. The intent of the bill was to implement reforms that would provide for ease in the health insurance contracting process, fairness in contracting, a standardized credentialing process and web-based eligibility verification. However, after many hearings and interested party meetings, the bill has been changed radically since it was first introduced.

Several amendments added to the legislation by insurers now provide for additional flexibility for insurers regarding the way in which providers access the web-based eligibility system and insurers may also continue to use existing codes based on Social Security numbers or birth dates to avoid the cost of creating a new method. Other amendments dealt with health insurance industry concerns over definitions, the contract amendment process, the credentialing time line, applicability of the bill to programs of the Department of Job and Family Services and physician groups, summary disclosure forms, and other issues. The language concerning insurance company usage of a most favored nation clause in insurance contacts was changed to allow for a moratorium in contracts on this type of clause for two years and called for the formation of a joint legislative committee to review this topic in the future.

There had been discussions about including a definition of medical necessity in the legislation but this was not accepted. The AMCNO has been in contact with the bill’s sponsor regarding the possibility of including a medical necessity definition in the legislation as well as asking for consideration of adding language that would provide physicians with the ability to jointly negotiate with insurance companies. The AMCNO will continue to monitor this legislation as it moves through the Ohio Senate.