Resources

Client Alerts, News Articles, Blog Posts, & Multimedia

Everything you need to know about BMD and the industry.

Ohio House Passes Bill 388 Including Out-of-Network Reimbursement Requirements

Client Alert
July 6, 2020

On May 20, 2020, the Ohio House of Representatives unanimously passed House Bill 388, which would enact five new Ohio Revised Code sections regarding out-of-network care and reimbursement. Sponsored by Representative Adam Holes – District 97 – House Bill 388 would require a health plan issuer to reimburse the following: 

  • An out-of-network provider for unanticipated out-of-network care provided at an in-network facility. 
  • An out-of-network provider or emergency facility for emergency services provided at an out-of-network emergency facility. 
  • An out-of-network ambulance for emergency services provided in an out-of-network ambulance. 
  • An out-of-network provider or facility for clinical laboratory services provided in connection with unanticipated out-of-network care or emergency services. 

As used above, "unanticipated out-of-network care" means health care services, including clinical laboratory services, that are covered under a health benefit plan and that are provided by an out-of-network provider when either of the following conditions applies: (1) the covered person did not have the ability to request such services from an in-network provider; or (2) the services provided were emergency services.

In addition to the above requirements, House Bill 388 also sets forth the following: 

  • Prohibits a provider, facility, emergency facility, or ambulance from balance billing a patient for unanticipated or emergency care when that care is provided in Ohio. 
  • Provides that a covered person’s cost-sharing responsibility for the services described above cannot be greater than if the services were provided in network. 
  • Establishes the default reimbursement rate as the greatest of the in-network rate, the out-of-network rate, or the Medicare rate and establishes procedures by which payees (providers, facilities, emergency facilities, and ambulances) may seek to negotiate the reimbursement in lieu of the default reimbursement rate. 
  • Permits certain payees to seek arbitration if negotiation is unsuccessful, and establishes criteria to be eligible for arbitration, and establishes procedures for the conduct of the arbitration. (Requires the Superintendent of Insurance to select an arbitration entity to conduct arbitrations under the bill using specified criteria). 
  • Requires a provider to disclose certain information to patients regarding the cost of out-of-network services that are not unanticipated out-of-network care or emergency services. 

The requirements found in House Bill 388 would be effective nine months following the bill’s effective date. Any payee or issuer in violation of these requirements would face disciplinary actions and/or penalties. The bill now continues the rule making path and will be debated and voted on by the Ohio Senate.

Please contact a BMD healthcare attorney if you have any questions regarding House Bill 388, any other reimbursement question, or other general healthcare questions.

Ohio House of RepresentativesHouse Bill 388out of networkout of network careout of network reimbursementprovidershealthcare providershealthcarephysiciansBMD Healthcare & Hospital Law GroupKevin Cripe
Client Alert

Interim Final Rule for Surprise Billing

July 12, 2021In an effort to implement the new bipartisan No Surprises Act, on July 1, 2021, the Department of Health and Human Services (HHS), along with the Departments of Labor and Treasury, issued an interim final rule to safeguard patients against unforeseen medical bills arising from out-of-network care.Client Alert

President Biden Seeks to Limit Non-Compete Agreements

July 8, 2021Today, President Biden announced he would issue an Executive Order that calls on the Federal Trade Commission (FTC) to adopt rules to curtail worker non-compete agreements. Interestingly, a week ago, the FTC approved changes to its Rules of Practice to modernize and expedite the way it issues Trade Regulation Rules. If you have followed our alerts, we predicted the elimination of non-competes would probably happen. In 2016, then-Vice President Biden was a vocal opponent against non-compete agreements. He led the Obama administration’s initiative seeking to limit or eliminate non-compete agreements. In his presidential campaign, Biden promised to “work with Congress to eliminate all non-compete agreements, except the very few that are absolutely necessary to protect a narrowly defined category of trade secrets . . ..”Client Alert

New NIL Opportunities for Student-Athletes Require Diligent Review

July 8, 2021On June 28, 2021, Governor Mike DeWine signed Executive Order 2021-10D, “Establishing the Duties of Colleges and Universities as to Name, Image, and Likeness Compensation of Student-Athletes.” The Executive Order was motivated by the passage of similar name, image, and likeness (“NIL”) regulations in seventeen (17) other states; Ohio followed suit to avoid a significant competitive disadvantage in attracting student-athletes to the state.Client Alert

Tax Savings Potentially on the Chopping Block under President Biden’s American Jobs Plan and American Families Plan

June 18, 2021Recently, President Biden has proposed several tax law changes in his American Jobs Plan and American Families Plan. Outlined below, are a few of the tax savings that could be significantly changed or eliminated under Biden’s plans.Client Alert

Here are the Final Candidates for Mayor of Cleveland

June 17, 2021Earlier this year, current Cleveland Mayor, Frank Jackson, announced he would not run for re-election this fall. With no need to beat an incumbent, the Cleveland mayoral race suddenly became competitive. Thirteen individuals declared their intent to run for mayor. The City of Cleveland, however, has a difficult qualification requirement to run: 3,000 valid signatures from Cleveland residents. The deadline to file a petition to run, with the 3,000 valid signatures, had to be submitted by June 16 (yesterday).
Older posts
Newer posts