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

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.

Changes to Physician Assistant Statutes in Florida

In the last year, there have been many changes to the scope of practice and collaboration/supervision requirements for advanced practice providers such as APRNs and physician assistants in the state of Florida. In a previous Client Alert we discussed House Bill 607, which expanded the autonomous practice of APRNs providing primary care services in Florida.

Ohio Senate Bill 49 – Ohio Expands Lien Rights for Design Professionals

Effective September 30, 2021, Ohio granted limited lien rights to design professionals, including architects, landscape architects, engineers, and surveyors. Ohio Governor Mike DeWine signed Senate Bill 49 into law on July 1, 2021. This new law established a statutory right to lien commercial real estate by Ohio design professionals who, until now, could not file a lien for non-payment of professional services. Senator Vernon Sykes, a primary sponsor of Senate Bill 49, stated that the “legislation ensures that architects, engineers and other designers will get paid for their work, regardless of the outcome of their projects . . . It will support hardworking Ohioans by protecting the value of their labor . . ..”

Primary Care Practice Officially Defined in Florida for APRNs Practicing Autonomously

As many providers in Florida are aware, House Bill 607 (the “Bill”), which was passed in February of last year, gives certain APRNs in Florida the ability to practice autonomously. The only catch is that they must work in primary practice. When the Bill was initially passed, there was question as to what was exactly considered primary care, absent a definition from the Florida Board of Nursing. However, as of February 25, 2021, “primary care practice” has officially been defined.

Part II of the No Surprises Act

The Department of Health and Human Services (“HHS”) published Part II of the No Surprises Act on September 30, 2021, which will take effect on January 1, 2022. The new guidance, in large part, focuses on the independent dispute resolution process that was briefly mentioned in Part I of the Act. In addition, there is now guidance on good faith estimate requirements, the patient-provider dispute resolution processes, and added external review provisions.

Safer Federal Workforce Task Force - Guidance for Federal Contractors and Subcontractors

The Safer Federal Workforce Task Force has issued its Guidance for Federal Contractors and Subcontractors (Guidance). Note that the Guidance applies only to “covered contracts,” which are contracts that include the clause (Clause) set forth in Sec. 2(a) of Executive Order 14042 (Ensuring Adequate COVID Safety Protocols for Federal Contractors). The Federal Acquisition Regulatory Council (FARC) is to conduct rulemaking and take related action to ensure that the Clause is incorporated into federal contracts. Until that happens, federal contractors likely will not see the Clause in its contracts. Following is a broad summary of the Guidance.