09/20/2023

Ohio Legislature Returns for the Fall: What’s on OSMA’s Agenda?

The Ohio Legislature is back from its summer recess, but now that elected officials are back in town, what can we expect for fall 2023’s legislative sessions? OSMA has been working on some of our priority issues over the summer months in order to prepare. Along with monitoring dozens of pieces of legislation so far this year, there are several items we will be focusing our advocacy efforts on heading into late September, October, and beyond.

House Bill 130: Prior Authorization Gold Card

HB 130 was introduced in the Ohio House in March 2023 by Rep. Kevin Miller (R-Newark). The bill, if enacted, would create an exemption system that rewards Ohio healthcare providers who consistently receive a prior authorization approval rate of 80% or more for a specific service, device, or drug in the prior 12-month period. These providers would receive a “gold card” exempting them from the burden of prior authorization for that specific service, device, or drug.

On June 7, the House Insurance Committee held a proponent hearing for HB 130, and OSMA VP of Advocacy, Monica Hueckel, gave testimony in support, detailing the hassles of prior authorization and concerns about how prior authorization is currently broadly applied. 27 total testimonies were submitted, illustrating the negative impact prior authorization has upon the ability of providers across the state to provide efficient, high quality, day-to-day care to patients.

OSMA is spearheading a coalition in support of this legislation alongside dozens of groups which include numerous other health care organizations, as well as patient advocacy groups. Continuing to support HB 130 will be among OSMA’s top fall advocacy priorities. For more information, please visit: www.osma.org/insurance-reform. 
 

Additional Insurance Reform Initiative:

OSMA is also preparing to take legislative action regarding other insurance-related issues such as automatic downcoding of claims and retroactive takebacks.

We have collected a lot of feedback and information from members about how these issues are causing administrative burden on practices, and hope to create meaningful changes in the legislative space that will alleviate these difficulties for Ohio physicians. We hope to get legislation introduced prior to the end of the year.
 

Scope of Practice:

OSMA continues to monitor legislation for proposed expansions to the scope of practice of certain allied practitioners. We urge legislators to support the physician-led team-based care model, to help ensure safety and positive health outcomes for those seeking care.

Tanning Ban for Minors:

For numerous years, OSMA has been working closely with the Ohio Dermatological Association (ODA) on an effort to support prohibiting the use of indoor tanning services for individuals under the age of 18 in Ohio. We are advocating for this legislation again this year (SB 59 and HB 169), and hope to make this general assembly the one in which we will finally pass it into state law.

Senate Bill 59 was introduced in February and referred to the Senate Health Committee. It is sponsored by Senator and physician Terry Johnson, DO (R-McDermott) has had four hearings since its introduction. In March, Dr. Shannon Trotter testified in support of SB 59 on behalf of OSMA and ODA.

Its companion bill, House Bill 169, was introduced in May and referred to the House Health Provider Services Committee. It has had two hearings since, and Dr. Trotter also testified in support of this legislation, at its proponent hearing in June. HB 169 is sponsored by Rep. Brett Hillyer (R-Uhrichsville), and not only contains the same protections as SB 59, but additional provisions which require that the term “dermatologist” be used only to refer to a physician with an MD or DO. We will encourage that this language be included in SB 59 as well.

Prudent Layperson:

This week, OSMA President Dr. Eric Drobny testified before the House Insurance Committee on behalf of OSMA and the Ohio Chapter of the American College of Emergency Physicians in support of House Bill 99, which would strengthen Ohio’s prudent layperson standard. The goal of this bill is to protect Ohioans from unexpected medical bills due to their insurer denying claims for emergency care after the care has been sought and provided. We believe it is critical that patients not delay seeking emergency care out of fear that their insurers will not cover their visit.

HB 99 was introduced in March by Rep. Susan Manchester (R-Waynesfield) and has had several hearings since its introduction. This legislation would not prohibit insurers from ever denying a claim, but it would ensure that the claim could not be denied merely on the basis of the final diagnosis, and require insurers to take all other relevant medical information into account, including the symptoms the patient presented with at the time of seeking emergency care.

Gender-Affirming Care:

This fall, OSMA will continue to oppose House Bill 68, which would prohibit medical professionals in Ohio from providing gender-affirming care to minors. This legislation was introduced in February by Rep. Gary Click (R-Vickery), and had several hearings in the House Public Health Policy Committee before passing out of the Ohio House in June.

OSMA policy supports individualized, gender-affirming, evidence-based treatment and clinical practices in caring for transgender and gender minority patients. It also opposes efforts to ban administration of evidence-based care to patients when determined to be clinically indicated by their physician, including the administration of evidence-based gender-affirming care.

We have previously testified against the bill, concerned about it being detrimental to the physician-patient relationship, criminalizing necessary medical care, and creating a hostile environment for young people and their families—as well as for the healthcare professionals from whom they seek guidance and care. OSMA’s advocacy team will continue to monitor this legislation’s activity in the Ohio Senate and will voice these concerns to legislators when necessary. 

Co-pay Accumulator:

OSMA is supporting House Bill 177, which was introduced in May by Rep. Susan Manchester (R-Waynesfield), and is awaiting hearings in the House Public Health Policy Committee. Health plans and pharmacy benefit managers (PBMs) may apply co-pay accumulator adjustment policies when patients attempt to use copay assistance programs. These prohibit a patient’s copay assistance amount from count toward their deductible and maximum out-of-pocket cap. HB 177 would require insurers and PBMs to count all payments made by patients directly or on their behalf toward their deductibles and out-of-pocket cost.

This legislation had a sponsor hearing this week, and in advance of this hearing, OSMA signed on to a letter of support along with several other groups. We will continue to advocate in support of HB 177 moving forward in the legislative process.

Stay tuned for continuous updates from OSMA’s Advocacy team as new issues and developments arise in the coming weeks.