OSMA's State Legislative Update
As the summer recess approaches, the Ohio Legislature is bustling with activity. OSMA’s advocacy team has been on-hand to work with elected officials regarding several major topics in the past few weeks, including the following items.
House Bill 270, sponsored by Rep. Susan Manchester (R-Waynesfield) and Rep. Terrence Upchurch (D-Cleveland) had its third hearing in the House Insurance Committee this Wednesday, with testimony presented from several interested parties. OSMA previously testified in support of the bill, which would strengthen Ohio’s prudent layperson standard.
Ohio’s prudent layperson standard law essentially means that if a person with the average amount of medical knowledge believes that they are experiencing a medical emergency, their emergency room visit should be considered a medical emergency. House Bill 270 would require insurers to conduct a comprehensive and robust emergency physician review of a claim before issuing a denial of the claim or a reduction in reimbursement, and also require insurers to inform their enrollees of their emergency services coverage. 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.
House Bill 451, sponsored by Rep. Gayle Manning (R-North Ridgeville) and Rep. Scott Oelslager (R-North Canton), also had a hearing Wednesday, the fourth for this bill in the House Insurance Committee. OSMA is a part of a coalition supporting House Bill 451, which would prohibit a health benefit plan from requiring that physician-administered drugs be dispensed by a pharmacy or affiliated pharmacy as a condition of coverage, limiting coverage when such drugs are not dispensed by a pharmacy or affiliated pharmacy, if the drug is otherwise covered under the health benefit plan or pharmacy benefit plan, or covering such drugs with higher cost-sharing if dispensed in a setting other than a pharmacy.
HB 451 is designed to better ensure safety for patients while promoting better health outcomes and saving patients from higher cost-sharing responsibilities that often come from insurer “white-bagging” mandates.
Midwives Scope of Practice:
House Bill 496 had a proponent hearing Thursday. This bill would license certified midwives in Ohio and regulate their practice. OSMA is opposed to this legislation due to numerous concerns about provisions regarding scope of practice, eligibility criteria, and license requirements. OSMA’s advocacy team has been involved in discussions about this bill, detailing the concerns with the sponsors and other interested parties.
OSMA’s advocacy team has been making the rounds to help educate legislators about the history of the opioid epidemic in Ohio, and the response to it by the Legislature, licensing boards, and other regulators within the past decade. Several recent legislative proposals include provisions that would further limit opioid prescribing and create additional limits or burdens that could be a detriment to physicians and patient care, and OSMA is working to demonstrate that these proposals, while well-intentioned, are neither necessary nor effective. OSMA has worked over the past several years to try to shift the focus of the response to the drug abuse and overdose crisis in the state, promoting reduction of barriers to mental health and substance use disorder treatment (including medication-assisted treatment), utilization of telehealth, and access to harm reduction services.