ISSUE #1: Stroke Response and Treatment System – Support H.B. 427

Sponsors: Representatives Boyd, Gardner
Cosponsors: Representatives Barnes, Lundy, Murray, Garland, Ashford, Ramos, Goyal, Letson, Reece, Yuko, Antonio, Landis, Fende
H.B. 427 replaces the Council on Stroke Prevention and Education with the Stroke System of Care Task Force in the Department of Health. The Task Force will address matters regarding triage, treatment, and transport of patients who may be experiencing acute stroke. The Task Force is charged with making recommendations in consultation with the State Board of Emergency Medical Services, paying particular attention to the rural areas of Ohio. The recommendations must include all of the following:

• Procedures for coordination and communication between hospitals that are recognized primary stroke centers and hospitals that are no recognized primary stroke centers
• A plan for achieving continuous improvement in the quality of care provided under the statewide system for stroke response and treatment;
• Strategies for use of telemedicine services in Ohio for inter-hospital communication between primary stroke centers and non-recognized hospitals. The bill also requires the DOH to establish a statewide system for stroke response and treatment based on the Task Force’s recommendations. At least on an annual basis, the DOH is required to post both the list hospitals recognized as primary stroke centers and the standardized stroke assessment and protocol tool that will be developed by the State Board of Emergency Medical services, the DOH, and primary stroke centers.

ISSUE #2: Prior Authorization or Precertification Requirements – Support S.B. 136

Senators Oelslager, Cafaro

Cosponsors: Senators Seitz, Lehner, Gillmor, Patton, Manning, Tavares, Grendell, Sawyer, Wagoner
S.B. 136 prohibits health insuring corporations and utilization review organizations, as well as third-party payers (i.e. insurance companied, labor organizations, and employers), from denying payment for a service during or after the performance of the service if the health insuring corporation, utilization review organization, or third-party payer had, prior to the performance of the service, agreed, in writing, to provide coverage for the service. An exception to this prohibition is made in the case of the agreement to cover the service being based on fraudulent information provided by the enrollee or the provider. Additionally, the bill revises third-party payer deadlines to account for electronic and non-electronic submission of claims. Third-party payers that require notification, authorization, or certification before a health service can be performed, are required to do all of the following:

• Make current prior authorization or recertification requirements readily accessible on the third-party payer’s website;
• Update the website to reflect changes to prior authorization or precertification requirements at least 60 days prior to the effective date of the change;
• Provide written notice to providers of changes to prior authorization or precertification requirements at least 60 days prior to the effective date of the change; and
• Establish and maintain a web-based system through which beneficiaries and providers may provide that prenotificaiton or obtain necessary prior authorization or precertification.The posted prior authorization or precertification requirements and restrictions must also meet the following:
  • Include written clinical criteria;
  • Be described in detail; and
  • Be described in easily understandable language. The third-party payer must also make statistics that detail the number of approvals and denials of prior authorization or precertification claims readily accessible on the third-party payer’s website in the categories of physician specialty, medication or diagnostic tests and procedures, indication offered in the request, and reason for denial.

ISSUE #3: Enhance Ohio’s Medical Liability Protections/Tort Reform – Support S. B. 129

Senators Bacon, Hite
Cosponsors: Senators Schaffer, Stewart, Obhof, Jordan, Lehner, Gillmor, Widener
S.B. 129 will extend the limited liability protection provided to physicians under Ohio’s Good Samaritan law to physicians providing emergency care and in declared disaster situations.

• Ohio’s emergency departments (ED) are strained, specifically as it applies to getting specialists to cover on-call shifts in the ED. One of the reasons cited for the shortage of on-call coverage is the lack of adequate liability protections for specialists providing care under the federally mandated EMTALA requirement.
• Ohio’s physicians remain vulnerable when providing emergency care in disaster situations. Our state lacks the necessary statutory protections to account for the challenging practice settings and situations physicians are faced with when providing emergency care during disaster situations like tornados, flooding, a terrorist attack or other disasters. The changes proposed by S.B. 129 will help resolve some of the issues related to providing care under the federal EMTALA mandate and in a declared disaster situation.
• Ohio is still lacking necessary statutory protections for those physicians providing emergency care in disaster and EMTALA situations. Several states, including Texas, Florida, Georgia, South Carolina and Oklahoma all have enhanced medical liability standards for physicians providing care in emergency and disaster situations.

ISSUE #4: Solving Ohio’s Tobacco Crisis – Support S.B. 250

Senator Tavares

Tobacco use affects every Ohio taxpayer – whether they smoke or not- every Ohio business, and the State. Tobacco use costs Ohio businesses through increased health care costs and reduced productivity from their employees. Over 40% of Ohio Medicaid recipients smoke. Tobacco-related illnesses cost Ohio’s Medicaid program $1.4 billion annually. Comprehensive tobacco prevention and cessation programs based on CDC best-practices could effectively reduce smoking rates in Ohio. Ohio ranks last in states for funding tobacco prevention and cessation programs. Already we’ve seen the results of this lack of investment—Ohio’s smoking rates are increasing while the rest of the country’s rates are going down. To generate sufficient revenue to sustain these programs, which are proven to reduce smoking rates, Ohio lawmakers can close the loophole that allows non-cigarette forms of tobacco to be taxes at less than half the rate of cigarettes. Correcting the imbalance in the impact fees so that Other Tobacco Product Tax is at 55% of wholesale price – comparable to the cigarette tax – could reduce youth users of these products by 25%. This smart choice would allow Ohio to recoup expenses incurred by the state, such as Medicaid costs for treating tobacco-related illnesses, while using the funds to prevent future expenses. Equalizing the tax rates and funding comprehensive tobacco prevention and cessation programs would reduce tobacco use rates among adults and youth leading to lives and money saved.

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