Ohio-ACC members participated in the Ohio-ACC Legislative Day on Tuesday, May 10, 2011. We discussed the following:

ISSUE #1: Health Insurance Modernization Act - Support S.B. 136

Policies that require physicians to ask permission from a patient’s insurance company before performing a treatment - known as “prior authorization” (PA) - are becoming more widespread and are unfortunately having a negative impact on patient care.

S.B. 136 will require all insurer PA programs to:

• Ensure that PA requirements or restrictions are listed on the health insurer’s Web site;
• Allow providers and patients to obtain PA authorizations through a web-based system;
• Ensure that a new or future PA requirement is disclosed at least 60 days prior to the new requirement being implemented;
• Guarantee that once a PA has been approved, the insurer will not retroactively deny coverage for the approved service;
• Disclose on their Web sites statistics regarding PA approvals and denials.

Timely Payment

This  legislation updates Ohio’s “prompt pay” law by requiring insurers and third party payers to process and pay claims in 15 days.

Health Insurer Retrospective Audits

In a retrospective audit, insurance companies and HMOs review claims paid to a physician practice over a set period of time to determine whether there has been an overpayment of claims.  A recoupment or “take-back” results when an insurer, based on the findings of the retrospective audit, demands that a physician practice return money on the grounds that an overpayment has occurred.  Most take-backs are a result of insurance eligibility disputes.  In other words, at the time the medical service was provided, did the patient in fact have coverage by the XYZ insurance company? Incredibly, even if a physician verifies eligibility with the patient’s insurer, the physician can later be asked to return payment because the eligibility information provided by the insurer was inaccurate.  And these take-backs can occur up to 2 years after the payment was received.Again, with the advances in health information technology and electronic claims processing, the draft legislation will update Ohio’s retrospective audit law to continue permitting take-backs, subject to following guidelines:

• Take-backs may occur up to 6 months after a payment is made or;
• If the insurer requires the physician to submit claims for a period less than 6 months, then the take-back period will equal the time period to submit the claim.

Contract Fairness

During the 127^th General Assembly, legislation was enacted (H.B. 125, the Healthcare Simplification Act) that, among other things, created greater transparency and fairness in the contracting process between health insurers and physicians.  One of the key provisions of the law prohibits unilateral amendments in health care contracts.  In other words, once a contract between an insurer and physician has been executed it can only later be changed upon mutual consent of the two parties. Because of an ambiguity in the language that was adopted in H.B. 125, the goal of prohibiting unilateral contract amendments is not being followed in practice.

ISSUE #2: Support Funding for Smoke Free Ohio

Smoke Free Ohio was approved with nearly 60 percent support of the voters and has more support now that it did when it was on the ballot. Unfortunately, Governor Kasich’s proposed budget doesn’t provide any funding to educate businesses owners or enforce the law. With no funding, local departments of health will not be able to follow up with businesses where employees or customers are exposed to secondhand smoke. Ohioans asked for the state to be smoke free and expect that law will be enforced. We hope that the law will not be ignored and that there will be funding support  to make sure the Smoke Free Workplace Act remains strong. Please support funding the Smoke Free Workplace Act to keep Ohioans healthier.

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

This legislation 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: Costly and Bureaucratic Requirement When Writing Prescriptions - Oppose H. B. 71

H.B. 71 would require all physician prescribers to pay a $250 annual “computer maintenance fee” to the Ohio Board of Pharmacy (Ohio BOP) for the purchase of an official tamper-resistant Ohio prescription pad. The bill prohibits licensed health professionals from prescribing drugs and pharmacists from dispensing a drug, after July 1, 2010, unless the prescription is written on the official Ohio prescription pad. The goal of this legislation is to require a uniform, tamper-resistant prescription pad for the state of Ohio in hopes of eliminating fraudulent and forged prescriptions from being written and filled. While we support the goal of eliminating fraudulent and forged prescriptions, we are not convinced this is the best mechanism to accomplish that goal. We have serious concerns about the regressive nature of this proposal as the medical community makes significant capital investments to transition to electronic prescribing and electronic medical records (EMR).

• Statutorily mandating the use of an official Ohio prescription pad would be a step in the wrong direction for this state.  This action would prolong a paper based prescription system and interfere with the progress physicians across Ohio are making in the transition to e-prescribing.  In addition, the $250 computer maintenance fee would divert scarce resources that physicians have allocated for investment in e-prescribing and EMR systems.
• This bill would be an unnecessary duplication of state and federal regulations for tamper-resistant prescription pads.  In October 2008, the federal government required that all Medicaid prescriptions must be written on tamper resistant prescription pads as proposed in H.B. 71.  When this mandate was implemented, many Ohio practices transitioned from the old prescription pads to tamper resistant pads for my entire patient population.
• The Ohio BOP has the strictest e-prescribing approval process in the country and it has become an impediment to the physicians' ability to implement e-prescribing systems into their EMRs or practice management systems.