As Introduced 1
123rd General Assembly 4
Regular Session H. B. No. 221 5
1999-2000 6
REPRESENTATIVES VAN VYVEN-ALLEN-CALLENDER-CATES- 8
JERSE-MOTTLEY-OGG-SALERNO-SCHULER-STAPLETON-TERWILLEGER- 9
TRAKAS-YOUNG 10
_________________________________________________________________ 11
A B I L L
To enact sections 103.144, 105.01, 105.02, 105.03, 13
105.05, 105.07, and 105.09 of the Revised Code to 14
require the Ohio Legislative Service Commission 15
to prepare a mandated benefit report for each
bill that receives second consideration, to 16
provide for the establishment and operation of 17
the Ohio Mandated Benefits Review Council, and to 18
terminate the provisions of this act on December 19
31, 2003, by repealing sections 103.144, 105.01,
105.02, 105.03, 105.05, 105.07, and 105.09 of the 20
Revised Code on that date.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO: 22
Section 1. That sections 103.144, 105.01, 105.02, 105.03, 24
105.05, 105.07, and 105.09 of the Revised Code be enacted to read 25
as follows: 26
Sec. 103.144. (A) AS USED IN THIS SECTION, "MANDATED 28
BENEFIT" HAS THE SAME MEANING AS IN SECTION 105.01 OF THE REVISED 30
CODE. 31
(B) WITHIN SEVEN DAYS AFTER A BILL RECEIVES SECOND 33
CONSIDERATION IN EITHER HOUSE OF THE GENERAL ASSEMBLY, THE 34
LEGISLATIVE SERVICE COMMISSION SHALL DO BOTH OF THE FOLLOWING: 35
(1) REVIEW THE BILL TO DETERMINE WHETHER THE BILL INCLUDES 37
A MANDATED BENEFIT. 38
(2) PREPARE A WRITTEN MANDATED BENEFITS REPORT SETTING 40
2
FORTH THE RESULTS OF THE REVIEW PERFORMED UNDER DIVISION (B)(1) 41
OF THIS SECTION. 42
(3) DISTRIBUTE COPIES OF THE REPORT TO THE CHAIRPERSON OF 44
THE COMMITTEE TO WHICH THE BILL HAS BEEN ASSIGNED, THE OHIO 45
MANDATED BENEFITS REVIEW COUNCIL CREATED UNDER SECTION 105.02 OF 46
THE REVISED CODE, AND THE SUPERINTENDENT OF INSURANCE. 48
(C) WITHIN SEVEN DAYS AFTER AN AMENDMENT TO THE BILL IS 50
OFFERED, OR A SUBSTITUTE BILL IS PRESENTED, TO THE COMMITTEE, THE 51
LEGISLATIVE SERVICE COMMISSION SHALL REVISE THE MANDATED BENEFITS 52
REPORT TO REFLECT CHANGES PROPOSED BY THE AMENDMENT OR SUBSTITUTE 53
BILL AND DISTRIBUTE COPIES OF THE REPORT IN ACCORDANCE WITH 54
DIVISION (B)(3) OF THIS SECTION. 55
(D) NO BILL SHALL BE REPORTED BY A COMMITTEE WITH A 57
RECOMMENDATION FOR PASSAGE, AND NO VOTE SHALL BE TAKEN BY A 59
COMMITTEE ON ANY PROPOSED AMENDMENT OR SUBSTITUTE BILL, UNTIL
AFTER THE COMMITTEE MEMBERS HAVE RECEIVED A MANDATED BENEFITS 61
REPORT OR, IF APPLICABLE, A REVISED MANDATED BENEFITS REPORT, 62
UNLESS APPROVED BY A TWO-THIRDS VOTE OF THE MEMBERSHIP OF THE
COMMITTEE. 63
Sec. 105.01. AS USED IN SECTIONS 105.01 TO 105.09 OF THE 65
REVISED CODE, "MANDATED BENEFIT" MEANS THE FOLLOWING, WHEN 66
CONSIDERED IN THE CONTEXT OF A SICKNESS AND ACCIDENT INSURANCE 67
POLICY OR A HEALTH INSURING CORPORATION POLICY, CONTRACT, OR 68
AGREEMENT: 69
(A) ANY REQUIRED COVERAGE FOR A SPECIFIC MEDICAL OR 71
HEALTH-RELATED SERVICE, TREATMENT, MEDICATION, OR PRACTICE; 72
(B) ANY REQUIRED COVERAGE FOR THE SERVICES OF SPECIFIC 74
HEALTH CARE PRACTITIONERS; 75
(C) ANY REQUIREMENT THAT AN INSURER OR HEALTH INSURING 77
CORPORATION OFFER COVERAGE TO SPECIFIC INDIVIDUALS OR GROUPS; 78
(D) ANY REQUIREMENT THAT AN INSURER OR HEALTH INSURING 80
CORPORATION OFFER SPECIFIC HEALTH CARE SERVICES, TREATMENTS, OR 81
PRACTICES TO EXISTING INSUREDS OR ENROLLEES; 82
(E) ANY REQUIRED EXPANSION OF, OR ADDITION TO, EXISTING 84
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COVERAGE; 85
(F) ANY REQUIRED AMOUNT OF REIMBURSEMENT OF SPECIFIC 87
HEALTH CARE PRACTITIONERS. 88
Sec. 105.02. (A) THERE IS HEREBY CREATED THE OHIO 90
MANDATED BENEFITS REVIEW COUNCIL. 92
(B) THE COUNCIL SHALL CONSIST OF FIFTEEN MEMBERS, AS 94
FOLLOWS:
(1) THREE MEMBERS OF THE SENATE, APPOINTED BY THE 96
PRESIDENT OF THE SENATE, NOT MORE THAN TWO OF WHOM MAY BE MEMBERS 97
OF THE SAME POLITICAL PARTY; 98
(2) THREE MEMBERS OF THE HOUSE OF REPRESENTATIVES, 100
APPOINTED BY THE SPEAKER OF THE HOUSE OF REPRESENTATIVES, NOT 101
MORE THAN TWO OF WHOM MAY BE MEMBERS OF THE SAME POLITICAL PARTY; 102
(3) THREE REPRESENTATIVES OF CONSUMERS, APPOINTED BY THE 104
GOVERNOR WITH THE ADVICE AND CONSENT OF THE SENATE, NOT MORE THAN 105
TWO OF WHOM SHALL BE MEMBERS OF THE SAME POLITICAL PARTY. NONE 106
OF THESE MEMBERS MAY BE EMPLOYED BY, OR IN ANY WAY AFFILIATED 107
WITH OR BIASED TOWARD, ANY OF THE PERSONS OR ENTITIES LISTED IN 108
DIVISION (B)(4) OF THIS SECTION. 109
(4) THE FOLLOWING NONVOTING MEMBERS: 111
(a) TWO REPRESENTATIVES OF HEALTH CARE PROVIDERS, ONE OF 113
WHOM IS TO BE APPOINTED BY THE PRESIDENT OF THE SENATE AND THE 114
OTHER BY THE SPEAKER OF THE HOUSE OF REPRESENTATIVES. 116
(b) ONE REPRESENTATIVE OF HEALTH INSURING CORPORATIONS, 118
APPOINTED BY THE PRESIDENT OF THE SENATE. 119
(c) ONE REPRESENTATIVE OF SICKNESS AND ACCIDENT INSURERS, 121
APPOINTED BY THE SPEAKER OF THE HOUSE OF REPRESENTATIVES. 122
(d) ONE REPRESENTATIVE OF EMPLOYERS IN THIS STATE, OTHER 124
THAN THE EMPLOYERS LISTED IN DIVISIONS (B)(4)(a) TO (c) OF THIS 126
SECTION, THAT EMPLOY LESS THAN TWENTY-FIVE EMPLOYEES, APPOINTED 127
BY THE PRESIDENT OF THE SENATE. 128
(e) ONE REPRESENTATIVE OF EMPLOYERS IN THIS STATE, OTHER 130
THAN THE EMPLOYERS LISTED IN DIVISIONS (B)(4)(a) TO (c) OF THIS 132
SECTION, THAT EMPLOY AT LEAST TWENTY-FIVE EMPLOYEES, APPOINTED BY 133
4
THE SPEAKER OF THE HOUSE OF REPRESENTATIVES. 134
(C) WITH RESPECT TO THE MEMBERS OF THE COUNCIL OTHER THAN 136
THOSE APPOINTED FROM THE MEMBERSHIP OF THE SENATE AND THE HOUSE 137
OF REPRESENTATIVES, ALL OF THE FOLLOWING APPLY: 138
(1) OF THE INITIAL APPOINTMENTS, THREE SHALL BE FOR A TERM 140
ENDING JUNE 30, 2001, THREE SHALL BE FOR A TERM ENDING JUNE 30, 141
2002, AND THREE SHALL BE FOR A TERM ENDING JUNE 30, 2003. 143
THEREAFTER, TERMS OF OFFICE SHALL BE FOR THREE YEARS, WITH EACH 144
TERM ENDING ON THE SAME DAY OF THE SAME MONTH AS DID THE TERM 146
THAT IT SUCCEEDS.
(2) EACH MEMBER SHALL HOLD OFFICE FROM THE DATE OF 148
APPOINTMENT UNTIL THE END OF THE TERM FOR WHICH THE MEMBER WAS 149
APPOINTED.
(3) ANY MEMBER APPOINTED TO FILL A VACANCY OCCURRING PRIOR 151
TO THE EXPIRATION DATE OF THE TERM FOR WHICH THE MEMBER'S 152
PREDECESSOR WAS APPOINTED SHALL HOLD OFFICE AS A MEMBER FOR THE 153
REMAINDER OF THAT TERM. 154
(4) A MEMBER SHALL CONTINUE IN OFFICE SUBSEQUENT TO THE 156
EXPIRATION DATE OF THE MEMBER'S TERM UNTIL THE MEMBER'S SUCCESSOR 157
TAKES OFFICE OR UNTIL A PERIOD OF SIXTY DAYS HAS ELAPSED, 158
WHICHEVER OCCURS FIRST. 159
(D) THE MEMBERS OF THE COUNCIL WHO ARE APPOINTED FROM THE 161
MEMBERSHIP OF THE SENATE OR THE HOUSE OF REPRESENTATIVES SHALL 162
SERVE DURING THEIR TERMS AS MEMBERS OF THE GENERAL ASSEMBLY AND 163
UNTIL THEIR SUCCESSORS ARE APPOINTED AND QUALIFIED, 164
NOTWITHSTANDING THE ADJOURNMENT OF THE GENERAL ASSEMBLY OF WHICH 165
THEY ARE MEMBERS OR THE EXPIRATION OF THEIR TERMS AS MEMBERS OF 166
SUCH GENERAL ASSEMBLY. 167
(E) VACANCIES ON THE COUNCIL SHALL BE FILLED IN THE MANNER 169
PROVIDED FOR ORIGINAL APPOINTMENTS. 170
Sec. 105.03. MEETINGS OF THE MANDATED BENEFITS REVIEW 172
COUNCIL SHALL BE CALLED IN SUCH MANNER AND AT SUCH TIMES AS 173
PRESCRIBED BY RULES ADOPTED BY THE COUNCIL. A MAJORITY OF THE 174
MEMBERSHIP OF THE COUNCIL CONSTITUTES A QUORUM AND NO ACTION 175
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SHALL BE TAKEN BY THE COUNCIL UNLESS APPROVED BY AT LEAST FIVE 176
VOTING MEMBERS.
THE COUNCIL SHALL ORGANIZE BY SELECTING FROM AMONG THE 178
VOTING MEMBERS A CHAIRPERSON, A VICE-CHAIRPERSON, AND SUCH OTHER 179
OFFICERS AS IT CONSIDERS NECESSARY. THE COUNCIL SHALL ADOPT 180
RULES FOR THE CONDUCT OF ITS BUSINESS AND THE ELECTION OF ITS 181
OFFICERS. EACH MEMBER OF THE COUNCIL, BEFORE ENTERING UPON THE 182
MEMBER'S OFFICIAL DUTIES, SHALL TAKE AND SUBSCRIBE TO AN OATH OF 183
OFFICE, TO UPHOLD THE CONSTITUTION AND LAWS OF THE UNITED STATES 184
AND THIS STATE, AND TO PERFORM THE DUTIES OF THE OFFICE HONESTLY, 186
FAITHFULLY, AND IMPARTIALLY. 187
MEMBERS OF THE COUNCIL SHALL SERVE WITHOUT COMPENSATION BUT 189
SHALL BE REIMBURSED FOR ACTUAL AND NECESSARY EXPENSES INCURRED IN 190
THE PERFORMANCE OF THEIR DUTIES. 191
Sec. 105.05. (A) UPON RECEIPT OF A MANDATED BENEFITS 193
REPORT PREPARED BY THE LEGISLATIVE SERVICE COMMISSION UNDER 194
SECTION 103.144 OF THE REVISED CODE, THE MANDATED BENEFITS REVIEW 195
COUNCIL SHALL REVIEW THE REPORT TO DETERMINE IF IT INDICATES THE 196
INCLUSION OF A MANDATED BENEFIT. IF IT DOES SO INDICATE, THE 197
COUNCIL SHALL REQUEST THE SUPERINTENDENT OF INSURANCE TO ARRANGE 198
FOR AN INDEPENDENT ACTUARIAL REVIEW OF THE MANDATED BENEFIT, AND 199
MAKE FINDINGS AND RECOMMENDATIONS, AS PROVIDED IN SECTION 105.07 200
OF THE REVISED CODE. 201
THE COUNCIL SHALL HOLD A PUBLIC MEETING TO CONSIDER THE 203
FINDINGS AND RECOMMENDATIONS OF THE SUPERINTENDENT. THE COUNCIL 204
MAY ADMINISTER OATHS AND HOLD PUBLIC HEARINGS AT SUCH TIMES AND 205
PLACES WITHIN THE STATE AS MAY BE NECESSARY TO CARRY OUT THE 206
PURPOSES AND INTENT OF SECTIONS 105.01 TO 105.09 OF THE REVISED 208
CODE.
WITHIN THIRTY DAYS AFTER RECEIPT OF THE SUPERINTENDENT'S 210
FINDINGS AND RECOMMENDATIONS, THE COUNCIL SHALL MAKE A WRITTEN 211
RECOMMENDATION TO THE GENERAL ASSEMBLY. NO RECOMMENDATION SHALL 212
BE MADE BY THE COUNCIL UNLESS APPROVED BY AT LEAST FIVE VOTING 213
MEMBERS.
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(B) THE COUNCIL MAY, FROM TIME TO TIME, REVIEW THE 215
PROVISIONS OF THE REVISED CODE THAT INCLUDE MANDATED BENEFITS AND 216
REQUEST THE SUPERINTENDENT TO ARRANGE FOR AN INDEPENDENT 218
ACTUARIAL REVIEW OF THE MANDATED BENEFITS, AND MAKE FINDINGS AND 219
RECOMMENDATIONS, AS PROVIDED IN SECTION 105.07 OF THE REVISED 220
CODE. THE COUNCIL SHALL FORWARD ITS RECOMMENDATIONS REGARDING 222
SUCH MANDATED BENEFITS TO THE PRESIDENT OF THE SENATE, THE 223
SPEAKER OF THE HOUSE OF REPRESENTATIVES, AND THE CHAIRPERSONS OF 224
THE COMMITTEES OF THE GENERAL ASSEMBLY THAT HAVE PRIMARY 225
JURISDICTION OVER HEALTH INSURANCE. 226
(C) THE COUNCIL SHALL PREPARE AN ANNUAL SUMMARY OF ITS 228
RECOMMENDATIONS WITH RESPECT TO PROPOSED AND EXISTING MANDATED 229
BENEFITS, AND SUBMIT A COPY OF THAT SUMMARY TO THE GOVERNOR, THE 230
SPEAKER OF THE HOUSE OF REPRESENTATIVES, AND THE PRESIDENT OF THE 231
SENATE. 232
Sec. 105.07. (A) UPON RECEIPT OF A REQUEST FROM THE 234
MANDATED BENEFITS REVIEW COUNCIL PURSUANT TO SECTION 105.05 OF 235
THE REVISED CODE, THE SUPERINTENDENT OF INSURANCE SHALL RETAIN, 237
ON A CONSULTING BASIS, AN INDEPENDENT ACTUARY TO DETERMINE THE
MEDICAL EFFICACY AND FINANCIAL IMPACT OF THE MANDATED BENEFIT IN 238
ACCORDANCE WITH DIVISION (B) OF THIS SECTION. THE SUPERINTENDENT 239
SHALL ASSIST THE ACTUARY IN OBTAINING ANY INFORMATION NEEDED. 240
WITHIN FORTY-FIVE DAYS AFTER RECEIVING THE REQUEST, THE 242
SUPERINTENDENT SHALL SUBMIT THE FINDINGS OF THE ACTUARIAL REVIEW 243
AND THE SUPERINTENDENT'S RECOMMENDATIONS TO THE COUNCIL. 244
(B) IN PERFORMING AN ACTUARIAL REVIEW OF A MANDATED 246
BENEFIT, THE ACTUARY SHALL DO THE FOLLOWING: 247
(1) USE APPROPRIATE ASSUMPTIONS THAT ACCURATELY 249
DEMONSTRATE THE FINANCIAL IMPACT OF THE MANDATED BENEFIT; 250
(2) DETERMINE TO WHAT EXTENT THE ABSENCE OF THE MANDATED 252
BENEFIT RESULTS IN FINANCIAL HARDSHIP TO THE GENERAL POPULATION; 253
(3) DETERMINE THE EXTENT OF PUBLIC DEMAND FOR THE MANDATED 255
BENEFIT, AND TO WHAT EXTENT VOLUNTARY COVERAGE OF THE BENEFIT IS 256
AVAILABLE; 257
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(4) DETERMINE THE EXTENT OF PUBLIC DEMAND FOR INCLUSION OF 259
THE MANDATED BENEFIT IN ARRANGEMENTS NEGOTIATED THROUGH 260
COLLECTIVE BARGAINING; 261
(5) CONSULT WITH RELEVANT MEDICAL EXPERTS; 263
(6) CONSIDER THE RESULTS OF AT LEAST ONE PROFESSIONALLY 265
ACCEPTABLE CONTROLLED TRIAL AND THE RESULTS OF ANY OTHER RELEVANT 266
PEER REVIEWED RESEARCH SPECIFICALLY CENTERED AROUND THE BENEFIT; 267
(7) IF APPLICABLE, DETERMINE THE EXTENT TO WHICH: 269
(a) COVERAGE WILL INCREASE OR DECREASE THE COST OF THE 272
TREATMENT OR SERVICE;
(b) A SIMILAR MANDATED BENEFIT IN OTHER STATES HAS 275
AFFECTED CHARGES, COSTS, UTILIZATION, AND PAYMENTS FOR SERVICES 276
AND TREATMENTS IN THOSE STATES;
(c) COVERAGE WILL INCREASE OR DECREASE THE APPROPRIATE USE 279
OF THE TREATMENT OR SERVICE; 280
(d) COVERAGE WILL INCREASE OR DECREASE THE ADMINISTRATIVE 282
EXPENSES OF INSURANCE COMPANIES AND HEALTH INSURING CORPORATIONS; 283
(e) COVERAGE WILL INCREASE OR DECREASE PREMIUMS; 285
(f) EXISTING MANDATED BENEFITS MEET THE PROPOSED 288
REQUIREMENTS;
(g) SMALL EMPLOYER, MEDIUM-SIZED EMPLOYERS, AND LARGE 290
EMPLOYERS WILL BE FINANCIALLY IMPACTED; AND 291
(h) COVERAGE WILL IMPACT THE TOTAL COST OF HEALTH CARE. 294
(C) THE SUPERINTENDENT SHALL ALSO PROVIDE ANY APPROPRIATE 296
PROFESSIONAL, TECHNICAL, AND CLERICAL SUPPORT FROM THE 297
SUPERINTENDENT'S STAFF THAT IS NEEDED BY THE COUNCIL TO FULFILL 298
ITS DUTIES.
Sec. 105.09. NO COMMITTEE OF THE GENERAL ASSEMBLY SHALL 300
REPORT A BILL WITH A RECOMMENDATION FOR PASSAGE, WHICH BILL HAS 301
BEEN IDENTIFIED BY THE LEGISLATIVE SERVICE COMMISSION AS 302
INCLUDING A MANDATED BENEFIT, WITHOUT THE WRITTEN RECOMMENDATION 303
OF THE MANDATED BENEFITS REVIEW COUNCIL, EXCEPT BY A TWO-THIRDS 304
VOTE OF THE MEMBERS OF THE COMMITTEE. 305
Section 2. Sections 103.144, 105.01, 105.02, 105.03, 307
8
105.05, 105.07, and 105.09 of the Revised Code, as enacted by 308
this act, are hereby repealed, effective December 31, 2003. 309
Section 3. Initial appointments to the Ohio Mandated 311
Benefits Review Council shall be made no later than sixty days 312
after the effective date of this act. 313