As Reported by House Insurance Committee 1
CORRECTED VERSION 3
123rd General Assembly 6
Regular Session Sub. H. B. No. 221 7
1999-2000 8
REPRESENTATIVES VAN VYVEN-ALLEN-CALLENDER-CATES- 10
JERSE-MOTTLEY-OGG-SALERNO-SCHULER-TERWILLEGER-TRAKAS-YOUNG 11
_________________________________________________________________ 12
A B I L L
To enact sections 103.144, 105.01, 105.02, 105.03, 14
105.05, and 105.07 of the Revised Code to require 15
the Ohio Legislative Service Commission to 16
prepare a mandated benefit report for each bill 17
that receives second consideration, to provide
for the establishment and operation of the Ohio 18
Mandated Benefits Review Council, and to 19
terminate the provisions of this act on December 20
31, 2003, by repealing sections 103.144, 105.01,
105.02, 105.03, 105.05, and 105.07 of the Revised 21
Code on that date.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO: 23
Section 1. That sections 103.144, 105.01, 105.02, 105.03, 25
105.05, and 105.07 of the Revised Code be enacted to read as 26
follows: 27
Sec. 103.144. (A) AS USED IN THIS SECTION, "MANDATED 29
BENEFIT" HAS THE SAME MEANING AS IN SECTION 105.01 OF THE REVISED 31
CODE. 32
(B) WITHIN SEVEN DAYS AFTER A BILL RECEIVES SECOND 34
CONSIDERATION IN EITHER HOUSE OF THE GENERAL ASSEMBLY, THE 35
LEGISLATIVE SERVICE COMMISSION SHALL REVIEW THE BILL TO DETERMINE 37
WHETHER THE BILL INCLUDES A MANDATED BENEFIT. IF THE LEGISLATIVE 39
SERVICE COMMISSION DETERMINES THAT THE BILL INCLUDES A MANDATED 40
2
BENEFIT, THE COMMISSION SHALL PREPARE A WRITTEN MANDATED BENEFITS 42
REPORT WITHIN THE SEVEN-DAY REVIEW PERIOD SETTING FORTH THE 43
RESULTS OF THE REVIEW AND SHALL DISTRIBUTE COPIES OF THE REPORT 45
TO THE CHAIRPERSON OF THE COMMITTEE TO WHICH THE BILL HAS BEEN 46
ASSIGNED, THE OHIO MANDATED BENEFITS REVIEW COUNCIL CREATED UNDER 47
SECTION 105.02 OF THE REVISED CODE, AND THE SUPERINTENDENT OF 49
INSURANCE.
(C) WITHIN SEVEN DAYS AFTER AN AMENDMENT TO THE BILL IS 51
ADOPTED, OR A SUBSTITUTE BILL IS ADOPTED, BY THE COMMITTEE, THE 52
LEGISLATIVE SERVICE COMMISSION SHALL REVIEW THE AMENDMENT OR 55
SUBSTITUTE BILL TO DETERMINE WHETHER THE AMENDMENT OR SUBSTITUTE 56
BILL INCLUDES A MANDATED BENEFIT. IF THE LEGISLATIVE SERVICE 57
COMMISSION DETERMINES THAT THE AMENDMENT OR SUBSTITUTE BILL
INCLUDES A MANDATED BENEFIT, THE COMMISSION SHALL PREPARE A 58
WRITTEN MANDATED BENEFITS REPORT WITHIN THE SEVEN-DAY REVIEW 59
PERIOD IF A REPORT WAS NOT PREVIOUSLY PREPARED IN CONNECTION WITH 61
THE BILL OR SHALL PREPARE A REVISION OF ANY PREVIOUSLY ISSUED 62
MANDATED BENEFITS REPORT WITHIN THE SEVEN-DAY REVIEW PERIOD TO 64
REFLECT CHANGES PROPOSED BY THE AMENDMENT OR SUBSTITUTE BILL. 66
THE LEGISLATIVE SERVICE COMMISSION SHALL DISTRIBUTE COPIES OF ANY
REPORT PREPARED OR REVISED IN ACCORDANCE WITH THIS DIVISION TO 68
THE PARTIES IDENTIFIED IN DIVISION (B) OF THIS SECTION. 69
Sec. 105.01. AS USED IN SECTIONS 105.01 TO 105.07 OF THE 71
REVISED CODE: 72
(A) "MANDATED BENEFIT" MEANS THE FOLLOWING, WHEN 74
CONSIDERED IN THE CONTEXT OF A SICKNESS AND ACCIDENT INSURANCE 75
POLICY OR A HEALTH INSURING CORPORATION POLICY, CONTRACT, OR 76
AGREEMENT: 77
(1) ANY REQUIRED COVERAGE FOR A SPECIFIC MEDICAL OR 79
HEALTH-RELATED SERVICE, TREATMENT, MEDICATION, OR PRACTICE; 80
(2) ANY REQUIRED COVERAGE FOR THE SERVICES OF SPECIFIC 82
HEALTH CARE PRACTITIONERS; 83
(3) ANY REQUIREMENT THAT AN INSURER OR HEALTH INSURING 85
CORPORATION OFFER COVERAGE TO SPECIFIC INDIVIDUALS OR GROUPS; 86
3
(4) ANY REQUIREMENT THAT AN INSURER OR HEALTH INSURING 88
CORPORATION OFFER SPECIFIC HEALTH CARE SERVICES, TREATMENTS, OR 89
PRACTICES TO EXISTING INSUREDS OR ENROLLEES; 90
(5) ANY REQUIRED EXPANSION OF, OR ADDITION TO, EXISTING 92
COVERAGE; 93
(6) ANY MANDATED REIMBURSEMENT AMOUNT TO SPECIFIC HEALTH 95
CARE PRACTITIONERS. 96
(B) "MANDATED BENEFIT" DOES NOT INCLUDE ANY REQUIRED 98
COVERAGE OR OFFER OF COVERAGE, ANY REQUIRED EXPANSION OF, OR 99
ADDITION TO, EXISTING COVERAGE, OR ANY MANDATED REIMBURSEMENT 101
AMOUNT TO SPECIFIC PRACTITIONERS, AS DESCRIBED IN DIVISION (A) OF 102
THIS SECTION, WITHIN THE CONTEXT OF ANY PUBLIC HEALTH BENEFITS 103
ARRANGEMENT, INCLUDING BUT NOT LIMITED TO, THE COVERAGE OF 104
BENEFICIARIES ENROLLED IN TITLE XVIII OF THE "SOCIAL SECURITY 106
ACT," 49 STAT. 620 (1935), 42 U.S.C.A. 301, AS AMENDED, PURSUANT 108
TO A MEDICARE RISK CONTRACT OR MEDICARE COST CONTRACT, OR TO THE 109
COVERAGE OF BENEFICIARIES ENROLLED IN TITLE XIX OF THE "SOCIAL 111
SECURITY ACT," 49 STAT. 620 (1935), 42 U.S.C.A. 301, AS AMENDED, 115
KNOWN AS THE MEDICAL ASSISTANCE PROGRAM OR MEDICAID, PROVIDED BY 116
THE OHIO DEPARTMENT OF HUMAN SERVICES UNDER CHAPTER 5111. OF THE 118
REVISED CODE. 119
Sec. 105.02. (A) THERE IS HEREBY CREATED THE OHIO 121
MANDATED BENEFITS REVIEW COUNCIL. 123
(B) THE COUNCIL SHALL CONSIST OF FIFTEEN MEMBERS, SIX OF 126
WHOM SHALL BE VOTING MEMBERS AND NINE ADDITIONAL MEMBERS WHO 127
SHALL NOT VOTE EXCEPT IN THE EVENT THAT A TIE VOTE IS CAST BY THE 128
VOTING MEMBERS.
(1) THE VOTING MEMBERS SHALL CONSIST OF THE FOLLOWING: 130
(a) THREE MEMBERS OF THE SENATE, APPOINTED BY THE 132
PRESIDENT OF THE SENATE, NOT MORE THAN TWO OF WHOM MAY BE MEMBERS 133
OF THE SAME POLITICAL PARTY; 134
(b) THREE MEMBERS OF THE HOUSE OF REPRESENTATIVES, 136
APPOINTED BY THE SPEAKER OF THE HOUSE OF REPRESENTATIVES, NOT 137
MORE THAN TWO OF WHOM MAY BE MEMBERS OF THE SAME POLITICAL PARTY. 138
4
(2) THE ADDITIONAL MEMBERS SHALL CONSIST OF THE FOLLOWING: 140
(a) THREE REPRESENTATIVES OF CONSUMERS, APPOINTED BY THE 142
GOVERNOR WITH THE ADVICE AND CONSENT OF THE SENATE, NOT MORE THAN 143
TWO OF WHOM SHALL BE MEMBERS OF THE SAME POLITICAL PARTY. NONE 144
OF THESE MEMBERS MAY BE EMPLOYED BY, OR IN ANY WAY AFFILIATED 145
WITH OR BIASED TOWARD, ANY OF THE PERSONS OR ENTITIES LISTED IN 146
DIVISIONS (B)(2)(b) TO (f) OF THIS SECTION. ONE OF THESE MEMBERS 148
SHALL REPRESENT THE INTERESTS OF PUBLIC EMPLOYERS AND THEIR 149
EMPLOYEES AS CONSUMERS OF HEALTH CARE. 150
(b) TWO REPRESENTATIVES OF HEALTH CARE PROVIDERS, ONE OF 152
WHOM IS TO BE APPOINTED BY THE PRESIDENT OF THE SENATE AND THE 153
OTHER BY THE SPEAKER OF THE HOUSE OF REPRESENTATIVES. 155
(c) ONE REPRESENTATIVE OF HEALTH INSURING CORPORATIONS, 157
APPOINTED BY THE PRESIDENT OF THE SENATE. 158
(d) ONE REPRESENTATIVE OF SICKNESS AND ACCIDENT INSURERS, 160
APPOINTED BY THE SPEAKER OF THE HOUSE OF REPRESENTATIVES. 161
(e) ONE REPRESENTATIVE OF EMPLOYERS IN THIS STATE, OTHER 163
THAN THE EMPLOYERS LISTED IN DIVISIONS (B)(2)(b) TO (d) OF THIS 165
SECTION, THAT EMPLOY FIFTY OR FEWER EMPLOYEES, APPOINTED BY THE 166
PRESIDENT OF THE SENATE. 167
(f) ONE REPRESENTATIVE OF EMPLOYERS IN THIS STATE, OTHER 169
THAN THE EMPLOYERS LISTED IN DIVISIONS (B)(2)(b) TO (d) OF THIS 171
SECTION, THAT EMPLOY MORE THAN FIFTY EMPLOYEES, APPOINTED BY THE 172
SPEAKER OF THE HOUSE OF REPRESENTATIVES. 173
(C) WITH RESPECT TO THE MEMBERS OF THE COUNCIL OTHER THAN 175
THOSE APPOINTED FROM THE MEMBERSHIP OF THE SENATE AND THE HOUSE 176
OF REPRESENTATIVES, ALL OF THE FOLLOWING APPLY: 177
(1) OF THE INITIAL APPOINTMENTS, THREE SHALL BE FOR A TERM 179
ENDING JUNE 30, 2001, THREE SHALL BE FOR A TERM ENDING JUNE 30, 180
2002, AND THREE SHALL BE FOR A TERM ENDING JUNE 30, 2003. 182
THEREAFTER, TERMS OF OFFICE SHALL BE FOR THREE YEARS, WITH EACH 183
TERM ENDING ON THE SAME DAY OF THE SAME MONTH AS DID THE TERM 185
THAT IT SUCCEEDS.
(2) EACH MEMBER SHALL HOLD OFFICE FROM THE DATE OF 187
5
APPOINTMENT UNTIL THE END OF THE TERM FOR WHICH THE MEMBER WAS 188
APPOINTED.
(3) ANY MEMBER APPOINTED TO FILL A VACANCY OCCURRING PRIOR 190
TO THE EXPIRATION DATE OF THE TERM FOR WHICH THE MEMBER'S 191
PREDECESSOR WAS APPOINTED SHALL HOLD OFFICE AS A MEMBER FOR THE 192
REMAINDER OF THAT TERM. 193
(4) A MEMBER SHALL CONTINUE IN OFFICE SUBSEQUENT TO THE 195
EXPIRATION DATE OF THE MEMBER'S TERM UNTIL THE MEMBER'S SUCCESSOR 196
TAKES OFFICE OR UNTIL A PERIOD OF SIXTY DAYS HAS ELAPSED, 197
WHICHEVER OCCURS FIRST. 198
(D) THE MEMBERS OF THE COUNCIL WHO ARE APPOINTED FROM THE 200
MEMBERSHIP OF THE SENATE OR THE HOUSE OF REPRESENTATIVES SHALL 201
SERVE DURING THEIR TERMS AS MEMBERS OF THE GENERAL ASSEMBLY AND 202
UNTIL THEIR SUCCESSORS ARE APPOINTED AND QUALIFIED, 203
NOTWITHSTANDING THE ADJOURNMENT OF THE GENERAL ASSEMBLY OF WHICH 204
THEY ARE MEMBERS OR THE EXPIRATION OF THEIR TERMS AS MEMBERS OF 205
SUCH GENERAL ASSEMBLY. 206
(E) VACANCIES ON THE COUNCIL SHALL BE FILLED IN THE MANNER 208
PROVIDED FOR ORIGINAL APPOINTMENTS. 209
Sec. 105.03. MEETINGS OF THE MANDATED BENEFITS REVIEW 211
COUNCIL SHALL BE CALLED IN SUCH MANNER AND AT SUCH TIMES AS 212
PRESCRIBED BY RULES ADOPTED BY THE COUNCIL. A MAJORITY OF THE 213
MEMBERSHIP OF THE COUNCIL CONSTITUTES A QUORUM AND NO ACTION 214
SHALL BE TAKEN BY THE COUNCIL UNLESS APPROVED BY A MAJORITY OF 215
THE VOTING MEMBERS. IF A TIE VOTE IS CAST BY THE VOTING MEMBERS, 217
THE ADDITIONAL COUNCIL MEMBERS SHALL BE REQUIRED TO CAST A VOTE 218
ON WHETHER TO APPROVE THE ACTION. THE MAJORITY VOTE OF THE 219
ADDITIONAL COUNCIL MEMBERS SHALL BE COUNTED AS A SINGLE VOTE FOR 220
THE PURPOSE OF BREAKING THE TIE VOTE CAST BY THE VOTING MEMBERS. 221
THE COUNCIL SHALL ORGANIZE BY SELECTING FROM AMONG THE 223
VOTING MEMBERS A CHAIRPERSON, A VICE-CHAIRPERSON, AND SUCH OTHER 224
OFFICERS AS IT CONSIDERS NECESSARY. THE COUNCIL SHALL ADOPT 225
RULES FOR THE CONDUCT OF ITS BUSINESS AND THE ELECTION OF ITS 226
OFFICERS. EACH MEMBER OF THE COUNCIL, BEFORE ENTERING UPON THE 227
6
MEMBER'S OFFICIAL DUTIES, SHALL TAKE AND SUBSCRIBE TO AN OATH OF 228
OFFICE, TO UPHOLD THE CONSTITUTION AND LAWS OF THE UNITED STATES 229
AND THIS STATE, AND TO PERFORM THE DUTIES OF THE OFFICE HONESTLY, 231
FAITHFULLY, AND IMPARTIALLY. 232
MEMBERS OF THE COUNCIL SHALL SERVE WITHOUT COMPENSATION BUT 234
SHALL BE REIMBURSED FOR ACTUAL AND NECESSARY EXPENSES INCURRED IN 235
THE PERFORMANCE OF THEIR DUTIES UNDER SECTIONS 105.01 TO 105.07 236
OF THE REVISED CODE. 237
Sec. 105.05. (A)(1) THE COUNCIL SHALL HOLD A PUBLIC 239
MEETING TO CONSIDER THE FINDINGS OF AN INDEPENDENT ACTUARIAL 241
REVIEW PERFORMED UNDER SECTION 105.07 OF THE REVISED CODE. THE 242
COUNCIL MAY ADMINISTER OATHS AND HOLD PUBLIC HEARINGS AT SUCH 243
TIMES AND PLACES WITHIN THE STATE AS MAY BE NECESSARY TO CARRY 244
OUT THE PURPOSES AND INTENT OF SECTIONS 105.01 TO 105.07 OF THE 245
REVISED CODE. 246
(2) WITHIN THIRTY DAYS AFTER RECEIPT OF THE FINDINGS OF 249
THE INDEPENDENT ACTUARIAL REVIEW, THE COUNCIL SHALL MAKE A
WRITTEN RECOMMENDATION TO THE GENERAL ASSEMBLY. NO 251
RECOMMENDATION SHALL BE MADE BY THE COUNCIL UNLESS APPROVED BY A 252
MAJORITY OF THE VOTING MEMBERS. IF A TIE VOTE IS CAST BY THE 253
VOTING MEMBERS, THE ADDITIONAL COUNCIL MEMBERS SHALL BE REQUIRED 254
TO CAST A VOTE ON WHETHER TO APPROVE THE RECOMMENDATION. THE 255
MAJORITY VOTE OF THE ADDITIONAL COUNCIL MEMBERS SHALL BE COUNTED 256
AS A SINGLE VOTE FOR THE PURPOSE OF BREAKING THE TIE VOTE CAST BY 257
THE VOTING MEMBERS.
(B) THE COUNCIL MAY, FROM TIME TO TIME, REVIEW THE 259
PROVISIONS OF THE REVISED CODE THAT INCLUDE MANDATED BENEFITS AND 260
REQUEST THE SUPERINTENDENT TO ARRANGE FOR AN INDEPENDENT 262
ACTUARIAL REVIEW OF THE MANDATED BENEFITS AS PROVIDED IN SECTION 264
105.07 OF THE REVISED CODE. THE COUNCIL SHALL FORWARD ITS 266
RECOMMENDATIONS REGARDING SUCH MANDATED BENEFITS TO THE PRESIDENT
OF THE SENATE, THE SPEAKER OF THE HOUSE OF REPRESENTATIVES, AND 268
THE CHAIRPERSONS OF THE COMMITTEES OF THE GENERAL ASSEMBLY THAT 269
HAVE PRIMARY JURISDICTION OVER HEALTH INSURANCE. 270
7
(C) THE COUNCIL SHALL PREPARE AN ANNUAL SUMMARY OF ITS 272
RECOMMENDATIONS WITH RESPECT TO PROPOSED AND EXISTING MANDATED 273
BENEFITS, AND SUBMIT A COPY OF THAT SUMMARY TO THE GOVERNOR, THE 274
SPEAKER OF THE HOUSE OF REPRESENTATIVES, AND THE PRESIDENT OF THE 275
SENATE. 276
Sec. 105.07. (A) UPON RECEIPT OF A REQUEST FROM THE 278
MANDATED BENEFITS REVIEW COUNCIL PURSUANT TO DIVISION (B) OF 279
SECTION 105.05 OF THE REVISED CODE OR UPON RECEIPT OF A MANDATED 281
BENEFITS REPORT PREPARED BY THE LEGISLATIVE SERVICE COMMISSION 282
UNDER SECTION 103.144 OF THE REVISED CODE, THE SUPERINTENDENT OF 283
INSURANCE SHALL ARRANGE FOR THE PERFORMANCE OF AN INDEPENDENT 285
ACTUARIAL REVIEW OF THE MANDATED BENEFIT. IN MAKING THIS 286
ARRANGEMENT, THE SUPERINTENDENT SHALL RETAIN ONE OR MORE 287
INDEPENDENT ACTUARIES ON A CONSULTING BASIS TO DETERMINE THE 288
MEDICAL EFFICACY AND FINANCIAL IMPACT OF THE MANDATED BENEFIT IN 289
ACCORDANCE WITH DIVISION (B) OF THIS SECTION. THE SUPERINTENDENT 290
SHALL ASSIST THE ACTUARY OR ACTUARIES IN OBTAINING ANY 291
INFORMATION NEEDED.
WITHIN FORTY-FIVE DAYS AFTER RECEIVING THE REQUEST OR 293
REPORT, THE SUPERINTENDENT SHALL SUBMIT THE FINDINGS OF THE 294
ACTUARIAL REVIEW TO THE COUNCIL. 295
(B) IN PERFORMING AN ACTUARIAL REVIEW OF A MANDATED 297
BENEFIT, THE ACTUARY SHALL DO THE FOLLOWING: 298
(1) USE APPROPRIATE ASSUMPTIONS THAT ACCURATELY 300
DEMONSTRATE THE FINANCIAL IMPACT OF THE MANDATED BENEFIT; 301
(2) DETERMINE TO WHAT EXTENT THE ABSENCE OF THE MANDATED 303
BENEFIT RESULTS IN FINANCIAL HARDSHIP TO THE GENERAL POPULATION; 304
(3) DETERMINE THE EXTENT OF PUBLIC DEMAND FOR THE MANDATED 306
BENEFIT, AND TO WHAT EXTENT VOLUNTARY COVERAGE OF THE BENEFIT IS 307
AVAILABLE; 308
(4) DETERMINE THE EXTENT OF PUBLIC DEMAND FOR INCLUSION OF 310
THE MANDATED BENEFIT IN ARRANGEMENTS NEGOTIATED THROUGH 311
COLLECTIVE BARGAINING; 312
(5) CONSULT WITH RELEVANT MEDICAL EXPERTS, ATTORNEYS, AND 314
8
OTHER PROFESSIONALS KNOWLEDGEABLE IN MATTERS RELATED TO THE 315
PERFORMANCE OF AN ACTUARIAL REVIEW OF A MANDATED BENEFIT; 316
(6) CONSIDER THE RESULTS OF AT LEAST ONE PROFESSIONALLY 318
ACCEPTABLE CONTROLLED TRIAL AND THE RESULTS OF ANY OTHER RELEVANT 319
PEER REVIEWED RESEARCH SPECIFICALLY CENTERED AROUND THE BENEFIT; 320
(7) IF APPLICABLE, DETERMINE THE EXTENT TO WHICH: 322
(a) COVERAGE WILL INCREASE OR DECREASE THE COST OF THE 325
TREATMENT OR SERVICE;
(b) A SIMILAR MANDATED BENEFIT IN OTHER STATES HAS 328
AFFECTED CHARGES, COSTS, UTILIZATION, AND PAYMENTS FOR SERVICES 329
AND TREATMENTS IN THOSE STATES;
(c) COVERAGE WILL INCREASE OR DECREASE THE APPROPRIATE USE 332
OF THE TREATMENT OR SERVICE; 333
(d) COVERAGE WILL INCREASE OR DECREASE THE ADMINISTRATIVE 335
EXPENSES OF INSURANCE COMPANIES AND HEALTH INSURING CORPORATIONS; 336
(e) COVERAGE WILL INCREASE OR DECREASE PREMIUMS; 338
(f) EXISTING MANDATED BENEFITS MEET THE PROPOSED 341
REQUIREMENTS;
(g) SMALL EMPLOYER, MEDIUM-SIZED EMPLOYERS, AND LARGE 343
EMPLOYERS WILL BE FINANCIALLY IMPACTED; AND 344
(h) COVERAGE WILL IMPACT THE TOTAL COST OF HEALTH CARE. 347
(C) THE SUPERINTENDENT SHALL ALSO PROVIDE ANY APPROPRIATE 349
PROFESSIONAL, TECHNICAL, AND CLERICAL SUPPORT FROM THE 350
SUPERINTENDENT'S STAFF THAT IS NEEDED BY THE COUNCIL TO FULFILL 351
ITS DUTIES.
Section 2. Sections 103.144, 105.01, 105.02, 105.03, 353
105.05, and 105.07 of the Revised Code, as enacted by this act, 354
are hereby repealed, effective December 31, 2003. 355
Section 3. Initial appointments to the Ohio Mandated 357
Benefits Review Council shall be made no later than sixty days 358
after the effective date of this act. 359