As Passed by the Senate 1
123rd General Assembly 4
Regular Session Sub. H. B. No. 221 5
1999-2000 6
REPRESENTATIVES VAN VYVEN-CALLENDER-CATES-MOTTLEY- 8
SCHULER-TERWILLEGER-TRAKAS-YOUNG-TIBERI-OLMAN- 10
SENATORS NEIN-CUPP-WACHTMANN-FINAN
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A B I L L
To enact sections 103.144, 103.145, 103.146, and 14
103.147 of the Revised Code to require, under 15
certain circumstances, the Legislative Budget 16
Officer to arrange for independent healthcare 17
actuarial reviews of bills that include a
mandated benefit and to make an appropriation. 18
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO: 20
Section 1. That sections 103.144, 103.145, 103.146, and 23
103.147 of the Revised Code be enacted to read as follows: 24
Sec. 103.144. AS USED IN SECTIONS 103.144 TO 103.147 OF 26
THE REVISED CODE: 27
(A) "MANDATED BENEFIT" MEANS THE FOLLOWING, WHEN 29
CONSIDERED IN THE CONTEXT OF A SICKNESS AND ACCIDENT INSURANCE 30
POLICY OR A HEALTH INSURING CORPORATION POLICY, CONTRACT, OR 31
AGREEMENT: 32
(1) ANY REQUIRED COVERAGE FOR A SPECIFIC MEDICAL OR 34
HEALTH-RELATED SERVICE, TREATMENT, MEDICATION, OR PRACTICE; 35
(2) ANY REQUIRED COVERAGE FOR THE SERVICES OF SPECIFIC 37
HEALTH CARE PROVIDERS; 38
(3) ANY REQUIREMENT THAT AN INSURER OR HEALTH INSURING 40
CORPORATION OFFER COVERAGE TO SPECIFIC INDIVIDUALS OR GROUPS; 41
(4) ANY REQUIREMENT THAT AN INSURER OR HEALTH INSURING 43
CORPORATION OFFER SPECIFIC MEDICAL OR HEALTH-RELATED SERVICES, 44
TREATMENTS, MEDICATIONS, OR PRACTICES TO EXISTING INSUREDS OR 46
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ENROLLEES;
(5) ANY REQUIRED EXPANSION OF, OR ADDITION TO, EXISTING 48
COVERAGE; 49
(6) ANY MANDATED REIMBURSEMENT AMOUNT TO SPECIFIC HEALTH 51
CARE PROVIDERS. 52
(B) "MANDATED BENEFIT" DOES NOT INCLUDE ANY REQUIRED 54
COVERAGE OR OFFER OF COVERAGE, ANY REQUIRED EXPANSION OF, OR 55
ADDITION TO, EXISTING COVERAGE, OR ANY MANDATED REIMBURSEMENT 57
AMOUNT TO SPECIFIC PROVIDERS, AS DESCRIBED IN DIVISION (A) OF 58
THIS SECTION, WITHIN THE CONTEXT OF ANY PUBLIC HEALTH BENEFITS 59
ARRANGEMENT, INCLUDING BUT NOT LIMITED TO, THE COVERAGE OF 60
BENEFICIARIES ENROLLED IN TITLE XVIII OF THE "SOCIAL SECURITY 62
ACT," 49 STAT. 620 (1935), 42 U.S.C.A. 301, AS AMENDED, PURSUANT 64
TO A MEDICARE RISK CONTRACT OR MEDICARE COST CONTRACT, OR TO THE 65
COVERAGE OF BENEFICIARIES ENROLLED IN TITLE XIX OF THE "SOCIAL 67
SECURITY ACT," 49 STAT. 620 (1935), 42 U.S.C.A. 301, AS AMENDED, 71
KNOWN AS THE MEDICAL ASSISTANCE PROGRAM OR MEDICAID, PROVIDED BY 72
THE OHIO DEPARTMENT OF JOB AND FAMILY SERVICES UNDER CHAPTER 73
5111. OF THE REVISED CODE. 74
Sec. 103.145. (A) WHENEVER ANY BILL RECEIVES A SECOND 76
HEARING IN A STANDING COMMITTEE IN THE HOUSE OF THE GENERAL 77
ASSEMBLY IN WHICH THE BILL ORIGINATED, THE LEGISLATIVE BUDGET 78
OFFICER SHALL REVIEW THE BILL TO DETERMINE WHETHER THE BILL 79
INCLUDES A MANDATED BENEFIT. IF THE LEGISLATIVE BUDGET OFFICER 80
DETERMINES THAT THE BILL INCLUDES A MANDATED BENEFIT, THE
LEGISLATIVE BUDGET OFFICER SHALL ARRANGE FOR THE PERFORMANCE OF 82
AN INDEPENDENT HEALTHCARE ACTUARIAL REVIEW OF THE MANDATED 83
BENEFIT. IN MAKING THIS ARRANGEMENT, THE LEGISLATIVE BUDGET 84
OFFICER SHALL RETAIN ONE OR MORE INDEPENDENT ACTUARIES ON A 85
CONSULTING BASIS TO DETERMINE THE FINANCIAL IMPACT OF THE 86
MANDATED BENEFIT IN ACCORDANCE WITH SECTION 103.146 OF THE 88
REVISED CODE. EACH ACTUARY RETAINED SHALL BE A MEMBER IN GOOD 89
STANDING OF THE AMERICAN ACADEMY OF ACTUARIES. THE LEGISLATIVE 90
BUDGET OFFICER SHALL ASSIST THE ACTUARY OR ACTUARIES IN OBTAINING 92
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ANY INFORMATION NEEDED.
NO LATER THAN SIXTY DAYS AFTER THE SECOND HEARING OF THE 94
BILL, THE LEGISLATIVE BUDGET OFFICER SHALL SUBMIT THE FINDINGS OF 95
THE ACTUARIAL REVIEW TO THE CHAIRPERSON OF THE COMMITTEE TO WHICH 96
THE BILL IS ASSIGNED AND TO THE RANKING MINORITY MEMBER OF THAT 97
COMMITTEE.
(B) TO ASSIST THE ACTUARY OR ACTUARIES IN OBTAINING 99
INFORMATION NEEDED TO PERFORM THE HEALTHCARE ACTUARIAL REVIEW, 101
THE LEGISLATIVE BUDGET OFFICE OF THE LEGISLATIVE SERVICE 102
COMMISSION MAY REQUEST ANY DEPARTMENT, DIVISION, INSTITUTION, 103
BOARD, COMMISSION, AUTHORITY, BUREAU, OR OTHER INSTRUMENTALITY OR 105
OFFICER OF THE STATE, A COUNTY, A MUNICIPAL CORPORATION, A
TOWNSHIP, A SCHOOL DISTRICT, OR OTHER GOVERNMENTAL ENTITY OF THE 107
STATE TO PROVIDE ANY INFORMATION THE LEGISLATIVE BUDGET OFFICE 108
REQUIRES FOR PURPOSES OF THE REVIEW.
AN INSTRUMENTALITY, OFFICER, OR ENTITY SHALL COMPLY WITH A 110
REQUEST AS SOON AS REASONABLY POSSIBLE AFTER RECEIVING IT. THE 111
LEGISLATIVE BUDGET OFFICE SHALL SPECIFY THE MANNER OF COMPLIANCE, 112
AND THE PERIOD OF TIME FOR COMPLIANCE, IN ITS REQUEST. 113
Sec. 103.146. IN PERFORMING AN INDEPENDENT HEALTHCARE 115
ACTUARIAL REVIEW OF A MANDATED BENEFIT, THE ACTUARY OR ACTUARIES 118
RETAINED BY THE LEGISLATIVE BUDGET OFFICER SHALL CONSULT WITH 119
PROFESSIONALS KNOWLEDGEABLE IN MATTERS RELATED TO THE PERFORMANCE 120
OF AN ACTUARIAL REVIEW OF A MANDATED BENEFIT AND SHALL CONSIDER 122
THE RESULTS OF ANY PROFESSIONALLY ACCEPTABLE CONTROLLED TRIAL AND 123
ANY OTHER RELEVANT RESEARCH SPECIFICALLY CENTERED AROUND THE 124
BENEFIT. THE ACTUARY OR ACTUARIES SHALL DETERMINE THE EXTENT TO 125
WHICH:
(A) THE MANDATED BENEFIT WILL INCREASE OR DECREASE THE 127
ADMINISTRATIVE EXPENSES OF INSURANCE COMPANIES AND HEALTH 129
INSURING CORPORATIONS;
(B) THE MANDATED BENEFIT WILL INCREASE OR DECREASE 131
PREMIUMS;
(C) SMALL EMPLOYERS, MEDIUM-SIZED EMPLOYERS, LARGE 133
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EMPLOYERS, AND, IF APPLICABLE, THE STATE AND POLITICAL 134
SUBDIVISIONS OF THE STATE, WILL BE FINANCIALLY IMPACTED; 135
(D) THE MANDATED BENEFIT WILL INCREASE OR DECREASE THE 137
NUMBER OF INSURED INDIVIDUALS IN THIS STATE; AND 139
(E) THE MANDATED BENEFIT WILL IMPACT THE TOTAL COST AND 141
QUALITY OF HEALTH CARE, INCLUDING ANY POTENTIAL COST SAVINGS THAT 143
MAY BE REALIZED.
Sec. 103.147. THE CHAIRPERSON OF A STANDING COMMITTEE OF 145
EITHER HOUSE OF THE GENERAL ASSEMBLY MAY, AT ANY TIME, REQUEST 146
THE LEGISLATIVE BUDGET OFFICER TO REVIEW ANY BILL THAT IS 147
ASSIGNED TO THE CHAIRPERSON'S COMMITTEE IN ORDER TO DETERMINE 148
WHETHER THE BILL INCLUDES A MANDATED BENEFIT. THE LEGISLATIVE
BUDGET OFFICER SHALL REVIEW THE BILL AND, IF THE LEGISLATIVE 149
BUDGET OFFICER DETERMINES THAT THE BILL INCLUDES A MANDATED 150
BENEFIT, SHALL ARRANGE FOR THE PERFORMANCE OF AN INDEPENDENT 151
HEALTHCARE ACTUARIAL REVIEW OF THE MANDATED BENEFIT IN THE SAME 152
MANNER AS PROVIDED IN SECTION 103.145 OF THE REVISED CODE. 153
NO LATER THAN SIXTY DAYS AFTER RECEIVING THE CHAIRPERSON'S 155
REQUEST, THE LEGISLATIVE BUDGET OFFICER SHALL SUBMIT THE FINDINGS 156
OF THE ACTUARIAL REVIEW TO THE CHAIRPERSON AND TO THE RANKING 158
MINORITY MEMBER OF THE CHAIRPERSON'S COMMITTEE. 159
Section 2. Section 1 of the act shall take effect January 161
1, 2001.
Section 3. On or before July 15, 2000, the Director of 163
Budget and Management shall determine and certify to the 164
Legislative Budget Officer the total amount of unexpended, 165
unobligated appropriations made to the Legislative Budget Office 166
of the Legislative Service Commission for fiscal year 2000 in
appropriation item 035-403, Legislative Budget Office. 167
Additional appropriation authority equal to the amount certified 168
is hereby appropriated to appropriation item 035-403, Legislative 169
Budget Office, for fiscal year 2001. 170
This section is not subject to the referendum. Therefore, 172
under Ohio Constitution, Article II, Section 1d and section 1.471 173
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of the Revised Code, this section goes into immediate effect when 174
this act becomes law.