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| To enact sections 1751.111 and 3923.601 of the | 1 |
| Revised Code to require the inclusion of specified | 2 |
| pharmacy benefits information when health insurers | 3 |
| issue or require the use of standardized | 4 |
| identification cards or electronic technology for | 5 |
| submission of claims. | 6 |
| Section 1. That sections 1751.111 and 3923.601 of the Revised | 7 |
| Code be enacted to read as follows: | 8 |
| Sec. 1751.111. (A)(1) This section applies to every health | 9 |
| insuring corporation, and to every person under contract with the | 10 |
| health insuring corporation to provide managerial or | 11 |
| administrative services, that issues or requires the use of a | 12 |
| standardized identification card or an electronic technology for | 13 |
| submission and routing of prescription drug and device claims | 14 |
| pursuant to a policy, contract, or agreement for health care | 15 |
| services. | 16 |
| (2) Notwithstanding division (A)(1) of this section, this | 17 |
| section does not apply to the issuance or required use of a | 18 |
| standardized identification card or an electronic technology for | 19 |
| submission and routing of prescription drug and device claims in | 20 |
| connection with coverage provided to beneficiaries enrolled in the | 21 |
| medicare advantage program operated under Part C of Title XVIII of | 22 |
| the "Social Security Act," 49 Stat. 62 (1935), 42 U.S.C. 301, as | 23 |
| amended. | 24 |
| (3) Notwithstanding division (A)(1) of this section, this | 25 |
| section does not apply to the issuance or required use of a | 26 |
| standardized identification card or an electronic technology for | 27 |
| submission and routing of prescription drug and device claims in | 28 |
| connection with coverage provided to beneficiaries enrolled in | 29 |
| Title XIX of the "Social Security Act," 49 Stat. 620 (1935), 42 | 30 |
| U.S.C.A. 301, as amended, known as the medical assistance program | 31 |
| or medicaid, by the department of job and family services under | 32 |
| Chapter 5111. of the Revised Code. | 33 |
| (B) A standardized identification card or an electronic | 34 |
| technology issued or required to be used as provided in division | 35 |
| (A) of this section shall contain uniform prescription drug and | 36 |
| device information in accordance with either division (B)(1) or | 37 |
| (2) of this section. | 38 |
| (1) The standardized identification card or the electronic | 39 |
| technology shall be in a format and contain information fields | 40 |
| approved by the national council for prescription drug programs, | 41 |
| as specified in the council's pharmacy identification card | 42 |
| implementation guide in effect on the first day of October most | 43 |
| immediately preceding the issuance or required use of the | 44 |
| standardized identification card or the electronic technology. | 45 |
| (2) If the health insuring corporation or the person under | 46 |
| contract with the corporation to provide managerial or | 47 |
| administrative services requires the information for the | 48 |
| submission and routing of a claim, the standardized identification | 49 |
| card or the electronic technology shall contain any of the | 50 |
| following information: | 51 |
| (a) The health insuring corporation's name; | 52 |
| (b) The enrollee's name, group number, and identification | 53 |
| number; | 54 |
| (c) A telephone number to inquire about pharmacy-related | 55 |
| issues; | 56 |
| (d) The issuer's international identification number, labeled | 57 |
| as "ANSI BIN" or "RxBIN"; | 58 |
| (e) The processor's control number, labeled as "RxPCN"; | 59 |
| (f) The enrollee's pharmacy benefits group number if | 60 |
| different from the enrollee's medical group number, labeled as | 61 |
| "RxGrp." | 62 |
| (C) If the standardized identification card or the electronic | 63 |
| technology issued or required to be used as provided in division | 64 |
| (A)(1) of this section is also used for submission and routing of | 65 |
| nonpharmacy claims, the designation "Rx" is not required to be | 66 |
| included as part of the labels identified in divisions (B)(2)(d) | 67 |
| and (e) of this section. | 68 |
| (D)(1) Except as provided in division (D)(2) of this section, | 69 |
| if there is a change in the information contained in the | 70 |
| standardized identification card or the electronic technology | 71 |
| issued to an enrollee, the health insuring corporation or person | 72 |
| under contract with the corporation to provide managerial or | 73 |
| administrative services shall issue a new card or electronic | 74 |
| technology to the enrollee. | 75 |
| (2) A health insuring corporation or person under contract | 76 |
| with the corporation is not required under division (D)(1) of this | 77 |
| section to issue a new card or electronic technology to an | 78 |
| enrollee more than once during a twelve-month period. | 79 |
| (E) Nothing in this section shall be construed as requiring a | 80 |
| health insuring corporation to produce more than one standardized | 81 |
| identification card or one electronic technology for use by | 82 |
| enrollees accessing health care benefits provided under a policy, | 83 |
| contract, or agreement for health care services. | 84 |
| Sec. 3923.601. (A)(1) This section applies to every sickness | 85 |
| and accident insurer, and to every person under contract with the | 86 |
| insurer to provide managerial or administrative services, that | 87 |
| issues or requires the use of a standardized identification card | 88 |
| or electronic technology for the submission and routing of | 89 |
| prescription drug and device claims pursuant to a policy of | 90 |
| sickness and accident insurance. This section also applies to | 91 |
| every pharmacy benefit manager, and to every health benefit plan | 92 |
| established by this state, that issues or requires the use of a | 93 |
| standardized identification card or an electronic technology for | 94 |
| the submission and routing of prescription drug and device claims. | 95 |
| (2) Notwithstanding division (A)(1) of this section, this | 96 |
| section does not apply to the issuance or required use of a | 97 |
| standardized identification card or an electronic technology for | 98 |
| the submission and routing of prescription drug and device claims | 99 |
| in connection with any individual or group policy of sickness and | 100 |
| accident insurance covering only accident, credit, dental, | 101 |
| disability income, long-term care, hospital indemnity, medicare | 102 |
| supplement, medicare, tricare, specified disease, or vision care; | 103 |
| coverage under a one-time-limited-duration policy of not longer | 104 |
| than six months; coverage issued as a supplement to liability | 105 |
| insurance; insurance arising out of workers' compensation or | 106 |
| similar law; automobile medical payment insurance; or insurance | 107 |
| under which benefits are payable with or without regard to fault | 108 |
| and which is statutorily required to be contained in any liability | 109 |
| insurance policy or equivalent self-insurance. | 110 |
| (3) Notwithstanding division (A)(1) of this section, this | 111 |
| section does not apply to the issuance or required use of a | 112 |
| standardized identification card or an electronic technology for | 113 |
| the submission and routing of prescription drug and device claims | 114 |
| in connection with coverage provided to beneficiaries enrolled in | 115 |
| Title XIX of the "Social Security Act," 49 Stat. 620 (1935), 42 | 116 |
| U.S.C.A. 301, as amended, known as the medical assistance program | 117 |
| or medicaid, by the department of job and family services under | 118 |
| Chapter 5111. of the Revised Code. | 119 |
| (B) A standardized identification card or an electronic | 120 |
| technology issued or required to be used as provided in division | 121 |
| (A)(1) of this section shall contain uniform prescription drug and | 122 |
| device information in accordance with either division (B)(1) or | 123 |
| (2) of this section. | 124 |
| (1) The standardized identification card or the electronic | 125 |
| technology shall be in a format and contain information fields | 126 |
| approved by the national council for prescription drug programs, | 127 |
| as specified in the council's pharmacy identification card | 128 |
| implementation guide in effect on the first day of October most | 129 |
| immediately preceding the issuance or required use of the | 130 |
| standardized identification card or the electronic technology. | 131 |
| (2) If the insurer or person under contract with the insurer | 132 |
| to provide managerial or administrative services requires the | 133 |
| information for the submission and routing of a claim, the | 134 |
| standardized identification card or the electronic technology | 135 |
| shall contain any of the following information: | 136 |
| (a) The insurer's name; | 137 |
| (b) The insured's name, group number, and identification | 138 |
| number; | 139 |
| (c) A telephone number to inquire about pharmacy-related | 140 |
| issues; | 141 |
| (d) The issuer's international identification number, labeled | 142 |
| as "ANSI BIN" or "RxBIN"; | 143 |
| (e) The processor's control number, labeled as "RxPCN"; | 144 |
| (f) The insured's pharmacy benefits group number if different | 145 |
| from the insured's medical group number, labeled as "RxGrp." | 146 |
| (C) If the standardized identification card or the electronic | 147 |
| technology issued or required to be used as provided in division | 148 |
| (A)(1) of this section is also used for submission and routing of | 149 |
| nonpharmacy claims, the designation "Rx" is not required to be | 150 |
| included as part of the labels identified in divisions (B)(2)(d) | 151 |
| and (e) of this section. | 152 |
| (D)(1) Except as provided in division (D)(2) of this section, | 153 |
| if there is a change in the information contained in the | 154 |
| standardized identification card or the electronic technology | 155 |
| issued to an insured, the insurer or person under contract with | 156 |
| the insurer to provide managerial or administrative services shall | 157 |
| issue a new card or electronic technology to the insured. | 158 |
| (2) An insurer or person under contract with the insurer is | 159 |
| not required under division (D)(1) of this section to issue a new | 160 |
| card or electronic technology to an insured more than once during | 161 |
| a twelve-month period. | 162 |
| (E) Nothing in this section shall be construed as requiring | 163 |
| an insurer to produce more than one standardized identification | 164 |
| card or one electronic technology for use by insureds accessing | 165 |
| health care benefits provided under a policy of sickness and | 166 |
| accident insurance or a health benefit plan. | 167 |
| Section 2. Section 1 of this act shall take effect one year | 168 |
| after the effective date of this act. | 169 |
| Section 3. (A) Section 1751.111 of the Revised Code, as | 170 |
| enacted by this act, shall apply only with respect to policies, | 171 |
| contracts, and agreements delivered, issued for delivery, or | 172 |
| renewed in this state on or after the effective date of Section 1 | 173 |
| of this act. | 174 |
| (B) Section 3923.601 of the Revised Code, as enacted by this | 175 |
| act, shall apply only with respect to the following: | 176 |
| (1) Policies of sickness and accident insurance delivered, | 177 |
| issued for delivery, renewed, or used in this state on or after | 178 |
| the effective date of Section 1 of this act; | 179 |
| (2) Health benefit plans, other than Medicaid, established or | 180 |
| modified by this state on or after the effective date of Section 1 | 181 |
| of this act. | 182 |