As Reported by the House Civil and Commercial Law Committee

127th General Assembly Regular Session 2007-2008

Sub. H. B. No. 125

Representative Huffman 

Cosponsors: Representatives DeGeeter, Seitz, McGregor, J., Schneider, Latta, Adams, Gibbs, Setzer, Oelslager, Uecker, McGregor, R., Stewart, J., Stebelton, Fessler, Barrett, Wagoner, Celeste, Reinhard, Widener, Blessing, Book, Carmichael, Lundy, Hughes, Core, Dodd 

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A BILL

To amend sections 1751.13, 1753.01, 1753.07, 1753.09,

1

and 5111.17, to enact sections 3963.01 to 3963.10,

2

and to repeal sections 1753.03, 1753.04,

3

1753.05, and 1753.08 of the Revised Code to

4

establish certain uniform contract provisions

5

between health care providers and contracting

6

entities, to establish standardized

7

credentialing, to require contracting entities

8

to provide to health care providers specified

9

information concerning enrollees, to require

10

the Department of Job and Family Services to

11

allow managed care plans to use providers to

12

render care, and to create a Joint Legislative

13

Study Commission on Most Favored Nation Clauses

14

in Health Care Contracts.

15

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 1751.13, 1753.01, 1753.07, 1753.09,	16
and 5111.17 be amended and sections 3963.01, 3963.02, 3963.03,	17
3963.04, 3963.05, 3963.06, 3963.07, 3963.08, 3963.09, and 3963.10	18
of the Revised Code be enacted to read as follows:	19

Sec. 1751.13.  (A)(1)(a) A health insuring corporation shall,	20
either directly or indirectly, enter into contracts for the	21
provision of health care services with a sufficient number and	22
types of providers and health care facilities to ensure that all	23
covered health care services will be accessible to enrollees from	24
a contracted provider or health care facility.	25

(b) A health insuring corporation shall not refuse to	26
contract with a physician for the provision of health care	27
services or refuse to recognize a physician as a specialist on the	28
basis that the physician attended an educational program or a	29
residency program approved or certified by the American	30
osteopathic association. A health insuring corporation shall not	31
refuse to contract with a health care facility for the provision	32
of health care services on the basis that the health care facility	33
is certified or accredited by the American osteopathic association	34
or that the health care facility is an osteopathic hospital as	35
defined in section 3702.51 of the Revised Code.	36

(c) Nothing in division (A)(1)(b) of this section shall be	37
construed to require a health insuring corporation to make a	38
benefit payment under a closed panel plan to a physician or health	39
care facility with which the health insuring corporation does not	40
have a contract, provided that none of the bases set forth in that	41
division are used as a reason for failing to make a benefit	42
payment.	43

(2) When a health insuring corporation is unable to provide a	44
covered health care service from a contracted provider or health	45
care facility, the health insuring corporation must provide that	46
health care service from a noncontracted provider or health care	47
facility consistent with the terms of the enrollee's policy,	48
contract, certificate, or agreement. The health insuring	49
corporation shall either ensure that the health care service be	50
provided at no greater cost to the enrollee than if the enrollee	51
had obtained the health care service from a contracted provider or	52
health care facility, or make other arrangements acceptable to the	53
superintendent of insurance.	54

(3) Nothing in this section shall prohibit a health insuring	55
corporation from entering into contracts with out-of-state	56
providers or health care facilities that are licensed, certified,	57
accredited, or otherwise authorized in that state.	58

(B)(1) A health insuring corporation shall, either directly	59
or indirectly, enter into contracts with all providers and health	60
care facilities through which health care services are provided to	61
its enrollees.	62

(2) A health insuring corporation, upon written request,	63
shall assist its contracted providers in finding stop-loss or	64
reinsurance carriers.	65

(C) A health insuring corporation shall file an annual	66
certificate with the superintendent certifying that all provider	67
contracts and contracts with health care facilities through which	68
health care services are being provided contain the following:	69

(1) A description of the method by which the provider or	70
health care facility will be notified of the specific health care	71
services for which the provider or health care facility will be	72
responsible, including any limitations or conditions on such	73
services;	74

(2) The specific hold harmless provision specifying	75
protection of enrollees set forth as follows:	76

"[Provider/Health Care Facility] agrees that in no event,	77
including but not limited to nonpayment by the health insuring	78
corporation, insolvency of the health insuring corporation, or	79
breach of this agreement, shall [Provider/Health Care Facility]	80
bill, charge, collect a deposit from, seek remuneration or	81
reimbursement from, or have any recourse against, a subscriber,	82
enrollee, person to whom health care services have been provided,	83
or person acting on behalf of the covered enrollee, for health	84
care services provided pursuant to this agreement. This does not	85
prohibit [Provider/Health Care Facility] from collecting	86
co-insurance, deductibles, or copayments as specifically provided	87
in the evidence of coverage, or fees for uncovered health care	88
services delivered on a fee-for-service basis to persons	89
referenced above, nor from any recourse against the health	90
insuring corporation or its successor."	91

(3) Provisions requiring the provider or health care facility	92
to continue to provide covered health care services to enrollees	93
in the event of the health insuring corporation's insolvency or	94
discontinuance of operations. The provisions shall require the	95
provider or health care facility to continue to provide covered	96
health care services to enrollees as needed to complete any	97
medically necessary procedures commenced but unfinished at the	98
time of the health insuring corporation's insolvency or	99
discontinuance of operations. The completion of a medically	100
necessary procedure shall include the rendering of all covered	101
health care services that constitute medically necessary follow-up	102
care for that procedure. If an enrollee is receiving necessary	103
inpatient care at a hospital, the provisions may limit the	104
required provision of covered health care services relating to	105
that inpatient care in accordance with division (D)(3) of section	106
1751.11 of the Revised Code, and may also limit such required	107
provision of covered health care services to the period ending	108
thirty days after the health insuring corporation's insolvency or	109
discontinuance of operations.	110

The provisions required by division (C)(3) of this section	111
shall not require any provider or health care facility to continue	112
to provide any covered health care service after the occurrence of	113
any of the following:	114

(a) The end of the thirty-day period following the entry of a	115
liquidation order under Chapter 3903. of the Revised Code;	116

(b) The end of the enrollee's period of coverage for a	117
contractual prepayment or premium;	118

(c) The enrollee obtains equivalent coverage with another	119
health insuring corporation or insurer, or the enrollee's employer	120
obtains such coverage for the enrollee;	121

(d) The enrollee or the enrollee's employer terminates	122
coverage under the contract;	123

(e) A liquidator effects a transfer of the health insuring	124
corporation's obligations under the contract under division (A)(8)	125
of section 3903.21 of the Revised Code.	126

(4) A provision clearly stating the rights and	127
responsibilities of the health insuring corporation, and of the	128
contracted providers and health care facilities, with respect to	129
administrative policies and programs, including, but not limited	130
to, payments systems, utilization review, quality assurance,	131
assessment, and improvement programs, credentialing,	132
confidentiality requirements, and any applicable federal or state	133
programs;	134

(5) A provision regarding the availability and	135
confidentiality of those health records maintained by providers	136
and health care facilities to monitor and evaluate the quality of	137
care, to conduct evaluations and audits, and to determine on a	138
concurrent or retrospective basis the necessity of and	139
appropriateness of health care services provided to enrollees.	140
The provision shall include terms requiring the provider or health	141
care facility to make these health records available to	142
appropriate state and federal authorities involved in assessing	143
the quality of care or in investigating the grievances or	144
complaints of enrollees, and requiring the provider or health care	145
facility to comply with applicable state and federal laws related	146
to the confidentiality of medical or health records.	147

(6) A provision that states that contractual rights and	148
responsibilities may not be assigned or delegated by the provider	149
or health care facility without the prior written consent of the	150
health insuring corporation;	151

(7) A provision requiring the provider or health care	152
facility to maintain adequate professional liability and	153
malpractice insurance. The provision shall also require the	154
provider or health care facility to notify the health insuring	155
corporation not more than ten days after the provider's or health	156
care facility's receipt of notice of any reduction or cancellation	157
of such coverage.	158

(8) A provision requiring the provider or health care	159
facility to observe, protect, and promote the rights of enrollees	160
as patients;	161

(9) A provision requiring the provider or health care	162
facility to provide health care services without discrimination on	163
the basis of a patient's participation in the health care plan,	164
age, sex, ethnicity, religion, sexual preference, health status,	165
or disability, and without regard to the source of payments made	166
for health care services rendered to a patient. This requirement	167
shall not apply to circumstances when the provider or health care	168
facility appropriately does not render services due to limitations	169
arising from the provider's or health care facility's lack of	170
training, experience, or skill, or due to licensing restrictions.	171

(10) A provision containing the specifics of any obligation	172
on the primary care provider to provide, or to arrange for the	173
provision of, covered health care services twenty-four hours per	174
day, seven days per week;	175

(11) A provision setting forth procedures for the resolution	176
of disputes arising out of the contract;	177

(12) A provision stating that the hold harmless provision	178
required by division (C)(2) of this section shall survive the	179
termination of the contract with respect to services covered and	180
provided under the contract during the time the contract was in	181
effect, regardless of the reason for the termination, including	182
the insolvency of the health insuring corporation;	183

(13) A provision requiring those terms that are used in the	184
contract and that are defined by this chapter, be used in the	185
contract in a manner consistent with those definitions.	186

This division does not apply to the coverage of beneficiaries	187
enrolled in Title XVIII of the "Social Security Act," 49 Stat. 620	188
(1935), 42 U.S.C.A. 301, as amended, pursuant to a medicare risk	189
contract or medicare cost contract, or to the coverage of	190
beneficiaries enrolled in the federal employee health benefits	191
program pursuant to 5 U.S.C.A. 8905, or to the coverage of	192
beneficiaries enrolled in Title XIX of the "Social Security Act,"	193
49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended, known as the	194
medical assistance program or medicaid, provided by the department	195
of job and family services under Chapter 5111. of the Revised	196
Code, or to the coverage of beneficiaries under any federal health	197
care program regulated by a federal regulatory body, or to the	198
coverage of beneficiaries under any contract covering officers or	199
employees of the state that has been entered into by the	200
department of administrative services.	201

(D)(1) No health insuring corporation contract with a	202
provider or health care facility shall contain any of the	203
following:	204

(a) A provision that directly or indirectly offers an	205
inducement to the provider or health care facility to reduce or	206
limit medically necessary health care services to a covered	207
enrollee;	208

(b) A provision that penalizes a provider or health care	209
facility that assists an enrollee to seek a reconsideration of the	210
health insuring corporation's decision to deny or limit benefits	211
to the enrollee;	212

(c) A provision that limits or otherwise restricts the	213
provider's or health care facility's ethical and legal	214
responsibility to fully advise enrollees about their medical	215
condition and about medically appropriate treatment options;	216

(d) A provision that penalizes a provider or health care	217
facility for principally advocating for medically necessary health	218
care services;	219

(e) A provision that penalizes a provider or health care	220
facility for providing information or testimony to a legislative	221
or regulatory body or agency. This shall not be construed to	222
prohibit a health insuring corporation from penalizing a provider	223
or health care facility that provides information or testimony	224
that is libelous or slanderous or that discloses trade secrets	225
which the provider or health care facility has no privilege or	226
permission to disclose.	227

(f) A provision that violates Chapter 3963. of the Revised	228
Code.	229

(2) Nothing in this division shall be construed to prohibit a	230
health insuring corporation from doing either of the following:	231

(a) Making a determination not to reimburse or pay for a	232
particular medical treatment or other health care service;	233

(b) Enforcing reasonable peer review or utilization review	234
protocols, or determining whether a particular provider or health	235
care facility has complied with these protocols.	236

(E) Any contract between a health insuring corporation and an	237
intermediary organization shall clearly specify that the health	238
insuring corporation must approve or disapprove the participation	239
of any provider or health care facility with which the	240
intermediary organization contracts.	241

(F) If an intermediary organization that is not a health	242
delivery network contracting solely with self-insured employers	243
subcontracts with a provider or health care facility, the	244
subcontract with the provider or health care facility shall do all	245
of the following:	246

(1) Contain the provisions required by divisions (C) and (G)	247
of this section, as made applicable to an intermediary	248
organization, without the inclusion of inducements or penalties	249
described in division (D) of this section;	250

(2) Acknowledge that the health insuring corporation is a	251
third-party beneficiary to the agreement;	252

(3) Acknowledge the health insuring corporation's role in	253
approving the participation of the provider or health care	254
facility, pursuant to division (E) of this section.	255

(G) Any provider contract or contract with a health care	256
facility shall clearly specify the health insuring corporation's	257
statutory responsibility to monitor and oversee the offering of	258
covered health care services to its enrollees.	259

(H)(1) A health insuring corporation shall maintain its	260
provider contracts and its contracts with health care facilities	261
at one or more of its places of business in this state, and shall	262
provide copies of these contracts to facilitate regulatory review	263
upon written notice by the superintendent of insurance.	264

(2) Any contract with an intermediary organization that	265
accepts compensation shall include provisions requiring the	266
intermediary organization to provide the superintendent with	267
regulatory access to all books, records, financial information,	268
and documents related to the provision of health care services to	269
subscribers and enrollees under the contract. The contract shall	270
require the intermediary organization to maintain such books,	271
records, financial information, and documents at its principal	272
place of business in this state and to preserve them for at least	273
three years in a manner that facilitates regulatory review.	274

(I)(1) A health insuring corporation shall notify its	275
affected enrollees of the termination of a contract for the	276
provision of health care services between the health insuring	277
corporation and a primary care physician or hospital, by mail,	278
within thirty days after the termination of the contract.	279

(a) Notice shall be given to subscribers of the termination	280
of a contract with a primary care physician if the subscriber, or	281
a dependent covered under the subscriber's health care coverage,	282
has received health care services from the primary care physician	283
within the previous twelve months or if the subscriber or	284
dependent has selected the physician as the subscriber's or	285
dependent's primary care physician within the previous twelve	286
months.	287

(b) Notice shall be given to subscribers of the termination	288
of a contract with a hospital if the subscriber, or a dependent	289
covered under the subscriber's health care coverage, has received	290
health care services from that hospital within the previous twelve	291
months.	292

(2) The health insuring corporation shall pay, in accordance	293
with the terms of the contract, for all covered health care	294
services rendered to an enrollee by a primary care physician or	295
hospital between the date of the termination of the contract and	296
five days after the notification of the contract termination is	297
mailed to a subscriber at the subscriber's last known address.	298

(J) Divisions (A) and (B) of this section do not apply to any	299
health insuring corporation that, on June 4, 1997, holds a	300
certificate of authority or license to operate under Chapter 1740.	301
of the Revised Code.	302

(K) Nothing in this section shall restrict the governing body	303
of a hospital from exercising the authority granted it pursuant to	304
section 3701.351 of the Revised Code.	305

Sec. 1753.01.  As used in this chapter:

306

(A) "Economic profiling" means a health insuring	307
corporation's use of economic performance data and economic	308
information in determining whether to contract with a provider for	309
the provision of covered health care services to enrollees as a	310
participating provider.	311

(B) "Basic, "basic health care services," "enrollee," "health	312
care facility," "health care services," "health insuring	313
corporation," "medical record," "person," "primary care provider,"	314
"provider," "subscriber," and "supplemental health care services"	315
have the same meanings as in section 1751.01 of the Revised Code.	316

Sec. 1753.07.  (A)(1) Prior to entering into a participation	317
contract with a provider under section 1751.13 of the Revised	318
Code, a health insuring corporation shall disclose basic	319
information regarding its programs and procedures to the provider,	320
upon the provider's request. The information shall include all of	321
the following:	322

(1)(a) How a participating provider is reimbursed for the	323
participating provider's services, including the range and	324
structure of any financial risk sharing arrangements, a	325
description of any incentive plans, and, if reimbursed according	326
to a type of fee-for-service arrangement, the level of	327
reimbursement for the participating provider's services;	328

(2)(b) Insofar as division (A)(1) of section 3963.03 of the	329
Revised Code is applicable, all of the information that is	330
described in that division and is not included in division	331
(A)(1)(a) of this section.	332

(2) Prior to entering into a participation contract with a	333
provider under section 1751.13 of the Revised Code, a health	334
insuring corporation shall disclose the following information upon	335
the provider's request:	336

(a) How referrals to other participating providers or to	337
nonparticipating providers are made;	338

(3)(b) The availability of dispute resolution procedures and	339
the potential for cost to be incurred;	340

(4)(c) How a participating provider's name and address will	341
be used in marketing materials.	342

(B) A health insuring corporation shall provide all of the	343
following to a participating provider:	344

(1) Any material incorporated by reference into the	345
participation contract, that is not otherwise available as a	346
public record, if such material affects the participating	347
provider;	348

(2) Administrative manuals related to provider participation,	349
if any;	350

(3) Insofar as division (B) of section 3963.03 of the Revised	351
Code is applicable, the summary disclosure form with the	352
disclosures required under that division;	353

(4) A signed and dated copy of the final participation	354
contract.	355

Sec. 1753.09.  (A) Except as provided in division (D) of this	356
section, prior to terminating the participation of a provider on	357
the basis of the participating provider's failure to meet the	358
health insuring corporation's standards for quality or utilization	359
in the delivery of health care services, a health insuring	360
corporation shall give the participating provider notice of the	361
reason or reasons for its decision to terminate the provider's	362
participation and an opportunity to take corrective action. The	363
health insuring corporation shall develop a performance	364
improvement plan in conjunction with the participating provider.	365
If after being afforded the opportunity to comply with the	366
performance improvement plan, the participating provider fails to	367
do so, the health insuring corporation may terminate the	368
participation of the provider.	369

(B)(1) A participating provider whose participation has been	370
terminated under division (A) of this section may appeal the	371
termination to the appropriate medical director of the health	372
insuring corporation. The medical director shall give the	373
participating provider an opportunity to discuss with the medical	374
director the reason or reasons for the termination.	375

(2) If a satisfactory resolution of a participating	376
provider's appeal cannot be reached under division (B)(1) of this	377
section, the participating provider may appeal the termination to	378
a panel composed of participating providers who have comparable or	379
higher levels of education and training than the participating	380
provider making the appeal. A representative of the participating	381
provider's specialty shall be a member of the panel, if possible.	382
This panel shall hold a hearing, and shall render its	383
recommendation in the appeal within thirty days after holding the	384
hearing. The recommendation shall be presented to the medical	385
director and to the participating provider.	386

(3) The medical director shall review and consider the	387
panel's recommendation before making a decision. The decision	388
rendered by the medical director shall be final.	389

(C) A provider's status as a participating provider shall	390
remain in effect during the appeal process set forth in division	391
(B) of this section unless the termination was based on any of the	392
reasons listed in division (D) of this section.	393

(D) Notwithstanding division (A) of this section, a	394
provider's participation may be immediately terminated if the	395
participating provider's conduct presents an imminent risk of harm	396
to an enrollee or enrollees; or if there has occurred unacceptable	397
quality of care, fraud, patient abuse, loss of clinical	398
privileges, loss of professional liability coverage, incompetence,	399
or loss of authority to practice in the participating provider's	400
field; or if a governmental action has impaired the participating	401
provider's ability to practice.	402

(E) Divisions (A) to (D) of this section apply only to	403
providers who are natural persons.	404

(F)(1) Nothing in this section prohibits a health insuring	405
corporation from rejecting a provider's application for	406
participation, or from terminating a participating provider's	407
contract, if the health insuring corporation determines that the	408
health care needs of its enrollees are being met and no need	409
exists for the provider's or participating provider's services.	410

(2) Nothing in this section shall be construed as prohibiting	411
a health insuring corporation from terminating a participating	412
provider who does not meet the terms and conditions of the	413
participating provider's contract.	414

(3) Nothing in this section shall be construed as prohibiting	415
a health insuring corporation from terminating a participating	416
provider's contract pursuant to any provision of the contract	417
described in division (E)(2) of section 3963.02 of the Revised	418
Code, except that, notwithstanding any provision of a contract	419
described in that division, this section applies to the	420
termination of a participating provider's contract for any of the	421
causes described in divisions (A), (D), and (F)(1) and (2) of	422
this section.	423

(G) The superintendent of insurance may adopt rules as	424
necessary to implement and enforce sections 1753.04 to1753.06,	425
1753.07, and 1753.09 of the Revised Code. Such rules shall be	426
adopted in accordance with Chapter 119. of the Revised Code. The	427
director of health may make recommendations to the superintendent	428
for rules necessary to implement and enforce sections 1753.04 to	429
1753.06, 1753.07, and 1753.09 of the Revised Code. In adopting any	430
rules pursuant to this division, the superintendent shall consider	431
the recommendations of the director.	432

Sec. 3963.01. As used in this chapter:

433

(A) "Affiliate" means any person or entity that has ownership	434
or control of a contracting entity, is owned or controlled by a	435
contracting entity, or is under common ownership or control with a	436
contracting entity.	437

(B) "Basic health care services" has the same meaning as in	438
division (A) of section 1751.01 of the Revised Code, except that	439
it does not include any services listed in that division that are	440
provided by a pharmacist or nursing home.	441

(C) "Contracting entity" means any person that has a primary	442
business purpose of contracting with participating providers for	443
the delivery of health care services.	444

(D) "Credentialing" means the process of assessing and	445
validating the qualifications of a provider applying to be	446
approved by a contracting entity to provide basic or supplemental	447
health care services to the contracting entity's enrollees.	448

(E) "Edit" means adjusting one or more procedure codes billed	449
by a participating provider on a claim for payment or a	450
contracting entity's practice that results in any of the	451
following:	452

(1) Payment for some, but not all of the procedure codes	453
originally billed by a participating provider;	454

(2) Payment for a different procedure code than the procedure	455
code originally billed by a participating provider;	456

(3) A reduced payment as a result of services provided to an	457
enrollee that are claimed under more than one procedure code on	458
the same service date.	459

(F) "Enrollee" means any person eligible for health care	460
benefits under a health benefit plan and includes all of the	461
following terms:	462

(1) "Enrollee" and "subscriber" as defined by section 1751.01	463
of the Revised Code;	464

(2) "Member" as defined by section 1739.01 of the Revised	465
Code;	466

(3) "Insured" and "plan member" pursuant to Chapter 3923. of	467
the Revised Code;	468

(4) "Beneficiary" as defined by section 3901.38 of the	469
Revised Code.	470

(G) "Health care contract" means a contract entered into,	471
modified, or renewed between a contracting entity and a	472
participating provider for the delivery of basic or supplemental	473
health care services to enrollees.	474

(H) "Health care services" means basic health care services	475
and supplemental health care services.	476

(I) "Participating provider" means a provider that has a	477
health care contract with a contracting entity and is entitled to	478
reimbursement by the contracting entity for health care services	479
rendered to an enrollee under the health care contract.	480

(J) "Payer" means any person that assumes the financial risk	481
for the payment of claims under a health care contract or the	482
reimbursement for health care services provided to enrollees by	483
participating providers pursuant to a health care contract.	484

(K) "Primary enrollee" means a person who is responsible for	485
making payments to a contracting entity for participation in a	486
health care plan or an enrollee whose employment or other status	487
is the basis of eligibility for enrollment in a health care plan.	488

(L) "Procedure codes" includes the American medical	489
association's current procedural terminology code, the American	490
dental association's current dental terminology, and the centers	491
for medicare and medicaid services health care common procedure	492
coding system.	493

(M) "Product" means a product line for health care services,	494
including, but not limited to a health insuring corporation	495
product or a medicaid product as established by a contracting	496
entity and for which the participating provider may be obligated	497
to provide health care services pursuant to a health care	498
contract.	499

(N) "Provider" means a physician, podiatrist, dentist,	500
chiropractor, optometrist, psychologist, advanced practice nurse,	501
occupational therapist, massage therapist, physical therapist,	502
professional counselor, professional clinical counselor, hearing	503
aid dealer, orthotist, prosthetist, home medical equipment	504
services provider, hospital, ambulatory surgery center, or	505
medical transportation company. "Provider" does not mean a	506
pharmacist or nursing home.	507

(O) "Supplemental health care services" has the same meaning	508
as in division (B) of section 1751.01 of the Revised Code, except	509
that it does not include any services listed in that division that	510
are provided by a pharmacist or nursing home.	511

Sec. 3963.02. (A)(1) No contracting entity shall sell, rent,	512
or give the contracting entity's rights to a participating	513
provider's services pursuant to the contracting entity's health	514
care contract with the participating provider unless one of the	515
following applies:	516

(a) The third party accessing the participating provider's	517
services under the health care contract is an employer or other	518
entity providing coverage for health care services to its	519
employees or members, and that employer or entity has a contract	520
with the contracting entity or its affiliate for the	521
administration or processing of claims for payment or service	522
provided pursuant to the health care contract with the	523
participating provider.	524

(b) The third party accessing the participating provider's	525
services under the health care contract is either of the	526
following:	527

(i) An affiliate or subsidiary of the contracting entity;

528

(ii) Providing administrative services to, or receiving	529
administrative services from, the contracting entity or an	530
affiliate or subsidiary of the contracting entity.	531

(c) The health care contract specifically provides that it	532
applies to network rental arrangements and states that one purpose	533
of the contract is selling, renting, or giving the contracting	534
entity's rights to the services of the participating provider,	535
including other preferred provider organizations, and the third	536
party accessing the participating provider's services is either of	537
the following:	538

(i) A payer or a third-party administrator or other entity	539
responsible for administering claims on behalf of the payer;	540

(ii) A preferred provider organization or preferred provider	541
network that receives access to the participating provider's	542
services pursuant to an arrangement with the preferred provider	543
organization or preferred provider network in a contract with the	544
participating provider that is in compliance with division	545
(A)(1)(c) of this section, and is required to comply with all of	546
the terms, conditions, and affirmative obligations to which the	547
originally contracted primary participating provider network is	548
bound under its contract with the participating provider,	549
including, but not limited to, obligations concerning patient	550
steerage and the timeliness and manner of reimbursement.	551

(2) The contracting entity that sells, rents, or gives the	552
contracting entity's rights to the participating provider's	553
services pursuant to the contracting entity's health care contract	554
with the participating provider as provided in division (A)(1) of	555
this section shall do both of the following:	556

(a) Maintain a web page that contains a listing of third	557
parties described in divisions (A)(1)(b)(i) and (c) of this	558
section with whom a contracting entity contracts for the purpose	559
of selling, renting, or giving the contracting entity's rights to	560
the services of participating providers that is updated at least	561
every six months and is accessible to all participating providers,	562
or maintain a toll-free telephone number accessible to all	563
participating providers by means of which participating providers	564
may access the same listing of third parties;	565

(b) Require that the third party accessing the participating	566
provider's services through the participating provider's health	567
care contract is obligated to comply with all of the applicable	568
terms and conditions of the contract, including, but not limited	569
to, the products for which the participating provider has agreed	570
to provide services, except that a payer receiving administrative	571
services from the contracting entity or its affiliate shall be	572
solely responsible for payment to the participating provider.	573

(3) Any information disclosed to a participating provider	574
under this section shall be considered proprietary and shall not	575
be distributed by the participating provider.	576

(4) Except as provided in division (A)(1) of this section, no	577
entity other than a contracting entity shall sell, rent, or give a	578
contracting entity's rights to the participating provider's	579
services pursuant to a health care contract.	580

(B)(1) No contracting entity shall require, as a condition of	581
contracting with the contracting entity, that a participating	582
provider provide services for more than one product offered by the	583
contracting entity.	584

(2) Division (B)(1) of this section shall not be construed to	585
do any of the following:	586

(a) Prohibit any participating provider from voluntarily	587
accepting an offer by a contracting entity to provide health care	588
services under more than one of the contracting entity's products;	589

(b) Prohibit any contracting entity from offering any	590
financial incentive or other form of consideration specified in	591
the health care contract for a participating provider to provide	592
health care services under more than one of the contracting	593
entity's products;	594

(c) Require any contracting entity to contract with a	595
participating provider to provide health care services under only	596
one of the contracting entity's products if the contracting	597
entity does not wish to do so.	598

(3) Notwithstanding division (B)(2) of this section, no	599
contracting entity shall require, as a condition of contracting	600
with the contracting entity, that the participating provider	601
accept any future product offering that the contracting entity	602
makes.	603

(C) No contracting entity shall require, as a condition of	604
contracting with the contracting entity, that a participating	605
provider waive or forego any right or benefit to which the	606
participating provider may be entitled under state or federal law.	607
However, a contracting entity may restrict a participating	608
provider's scope of practice for the services to be provided	609
under the contract.	610

(D) No health care contract shall do either of the following:

611

(1) Prohibit any participating provider from entering into a	612
health care contract with any other contracting entity;	613

(2) Preclude its use or disclosure for the purpose of	614
enforcing this chapter or other state or federal law, except that	615
a health care contract may require that appropriate measures be	616
taken to preserve the confidentiality of any proprietary or	617
trade-secret information.	618

(E)(1) In addition to any other lawful reasons for	619
terminating a health care contract, a health care contract may be	620
terminated under the circumstances described in division (A)(2)	621
of section 3963.04 of the Revised Code.	622

(2) If the health care contract provides for termination for	623
cause by either party, the health care contract shall state the	624
reasons that may be used for termination for cause, which terms	625
shall be reasonable. Subject to division (E)(3) of this section,	626
the health care contract shall state the time by which the parties	627
must provide notice of termination for cause and to whom the	628
parties shall give the notice.	629

(3) Nothing in divisions (E)(1) and (2) of this section shall	630
be construed as prohibiting any health insuring corporation from	631
terminating a participating provider's contract for any of the	632
causes described in divisions (A), (D), and (F)(1) and (2) of	633
section 1753.09 of the Revised Code. Notwithstanding any provision	634
in a health care contract pursuant to division (E)(2) of this	635
section, section 1753.09 of the Revised Code applies to the	636
termination of a participating provider's contract for any of the	637
causes described in divisions (A), (D), and (F)(1) and (2) of	638
section 1753.09 of the Revised Code.	639

(F)(1) Disputes among parties that only concern the	640
enforcement of the contract rights conferred by sections 3963.02	641
and 3963.04, utilizing the applicable definitions in section	642
3963.01, of the Revised Code are subject to a mutually agreed	643
upon arbitration mechanism that is binding on all parties. The	644
arbitrator may award reasonable attorney's fees and costs for	645
arbitration relating to the enforcement of this section to the	646
prevailing party.	647

(2) A party shall not simultaneously maintain an arbitration	648
proceeding as described in division (F)(1) of this section and	649
pursue a complaint with the superintendent of insurance to	650
investigate the subject matter of the arbitration proceeding. If	651
the superintendent of insurance initiates an investigation into	652
the subject matter of a pending arbitration proceeding, the	653
arbitration proceeding shall be stayed at the request of any	654
party pending the outcome of the investigation by the	655
superintendent. The arbitrator shall make the arbitrator's	656
decision in an arbitration proceeding having due regard for any	657
applicable rules, bulletins, rulings, or decisions theretofore	658
issued by the department of insurance or any court concerning the	659
enforcement of the contract rights conferred by sections 3963.02	660
and 3963.04, utilizing the applicable definitions in section	661
3963.01, of the Revised Code.	662

Sec. 3963.03. (A) Each health care contract shall include all	663
of the following information:	664

(1)(a) Information sufficient for the participating provider	665
to determine the compensation or payment terms for health care	666
services, including all of the following, subject to division	667
(A)(1)(b) of this section:	668

(i) The manner of payment, such as fee-for-service,	669
capitation, or risk;	670

(ii) The fee schedule of procedure codes reasonably expected	671
to be billed by a participating provider's specialty for services	672
provided pursuant to the health care contract and the associated	673
payment or compensation for each procedure code. A fee schedule	674
may be provided electronically. Upon request, a contracting	675
entity shall provide a participating provider with the fee	676
schedule for any other procedure codes requested and a written	677
fee schedule, that shall not be required more frequently than	678
twice per year excluding when it is provided in connection with	679
any change to the schedule. The contracting entity also shall	680
state the effect, if any, on payment or compensation if more than	681
one procedure code applies to the service. A contracting entity	682
may satisfy this requirement by providing a clearly	683
understandable, readily available mechanism, such as a specific	684
web site address, that allows a participating provider to	685
determine the effect of procedure codes on payment or	686
compensation before a service is provided or a claim is	687
submitted.	688

(b) If the contracting entity is unable to include the	689
information described in division (A)(1)(a)(ii) of this section,	690
the contracting entity shall include both of the following types	691
of information instead:	692

(i) The methodology used to calculate any fee schedule, such	693
as relative value unit system and conversion factor or percentage	694
of billed charges. If applicable, the methodology disclosure	695
shall include the name of any relative value unit system, its	696
version, edition, or publication date, any applicable conversion	697
or geographic factor, and any date by which compensation or fee	698
schedules may be changed by the methodology as anticipated at the	699
time of contract.	700

(ii) The identity of any internal processing edits used by	701
the contracting entity, including the publisher, product name,	702
version, and version update of any editing software used by the	703
contracting entity.	704

(2) Any product or network for which the participating	705
provider is to provide services;	706

(3) The term of the health care contract;

707

(4) A specific web site address that contains the identity of	708
the contracting entity or payer responsible for the processing of	709
the participating provider's compensation or payment;	710

(5) Any internal mechanism provided by the contracting entity	711
to resolve disputes concerning the interpretation or application	712
of the terms and conditions of the contract. A contracting entity	713
may satisfy this requirement by providing a clearly	714
understandable, readily available mechanism, such as a specific	715
web site address or an appendix, that allows a participating	716
provider to determine the procedures for the internal mechanism to	717
resolve those disputes.	718

(6) A list of addenda, if any, to the contract.

719

(B)(1) Each contracting entity shall include a summary	720
disclosure form with a health care contract that includes all of	721
the information specified in division (A) of this section. The	722
information in the summary disclosure form shall refer to the	723
location in the health care contract, whether a page number,	724
section of the contract, appendix, or other identifiable location,	725
that specifies the provisions in the contract to which the	726
information in the form refers.	727

(2) The summary disclosure form shall include all of the	728
following statements:	729

(a) That the form is a guide to the health care contract and	730
that the terms and conditions of the health care contract	731
constitute the contract rights of the parties;	732

(b) That reading the form is not a substitute for reading the	733
entire health care contract;	734

(c) That by signing the health care contract, the	735
participating provider will be bound by the contract's terms and	736
conditions;	737

(d) That the terms and conditions of the health care contract	738
may be amended pursuant to section 3963.04 of the Revised Code and	739
the participating provider is encouraged to carefully read any	740
proposed amendments sent after execution of the contract;	741

(e) That nothing in the summary disclosure form creates any	742
additional rights or causes of action in favor of either party.	743

(3) No contracting entity that includes any information in	744
the summary disclosure form with the reasonable belief that the	745
information is truthful or accurate shall be subject to a civil	746
action for damages or to binding arbitration based on the summary	747
disclosure form. Division (B)(3) of this section does not impair	748
or affect any power of the department of insurance to enforce any	749
applicable law.	750

(4) The summary disclosure form described in divisions (B)(1)	751
and (2) of this section shall be in substantially the following	752
form:	753

"SUMMARY DISCLOSURE FORM	754

(1) Compensation terms

755

(a) Manner of payment

756

[ ] Fee for service

757

[ ] Capitation

758

[ ] Risk

759

[ ] Other ............... See ...............

760

(b) Fee schedule available at ...............

761

(c) Fee calculation schedule available at ...............

762

(d) Identity of internal processing edits available at	763
...............	764

(e) Information in (c) and (d) is not required if information	765
in (b) is provided.	766

(2) List of products or networks covered by this contract

767

[ ] ...............

768

[ ] ...............

769

[ ] ...............

770

[ ] ...............

771

[ ] ...............

772

(3) Term of this contract ...............

773

(4) Contracting entity or payer responsible for processing	774
payment available at ...............	775

(5) Internal mechanism for resolving disputes regarding	776
contract terms available at ...............	777

(6) Addenda to contract

778

Title           Subject

779

(a)

780

(b)

781

(c)

782

(d)

783

IMPORTANT INFORMATION - PLEASE READ CAREFULLY	784

The information provided in this Summary Disclosure Form is a	785
guide to the attached Health Care Contract as defined in section	786
3963.01(G) of the Ohio Revised Code. The terms and conditions of	787
the attached Health Care Contract constitute the contract rights	788
of the parties.	789

Reading this Summary Disclosure Form is not a substitute for	790
reading the entire Health Care Contract. When you sign the Health	791
Care Contract, you will be bound by its terms and conditions.	792
These terms and conditions may be amended over time pursuant to	793
section 3963.04 of the Ohio Revised Code. You are encouraged to	794
read any proposed amendments that are sent to you after execution	795
of the Health Care Contract.	796

Nothing in this Summary Disclosure Form creates any	797
additional rights or causes of action in favor of either party."	798

(C) When a contracting entity presents a proposed health care	799
contract for consideration by a participating provider, the	800
contracting entity shall provide in writing or make reasonably	801
available the information required in division (A)(1) of this	802
section. If the information is not disclosed in writing, it shall	803
be disclosed in a manner that allows the participating provider	804
to evaluate the participating provider's payment or compensation	805
for services under the health care contract. The contracting	806
entity need not provide such information to the participating	807
provider in written format more than twice a year.	808

(D) The contracting entity shall identify any utilization	809
management, quality improvement, or a similar program that the	810
contracting entity uses to review, monitor, evaluate, or assess	811
the services provided pursuant to a health care contract. The	812
contracting entity shall disclose the policies, procedures, or	813
guidelines of such a program applicable to a participating	814
provider upon request by the participating provider within	815
fourteen days after the date of the request.	816

(E) Nothing in this section shall be construed as preventing	817
or affecting the application of section 1753.07 of the Revised	818
Code that would otherwise apply to a contract with a participating	819
provider.	820

Sec. 3963.04. (A)(1) An amendment of a health care contract	821
shall occur only if the contracting entity provides to the	822
participating provider the proposed amendment in writing and	823
notice of the proposed amendment not later than sixty days prior	824
to the effective date of the amendment. The notice shall be	825
conspicuously entitled "Notice of Material Change to Contract" and	826
shall specify the effective date of the proposed amendment.	827

(2) Subject to division (A)(4) of this section, if within	828
thirty days after receiving the proposed amendment and notice	829
described in division (A)(1) of this section the participating	830
provider objects in writing to the proposed amendment, and there	831
is no resolution of the objection, either party may terminate	832
the health care contract upon written notice of termination	833
provided to the other party not later than thirty days prior to	834
the effective date of the proposed amendment.	835

(3) If the participating provider does not object to the	836
proposed amendment in the manner described in division (A)(2) of	837
this section, the amendment shall be effective as specified in	838
the notice described in division (A)(1) of this section.	839

(4) If a proposed amendment is the addition of a new category	840
of coverage under the health care contract, the participating	841
provider objects to that proposed amendment in the manner	842
described in division (A)(2) of this section, and there is no	843
resolution of the objection, the amendment shall not be effective	844
as to the participating provider, and the objection shall not be	845
a basis upon which the contracting entity may terminate the	846
contract under that division.	847

(B)(1) Division (A) of this section does not apply if the	848
delay caused by compliance with that division could result in	849
imminent harm to an enrollee or if the amendment of a health care	850
contract is required by state or federal law, rule, or regulation.	851

(2) This section does not apply under any of the following	852
circumstances:	853

(a) The participating provider's payment or compensation is	854
based on the current medicaid or medicare physician fee schedule,	855
and the change in payment or compensation results solely from a	856
change in that physician fee schedule.	857

(b) A routine change or update of the health care contract is	858
made in response to any addition, deletion, or revision of any	859
service code, procedure code, or reporting code, or a pricing	860
change is made by any third party source.	861

For purposes of division (B)(2)(b) of this section:

862

(i) "Service code, procedure code, or reporting code" means	863
the current procedural terminology (CPT), the healthcare common	864
procedure coding system (HCPCS), the international classification	865
of diseases (ICD), or the drug topics redbook average wholesale	866
price (AWP).	867

(ii) "Third party source" means the American medical	868
association, the centers for medicare and medicaid services, the	869
national center for health statistics, the department of health	870
and human services office of the inspector general, the Ohio	871
department of insurance, or the Ohio department of job and family	872
services.	873

(C) Notwithstanding divisions (A) and (B) of this section, a	874
health care contract may be modified, without the need for an	875
amendment pursuant to division (A) of this section, by operation	876
of law as required by any applicable state or federal law, rule,	877
or regulation. Nothing in this section shall be construed to	878
require the renegotiation of a health care contract that is in	879
existence before the effective date of this section, until the	880
time that the contract is renewed or modified.	881

Sec. 3963.05. (A) The department of insurance shall prepare	882
and adopt a form, in electronic or paper format, that is	883
substantially similar to the credentialing form used by the	884
council for affordable quality healthcare (CAQH), and that form	885
shall be the standard credentialing form for physicians. The	886
department of insurance also shall prepare the standard	887
credentialing form for all other providers.	888

(B) No contracting entity shall fail to use the applicable	889
standard credentialing form described in division (A) of this	890
section when initially credentialing or recredentialing providers	891
in connection with policies, health care contracts, and	892
agreements providing basic or supplemental health care services.	893

(C) No contracting entity shall require a provider to provide	894
any information in addition to the information required by the	895
applicable standard credentialing form described in division (A)	896
of this section in connection with policies, health care	897
contracts, and agreements providing basic or supplemental health	898
care services.	899

Sec. 3963.06. (A) If a provider, upon the oral or written	900
request of a contracting entity to submit a credentialing form,	901
submits a credentialing form that is not complete, the contracting	902
entity that receives the form shall notify the provider of the	903
deficiency electronically or by certified mail, return receipt	904
requested, not later than twenty-one days after the contracting	905
entity receives the form.	906

(B) If a contracting entity receives any information that is	907
inconsistent with the information given by the provider in the	908
credentialing form, the contracting entity may request the	909
provider to submit a written clarification of the inconsistency.	910
The contracting entity shall send the request described in this	911
division electronically or by certified mail, return receipt	912
requested.	913

(C)(1) The credentialing process under this section starts	914
when a provider initially submits a credentialing form upon the	915
oral or written request of a contracting entity. Subject to	916
division (C)(2) of this section, a contracting entity shall	917
complete the credentialing process not later than ninety days	918
after the contracting entity receives that credentialing form	919
from the provider. A contracting entity that does not complete the	920
credentialing process within the ninety-day period specified in	921
this division is liable for a civil penalty payable to the	922
provider in the amount of five hundred dollars per day, including	923
weekend days, starting at the expiration of that ninety-day period	924
until the provider's application for the health care contract is	925
granted or denied.	926

(2) The requirement that the credentialing process be	927
completed within the ninety-day period specified in division	928
(C)(1) of this section does not apply to a contracting entity if a	929
provider that submits a credentialing form to the contracting	930
entity under that division is a home medical equipment services	931
provider, hospital, ambulatory surgery center, or medical	932
transportation company.	933

Sec. 3963.07. (A)(1) Each contracting entity shall, upon a	934
participating provider's submission of an enrollee's name, the	935
enrollee's relationship to the primary enrollee, and the	936
enrollee's birth date, make available information maintained in	937
the ordinary course of business that is sufficient for the	938
participating provider to determine at the time of the enrollee's	939
visit all of the following:	940

(a) The enrollee's identification number assigned by the	941
contracting entity;	942

(b) The birth date and gender of the primary enrollee;

943

(c) The names, birth dates, and gender of all covered	944
dependents;	945

(d) The current enrollment and eligibility status of the	946
enrollee;	947

(e) Whether a specific type or category of service is a	948
covered benefit for the enrollee;	949

(f) The enrollee's excluded benefits or limitations, whether	950
group or individual;	951

(g) The enrollee's copayment requirements;

952

(h) The unmet amount of the enrollee's deductible or the	953
enrollee's financial responsibility.	954

(2) A contracting entity shall make available the information	955
required by division (A)(1) of this section electronically or by	956
an internet portal.	957

(3) Notwithstanding division (A)(1) of this section, no	958
contracting entity shall make the information required by that	959
division available to any person except to a participating	960
provider or the participating provider's agent or to any person or	961
governmental entity that is authorized under state and federal	962
law to receive personally identifiable information concerning an	963
enrollee or an enrollee's dependent.	964

(4) No contracting entity directly or indirectly shall charge	965
a participating provider any fee for the information the	966
contracting entity makes available pursuant to division (A) of	967
this section.	968

(5) A contracting entity is considered as having complied	969
with division (A) of this section if the information specified in	970
division (A)(1) of this section is updated once a month and the	971
date on which the information is updated is included with the	972
information that is made available electronically or by internet	973
portal pursuant to division (A)(2) of this section.	974

(B) All remittance notices sent by a payer, whether written	975
or electronic, shall include both of the following:	976

(1) The name of the payer issuing the payment to the	977
participating provider;	978

(2) The name of the contracting entity through which the	979
payment rate and any discount are claimed, if the contracting	980
entity is different from the payer.	981

(C) Division (A) of this section takes effect January 1,	982
2009.	983

Sec. 3963.08.  The superintendent of insurance shall adopt	984
any rules necessary for the implementation of this chapter.	985

Sec. 3963.09. (A) A series of violations of this chapter by	986
any person regulated by the department of insurance under Title	987
XVII or Title XXXIX of the Revised Code that, taken together,	988
constitute a pattern or practice of violating this chapter may be	989
defined as an unfair and deceptive insurance practice under	990
sections 3901.19 to 3901.26 of the Revised Code.	991

(B) The superintendent of insurance may conduct a market	992
conduct examination of any person regulated by the department of	993
insurance under Title XVII or Title XXXIX of the Revised Code to	994
determine whether any violation of this chapter has occurred. When	995
conducting that type of examination, the superintendent of	996
insurance may assess the costs of the examination against the	997
person examined. The superintendent may enter into a consent	998
agreement to impose any administrative assessment or fine for	999
conduct discovered that may be a violation of this chapter. All	1000
costs, assessments, and fines collected under this section shall	1001
be deposited to the credit of the department of insurance	1002
operating fund.	1003

Sec. 3963.10.  This chapter does not apply with respect to	1004
any of the following:	1005

(A) Payments made to providers for rendering health care	1006
services to medicaid recipients pursuant to the reimbursement	1007
system referred to by the department of job and family services	1008
as the fee-for-service system;	1009

(B) Payments made to providers for rendering health care	1010
services to claimants pursuant to claims made under Chapter 4121.,	1011
4123., 4127., or 4131. of the Revised Code;	1012

(C) Payments made to providers for rendering health care	1013
services to beneficiaries of the medicare program established	1014
under Title XVIII of the "Social Security Act," 79 Stat. 286	1015
(1965), 42 U.S.C. 1395, as amended;	1016

(D) An exclusive contract between a health insuring	1017
corporation and a single group of providers in a specific	1018
geographic area to provide or arrange for the provision of health	1019
care services.	1020

Sec. 5111.17.  (A) The department of job and family services	1021
may enter into contracts with managed care organizations,	1022
including health insuring corporations, under which the	1023
organizations are authorized to provide, or arrange for the	1024
provision of, health care services to medical assistance	1025
recipients who are required or permitted to obtain health care	1026
services through managed care organizations as part of the care	1027
management system established under section 5111.16 of the	1028
Revised Code.	1029

(B) The director of job and family services may adopt rules	1030
in accordance with Chapter 119. of the Revised Code to implement	1031
this section.	1032

(C) The department of job and family services shall allow	1033
managed care plans to use providers to render care upon	1034
completion of the managed care plan's credentialing process.	1035

Section 2. That existing sections 1751.13, 1753.01, 1753.07,	1036
1753.09, and 5111.17 and sections 1753.03, 1753.04, 1753.05, and	1037
1753.08 of the Revised Code are hereby repealed.	1038

Section 3. Sections 3963.01 to 3963.10 of the Revised Code,	1039
as enacted by this act, shall apply only to contracts that are	1040
delivered, issued for delivery, or renewed or modified in this	1041
state on or after the effective date of this act. A health	1042
insuring corporation having fewer than fifteen thousand enrollees	1043
shall comply with the provisions of this section within twelve	1044
months after the effective date of this act.	1045

Section 4. Division (A) of section 3963.07 of the Revised	1046
Code, as enacted by this act, takes effect January 1, 2009.	1047

Section 5. (A) As used in this section and Section 6 of this	1048
act:	1049

(1) "Most favored nation clause" means a provision in a	1050
health care contract that does any of the following:	1051

(a) Prohibits, or grants a contracting entity an option to	1052
prohibit, the participating provider from contracting with another	1053
contracting entity to provide health care services at a lower	1054
price than the payment specified in the contract;	1055

(b) Requires, or grants a contracting entity an option to	1056
require, the participating provider to accept a lower payment in	1057
the event the participating provider agrees to provide health care	1058
services to any other contracting entity at a lower price;	1059

(c) Requires, or grants a contracting entity an option to	1060
require, termination or renegotiation of the existing health care	1061
contract in the event the participating provider agrees to provide	1062
health care services to any other contracting entity at a lower	1063
price;	1064

(d) Requires the participating provider to disclose the	1065
participating provider's contractual reimbursement rates with	1066
other contracting entities.	1067

(2) "Contracting entity," "health care contract," "health	1068
care services," "participating provider," and "provider" have the	1069
same meanings as in section 3963.01 of the Revised Code, as	1070
enacted by this act.	1071

(B) No health care contract that includes a most favored	1072
nation clause shall be entered into, and no health care contract	1073
at the instance of a contracting entity shall be amended,	1074
modified, or renewed to include a most favored nation clause, for	1075
a period of two years after the effective date of this act,	1076
subject to extension as provided in Section 6 of this act.	1077

Section 6. (A) There is hereby created the Joint Legislative	1078
Study Commission on Most Favored Nation Clauses in Health Care	1079
Contracts consisting of fifteen members as follows:	1080

(1) The Superintendent of Insurance;

1081

(2) Two members of the House of Representatives, one	1082
representing the majority party and one representing the minority	1083
party;	1084

(3) Two members of the Senate, one representing the majority	1085
party and one representing the minority party;	1086

(4) Three providers who are individuals;

1087

(5) Two representatives of hospitals;

1088

(6) Two representatives of contracting entities regulated by	1089
the Department of Insurance under Title XVII of the Revised Code;	1090

(7) Two representatives of contracting entities regulated by	1091
the Department of Insurance under Title XXXIX of the Revised Code;	1092

(8) One representative of an employer that pays for the	1093
health insurance coverage of its employees.	1094

(B) The members of the Commission shall be appointed as	1095
follows:	1096

(1) The Speaker of the House of Representatives shall appoint	1097
the two members of the House specified in division (A)(2) of this	1098
section.	1099

(2) The President of the Senate shall appoint the two members	1100
of the Senate specified in division (A)(3) of this section.	1101

(3) The Speaker of the House of Representatives and the	1102
President of the Senate jointly shall appoint the remaining	1103
members specified in divisions (A)(4) to (8) of this section.	1104

(C) Initial appointments to the Commission shall be made	1105
within thirty days after the effective date of this act. The	1106
appointments shall be for the term of the Commission as provided	1107
in division (F)(2) of this section. Vacancies shall be filled in	1108
the same manner provided for original appointments.	1109

(D)(1) The Superintendent of Insurance shall be the	1110
Chairperson of the Commission. Meetings of the Commission shall be	1111
at the call of the Chairperson. All of the members of the	1112
Commission shall be voting members. Meetings of the Commission	1113
shall be held pursuant to section 121.22 of the Revised Code.	1114

(2) The Department of Insurance shall provide office space or	1115
other facilities, any administrative or other technical,	1116
professional, or clerical employees, and any necessary supplies	1117
for the work of the Commission.	1118

(3) The Chairperson of the Commission shall keep the records	1119
of the Commission. Upon submission of the Commission's final	1120
report to the General Assembly under division (F) of this section,	1121
the Chairperson shall deliver all of the Commission's records to	1122
the General Assembly.	1123

(E)(1) The Commission shall study the following areas	1124
pertaining to health care contracts:	1125

(a) The procompetitive and anticompetitive aspects of most	1126
favored nation clauses;	1127

(b) The impact of most favored nation clauses on health care	1128
costs and on the availability of and accessibility to quality	1129
health care;	1130

(c) The costs associated with the enforcement of most favored	1131
nation clauses;	1132

(d) Other state laws and rules pertaining to most favored	1133
nation clauses in their health care contracts;	1134

(e) Matters determined by the Department of Insurance as	1135
relevant to the study of most favored nation clauses;	1136

(f) Any other matters that the Commission considers	1137
appropriate to determine the effectiveness of most favored nation	1138
clauses.	1139

(2) The Commission may take testimony from experts or	1140
interested parties on the areas of its study as described in	1141
division (E)(1) of this section.	1142

(F)(1) Not less than ninety days prior to the expiration of	1143
the two-year period specified in Section 5 of this act, the	1144
Commission shall report its preliminary findings to the General	1145
Assembly and a recommendation of whether to extend that two-year	1146
period for one additional year. If the General Assembly does not	1147
grant the extension, the Commission shall submit its final report	1148
to the General Assembly not later than three months after the	1149
expiration of the two-year period specified in Section 5 of this	1150
act. If the General Assembly grants the extension, the extension	1151
shall be for not more than one year after the expiration of the	1152
two-year period specified in Section 5 of this act, and the	1153
Commission shall submit its final report to the General Assembly	1154
not later than six months prior to the expiration of the one-year	1155
extension.	1156

(2) The final report of the Commission shall include its	1157
findings and recommendations on whether state law should prohibit	1158
or restrict most favored nation clauses in health care contracts.	1159
The Commission shall cease to exist upon the submission of its	1160
final report to the General Assembly.	1161