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| To amend sections 1739.05 and 1751.35 and to enact | 1 |
| sections 1751.68, 1751.69, 3923.84, 3923.85, and | 2 |
| 4729.43 of the Revised Code regarding the delivery | 3 |
| of certain non-self-injectable and compounded | 4 |
| medications and insurance coverage for orally | 5 |
| administered cancer medications. | 6 |
| Section 1. That sections 1739.05 and 1751.35 be amended and | 7 |
| sections 1751.68, 1751.69, 3923.84, 3923.85, and 4729.43 of the | 8 |
| Revised Code be enacted to read as follows: | 9 |
| Sec. 1739.05. (A) A multiple employer welfare arrangement | 10 |
| that is created pursuant to sections 1739.01 to 1739.22 of the | 11 |
| Revised Code and that operates a group self-insurance program may | 12 |
| be established only if any of the following applies: | 13 |
| (1) The arrangement has and maintains a minimum enrollment of | 14 |
| three hundred employees of two or more employers. | 15 |
| (2) The arrangement has and maintains a minimum enrollment of | 16 |
| three hundred self-employed individuals. | 17 |
| (3) The arrangement has and maintains a minimum enrollment of | 18 |
| three hundred employees or self-employed individuals in any | 19 |
| combination of divisions (A)(1) and (2) of this section. | 20 |
| (B) A multiple employer welfare arrangement that is created | 21 |
| pursuant to sections 1739.01 to 1739.22 of the Revised Code and | 22 |
| that operates a group self-insurance program shall comply with all | 23 |
| laws applicable to self-funded programs in this state, including | 24 |
| sections 3901.04, 3901.041, 3901.19 to 3901.26, 3901.38, 3901.381 | 25 |
| to 3901.3814, 3901.40, 3901.45, 3901.46, 3902.01 to 3902.14, | 26 |
| 3923.24, 3923.282, 3923.30, 3923.301, 3923.38, 3923.581, 3923.63, | 27 |
| 3923.80, 3923.84, 3923.85, 3924.031, 3924.032, and 3924.27 of the | 28 |
| Revised Code. | 29 |
| (C) A multiple employer welfare arrangement created pursuant | 30 |
| to sections 1739.01 to 1739.22 of the Revised Code shall solicit | 31 |
| enrollments only through agents or solicitors licensed pursuant to | 32 |
| Chapter 3905. of the Revised Code to sell or solicit sickness and | 33 |
| accident insurance. | 34 |
| (D) A multiple employer welfare arrangement created pursuant | 35 |
| to sections 1739.01 to 1739.22 of the Revised Code shall provide | 36 |
| benefits only to individuals who are members, employees of | 37 |
| members, or the dependents of members or employees, or are | 38 |
| eligible for continuation of coverage under section 1751.53 or | 39 |
| 3923.38 of the Revised Code or under Title X of the "Consolidated | 40 |
| Omnibus Budget Reconciliation Act of 1985," 100 Stat. 227, 29 | 41 |
| U.S.C.A. 1161, as amended. | 42 |
| Sec. 1751.35. (A) The superintendent of insurance may | 43 |
| suspend or revoke any certificate of authority issued to a health | 44 |
| insuring corporation under this chapter if the superintendent | 45 |
| finds that: | 46 |
| (1) The health insuring corporation is operating in | 47 |
| contravention of its articles of incorporation, its health care | 48 |
| plan or plans, or in a manner contrary to that described in and | 49 |
| reasonably inferred from any other information submitted under | 50 |
| section 1751.03 of the Revised Code, unless amendments to such | 51 |
| submissions have been filed and have taken effect in compliance | 52 |
| with this chapter. | 53 |
| (2) The health insuring corporation fails to issue evidences | 54 |
| of coverage in compliance with the requirements of section 1751.11 | 55 |
| of the Revised Code. | 56 |
| (3) The contractual periodic prepayments or premium rates | 57 |
| used do not comply with the requirements of section 1751.12 of the | 58 |
| Revised Code. | 59 |
| (4) The health insuring corporation enters into a contract, | 60 |
| agreement, or other arrangement with any health care facility or | 61 |
| provider, that does not comply with the requirements of section | 62 |
| 1751.13 of the Revised Code, or the corporation fails to provide | 63 |
| an annual certificate as required by section 1751.13 of the | 64 |
| Revised Code. | 65 |
| (5) The superintendent determines, after a hearing conducted | 66 |
| in accordance with Chapter 119. of the Revised Code, that the | 67 |
| health insuring corporation no longer meets the requirements of | 68 |
| section 1751.04 of the Revised Code. | 69 |
| (6) The health insuring corporation is no longer financially | 70 |
| responsible and may reasonably be expected to be unable to meet | 71 |
| its obligations to enrollees or prospective enrollees. | 72 |
| (7) The health insuring corporation has failed to implement | 73 |
| the complaint system that complies with the requirements of | 74 |
| section 1751.19 of the Revised Code. | 75 |
| (8) The health insuring corporation, or any agent or | 76 |
| representative of the corporation, has advertised, merchandised, | 77 |
| or solicited on its behalf in contravention of the requirements of | 78 |
| section 1751.31 of the Revised Code. | 79 |
| (9) The health insuring corporation has unlawfully | 80 |
| discriminated against any enrollee or prospective enrollee with | 81 |
| respect to enrollment, disenrollment, or price or quality of | 82 |
| health care services. | 83 |
| (10) The continued operation of the health insuring | 84 |
| corporation would be hazardous or otherwise detrimental to its | 85 |
| enrollees. | 86 |
| (11) The health insuring corporation has submitted false | 87 |
| information in any filing or submission required under this | 88 |
| chapter or any rule adopted under this chapter. | 89 |
| (12) The health insuring corporation has otherwise failed to | 90 |
| substantially comply with this chapter or any rule adopted under | 91 |
| this chapter. | 92 |
| (13) The health insuring corporation is not operating a | 93 |
| health care plan. | 94 |
| (14) The health insuring corporation has failed to comply | 95 |
| with any of the requirements of sections 1751.77 to 1751.88 of the | 96 |
| Revised Code. | 97 |
| (15) The health insuring corporation has failed to comply | 98 |
| with section 1751.68 or 1751.69 of the Revised Code. | 99 |
| (B) A certificate of authority shall be suspended or revoked | 100 |
| only after compliance with the requirements of Chapter 119. of the | 101 |
| Revised Code. | 102 |
| (C) When the certificate of authority of a health insuring | 103 |
| corporation is suspended, the health insuring corporation, during | 104 |
| the period of suspension, shall not enroll any additional | 105 |
| subscribers or enrollees except newborn children or other newly | 106 |
| acquired dependents of existing subscribers or enrollees, and | 107 |
| shall not engage in any advertising or solicitation whatsoever. | 108 |
| (D) When the certificate of authority of a health insuring | 109 |
| corporation is revoked, the health insuring corporation, following | 110 |
| the effective date of the order of revocation, shall conduct no | 111 |
| further business except as may be essential to the orderly | 112 |
| conclusion of the affairs of the health insuring corporation. The | 113 |
| health insuring corporation shall engage in no further advertising | 114 |
| or solicitation whatsoever. The superintendent, by written order, | 115 |
| may permit such further operation of the health insuring | 116 |
| corporation as the superintendent may find to be in the best | 117 |
| interest of enrollees, to the end that enrollees will be afforded | 118 |
| the greatest practical opportunity to obtain continuing health | 119 |
| care coverage. | 120 |
| Sec. 1751.68. (A) As used in this section: | 121 |
| (1) "Dangerous drug" has the same meaning as in section | 122 |
| 4729.01 of the Revised Code. | 123 |
| (2) "Non-self-injectable medication" means a dangerous drug | 124 |
| intended for administration by injection that an individual cannot | 125 |
| reasonably self-administer. | 126 |
| (B) No individual or group health insuring corporation | 127 |
| policy, contract, or agreement providing basic health care | 128 |
| services or prescription drug services that is delivered, issued | 129 |
| for delivery, or renewed in this state, if the policy, contract, | 130 |
| or agreement provides coverage for non-self-injectable | 131 |
| medications, medications that must be compounded immediately prior | 132 |
| to administration, or both, shall require an enrollee to have such | 133 |
| a medication delivered directly to the enrollee by mail or any | 134 |
| means of commercial shipment. | 135 |
| (C) The superintendent of insurance may conduct hearings to | 136 |
| determine whether violations of this section have occurred. The | 137 |
| hearings shall be conducted in accordance with Chapter 119. of the | 138 |
| Revised Code. | 139 |
| (D) If the superintendent, by written order, finds that a | 140 |
| health insuring corporation has violated this section, the | 141 |
| superintendent may do one or more of the following: | 142 |
| (1) Issue an order requiring the health insuring corporation | 143 |
| to cease and desist from engaging in the violation; | 144 |
| (2) Pursuant to division (A)(15) of section 1751.35 of the | 145 |
| Revised Code, suspend or revoke the health insuring corporation's | 146 |
| certificate of authority issued under this chapter; | 147 |
| (3) Order the health insuring corporation neither to employ | 148 |
| any individual who is associated with the violation nor permit | 149 |
| such an individual to serve as a director, consultant, or in any | 150 |
| other capacity for a duration of time the superintendent | 151 |
| determines would best serve the public interest. | 152 |
| (E) In addition to the sanctions the superintendent may | 153 |
| impose under division (D) of this section, a court may do either | 154 |
| or both of the following: | 155 |
| (1) Impose a civil penalty on the health insuring | 156 |
| corporation, not to exceed an aggregate amount of thirty-five | 157 |
| thousand dollars, for one or more violations of this section that | 158 |
| occur in any six-month period; | 159 |
| (2) Impose a civil penalty on the health insuring corporation | 160 |
| not to exceed ten thousand dollars for each violation of a cease | 161 |
| and desist order described in division (D)(1) of this section. | 162 |
| (F) All money collected under this section shall be deposited | 163 |
| in the state treasury to the credit of the department of | 164 |
| insurance's operating fund and shall be used only for the purpose | 165 |
| of enforcing this section and sections 1751.69, 3923.84, and | 166 |
| 3923.85 of the Revised Code. | 167 |
| Sec. 1751.69. (A) Notwithstanding section 3901.71 of the | 168 |
| Revised Code and subject to division (B) of this section, no | 169 |
| individual or group health insuring corporation policy, contract, | 170 |
| or agreement providing basic health care services or prescription | 171 |
| drug services that is delivered, issued for delivery, or renewed | 172 |
| in this state, if the policy, contract, or agreement provides | 173 |
| coverage for cancer chemotherapy treatment, shall fail to comply | 174 |
| with any of the following: | 175 |
| (1) The policy, contract, or agreement shall not provide | 176 |
| coverage for a prescribed, orally administered cancer medication | 177 |
| on a less favorable basis than the coverage it provides for | 178 |
| intraveneously administered or injected cancer medications. This | 179 |
| includes a prohibition on imposing a coverage limit, copayment, | 180 |
| coinsurance, deductible, or other out-of-pocket expense that is | 181 |
| greater than any coverage limit, copayment, coinsurance, | 182 |
| deductible, or other out-of-pocket expense in the policy, | 183 |
| contract, or agreement that applies to coverage for intraveneously | 184 |
| administered or injected cancer medications. | 185 |
| (2) The policy, contract, or agreement shall not impose a | 186 |
| coverage limit, copayment, coinsurance, deductible, or other | 187 |
| out-of-pocket expense on a prescribed, orally administered cancer | 188 |
| medication or intraveneously administered or injected cancer | 189 |
| medication that is greater than the coverage limit, copayment, | 190 |
| coinsurance, deductible, or other out-of-pocket expense that | 191 |
| applies to the medication on the effective date of this section. | 192 |
| (3) The policy, contract, or agreement shall not place a | 193 |
| prescribed, orally administered cancer medication or | 194 |
| intraveneously administered or injected cancer medication in a | 195 |
| more expensive price tier than the price tier the medication is in | 196 |
| on the effective date of this section. | 197 |
| (4) The policy, contract, or agreement shall not impose | 198 |
| conditions on an enrollee's treatment with prescribed, orally | 199 |
| administered cancer medication or intraveneously administered or | 200 |
| injected cancer medication that are more restrictive than the | 201 |
| conditions that apply to an enrollee's treatment with the | 202 |
| medication on the effective date of this section. | 203 |
| (B) The prohibitions in division (A) of this section do not | 204 |
| preclude an individual or group health insuring corporation | 205 |
| policy, contract, or agreement from requiring an enrollee to | 206 |
| obtain prior authorization before orally administered cancer | 207 |
| medication is dispensed to the enrollee. | 208 |
| (C) The superintendent of insurance may conduct hearings to | 209 |
| determine whether violations of this section have occurred. The | 210 |
| hearings shall be conducted in accordance with Chapter 119. of the | 211 |
| Revised Code. | 212 |
| (D) If the superintendent, by written order, finds that a | 213 |
| health insuring corporation has violated this section, the | 214 |
| superintendent may do one or more of the following: | 215 |
| (1) Issue an order requiring the health insuring corporation | 216 |
| to cease and desist from engaging in the violation; | 217 |
| (2) Pursuant to division (A)(15) of section 1751.35 of the | 218 |
| Revised Code, suspend or revoke the health insuring corporation's | 219 |
| certificate of authority issued under this chapter; | 220 |
| (3) Order the health insuring corporation neither to employ | 221 |
| any individual who is associated with the violation nor permit | 222 |
| such an individual to serve as a director, consultant, or in any | 223 |
| other capacity for a duration of time the superintendent | 224 |
| determines would best serve the public interest. | 225 |
| (E) In addition to the sanctions the superintendent may | 226 |
| impose under division (D) of this section, a court may do either | 227 |
| or both of the following: | 228 |
| (1) Impose a civil penalty on the health insuring | 229 |
| corporation, not to exceed an aggregate amount of thirty-five | 230 |
| thousand dollars, for one or more violations of this section that | 231 |
| occur in any six-month period; | 232 |
| (2) Impose a civil penalty on the health insuring corporation | 233 |
| not to exceed ten thousand dollars for each violation of a cease | 234 |
| and desist order described in division (D)(1) of this section. | 235 |
| (F) All money collected under this section shall be deposited | 236 |
| in the state treasury to the credit of the department of | 237 |
| insurance's operating fund and shall be used only for the purpose | 238 |
| of enforcing this section and sections 1751.69, 3923.84, and | 239 |
| 3923.85 of the Revised Code. | 240 |
| Sec. 3923.84. (A) As used in this section: | 241 |
| (1) "Dangerous drug" has the same meaning as in section | 242 |
| 4729.01 of the Revised Code. | 243 |
| (2) "Non-self-injectable medication" means a dangerous drug | 244 |
| intended for administration by injection that an individual cannot | 245 |
| reasonably self-administer. | 246 |
| (B) No individual or group policy of sickness and accident | 247 |
| insurance that is delivered, issued for delivery, or renewed in | 248 |
| this state, and no public employee benefit plan that is | 249 |
| established or modified in this state, if the policy or plan | 250 |
| provides coverage for non-self-injectable medications, medications | 251 |
| that must be compounded immediately prior to administration, or | 252 |
| both, shall require an insured or plan member to have such a | 253 |
| medication delivered directly to the insured or plan member by | 254 |
| mail or any means of commercial shipment. | 255 |
| (C) The superintendent of insurance may conduct hearings to | 256 |
| determine whether violations of this section have occurred. The | 257 |
| hearings shall be conducted in accordance with Chapter 119. of the | 258 |
| Revised Code. | 259 |
| (D) If the superintendent, by written order, finds that a | 260 |
| person has violated this section, the superintendent may do one or | 261 |
| more of the following: | 262 |
| (1) Issue an order requiring the person to cease and desist | 263 |
| from engaging in the violation; | 264 |
| (2) Suspend or revoke the person's license to engage in the | 265 |
| business of insurance under this chapter; | 266 |
| (3) Order the person neither to employ any individual who is | 267 |
| associated with the violation nor permit such an individual to | 268 |
| serve as a director, consultant, or in any other capacity for a | 269 |
| duration of time the superintendent determines would best serve | 270 |
| the public interest. | 271 |
| (E) In addition to the sanctions the superintendent may | 272 |
| impose under division (D) of this section, a court may do either | 273 |
| or both of the following: | 274 |
| (1) Impose a civil penalty on the person, not to exceed an | 275 |
| aggregate amount of thirty-five thousand dollars, for one or more | 276 |
| violations of this section that occur in any six-month period; | 277 |
| (2) Impose a civil penalty on the person not to exceed ten | 278 |
| thousand dollars for each violation of a cease and desist order | 279 |
| described in division (D)(1) of this section. | 280 |
| (F) All money collected under this section shall be deposited | 281 |
| in the state treasury to the credit of the department of | 282 |
| insurance's operating fund and shall be used only for the purpose | 283 |
| of enforcing this section and sections 1751.68, 1751.69, and | 284 |
| 3923.85 of the Revised Code. | 285 |
| Sec. 3923.85. (A) Notwithstanding section 3901.71 of the | 286 |
| Revised Code and subject to division (B) of this section, no | 287 |
| individual or group policy of sickness and accident insurance that | 288 |
| is delivered, issued for delivery, or renewed in this state and no | 289 |
| public employee benefit plan that is established or modified in | 290 |
| this state shall fail to comply with any of the following: | 291 |
| (1) The policy or plan shall not provide coverage for a | 292 |
| prescribed, orally administered cancer medication on a less | 293 |
| favorable basis than the coverage it provides for intraveneously | 294 |
| administered or injected cancer medications. This includes a | 295 |
| prohibition on imposing a coverage limit, copayment, coinsurance, | 296 |
| deductible, or other out-of-pocket expense that is greater than | 297 |
| any coverage limit, copayment, coinsurance, deductible, or other | 298 |
| out-of-pocket expense in the policy or plan that applies to | 299 |
| coverage for intraveneously administered or injected cancer | 300 |
| medications. | 301 |
| (2) The policy or plan shall not impose a coverage limit, | 302 |
| copayment, coinsurance, deductible, or other out-of-pocket expense | 303 |
| on a prescribed, orally administered cancer medication or | 304 |
| intraveneously administered or injected cancer medication that is | 305 |
| greater than the coverage limit, copayment, coinsurance, | 306 |
| deductible, or other out-of-pocket expense that applies to the | 307 |
| medication on the effective date of this section. | 308 |
| (3) The policy or plan shall not place a prescribed, orally | 309 |
| administered cancer medication or intraveneously administered or | 310 |
| injected cancer medication in a more expensive price tier than the | 311 |
| price tier the medication is in on the effective date of this | 312 |
| section. | 313 |
| (4) The policy or plan shall not impose conditions on an | 314 |
| insured's or plan member's treatment with prescribed, orally | 315 |
| administered cancer medication or intraveneously administered or | 316 |
| injected cancer medication that are more restrictive than the | 317 |
| conditions that apply to an insured's or plan member's treatment | 318 |
| with the medication on the effective date of this section. | 319 |
| (B) The prohibitions in division (A) of this section do not | 320 |
| preclude an individual or group policy of sickness and accident | 321 |
| insurance or public employee benefit plan from requiring an | 322 |
| insured or plan member to obtain prior authorization before orally | 323 |
| administered cancer medication is dispensed to the insured or plan | 324 |
| member. | 325 |
| (C) The superintendent of insurance may conduct hearings to | 326 |
| determine whether violations of this section have occurred. The | 327 |
| hearings shall be conducted in accordance with Chapter 119. of the | 328 |
| Revised Code. | 329 |
| (D) If the superintendent, by written order, finds that a | 330 |
| person has violated this section, the superintendent may do one or | 331 |
| more of the following: | 332 |
| (1) Issue an order requiring the person to cease and desist | 333 |
| from engaging in the violation; | 334 |
| (2) Suspend or revoke the person's license to engage in the | 335 |
| business of insurance under this chapter; | 336 |
| (3) Order the person neither to employ any individual who is | 337 |
| associated with the violation nor permit such an individual to | 338 |
| serve as a director, consultant, or in any other capacity for a | 339 |
| duration of time the superintendent determines would best serve | 340 |
| the public interest. | 341 |
| (E) In addition to the sanctions the superintendent may | 342 |
| impose under division (D) of this section, a court may do either | 343 |
| or both of the following: | 344 |
| (1) Impose a civil penalty on the person, not to exceed an | 345 |
| aggregate amount of thirty-five thousand dollars, for one or more | 346 |
| violations of this section that occur in any six-month period; | 347 |
| (2) Impose a civil penalty on the person not to exceed ten | 348 |
| thousand dollars for each violation of a cease and desist order | 349 |
| described in division (D)(1) of this section. | 350 |
| (F) All money collected under this section shall be deposited | 351 |
| in the state treasury to the credit of the department of | 352 |
| insurance's operating fund and shall be used only for the purpose | 353 |
| of enforcing this section and sections 1751.68, 1751.69, and | 354 |
| 3923.84 of the Revised Code. | 355 |
| Sec. 4729.43. (A) As used in this section, | 356 |
| "non-self-injectable medication" means a dangerous drug intended | 357 |
| for administration by injection that an individual cannot | 358 |
| reasonably self-administer. | 359 |
| (B) A pharmacist or pharmacy intern who is presented with a | 360 |
| prescription for a non-self-injectable medication or a medication | 361 |
| that must be compounded immediately prior to administration to the | 362 |
| patient shall not, under any circumstances, deliver the medication | 363 |
| to the patient's private residence unless the patient's private | 364 |
| residence is a nursing home, residential care facility, | 365 |
| rehabilitation facility, or similar institutional facility or | 366 |
| health care facility; the nursing home or facility consented to | 367 |
| the delivery; and the delivery does not violate the nursing home's | 368 |
| or facility's policies. | 369 |
| Section 2. That existing sections 1739.05 and 1751.35 of the | 370 |
| Revised Code are hereby repealed. | 371 |
| Section 3. This act shall be known as the "Robert L. Schuler | 372 |
| Act" in honor of the late Robert L. Schuler who served in both the | 373 |
| Ohio House of Representatives and the Ohio Senate. | 374 |
| Section 4. Sections 1739.05, 1751.68, and 1751.69 of the | 375 |
| Revised Code, as amended or enacted by this act, shall apply only | 376 |
| to policies, contracts, and agreements that are delivered, issued | 377 |
| for delivery, or renewed in this state on or after the effective | 378 |
| date of this act, and sections 3923.84 and 3923.85 of the Revised | 379 |
| Code, as enacted by this act, shall apply to policies of sickness | 380 |
| and accident insurance delivered, issued for delivery, or renewed | 381 |
| in this state and public employee benefit plans that are | 382 |
| established or modified in this state on or after the effective | 383 |
| date of this act. | 384 |