To enact sections 103.144, 105.01, 105.02, 105.03, 105.05, 105.07, and 105.09 of the Revised Code to require the Ohio Legislative Service Commission to prepare a mandated benefit report for each bill that receives second consideration, to provide for the establishment and operation of the Ohio Mandated Benefits Review Council, and to terminate the provisions of this act on December 31, 2003, by repealing sections 103.144, 105.01, 105.02, 105.03, 105.05, 105.07, and 105.09 of the Revised Code on that date.

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

Sec. 103.144. (A) AS USED IN THIS SECTION, "MANDATED BENEFIT" HAS THE SAME MEANING AS IN SECTION 105.01 OF THE REVISED CODE.

(B) WITHIN SEVEN DAYS AFTER A BILL RECEIVES SECOND CONSIDERATION IN EITHER HOUSE OF THE GENERAL ASSEMBLY, THE LEGISLATIVE SERVICE COMMISSION SHALL DO BOTH OF THE FOLLOWING:

(1) REVIEW THE BILL TO DETERMINE WHETHER THE BILL INCLUDES A MANDATED BENEFIT.

(2) PREPARE A WRITTEN MANDATED BENEFITS REPORT SETTING FORTH THE RESULTS OF THE REVIEW PERFORMED UNDER DIVISION (B)(1) OF THIS SECTION.

(3) DISTRIBUTE COPIES OF THE REPORT TO THE CHAIRPERSON OF THE COMMITTEE TO WHICH THE BILL HAS BEEN ASSIGNED, THE OHIO MANDATED BENEFITS REVIEW COUNCIL CREATED UNDER SECTION 105.02 OF THE REVISED CODE, AND THE SUPERINTENDENT OF INSURANCE.

(C) WITHIN SEVEN DAYS AFTER AN AMENDMENT TO THE BILL IS OFFERED, OR A SUBSTITUTE BILL IS PRESENTED, TO THE COMMITTEE, THE LEGISLATIVE SERVICE COMMISSION SHALL REVISE THE MANDATED BENEFITS REPORT TO REFLECT CHANGES PROPOSED BY THE AMENDMENT OR SUBSTITUTE BILL AND DISTRIBUTE COPIES OF THE REPORT IN ACCORDANCE WITH DIVISION (B)(3) OF THIS SECTION.

(D) NO BILL SHALL BE REPORTED BY A COMMITTEE WITH A RECOMMENDATION FOR PASSAGE, AND NO VOTE SHALL BE TAKEN BY A COMMITTEE ON ANY PROPOSED AMENDMENT OR SUBSTITUTE BILL, UNTIL AFTER THE COMMITTEE MEMBERS HAVE RECEIVED A MANDATED BENEFITS REPORT OR, IF APPLICABLE, A REVISED MANDATED BENEFITS REPORT, UNLESS APPROVED BY A TWO-THIRDS VOTE OF THE MEMBERSHIP OF THE COMMITTEE.

Sec. 105.01. AS USED IN SECTIONS 105.01 TO 105.09 OF THE REVISED CODE, "MANDATED BENEFIT" MEANS THE FOLLOWING, WHEN CONSIDERED IN THE CONTEXT OF A SICKNESS AND ACCIDENT INSURANCE POLICY OR A HEALTH INSURING CORPORATION POLICY, CONTRACT, OR AGREEMENT:

(A) ANY REQUIRED COVERAGE FOR A SPECIFIC MEDICAL OR HEALTH-RELATED SERVICE, TREATMENT, MEDICATION, OR PRACTICE;

(B) ANY REQUIRED COVERAGE FOR THE SERVICES OF SPECIFIC HEALTH CARE PRACTITIONERS;

(C) ANY REQUIREMENT THAT AN INSURER OR HEALTH INSURING CORPORATION OFFER COVERAGE TO SPECIFIC INDIVIDUALS OR GROUPS;

(D) ANY REQUIREMENT THAT AN INSURER OR HEALTH INSURING CORPORATION OFFER SPECIFIC HEALTH CARE SERVICES, TREATMENTS, OR PRACTICES TO EXISTING INSUREDS OR ENROLLEES;

(E) ANY REQUIRED EXPANSION OF, OR ADDITION TO, EXISTING COVERAGE;

(F) ANY REQUIRED AMOUNT OF REIMBURSEMENT OF SPECIFIC HEALTH CARE PRACTITIONERS.

Sec. 105.02. (A) THERE IS HEREBY CREATED THE OHIO MANDATED BENEFITS REVIEW COUNCIL.

(B) THE COUNCIL SHALL CONSIST OF FIFTEEN MEMBERS, AS FOLLOWS:

(1) THREE MEMBERS OF THE SENATE, APPOINTED BY THE PRESIDENT OF THE SENATE, NOT MORE THAN TWO OF WHOM MAY BE MEMBERS OF THE SAME POLITICAL PARTY;

(2) THREE MEMBERS OF THE HOUSE OF REPRESENTATIVES, APPOINTED BY THE SPEAKER OF THE HOUSE OF REPRESENTATIVES, NOT MORE THAN TWO OF WHOM MAY BE MEMBERS OF THE SAME POLITICAL PARTY;

(3) THREE REPRESENTATIVES OF CONSUMERS, APPOINTED BY THE GOVERNOR WITH THE ADVICE AND CONSENT OF THE SENATE, NOT MORE THAN TWO OF WHOM SHALL BE MEMBERS OF THE SAME POLITICAL PARTY. NONE OF THESE MEMBERS MAY BE EMPLOYED BY, OR IN ANY WAY AFFILIATED WITH OR BIASED TOWARD, ANY OF THE PERSONS OR ENTITIES LISTED IN DIVISION (B)(4) OF THIS SECTION.

(4) THE FOLLOWING NONVOTING MEMBERS:

(a) TWO REPRESENTATIVES OF HEALTH CARE PROVIDERS, ONE OF WHOM IS TO BE APPOINTED BY THE PRESIDENT OF THE SENATE AND THE OTHER BY THE SPEAKER OF THE HOUSE OF REPRESENTATIVES.

(b) ONE REPRESENTATIVE OF HEALTH INSURING CORPORATIONS, APPOINTED BY THE PRESIDENT OF THE SENATE.

(c) ONE REPRESENTATIVE OF SICKNESS AND ACCIDENT INSURERS, APPOINTED BY THE SPEAKER OF THE HOUSE OF REPRESENTATIVES.

(d) ONE REPRESENTATIVE OF EMPLOYERS IN THIS STATE, OTHER THAN THE EMPLOYERS LISTED IN DIVISIONS (B)(4)(a) TO (c) OF THIS SECTION, THAT EMPLOY LESS THAN TWENTY-FIVE EMPLOYEES, APPOINTED BY THE PRESIDENT OF THE SENATE.

(e) ONE REPRESENTATIVE OF EMPLOYERS IN THIS STATE, OTHER THAN THE EMPLOYERS LISTED IN DIVISIONS (B)(4)(a) TO (c) OF THIS SECTION, THAT EMPLOY AT LEAST TWENTY-FIVE EMPLOYEES, APPOINTED BY THE SPEAKER OF THE HOUSE OF REPRESENTATIVES.

(C) WITH RESPECT TO THE MEMBERS OF THE COUNCIL OTHER THAN THOSE APPOINTED FROM THE MEMBERSHIP OF THE SENATE AND THE HOUSE OF REPRESENTATIVES, ALL OF THE FOLLOWING APPLY:

(1) OF THE INITIAL APPOINTMENTS, THREE SHALL BE FOR A TERM ENDING JUNE 30, 2001, THREE SHALL BE FOR A TERM ENDING JUNE 30, 2002, AND THREE SHALL BE FOR A TERM ENDING JUNE 30, 2003. THEREAFTER, TERMS OF OFFICE SHALL BE FOR THREE YEARS, WITH EACH TERM ENDING ON THE SAME DAY OF THE SAME MONTH AS DID THE TERM THAT IT SUCCEEDS.

(2) EACH MEMBER SHALL HOLD OFFICE FROM THE DATE OF APPOINTMENT UNTIL THE END OF THE TERM FOR WHICH THE MEMBER WAS APPOINTED.

(3) ANY MEMBER APPOINTED TO FILL A VACANCY OCCURRING PRIOR TO THE EXPIRATION DATE OF THE TERM FOR WHICH THE MEMBER'S PREDECESSOR WAS APPOINTED SHALL HOLD OFFICE AS A MEMBER FOR THE REMAINDER OF THAT TERM.

(4) A MEMBER SHALL CONTINUE IN OFFICE SUBSEQUENT TO THE EXPIRATION DATE OF THE MEMBER'S TERM UNTIL THE MEMBER'S SUCCESSOR TAKES OFFICE OR UNTIL A PERIOD OF SIXTY DAYS HAS ELAPSED, WHICHEVER OCCURS FIRST.

(D) THE MEMBERS OF THE COUNCIL WHO ARE APPOINTED FROM THE MEMBERSHIP OF THE SENATE OR THE HOUSE OF REPRESENTATIVES SHALL SERVE DURING THEIR TERMS AS MEMBERS OF THE GENERAL ASSEMBLY AND UNTIL THEIR SUCCESSORS ARE APPOINTED AND QUALIFIED, NOTWITHSTANDING THE ADJOURNMENT OF THE GENERAL ASSEMBLY OF WHICH THEY ARE MEMBERS OR THE EXPIRATION OF THEIR TERMS AS MEMBERS OF SUCH GENERAL ASSEMBLY.

(E) VACANCIES ON THE COUNCIL SHALL BE FILLED IN THE MANNER PROVIDED FOR ORIGINAL APPOINTMENTS.

Sec. 105.03. MEETINGS OF THE MANDATED BENEFITS REVIEW COUNCIL SHALL BE CALLED IN SUCH MANNER AND AT SUCH TIMES AS PRESCRIBED BY RULES ADOPTED BY THE COUNCIL. A MAJORITY OF THE MEMBERSHIP OF THE COUNCIL CONSTITUTES A QUORUM AND NO ACTION SHALL BE TAKEN BY THE COUNCIL UNLESS APPROVED BY AT LEAST FIVE VOTING MEMBERS.

THE COUNCIL SHALL ORGANIZE BY SELECTING FROM AMONG THE VOTING MEMBERS A CHAIRPERSON, A VICE-CHAIRPERSON, AND SUCH OTHER OFFICERS AS IT CONSIDERS NECESSARY. THE COUNCIL SHALL ADOPT RULES FOR THE CONDUCT OF ITS BUSINESS AND THE ELECTION OF ITS OFFICERS. EACH MEMBER OF THE COUNCIL, BEFORE ENTERING UPON THE MEMBER'S OFFICIAL DUTIES, SHALL TAKE AND SUBSCRIBE TO AN OATH OF OFFICE, TO UPHOLD THE CONSTITUTION AND LAWS OF THE UNITED STATES AND THIS STATE, AND TO PERFORM THE DUTIES OF THE OFFICE HONESTLY, FAITHFULLY, AND IMPARTIALLY.

MEMBERS OF THE COUNCIL SHALL SERVE WITHOUT COMPENSATION BUT SHALL BE REIMBURSED FOR ACTUAL AND NECESSARY EXPENSES INCURRED IN THE PERFORMANCE OF THEIR DUTIES.

Sec. 105.05. (A) UPON RECEIPT OF A MANDATED BENEFITS REPORT PREPARED BY THE LEGISLATIVE SERVICE COMMISSION UNDER SECTION 103.144 OF THE REVISED CODE, THE MANDATED BENEFITS REVIEW COUNCIL SHALL REVIEW THE REPORT TO DETERMINE IF IT INDICATES THE INCLUSION OF A MANDATED BENEFIT. IF IT DOES SO INDICATE, THE COUNCIL SHALL REQUEST THE SUPERINTENDENT OF INSURANCE TO ARRANGE FOR AN INDEPENDENT ACTUARIAL REVIEW OF THE MANDATED BENEFIT, AND MAKE FINDINGS AND RECOMMENDATIONS, AS PROVIDED IN SECTION 105.07 OF THE REVISED CODE.

THE COUNCIL SHALL HOLD A PUBLIC MEETING TO CONSIDER THE FINDINGS AND RECOMMENDATIONS OF THE SUPERINTENDENT. THE COUNCIL MAY ADMINISTER OATHS AND HOLD PUBLIC HEARINGS AT SUCH TIMES AND PLACES WITHIN THE STATE AS MAY BE NECESSARY TO CARRY OUT THE PURPOSES AND INTENT OF SECTIONS 105.01 TO 105.09 OF THE REVISED CODE.

WITHIN THIRTY DAYS AFTER RECEIPT OF THE SUPERINTENDENT'S FINDINGS AND RECOMMENDATIONS, THE COUNCIL SHALL MAKE A WRITTEN RECOMMENDATION TO THE GENERAL ASSEMBLY. NO RECOMMENDATION SHALL BE MADE BY THE COUNCIL UNLESS APPROVED BY AT LEAST FIVE VOTING MEMBERS.

(B) THE COUNCIL MAY, FROM TIME TO TIME, REVIEW THE PROVISIONS OF THE REVISED CODE THAT INCLUDE MANDATED BENEFITS AND REQUEST THE SUPERINTENDENT TO ARRANGE FOR AN INDEPENDENT ACTUARIAL REVIEW OF THE MANDATED BENEFITS, AND MAKE FINDINGS AND RECOMMENDATIONS, AS PROVIDED IN SECTION 105.07 OF THE REVISED CODE. THE COUNCIL SHALL FORWARD ITS RECOMMENDATIONS REGARDING SUCH MANDATED BENEFITS TO THE PRESIDENT OF THE SENATE, THE SPEAKER OF THE HOUSE OF REPRESENTATIVES, AND THE CHAIRPERSONS OF THE COMMITTEES OF THE GENERAL ASSEMBLY THAT HAVE PRIMARY JURISDICTION OVER HEALTH INSURANCE.

(C) THE COUNCIL SHALL PREPARE AN ANNUAL SUMMARY OF ITS RECOMMENDATIONS WITH RESPECT TO PROPOSED AND EXISTING MANDATED BENEFITS, AND SUBMIT A COPY OF THAT SUMMARY TO THE GOVERNOR, THE SPEAKER OF THE HOUSE OF REPRESENTATIVES, AND THE PRESIDENT OF THE SENATE.

Sec. 105.07. (A) UPON RECEIPT OF A REQUEST FROM THE MANDATED BENEFITS REVIEW COUNCIL PURSUANT TO SECTION 105.05 OF THE REVISED CODE, THE SUPERINTENDENT OF INSURANCE SHALL RETAIN, ON A CONSULTING BASIS, AN INDEPENDENT ACTUARY TO DETERMINE THE MEDICAL EFFICACY AND FINANCIAL IMPACT OF THE MANDATED BENEFIT IN ACCORDANCE WITH DIVISION (B) OF THIS SECTION. THE SUPERINTENDENT SHALL ASSIST THE ACTUARY IN OBTAINING ANY INFORMATION NEEDED.

WITHIN FORTY-FIVE DAYS AFTER RECEIVING THE REQUEST, THE SUPERINTENDENT SHALL SUBMIT THE FINDINGS OF THE ACTUARIAL REVIEW AND THE SUPERINTENDENT'S RECOMMENDATIONS TO THE COUNCIL.

(B) IN PERFORMING AN ACTUARIAL REVIEW OF A MANDATED BENEFIT, THE ACTUARY SHALL DO THE FOLLOWING:

(1) USE APPROPRIATE ASSUMPTIONS THAT ACCURATELY DEMONSTRATE THE FINANCIAL IMPACT OF THE MANDATED BENEFIT;

(2) DETERMINE TO WHAT EXTENT THE ABSENCE OF THE MANDATED BENEFIT RESULTS IN FINANCIAL HARDSHIP TO THE GENERAL POPULATION;

(3) DETERMINE THE EXTENT OF PUBLIC DEMAND FOR THE MANDATED BENEFIT, AND TO WHAT EXTENT VOLUNTARY COVERAGE OF THE BENEFIT IS AVAILABLE;

(4) DETERMINE THE EXTENT OF PUBLIC DEMAND FOR INCLUSION OF THE MANDATED BENEFIT IN ARRANGEMENTS NEGOTIATED THROUGH COLLECTIVE BARGAINING;

(5) CONSULT WITH RELEVANT MEDICAL EXPERTS;

(6) CONSIDER THE RESULTS OF AT LEAST ONE PROFESSIONALLY ACCEPTABLE CONTROLLED TRIAL AND THE RESULTS OF ANY OTHER RELEVANT PEER REVIEWED RESEARCH SPECIFICALLY CENTERED AROUND THE BENEFIT;

(7) IF APPLICABLE, DETERMINE THE EXTENT TO WHICH:

(a) COVERAGE WILL INCREASE OR DECREASE THE COST OF THE TREATMENT OR SERVICE;

(b) A SIMILAR MANDATED BENEFIT IN OTHER STATES HAS AFFECTED CHARGES, COSTS, UTILIZATION, AND PAYMENTS FOR SERVICES AND TREATMENTS IN THOSE STATES;

(c) COVERAGE WILL INCREASE OR DECREASE THE APPROPRIATE USE OF THE TREATMENT OR SERVICE;

(d) COVERAGE WILL INCREASE OR DECREASE THE ADMINISTRATIVE EXPENSES OF INSURANCE COMPANIES AND HEALTH INSURING CORPORATIONS;

(e) COVERAGE WILL INCREASE OR DECREASE PREMIUMS;

(f) EXISTING MANDATED BENEFITS MEET THE PROPOSED REQUIREMENTS;

(g) SMALL EMPLOYER, MEDIUM-SIZED EMPLOYERS, AND LARGE EMPLOYERS WILL BE FINANCIALLY IMPACTED; AND

(h) COVERAGE WILL IMPACT THE TOTAL COST OF HEALTH CARE.

(C) THE SUPERINTENDENT SHALL ALSO PROVIDE ANY APPROPRIATE PROFESSIONAL, TECHNICAL, AND CLERICAL SUPPORT FROM THE SUPERINTENDENT'S STAFF THAT IS NEEDED BY THE COUNCIL TO FULFILL ITS DUTIES.

Sec. 105.09. NO COMMITTEE OF THE GENERAL ASSEMBLY SHALL REPORT A BILL WITH A RECOMMENDATION FOR PASSAGE, WHICH BILL HAS BEEN IDENTIFIED BY THE LEGISLATIVE SERVICE COMMISSION AS INCLUDING A MANDATED BENEFIT, WITHOUT THE WRITTEN RECOMMENDATION OF THE MANDATED BENEFITS REVIEW COUNCIL, EXCEPT BY A TWO-THIRDS VOTE OF THE MEMBERS OF THE COMMITTEE.