130th Ohio General Assembly
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S. B. No. 43  As Introduced
As Introduced

125th General Assembly
Regular Session
2003-2004
S. B. No. 43


Senators Spada, Robert Gardner, Blessing, Coughlin, Schuring, Jacobson, Fingerhut, DiDonato, Wachtmann, Harris, Schuler, Dann 



A BILL
To enact sections 1751.111 and 3923.601 of the Revised Code to require health care plans providing prescription drug benefits to use a standardized identification card or other standardized technology in the processing of claims.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 1751.111 and 3923.601 of the Revised Code be enacted to read as follows:
Sec. 1751.111. (A)(1) This section applies to every health insuring corporation, and to every person contracted by the health insuring corporation to provide managerial or administrative services, that issues or requires the use of a standardized identification card or other standardized technology for the processing of prescription drug and device claims pursuant to a policy, contract, or agreement for health care services.
(2) Notwithstanding division (A)(1) of this section, this section does not apply to the issuance or use of standardized identification cards or other standardized technology for the processing of prescription drug and device claims in connection with coverage provided to beneficiaries enrolled in Title XIX of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended, known as the medical assistance program or medicaid, by the department of job and family services under Chapter 5111. of the Revised Code.
(B) A standardized identification card or other standardized technology issued or used by a health insuring corporation, or a person providing managerial or administrative services for the health insuring corporation, as provided in division (A) of this section shall contain uniform prescription drug information that meets the requirements of either division (B)(1) or (2) of this section.
(1) The standardized identification card or other standardized technology shall be in a format and contain information fields approved by the national council for prescription drug programs as contained in the council pharmacy identification card implementation guide in effect on the first day of October most immediately preceding the issuance of the standardized identification card.
(2) The standardized identification card or other standardized technology shall contain any of the following information if required for the processing of a claim:
(a) The health insuring corporation's name;
(b) The enrollee's name, group number, and identification number;
(c) A telephone number to inquire about pharmacy-related issues;
(d) The issuer's international identification number or "ANSI BIN" number, labeled as "ANSI BIN" or "RxBIN";
(e) The processor's control number, labeled as "RxPCN";
(f) The enrollee's pharmacy benefits group number if different than the enrollee's medical group number, labeled as "RxGrp."
(C) If a standardized identification card or other standardized technology issued under division (B)(2) of this section is also used to process nonpharmacy claims, the use of the designation "Rx" is not required in connection with the labels identified in divisions (B)(2)(d) to (f) of this section.
(D) Health insuring corporations, and persons providing managerial or administrative services for health insuring corporations, shall not be required to issue a standardized identification card or other standardized technology with uniform prescription drug information to an enrollee more than once during a twelve-month period.
(E) Nothing in this section shall be construed as requiring a health insuring corporation to produce more than one standardized identification card or other standardized technology for use by enrollees accessing health care benefits provided under a policy, contract, or agreement for health care services.
Sec. 3923.601. (A)(1) This section applies to every sickness and accident insurer, and to every person contracted by the insurer to provide managerial or administrative services, that issues or requires the use of a standardized identification card or other standardized technology for the processing of prescription drug and device claims pursuant to a policy of sickness and accident insurance. This section also applies to every pharmacy benefit manager, and to every health benefit plan administered by the state, that issues or requires the use of a standardized identification card or other standardized technology for the processing of prescription drug and device claims.
(2) Notwithstanding division (A)(1) of this section, this section does not apply to the issuance or use of standardized identification cards and other standardized technology for the processing of prescription drug and device claims in connection with any individual or group policy of sickness and accident insurance covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, medicare, tricare, specified disease, or vision care; coverage under a one-time-limited-duration policy of not longer than six months; coverage issued as a supplement to liability insurance; insurance arising out of workers' compensation or similar law; automobile medical payment insurance; or insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.
(3) Notwithstanding division (A)(1) of this section, this section does not apply to the issuance or use of standardized identification cards or other standardized technology for the processing of prescription drug and device claims in connection with coverage provided to beneficiaries enrolled in Title XIX of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended, known as the medical assistance program or medicaid, by the department of job and family services under Chapter 5111. of the Revised Code.
(B) A standardized identification card or other standardized technology issued or used by an insurer, or a person providing managerial or administrative services for the insurer, as provided in division (A) of this section shall contain uniform prescription drug information that meets the requirements of either division (B)(1) or (2) of this section.
(1) The standardized identification card or other standardized technology shall be in a format and contain information fields approved by the national council for prescription drug programs as contained in the council pharmacy identification card implementation guide in effect on the first day of October most immediately preceding the issuance of the standardized identification card.
(2) The standardized identification card or other standardized technology shall contain any of the following information if required for the processing of a claim:
(a) The insurer's name;
(b) The insured's name, group number, and identification number;
(c) A telephone number to inquire about pharmacy-related issues;
(d) The issuer's international identification number or "ANSI BIN" number, labeled as "ANSI BIN" or "RxBIN";
(e) The processor's control number, labeled as "RxPCN";
(f) The insured's pharmacy benefits group number if different than the insured's medical group number, labeled as "RxGrp."
(C) If a standardized identification card or other standardized technology issued under division (B)(2) of this section is also used to process nonpharmacy claims, the use of the designation "Rx" is not required in connection with the labels identified in divisions (B)(2)(d) to (f) of this section.
(D) Insurers, and persons providing managerial or administrative services for insurers, shall not be required to issue a standardized identification card or other standardized technology with uniform prescription drug information to an insured more than once during a twelve-month period.
(E) Nothing in this section shall be construed as requiring an insurer to produce more than one standardized identification card or other standardized technology for use by insureds accessing health care benefits provided under a policy of sickness and accident insurance.
Section 2. Section 1 of this act shall take effect one year after the effective date of this act, and applies only to the issuance and use of cards and other technology for the processing of prescription drug and device claims in health care policies, plans, and agreements that are delivered, issued for delivery, renewed, or established on or after that date.
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