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S. B. No. 43 As IntroducedAs Introduced
125th General Assembly | Regular Session | 2003-2004 |
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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:
(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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