130th Ohio General Assembly
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Sub. S. B. No. 43As Passed by the Senate
As Passed by the Senate

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


SENATORS Spada, Robert Gardner, Blessing, Coughlin, Schuring, Jacobson, Fingerhut, DiDonato, Wachtmann, Harris, Schuler, Dann, Armbruster, Brady, Fedor, Hagan, Mallory, Roberts, Zurz



A BILL
To enact sections 1751.111 and 3923.601 of the Revised Code to require the inclusion of specified pharmacy benefits information when health insurers issue or require the use of standardized identification cards or electronic technology for submission 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 under contract with the health insuring corporation to provide managerial or administrative services, that issues or requires the use of a standardized identification card or an electronic technology for submission and routing 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 required use of a standardized identification card or an electronic technology for submission and routing of prescription drug and device claims in connection with coverage provided to beneficiaries enrolled in the medicare advantage program operated under Part C of Title XVIII of the "Social Security Act," 49 Stat. 62 (1935), 42 U.S.C. 301, as amended.
(3) Notwithstanding division (A)(1) of this section, this section does not apply to the issuance or required use of a standardized identification card or an electronic technology for submission and routing 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 an electronic technology issued or required to be used as provided in division (A) of this section shall contain uniform prescription drug and device information in accordance with either division (B)(1) or (2) of this section.
(1) The standardized identification card or the electronic technology shall be in a format and contain information fields approved by the national council for prescription drug programs, as specified in the council's pharmacy identification card implementation guide in effect on the first day of October most immediately preceding the issuance or required use of the standardized identification card or the electronic technology.
(2) If the health insuring corporation or the person under contract with the corporation to provide managerial or administrative services requires the information for the submission and routing of a claim, the standardized identification card or the electronic technology shall contain any of the following information:
(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, 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 from the enrollee's medical group number, labeled as "RxGrp."
(C) If the standardized identification card or the electronic technology issued or required to be used as provided in division (A)(1) of this section is also used for submission and routing of nonpharmacy claims, the designation "Rx" is not required to be included as part of the labels identified in divisions (B)(2)(d) and (e) of this section.
(D)(1) Except as provided in division (D)(2) of this section, if there is a change in the information contained in the standardized identification card or the electronic technology issued to an enrollee, the health insuring corporation or person under contract with the corporation to provide managerial or administrative services shall issue a new card or electronic technology to the enrollee.
(2) A health insuring corporation or person under contract with the corporation is not required under division (D)(1) of this section to issue a new card or electronic technology 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 one electronic 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 under contract with the insurer to provide managerial or administrative services, that issues or requires the use of a standardized identification card or electronic technology for the submission and routing 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 established by this state, that issues or requires the use of a standardized identification card or an electronic technology for the submission and routing of prescription drug and device claims.
(2) Notwithstanding division (A)(1) of this section, this section does not apply to the issuance or required use of a standardized identification card or an electronic technology for the submission and routing 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 required use of a standardized identification card or an electronic technology for the submission and routing 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 an electronic technology issued or required to be used as provided in division (A)(1) of this section shall contain uniform prescription drug and device information in accordance with either division (B)(1) or (2) of this section.
(1) The standardized identification card or the electronic technology shall be in a format and contain information fields approved by the national council for prescription drug programs, as specified in the council's pharmacy identification card implementation guide in effect on the first day of October most immediately preceding the issuance or required use of the standardized identification card or the electronic technology.
(2) If the insurer or person under contract with the insurer to provide managerial or administrative services requires the information for the submission and routing of a claim, the standardized identification card or the electronic technology shall contain any of the following information:
(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, 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 from the insured's medical group number, labeled as "RxGrp."
(C) If the standardized identification card or the electronic technology issued or required to be used as provided in division (A)(1) of this section is also used for submission and routing of nonpharmacy claims, the designation "Rx" is not required to be included as part of the labels identified in divisions (B)(2)(d) and (e) of this section.
(D)(1) Except as provided in division (D)(2) of this section, if there is a change in the information contained in the standardized identification card or the electronic technology issued to an insured, the insurer or person under contract with the insurer to provide managerial or administrative services shall issue a new card or electronic technology to the insured.
(2) An insurer or person under contract with the insurer is not required under division (D)(1) of this section to issue a new card or electronic technology 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 one electronic technology for use by insureds accessing health care benefits provided under a policy of sickness and accident insurance or a health benefit plan.
Section 2. Section 1 of this act shall take effect one year after the effective date of this act.
Section 3. (A) Section 1751.111 of the Revised Code, as enacted by this act, shall apply only with respect to policies, contracts, and agreements delivered, issued for delivery, or renewed in this state on or after the effective date of Section 1 of this act.
(B) Section 3923.601 of the Revised Code, as enacted by this act, shall apply only with respect to the following:
(1) Policies of sickness and accident insurance delivered, issued for delivery, renewed, or used in this state on or after the effective date of Section 1 of this act;
(2) Health benefit plans, other than Medicaid, established or modified by this state on or after the effective date of Section 1 of this act.
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