The online versions of legislation provided on this website are not official. Enrolled bills are the final version passed by the Ohio General Assembly and presented to the Governor for signature. The official version of acts signed by the Governor are available from the Secretary of State's Office in the Continental Plaza, 180 East Broad St., Columbus.
|
Am. Sub. H. B. No. 125 As Passed by the HouseAs Passed by the House
127th General Assembly | Regular Session | 2007-2008 |
| |
Cosponsors:
Representatives DeGeeter, Seitz, McGregor, J., Schneider, Latta, Adams, Gibbs, Setzer, Oelslager, Uecker, McGregor, R., Stewart, J., Stebelton, Fessler, Barrett, Wagoner, Celeste, Reinhard, Widener, Blessing, Book, Carmichael, Lundy, Hughes, Core, Dodd, Batchelder, Boyd, Budish, Chandler, Collier, Distel, Driehaus, Dyer, Evans, Flowers, Goyal, Hagan, J., Healy, Koziura, Letson, Luckie, Otterman, Patton, Yuko
A BILL
To amend sections 1751.13, 1753.01, 1753.07, 1753.09,
and 5111.17, to enact sections 3963.01 to 3963.10,
and
to repeal sections 1753.03,
1753.04,
1753.05, and
1753.08 of the Revised Code
to
establish certain
uniform contract provisions
between health care
providers and contracting
entities, to establish
standardized
credentialing,
to require
contracting entities
to provide to
health care
providers specified
information
concerning
enrollees, to
require
the
Department of Job and Family Services to
allow managed care plans to use providers to
render care, and to create a Joint
Legislative
Study Commission on Most Favored
Nation Clauses
in Health Care Contracts.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 1751.13, 1753.01, 1753.07, 1753.09,
and 5111.17 be amended and sections 3963.01, 3963.02, 3963.03,
3963.04, 3963.05, 3963.06, 3963.07, 3963.08, 3963.09, and 3963.10
of the Revised Code be enacted to read as follows:
Sec. 1751.13. (A)(1)(a) A health
insuring corporation shall,
either directly or indirectly, enter
into contracts for the
provision of health care services with a
sufficient number and
types of providers and health care
facilities to ensure that all
covered health care services will
be accessible to enrollees from
a contracted provider or health
care facility.
(b) A health insuring corporation shall not refuse
to
contract with a physician for the provision of health care
services or refuse to recognize a physician as a specialist on
the
basis that the physician attended an educational program or
a
residency program approved or certified by the
American
osteopathic association. A health insuring corporation
shall not
refuse to
contract with a health care facility for the provision
of health
care services on the basis that the health care facility
is
certified or accredited by the
American osteopathic association
or that the health care
facility is an osteopathic
hospital as
defined in section 3702.51 of the
Revised
Code.
(c) Nothing in division
(A)(1)(b)
of this section shall be
construed to require a health insuring
corporation to make a
benefit payment under a closed panel plan
to a physician or health
care facility with which the health
insuring corporation does not
have a contract, provided that
none of the bases set forth in that
division are used as a
reason for failing to make a benefit
payment.
(2) When a health insuring corporation is unable to
provide a
covered health care service from a contracted provider
or health
care facility, the health insuring corporation must
provide that
health care service from a noncontracted provider
or health care
facility consistent with the terms of the
enrollee's policy,
contract, certificate, or agreement. The
health insuring
corporation shall either ensure that the health
care service be
provided at no greater cost to the enrollee than
if the enrollee
had obtained the health care service from a
contracted provider or
health care facility, or make other
arrangements acceptable to the
superintendent of
insurance.
(3) Nothing in this section shall prohibit a health
insuring
corporation from entering into contracts with
out-of-state
providers or health care facilities that are
licensed, certified,
accredited, or otherwise authorized in that
state.
(B)(1) A health insuring
corporation shall, either directly
or indirectly, enter into
contracts with all providers and health
care facilities through
which health care services are provided to
its enrollees.
(2) A health insuring corporation, upon written request,
shall assist its
contracted providers in finding stop-loss or
reinsurance carriers.
(C) A health insuring corporation shall file an annual
certificate with the superintendent certifying that all provider
contracts
and contracts with health care facilities through which
health
care services are being provided contain the following:
(1) A description of the method by which the provider or
health care facility will be notified of the specific health
care
services for which the provider or health care facility
will be
responsible, including any limitations or conditions on
such
services;
(2) The specific hold harmless provision specifying
protection of enrollees set forth as follows:
"[Provider/Health Care
Facility] agrees that in no event,
including but not limited to
nonpayment by the health insuring
corporation, insolvency of the health
insuring corporation, or
breach of this agreement, shall
[Provider/Health Care
Facility]
bill, charge, collect a deposit from, seek
remuneration or
reimbursement from, or have any recourse
against, a subscriber,
enrollee, person to whom health care services have been
provided,
or person acting on behalf of the covered enrollee,
for health
care services provided pursuant to this agreement.
This does not
prohibit [Provider/Health
Care Facility] from collecting
co-insurance, deductibles, or copayments as specifically
provided
in the evidence of coverage, or fees for uncovered
health care
services delivered on a fee-for-service basis to
persons
referenced above, nor from any recourse against the
health
insuring corporation or its successor."
(3) Provisions requiring the provider or health care
facility
to continue to provide covered health care services to
enrollees
in the event of the health insuring corporation's
insolvency or
discontinuance of operations. The
provisions shall require the
provider or health care facility to
continue to provide covered
health care services to enrollees as
needed to complete any
medically necessary procedures commenced
but unfinished at the
time of the health insuring corporation's
insolvency or
discontinuance of operations. The completion of a medically
necessary procedure shall
include the rendering of all covered
health care services that constitute
medically necessary follow-up
care
for that procedure. If an enrollee is
receiving necessary
inpatient care at a hospital, the provisions
may limit the
required provision of covered health care services
relating to
that inpatient care in accordance with division
(D)(3) of section
1751.11 of the Revised
Code, and may also limit such required
provision of
covered health care services to the period ending
thirty days
after the health insuring corporation's insolvency or
discontinuance of operations.
The provisions required by division (C)(3) of this
section
shall not require any provider or health care facility
to continue
to provide any covered health care service after the
occurrence of
any of the following:
(a) The end of the thirty-day period following the entry
of a
liquidation order under Chapter 3903. of the
Revised Code;
(b) The end of the enrollee's period of coverage for a
contractual prepayment or premium;
(c) The enrollee obtains equivalent coverage with another
health insuring corporation or insurer, or the enrollee's
employer
obtains such coverage for the enrollee;
(d) The enrollee or the enrollee's employer terminates
coverage under the contract;
(e) A liquidator effects a transfer of the health
insuring
corporation's obligations under the contract under
division (A)(8)
of section 3903.21 of the Revised Code.
(4) A provision clearly stating the rights and
responsibilities of the health insuring corporation, and of the
contracted providers and health care facilities, with respect to
administrative policies and programs, including, but not limited
to, payments systems, utilization review, quality assurance,
assessment, and improvement programs, credentialing,
confidentiality
requirements, and any applicable federal or state
programs;
(5) A provision regarding the availability and
confidentiality of those health records maintained by providers
and health care facilities to monitor and evaluate the quality
of
care, to conduct evaluations and audits, and to determine on
a
concurrent or retrospective basis the necessity of and
appropriateness of health care services provided to enrollees.
The provision shall include terms requiring the provider or
health
care facility to make these health records available to
appropriate state and federal authorities involved in assessing
the quality of care or in investigating the grievances or
complaints of enrollees, and requiring the provider or health
care
facility to comply with applicable state and federal laws
related
to the confidentiality of medical or health
records.
(6) A provision that states that contractual rights and
responsibilities may not be assigned or delegated by the
provider
or health care facility without the prior written
consent of the
health insuring corporation;
(7) A provision requiring the provider or health care
facility to maintain adequate professional liability and
malpractice insurance. The provision shall also require the
provider or health care facility to notify the health insuring
corporation not more than ten days after the provider's or
health
care facility's receipt of notice of any reduction or
cancellation
of such coverage.
(8) A provision requiring the provider or health care
facility to observe, protect, and promote the rights of
enrollees
as patients;
(9) A provision requiring the provider or health care
facility to provide health care services without discrimination
on
the basis of a patient's participation in the health care
plan,
age, sex, ethnicity, religion, sexual preference, health
status,
or disability, and without regard to the source of
payments made
for health care services rendered to a patient.
This requirement
shall not apply to circumstances when the
provider or health care
facility appropriately does not render
services due to limitations
arising from the provider's or
health care facility's lack of
training, experience, or skill,
or due to licensing restrictions.
(10) A provision containing the specifics of any
obligation
on the primary care provider
to provide,
or to arrange for the
provision of, covered health care services
twenty-four hours per
day, seven days per week;
(11) A provision setting forth procedures for the
resolution
of disputes arising out of the contract;
(12) A provision stating that the hold harmless provision
required by division (C)(2) of
this section shall survive the
termination of the contract with respect to
services covered and
provided under the contract during the time the contract
was in
effect, regardless of the reason for the termination, including
the
insolvency of the health insuring corporation;
(13) A provision requiring those terms that are used in
the
contract and that are defined by this chapter, be used in
the
contract in a manner consistent with those
definitions.
This division does not apply to the coverage of
beneficiaries
enrolled in Title
XVIII of the
"Social
Security
Act," 49
Stat. 620
(1935), 42
U.S.C.A.
301, as amended, pursuant to a medicare risk
contract or
medicare cost contract, or to the coverage of
beneficiaries
enrolled in the federal employee health benefits
program
pursuant to 5
U.S.C.A.
8905, or to the coverage of
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, provided by the
department
of job and family services under
Chapter 5111. of the
Revised
Code, or to the coverage of
beneficiaries under any federal health
care program regulated by
a federal regulatory body, or to the
coverage of beneficiaries
under any contract covering officers or
employees of the state
that has been entered into by the
department of
administrative services.
(D)(1) No health insuring
corporation contract with a
provider or health care facility
shall contain any of the
following:
(a) A provision that directly or indirectly
offers an
inducement to the provider or health care
facility to reduce or
limit medically
necessary health care services to a covered
enrollee;
(b) A provision that penalizes a
provider or health care
facility that
assists an enrollee to seek a reconsideration of the
health
insuring corporation's decision to deny or limit benefits
to the
enrollee;
(c) A provision that limits or otherwise restricts
the
provider's or health care facility's ethical and legal
responsibility to fully advise enrollees about their medical
condition and about medically appropriate treatment
options;
(d) A provision that penalizes a provider or
health care
facility for principally advocating for medically
necessary health
care services;
(e) A provision that penalizes a provider or health care
facility for providing information or testimony to a legislative
or regulatory body or agency. This shall not be construed to
prohibit a health insuring corporation from penalizing a
provider
or health care facility that provides information or
testimony
that is libelous or slanderous or that discloses trade
secrets
which the provider or health care facility has no
privilege or
permission to disclose.
(f) A provision that violates Chapter 3963. of the Revised
Code.
(2) Nothing in this division shall be construed to
prohibit a
health insuring corporation from doing either of the
following:
(a) Making a determination not to reimburse or pay
for a
particular medical treatment or other health care
service;
(b) Enforcing reasonable peer review or
utilization review
protocols, or determining whether a
particular provider or health
care facility has complied with
these protocols.
(E) Any contract between
a health insuring corporation and an
intermediary organization
shall clearly specify that the health
insuring corporation must
approve or disapprove the participation
of any provider or
health care facility with which the
intermediary organization
contracts.
(F) If an intermediary organization that is not a health
delivery
network contracting solely with self-insured employers
subcontracts with a
provider or health care facility, the
subcontract with the provider or health
care facility shall do all
of the following:
(1) Contain the provisions required by divisions
(C) and (G)
of this section, as made
applicable to an intermediary
organization, without the inclusion of
inducements or penalties
described in division (D) of this
section;
(2) Acknowledge that the health insuring corporation is a
third-party beneficiary to the agreement;
(3) Acknowledge the health insuring corporation's role in
approving the participation of the provider or health care
facility, pursuant to division
(E) of this section.
(G) Any provider
contract or contract with a health care
facility shall clearly
specify the health insuring corporation's
statutory
responsibility to monitor and oversee the offering of
covered
health care services to its enrollees.
(H)(1) A health insuring
corporation shall maintain its
provider contracts and its contracts with
health care facilities
at one or more of its places of business in
this state, and shall
provide copies of these contracts to
facilitate regulatory review
upon written notice by the
superintendent of insurance.
(2) Any contract with an intermediary organization that
accepts
compensation shall
include provisions requiring the
intermediary organization to
provide the superintendent with
regulatory access to all books,
records, financial information,
and documents related to the
provision of health care services to
subscribers and enrollees
under the contract. The contract shall
require the intermediary
organization to maintain such books,
records, financial
information, and documents at its principal
place of business in
this state and to preserve them for at least
three years in a
manner that facilitates regulatory review.
(I)(1) A health insuring corporation shall
notify its
affected enrollees of the termination of a
contract for the
provision of health care services
between the health insuring
corporation and a primary care
physician
or hospital, by mail,
within thirty days after the termination
of the contract.
(a) Notice shall be given to subscribers of the
termination
of a contract with a primary care physician if the
subscriber, or
a dependent covered under the subscriber's health
care coverage,
has received health care services from the
primary care physician
within the previous twelve months or if
the subscriber or
dependent has selected the physician as the
subscriber's or
dependent's primary care physician within the
previous twelve
months.
(b) Notice shall be given to subscribers of the
termination
of a contract with a hospital if the subscriber, or
a dependent
covered under the subscriber's health care coverage,
has received
health care services from that hospital within the
previous twelve
months.
(2) The health insuring corporation shall pay, in accordance
with the
terms of the contract, for all
covered health care
services rendered to an enrollee by a
primary care physician or
hospital between the date of the
termination of the contract and
five days after the notification
of the contract termination is
mailed to a subscriber at the
subscriber's last known address.
(J) Divisions (A) and (B) of this section do
not apply to any
health insuring corporation that, on June
4, 1997, holds a
certificate of authority or
license to operate under Chapter 1740.
of the Revised
Code.
(K) Nothing in this section shall restrict the governing body
of
a hospital from exercising the authority granted it pursuant to
section
3701.351 of the Revised Code.
Sec. 1753.01. As used in this chapter:
(A) "Economic profiling" means a health insuring
corporation's use of economic performance data and economic
information in determining whether to contract with a provider
for
the provision of covered health care services to enrollees
as a
participating provider.
(B) "Basic, "basic health care services," "enrollee," "health
care
facility," "health care services," "health insuring
corporation,"
"medical
record," "person," "primary care provider,"
"provider,"
"subscriber," and "supplemental health care services"
have the
same
meanings as in section 1751.01 of
the Revised Code.
Sec. 1753.07. (A)(1) Prior to entering into a
participation
contract with a provider under
section 1751.13 of the Revised
Code, a health insuring
corporation shall disclose basic
information regarding its
programs and procedures to the provider,
upon the provider's
request. The information shall include all of
the following:
(1)(a) How a participating provider is reimbursed for the
participating
provider's
services, including the range and
structure of
any financial risk sharing arrangements, a
description of
any incentive plans, and, if reimbursed according
to a type of
fee-for-service arrangement, the level of
reimbursement for the
participating provider's services;
(2)(b) Insofar as division (A)(1) of section 3963.03 of the
Revised Code is applicable, all of the information that is
described in that division and is not included in division
(A)(1)(a) of this section.
(2) Prior to entering into a participation contract with a
provider under section 1751.13 of the Revised Code, a health
insuring corporation shall disclose the following information upon
the provider's request:
(a) How referrals to other participating providers or to
nonparticipating providers are made;
(3)(b) The availability of dispute resolution procedures and
the potential for cost to be incurred;
(4)(c) How a participating provider's name and address will
be used in
marketing materials.
(B) A health insuring corporation shall provide
all of the
following to a participating provider:
(1) Any material incorporated by reference into the
participation contract, that is not otherwise available as a
public record, if
such material affects the participating
provider;
(2) Administrative manuals related to provider
participation,
if any;
(3) Insofar as division (B) of section 3963.03 of the Revised
Code is applicable, the summary disclosure form with the
disclosures required under that division;
(4) A signed and dated copy of the final participation
contract.
Sec. 1753.09. (A) Except as provided in division
(D) of this
section, prior to
terminating the participation of a provider on
the
basis of the participating provider's failure to meet the
health insuring
corporation's standards for quality or utilization
in the delivery of health
care
services, a health insuring
corporation shall give the
participating provider notice of the
reason or reasons for its
decision to terminate the provider's
participation and an opportunity to take
corrective action. The
health insuring corporation shall
develop a performance
improvement plan in conjunction with the
participating provider.
If after being afforded the opportunity
to comply with the
performance improvement plan, the participating provider
fails to
do so, the health insuring corporation may terminate the
participation of the provider.
(B)(1) A participating provider whose participation has
been
terminated under division
(A) of this section may appeal
the
termination to the appropriate medical director of the
health
insuring corporation. The medical director shall give
the
participating provider an opportunity to discuss with the
medical
director the reason or reasons for the termination.
(2) If a satisfactory resolution of a participating
provider's appeal cannot be reached under division
(B)(1) of this
section, the participating provider
may appeal the termination to
a panel composed of participating
providers
who have comparable or
higher levels of
education and training than the participating
provider making
the appeal. A representative of the participating
provider's
specialty shall be a member of the panel, if possible.
This
panel shall hold a hearing, and shall render its
recommendation in the
appeal within thirty days after holding the
hearing. The
recommendation shall be presented to the medical
director and to the
participating provider.
(3) The medical director shall review and consider the
panel's recommendation before making a decision. The decision
rendered by the medical director shall be final.
(C) A
provider's status as a participating provider shall
remain in effect during
the appeal
process set forth in division
(B) of this
section unless the termination was based on any of the
reasons
listed in division (D) of this
section.
(D) Notwithstanding division (A) of this section, a
provider's participation may be
immediately terminated if the
participating provider's conduct presents an
imminent risk of harm
to
an enrollee or enrollees; or if there has occurred unacceptable
quality of care, fraud, patient abuse, loss of clinical
privileges, loss of professional liability coverage, incompetence,
or loss of
authority to practice in the participating provider's
field; or if a
governmental action has
impaired the participating
provider's ability to practice.
(E) Divisions (A) to (D) of this section apply
only to
providers who are natural persons.
(F)(1) Nothing in this
section prohibits a health insuring
corporation from rejecting a
provider's application for
participation, or from
terminating a participating provider's
contract, if the health
insuring corporation determines that the
health care needs of
its enrollees are being met and no need
exists for the
provider's or participating provider's services.
(2) Nothing in this section shall be construed as prohibiting
a health
insuring corporation from terminating a participating
provider who does not
meet the terms
and conditions of the
participating provider's contract.
(3) Nothing in this section shall be construed as prohibiting
a health insuring corporation from terminating a participating
provider's contract pursuant to any provision of the contract
described in division (E)(2) of section 3963.02 of the
Revised
Code, except that, notwithstanding any provision of a
contract
described in that division, this section applies to the
termination of a
participating provider's contract for any of the
causes described
in divisions (A), (D), and (F)(1) and (2) of
this section.
(G) The superintendent of insurance may adopt
rules as
necessary to implement and enforce sections 1753.04 to
1753.06,
1753.07, and 1753.09 of the Revised
Code. Such rules shall be
adopted in accordance with
Chapter 119. of the
Revised
Code. The
director of health
may make recommendations to the superintendent
for rules
necessary to implement and enforce sections 1753.04 to
1753.06, 1753.07, and 1753.09
of the Revised
Code. In adopting any
rules
pursuant to this division, the superintendent shall consider
the
recommendations of the director.
Sec. 3963.01. As used in this chapter:
(A) "Affiliate" means any person or entity that has ownership
or control of a contracting entity, is owned or controlled by a
contracting entity, or is under common ownership or control with a
contracting entity.
(B) "Basic health care services" has the same meaning as in
division (A) of section 1751.01 of the Revised Code, except that
it does not include any
services listed in that division that are
provided by a pharmacist or nursing home.
(C) "Contracting entity" means any person that has a primary
business purpose of contracting with participating providers for
the delivery of
health care services.
(D) "Credentialing" means the process of assessing and
validating the qualifications of a provider applying to be
approved by a contracting entity to provide basic or supplemental
health care services to enrollees.
(E) "Edit" means adjusting one or more procedure codes billed
by a participating provider on a claim for payment or a
practice
that results in any of the following:
(1) Payment for some, but not all of the procedure codes
originally billed by a participating provider;
(2) Payment for a different procedure code than the procedure
code originally billed by a participating provider;
(3) A reduced payment as a result of services provided to an
enrollee that are claimed under more than one procedure code on
the same service date.
(F) "Enrollee" means any person eligible for health care
benefits under a health benefit plan and includes all of the
following terms:
(1) "Enrollee" and "subscriber" as defined by section 1751.01
of
the Revised Code;
(2) "Member" as defined by section 1739.01 of the Revised
Code;
(3) "Insured" and "plan member" pursuant to Chapter 3923. of
the
Revised Code;
(4) "Beneficiary" as defined by section 3901.38 of the
Revised
Code.
(G) "Health care contract" means a contract entered into,
modified, or
renewed between a contracting entity and a
participating provider for the
delivery of basic or supplemental
health care services to
enrollees.
(H) "Health care services" means basic health care services
and supplemental health care services.
(I) "Participating provider" means a provider that has a
health care contract with a contracting entity and is entitled to
reimbursement for health care services
rendered to an enrollee
under the health care contract.
(J) "Payer" means any person that assumes the financial risk
for the payment of claims under a health care contract or the
reimbursement for health care services provided to enrollees by
participating providers pursuant to a health care contract.
(K) "Primary enrollee" means a person who is responsible for
making payments for participation in a
health care plan or an
enrollee whose employment or other status
is the basis of
eligibility for enrollment in a health care plan.
(L) "Procedure codes" includes the American medical
association's current procedural terminology code, the American
dental association's current dental terminology, and the centers
for medicare and medicaid services health care common procedure
coding system.
(M) "Product" means a product line for health care services,
including, but not limited to a health insuring corporation
product or a medicaid product
for which the participating provider
may be obligated
to
provide
health care services pursuant to a
health care contract.
(N) "Provider" means a physician, podiatrist, dentist,
chiropractor, optometrist, psychologist, advanced
practice nurse,
occupational therapist, massage therapist,
physical therapist,
professional counselor, professional clinical
counselor, hearing
aid dealer, orthotist, prosthetist, home
medical equipment
services provider, hospital, ambulatory surgery
center, or
medical
transportation company. "Provider"
does not mean a
pharmacist or nursing home.
(O) "Supplemental health care services" has the same meaning
as in division (B) of section 1751.01 of the Revised Code, except
that it does not include any services listed in that division that
are provided by a pharmacist or nursing home.
Sec. 3963.02. (A)(1) No contracting entity shall sell, rent,
or give the contracting entity's rights to a participating
provider's services pursuant to the contracting entity's health
care contract with the participating provider unless one of the
following applies:
(a) The third party accessing the participating provider's
services under the health care contract is an employer or other
entity providing coverage for health care services to its
employees or members, and that employer or entity has a contract
with the contracting entity or its affiliate for the
administration or processing of claims for payment or service
provided pursuant to the health care contract with the
participating provider.
(b) The third party accessing the participating provider's
services under the health care contract is either of the
following:
(i) An affiliate or subsidiary of the contracting entity;
(ii) Providing administrative services to, or receiving
administrative services from, the contracting entity or an
affiliate or subsidiary of the contracting entity.
(c) The health care contract specifically provides that it
applies to network rental arrangements and states that one purpose
of the contract is selling, renting, or giving the contracting
entity's rights to the services of the participating provider,
including other preferred provider organizations, and the third
party accessing the participating provider's services is either of
the following:
(i) A payer or a third-party administrator or other entity
responsible for administering claims on behalf of the payer;
(ii) A preferred provider organization or preferred provider
network that receives access to the participating provider's
services pursuant to an arrangement with the preferred provider
organization or preferred provider network in a contract with the
participating provider that is in compliance with division
(A)(1)(c) of this section, and is required to comply with all of
the terms, conditions, and affirmative obligations to which the
originally contracted primary participating provider network is
bound under its
contract with the participating provider,
including, but not
limited to, obligations concerning patient
steerage and the
timeliness and manner of reimbursement.
(2) The contracting entity that sells, rents, or gives the
contracting entity's rights to the participating provider's
services pursuant to the contracting entity's health care contract
with the participating provider as provided in division (A)(1) of
this section shall do both of the following:
(a) Maintain a web page that contains a listing of third
parties described in divisions (A)(1)(b)(i) and (c) of this
section with whom a contracting entity contracts for the purpose
of selling, renting, or giving the contracting entity's rights to
the services of participating providers that is updated at least
every six months and is accessible to all participating providers,
or maintain a toll-free telephone number accessible to all
participating providers by means of which participating providers
may access the same listing of third parties;
(b) Require that the third party accessing the participating
provider's services through the participating provider's health
care contract is obligated to comply with all of the applicable
terms and conditions of the contract, including, but not limited
to, the products for which the participating provider has agreed
to provide services, except that a payer receiving administrative
services from the contracting entity or its affiliate shall be
solely responsible for payment to the participating provider.
(3) Any information disclosed to a participating provider
under this section shall be considered proprietary and shall not
be distributed by the participating provider.
(4) Except as provided in division (A)(1) of this section, no
entity other than a contracting entity shall sell, rent, or give a
contracting entity's rights to the participating provider's
services pursuant to a health care contract.
(B)(1) No contracting entity shall require, as a condition of
contracting with the contracting entity, that a participating
provider provide services for more than one product offered by the
contracting entity.
(2) Division (B)(1) of this section shall not be construed to
do any of the following:
(a) Prohibit any participating provider from voluntarily
accepting an offer by a contracting entity to provide health care
services under more than one of the contracting entity's products;
(b) Prohibit any contracting entity from offering any
financial incentive or other form of consideration specified in
the health care contract for a participating provider to provide
health care services under more than one of the contracting
entity's products;
(c) Require any contracting entity to contract with a
participating provider to provide health care services under only
one of the
contracting entity's products if the
contracting
entity
does not wish to do so.
(3) Notwithstanding division (B)(2) of this section, no
contracting entity shall require, as a condition of contracting
with the contracting entity, that the participating provider
accept any future product offering that the contracting entity
makes.
(C) No contracting entity shall require, as a condition of
contracting with the contracting entity, that a participating
provider waive or forego any right or benefit to which the
participating
provider may be entitled under state or federal law.
However, a
contracting entity may restrict a participating
provider's scope
of practice for
the services to be provided
under the contract.
(D) No health care contract shall do either of the following:
(1) Prohibit any participating provider from entering into a
health care
contract with any other contracting entity;
(2) Preclude its use or disclosure for the purpose of
enforcing this chapter or other state or federal law, except that
a health care contract may require that appropriate measures be
taken to preserve the confidentiality of any proprietary or
trade-secret information.
(E)(1) In addition to any other lawful reasons for
terminating a health care contract, a health care contract may be
terminated under the
circumstances
described in division (A)(2)
of section 3963.04 of the
Revised Code.
(2) If the health care contract provides for termination for
cause by either party, the health care contract shall state the
reasons that may be used for termination for cause, which terms
shall be reasonable. Subject to division (E)(3) of this section,
the health care contract shall state the time by which the parties
must provide notice of termination for cause and to whom the
parties shall give the notice.
(3) Nothing in divisions (E)(1) and (2) of this section shall
be construed as prohibiting any health insuring corporation from
terminating a participating provider's contract for any of the
causes described in divisions (A), (D), and (F)(1) and (2) of
section 1753.09 of the Revised Code. Notwithstanding any provision
in a health care contract pursuant to division (E)(2) of this
section, section 1753.09 of the Revised Code applies to the
termination of a participating provider's contract for any of the
causes described in divisions (A), (D), and (F)(1) and (2) of
section 1753.09 of the Revised Code.
(F)(1) Disputes among parties that only concern the
enforcement of the contract rights conferred by
sections 3963.02
and 3963.04, utilizing the applicable definitions in section
3963.01, of the Revised Code are subject to a
mutually agreed
upon arbitration mechanism that is binding on all
parties. The
arbitrator may award reasonable attorney's fees and
costs for
arbitration relating to the enforcement of this section
to the
prevailing party.
(2) A party shall not simultaneously maintain an
arbitration
proceeding as described in division (F)(1) of this
section and
pursue a complaint with the superintendent of
insurance to
investigate the subject matter of the arbitration
proceeding. If
the superintendent of insurance initiates an
investigation into
the subject matter of a pending arbitration
proceeding, the
arbitration proceeding shall be stayed at the
request of any
party pending the outcome of the investigation by
the
superintendent. The arbitrator shall make the arbitrator's
decision in an arbitration proceeding having due regard for any
applicable rules, bulletins, rulings, or decisions theretofore
issued by the department of insurance or any court concerning the
enforcement of the contract rights conferred by sections 3963.02
and 3963.04, utilizing the applicable definitions in section
3963.01, of the Revised Code.
Sec. 3963.03. (A) Each health care contract shall include all
of the
following information:
(1)(a) Information sufficient for the participating provider
to determine the
compensation or payment terms for health care
services, including
all of the following, subject to division
(A)(1)(b) of this section:
(i) The manner of payment, such as fee-for-service,
capitation, or risk;
(ii) The fee schedule of procedure codes reasonably expected
to be billed by a participating provider's specialty for services
provided
pursuant to the health care contract and the associated
payment or
compensation for each procedure code. A fee schedule
may be
provided electronically. Upon request, a contracting
entity shall
provide a participating provider with the fee
schedule for any other procedure
codes requested and a written
fee schedule, that shall not be
required more frequently than
twice per year excluding when it is
provided in connection with
any change to the schedule. The
effect, if any, on payment
or
compensation if more than
one procedure code applies to the
service also shall be stated.
This requirement may be satisfied
by
providing a clearly
understandable, readily available
mechanism,
such as a specific
web site address, that allows a
participating provider to
determine the effect
of procedure
codes on payment or
compensation before a service is
provided or
a claim is submitted.
(b) If the contracting entity is unable to include the
information described in division (A)(1)(a)(ii) of this section,
the contracting entity shall include both of the following types
of information instead:
(i) The methodology used to calculate any fee schedule, such
as relative value unit system and conversion factor or percentage
of billed charges. If
applicable, the methodology disclosure
shall include the name of
any relative value unit system, its
version, edition, or
publication date, any applicable conversion
or geographic factor,
and any date by which compensation or fee
schedules may be changed
by the methodology as anticipated at the
time of contract.
(ii) The identity of any internal processing edits
,
including the publisher, product name,
version,
and version
update of any editing software.
(2) Any product or network for which the participating
provider is to
provide
services;
(3) The term of the health care contract;
(4) A specific web site address that contains the identity of
the contracting entity or payer responsible for the
processing of
the participating provider's compensation or payment;
(5) Any internal mechanism provided by the contracting entity
to resolve disputes concerning the interpretation or application
of the terms and conditions of the contract. A contracting entity
may satisfy this requirement by providing a clearly
understandable, readily available mechanism, such as a specific
web site address or an appendix, that allows a participating
provider to determine the procedures for the internal mechanism to
resolve those disputes.
(6) A list of addenda, if any, to the contract.
(B)(1) Each contracting entity shall include a summary
disclosure form with a health care contract that includes all of
the information specified in division (A) of this section. The
information in
the summary disclosure form shall refer to the
location in the health care contract, whether a page number,
section of the contract, appendix, or other identifiable location,
that specifies the provisions in the contract to which the
information in the form refers.
(2) The summary disclosure form shall include all of the
following statements:
(a) That the form is a guide to the health care contract and
that the terms and conditions of the health care contract
constitute the contract rights of the parties;
(b) That reading the form is not a substitute for reading the
entire health care contract;
(c) That by signing the health care contract, the
participating provider will be bound by the contract's terms and
conditions;
(d) That the terms and conditions of the health care contract
may be amended pursuant to section 3963.04 of the Revised Code and
the participating provider is encouraged to carefully read any
proposed amendments sent after execution of the contract;
(e) That nothing in the summary disclosure form creates any
additional rights or causes of action in favor of either party.
(3) No contracting entity that includes any information in
the summary disclosure form with the reasonable belief that the
information is truthful or accurate shall be subject to a civil
action for damages or to binding arbitration based on the summary
disclosure form. Division (B)(3) of this section does not impair
or affect any power of the department of insurance to enforce any
applicable law.
(4) The summary disclosure form described in divisions (B)(1)
and (2) of this section shall be in substantially the following
form:
"SUMMARY DISCLOSURE FORM
[ ] Other ............... See ...............
(b) Fee schedule available at ...............
(c) Fee calculation schedule available at ...............
(d) Identity of internal processing edits available at
...............
(e) Information in (c) and (d) is not required if information
in (b) is provided.
(2) List of products or networks covered by this contract
(3) Term of this contract ...............
(4) Contracting entity or payer responsible for processing
payment available at ...............
(5) Internal mechanism for resolving disputes regarding
contract terms available at ...............
IMPORTANT INFORMATION - PLEASE READ CAREFULLY
The information provided in this Summary Disclosure Form is a
guide to the attached Health Care Contract as defined in section
3963.01(G) of the Ohio Revised Code. The terms and conditions of
the attached Health Care Contract constitute the contract rights
of the parties.
Reading this Summary Disclosure Form is not a substitute for
reading the entire Health Care Contract. When you sign the Health
Care Contract, you will be bound by its terms and conditions.
These terms and conditions may be amended over time pursuant to
section 3963.04 of the Ohio Revised Code. You are encouraged to
read any proposed amendments that are sent to you after execution
of the Health Care Contract.
Nothing in this Summary Disclosure Form creates any
additional rights or causes of action in favor of either party."
(C) When a contracting entity presents a proposed health care
contract for consideration by a participating provider, the
contracting entity
shall provide in writing or make reasonably
available the
information required in division (A)(1) of this
section. If the
information is not disclosed in writing, it shall
be disclosed in
a manner that allows the participating provider
to evaluate the participating provider's
payment or compensation
for services under the health care
contract. The
contracting
entity need not provide such information to the participating
provider in written
format more than twice a year.
(D) The contracting entity shall identify any utilization
management, quality improvement, or a similar program that the
contracting entity uses to review, monitor, evaluate, or assess
the
services provided pursuant to a health care contract. The
contracting entity shall disclose the policies, procedures, or
guidelines of such a program applicable to a participating
provider upon request
by the participating provider within
fourteen days after the date of the
request.
(E) Nothing in this section shall be construed as preventing
or affecting the application of section 1753.07 of the Revised
Code that would otherwise apply to a contract with a participating
provider.
Sec. 3963.04. (A)(1) An amendment of a health care contract
shall occur only if the contracting entity provides to
the
participating provider the proposed amendment in writing and
notice of
the proposed amendment not later than sixty days prior
to the
effective date of the amendment. The notice shall be
conspicuously entitled "Notice of Material Change to Contract" and
shall specify the effective date of the proposed amendment.
(2) Subject
to division (A)(4) of this section, if within
thirty days after
receiving the proposed amendment and notice
described in division
(A)(1)
of this section the participating
provider objects in
writing to the proposed
amendment, and there
is no resolution of
the objection, either
party may terminate
the health care
contract upon written notice
of termination
provided to the other
party not later than thirty
days prior to
the effective date of
the proposed amendment.
(3) If the participating provider does not object to the
proposed amendment
in the manner described in division (A)(2) of
this section, the
amendment shall be effective as specified in
the notice described
in division (A)(1) of this section.
(4) If a proposed amendment is the addition of a new category
of coverage under the health care contract, the participating
provider objects
to that proposed amendment in the manner
described in division (A)(2)
of this section, and there is no
resolution of the objection, the
amendment shall not be effective
as to the participating provider, and the
objection shall not be
a basis upon which the contracting entity
may terminate the
contract under that division.
(B)(1) Division (A) of this section does not apply if the
delay caused by compliance with that division could result in
imminent harm to an enrollee or if the amendment of a health care
contract is required by state or federal law, rule, or regulation.
(2) This section does not apply under any of the following
circumstances:
(a) The participating
provider's payment or compensation is
based on the current
medicaid or medicare physician fee schedule,
and the change in payment or
compensation results solely from a
change in that physician fee
schedule.
(b) A routine change or update of the health care contract is
made in response to any addition, deletion, or revision of any
service code, procedure code, or reporting code, or a pricing
change is made by any third party source.
For purposes of division (B)(2)(b) of this section:
(i) "Service code, procedure code, or reporting code" means
the current procedural terminology (CPT), the healthcare common
procedure coding system (HCPCS), the international classification
of diseases (ICD), or the drug topics redbook average wholesale
price (AWP).
(ii) "Third party source" means the American medical
association, the centers for medicare and medicaid services, the
national center for health statistics, the department of health
and human services office of the inspector general, the Ohio
department of insurance, or the Ohio department of job and family
services.
(C) Notwithstanding divisions (A) and (B) of this section, a
health care contract may be modified, without the need for an
amendment pursuant to division (A) of this section, by operation
of law as required by any applicable state or federal law, rule,
or regulation. Nothing in this section shall be construed to
require the renegotiation of a health care contract that is in
existence before the effective date of this section, until the
time that the contract is renewed or modified.
Sec. 3963.05. (A) The department of insurance shall prepare
and adopt a form, in electronic or paper format, that is
substantially similar to the credentialing form used by the
council
for affordable quality healthcare (CAQH), and that form
shall be the standard credentialing form for physicians.
The
department of insurance also shall prepare the standard
credentialing form for all other providers.
(B) No contracting entity shall fail to use the applicable
standard
credentialing form described in division (A) of this
section when
initially credentialing or recredentialing providers
in connection
with policies, health care contracts, and
agreements providing
basic or supplemental health care services.
(C) No contracting entity shall require a provider to provide
any information in addition to the information required by the
applicable
standard credentialing form described in division (A)
of this
section in connection with policies, health care
contracts, and
agreements providing basic or supplemental health
care services.
Sec. 3963.06. (A) If a provider, upon the oral or written
request of a contracting entity to submit a credentialing form,
submits a credentialing form that is not complete, the contracting
entity that receives the form shall notify the provider of the
deficiency electronically or by certified mail, return receipt
requested, not later than twenty-one days after the contracting
entity receives the form.
(B) If a contracting entity receives any information that is
inconsistent with the information given by the provider in the
credentialing form, the contracting entity may request the
provider to submit a written clarification of the inconsistency.
The contracting entity shall send the request described in this
division electronically or by certified mail, return
receipt
requested.
(C)(1) The credentialing process under this section starts
when
a provider initially submits a credentialing form upon the
oral or
written request of a contracting entity. Subject to
division (C)(2) of this section, a contracting entity
shall
complete the credentialing
process not later than ninety
days
after the contracting entity receives that credentialing form
from the provider. A contracting entity that does not complete the
credentialing process within the ninety-day period specified in
this division is liable for a civil penalty payable to the
provider in the amount of five hundred dollars per day, including
weekend days, starting at the expiration of that ninety-day period
until the provider's application for the health care contract is
granted or denied.
(2) The requirement that the credentialing process be
completed within the ninety-day period specified in division
(C)(1) of this section does not apply to a contracting entity if a
provider that submits a credentialing form to the contracting
entity under that division is a home medical equipment services
provider, hospital, ambulatory surgery center, or medical
transportation company.
Sec. 3963.07. (A)(1) Upon a
participating provider's
submission of an enrollee's name, the
enrollee's relationship to
the primary enrollee, the
enrollee's birth date, or the
enrollee's social security number, each contracting entity shall
make available information maintained in
the ordinary course of
business that is sufficient for the
participating
provider to
determine at the time of the enrollee's
visit all of
the
following:
(a) The enrollee's identification number assigned by the
contracting entity;
(b) The birth date and gender of the primary enrollee;
(c) The names, birth dates, and gender of all covered
dependents;
(d) The current enrollment and eligibility status of the
enrollee;
(e) Whether a specific type or category of service is a
covered benefit for the enrollee;
(f) The enrollee's excluded benefits or limitations, whether
group or individual;
(g) The enrollee's copayment requirements;
(h) The unmet amount of the enrollee's deductible or the
enrollee's financial responsibility.
(2) A contracting entity that maintains enrollee information
in the ordinary course of business shall make available the
information
required by division (A)(1) of this section
electronically or by
an internet portal and shall maintain the
flexibility to determine the manner described in division (A)(1)
of this section by which the participating provider shall accesses
the information specified in that division. The information
required by division (A)(1) of this section shall include a
statement to the effect that the information made available is not
necessarily the final indication of the eligibility status of the
enrollee due to changes that may have occurred prior to or after
that date of which the contracting entity is unaware, and that the
information was obtained from sources that the contracting entity
reasonably believes to be accurate. Any information specified in
division (A)(1) of this section that is provided in good faith by
the contracting entity shall not be used in any enforcement action
under this chapter.
(3) Notwithstanding division (A)(1) of this section, no
contracting entity shall make the information required by that
division available to any person except to a participating
provider or the participating provider's agent or to any person or
governmental entity
that is authorized under
state and federal
law to receive
personally identifiable
information concerning an
enrollee or an
enrollee's dependent.
(4) No contracting entity directly or indirectly shall charge
a participating provider any fee for the information the
contracting entity makes
available pursuant to division (A) of
this section.
(5) A contracting entity is considered as having complied
with division (A) of this section if the information specified in
division (A)(1) of this
section is updated once a month and the
date on which the
information is updated is included with the
information that is
made available electronically or by internet
portal pursuant to
division (A)(2) of this section.
(B) All remittance notices sent by a payer, whether written
or electronic, shall include both of the following:
(1) The name of the payer issuing the payment to the
participating
provider;
(2) The name of the contracting entity through which the
payment rate and any discount are claimed, if the contracting
entity is different from the payer.
(C) Division (A) of this section takes effect January 1,
2009.
Sec. 3963.08. The superintendent of insurance shall adopt
any rules necessary for the implementation of this chapter.
Sec. 3963.09. (A) A series of violations of this chapter by
any person regulated by the department of insurance under Title
XVII or Title XXXIX of the Revised Code that, taken together,
constitute a pattern or practice of violating this chapter may be
defined as an unfair and deceptive insurance practice under
sections 3901.19 to 3901.26 of the Revised Code.
(B) The superintendent of insurance may conduct a market
conduct examination of any person regulated by the department of
insurance under Title XVII or Title XXXIX of the Revised Code to
determine whether any violation of this chapter has occurred. When
conducting that type of examination, the superintendent of
insurance may assess the costs of the examination against the
person examined. The superintendent may enter into a consent
agreement to impose any administrative assessment or fine for
conduct discovered that may be a violation of this chapter. All
costs, assessments, and fines collected under this section shall
be deposited to the credit of the department of insurance
operating fund.
Sec. 3963.10. This chapter does not apply with respect to
any of the following:
(A) Payments made to providers for rendering health care
services to
medicaid recipients pursuant to the reimbursement
system referred
to by the department of job and family services
as the
fee-for-service system;
(B) Payments made to providers for rendering health care
services to claimants pursuant to claims made under Chapter 4121.,
4123., 4127., or 4131. of the Revised Code;
(C) Payments made to providers for rendering health care
services to beneficiaries of the medicare program established
under Title XVIII of the "Social Security Act," 79 Stat. 286
(1965), 42 U.S.C. 1395, as amended;
(D) An exclusive contract between a health insuring
corporation and a single group of providers in a specific
geographic
area to provide or arrange for the provision of health
care services.
Sec. 5111.17. (A)
The department of
job and
family services
may enter into contracts
with managed
care organizations,
including health insuring corporations, under which the
organizations are authorized to
provide, or
arrange for the
provision of, health care services to
medical
assistance
recipients
who are required or permitted to obtain health care
services through managed care
organizations as part of the care
management system
established under
section 5111.16 of the
Revised Code.
(B) The director of job and family services
may
adopt rules
in accordance with
Chapter 119. of the Revised Code to
implement
this section.
(C) The department of job and family services shall allow
managed care
plans to use providers to render care upon
completion of
the managed care plan's credentialing process.
Section 2. That existing sections 1751.13, 1753.01, 1753.07,
1753.09, and 5111.17 and sections 1753.03, 1753.04, 1753.05, and
1753.08 of
the Revised Code are hereby repealed.
Section 3. Sections 3963.01 to 3963.10 of the Revised Code,
as enacted by this act, shall apply only to contracts that are
delivered, issued for delivery, or renewed or modified in this
state on or after the effective date of this act. A health
insuring corporation having fewer than fifteen thousand enrollees
shall comply with the provisions of this section within twelve
months after the effective date of this act.
Section 4. Division (A) of section 3963.07 of the Revised
Code, as enacted by
this act, takes effect January 1, 2009.
Section 5. (A) As used in this section and Section 6 of this
act:
(1) "Most favored nation clause" means a provision in a
health care contract that does any of the following:
(a) Prohibits, or grants a contracting entity an option to
prohibit, the participating provider from contracting with another
contracting entity to provide health care services at a lower
price than the payment specified in the contract;
(b) Requires, or grants a contracting entity an option to
require, the participating provider to accept a lower payment in
the event the participating provider agrees to provide health care
services to any other contracting entity at a lower price;
(c) Requires, or grants a contracting entity an option to
require, termination or renegotiation of the existing health care
contract in the event the participating provider agrees to provide
health care services to any other contracting entity at a lower
price;
(d) Requires the participating provider to disclose the
participating provider's contractual reimbursement rates with
other contracting entities.
(2) "Contracting entity," "health care contract," "health
care services," "participating provider," and "provider" have the
same meanings as in section 3963.01 of the Revised Code, as
enacted by this act.
(B) No health care contract that includes a most favored
nation clause shall be entered into, and no health care contract
at the instance of a contracting entity
shall be amended,
modified, or renewed to include a most favored
nation clause, for
a period of two years after the effective date
of this act,
subject to extension as provided in Section 6 of this
act.
Section 6. (A) There is hereby created the Joint Legislative
Study Commission on Most Favored Nation Clauses in Health Care
Contracts consisting of fifteen members as follows:
(1) The Superintendent of Insurance;
(2) Two members of the House of Representatives, one
representing the majority party and one representing the minority
party;
(3) Two members of the Senate, one representing the majority
party and one representing the minority party;
(4) Three providers who are individuals;
(5) Two representatives of hospitals;
(6) Two representatives of contracting entities regulated by
the Department of Insurance under Title XVII of the Revised Code;
(7) Two representatives of contracting entities regulated by
the Department of Insurance under Title XXXIX of the Revised Code;
(8) One representative of an employer that pays for the
health insurance coverage of its employees.
(B) The members of the Commission shall be appointed as
follows:
(1) The Speaker of the House of Representatives shall appoint
the two members of the House specified in division (A)(2) of this
section.
(2) The President of the Senate shall appoint the two members
of the Senate specified in division (A)(3) of this section.
(3) The Speaker of the House of Representatives and the
President of the Senate jointly shall appoint the remaining
members specified in divisions (A)(4) to (8) of this section.
(C) Initial appointments to the Commission shall be made
within thirty days after the effective date of this act. The
appointments shall be for the term of the Commission as provided
in division (F)(2) of this section. Vacancies shall be filled in
the same manner provided for original appointments.
(D)(1) The Superintendent of Insurance shall be the
Chairperson of the Commission. Meetings of the Commission shall be
at the call of the Chairperson. All of the members of the
Commission shall be voting members. Meetings of the Commission
shall be held pursuant to section 121.22 of the Revised Code.
(2) The Department of Insurance shall provide office space or
other facilities, any administrative or other technical,
professional, or clerical employees, and any necessary supplies
for the work of the Commission.
(3) The Chairperson of the Commission shall keep the records
of the Commission. Upon submission of the Commission's final
report to the General Assembly under division (F) of this section,
the Chairperson shall deliver all of the Commission's records to
the General Assembly.
(E)(1) The Commission shall study the following areas
pertaining to health care contracts:
(a) The procompetitive and anticompetitive aspects of most
favored nation clauses;
(b) The impact of most favored nation clauses on health care
costs and on the availability of and accessibility to quality
health care;
(c) The costs associated with the enforcement of most favored
nation clauses;
(d) Other state laws and rules pertaining to most favored
nation clauses in their health care contracts;
(e) Matters determined by the Department of Insurance as
relevant to the study of most favored nation clauses;
(f) Any other matters that the Commission considers
appropriate to determine the effectiveness of most favored nation
clauses.
(2) The Commission may take testimony from experts or
interested parties on the areas of its study as described in
division (E)(1) of this section.
(F)(1) Not less than ninety days prior to the expiration of
the two-year period specified in Section 5 of this act, the
Commission shall report its preliminary findings to the General
Assembly and a recommendation of whether to extend that two-year
period for one additional year. If the General Assembly does not
grant the extension, the Commission shall submit its final report
to the General Assembly not later than three months after the
expiration of the two-year period specified in Section 5 of this
act. If the General Assembly grants the extension, the extension
shall be for not more than one year after the expiration of the
two-year period specified in Section 5 of this act, and the
Commission shall submit its final report to the General Assembly
not later than six months prior to the expiration of the one-year
extension.
(2) The final report of the Commission shall include its
findings and recommendations on whether state law should prohibit
or restrict most favored nation clauses in health care contracts.
The Commission shall cease to exist upon the submission of its
final report to the General Assembly.
|