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Am. H. B. No. 81 As Passed by the House
As Passed by the House
128th General Assembly | Regular Session | 2009-2010 |
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Representatives Boyd, Gardner
Cosponsors:
Representatives Weddington, Mallory, Domenick, Newcomb, Luckie, Miller, Yuko, Williams, B., Murray, Foley, Hagan, Chandler, Harris, Skindell, Oelslager, Okey, Pryor, Phillips, Williams, S., Bolon, Letson, Stewart, Brown, Garrison, Fende, Book, Winburn, Garland, Patten, Belcher, Carney, Celeste, DeBose, Dodd, Dyer, Harwood, Heard, Lundy, Moran, Szollosi, Ujvagi, Yates
A BILL
To amend sections 1739.05 and 1751.01 and to enact
sections 1751.69 and 3923.71 of the Revised Code
to require certain health care policies,
contracts, agreements, and plans to provide
benefits for equipment, supplies, and medication
for the diagnosis, treatment, and management of
diabetes and for diabetes self-management
education and to create the Small Business Health
Care Affordability Task Force.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 1739.05 and 1751.01 be amended and
sections 1751.69 and 3923.71 of the Revised Code be enacted to
read as follows:
Sec. 1739.05. (A) A multiple employer welfare arrangement
that is created pursuant to sections 1739.01 to 1739.22 of the
Revised Code and that operates a group self-insurance program may
be established only if any of the following applies:
(1) The arrangement has and maintains a minimum enrollment of
three hundred employees of two or more employers.
(2) The arrangement has and maintains a minimum enrollment of
three hundred self-employed individuals.
(3) The arrangement has and maintains a minimum enrollment of
three hundred employees or self-employed individuals in any
combination of divisions (A)(1) and (2) of this section.
(B) A multiple employer welfare arrangement that is created
pursuant to sections 1739.01 to 1739.22 of the Revised Code and
that operates a group self-insurance program shall comply with all
laws applicable to self-funded programs in this state, including
sections 3901.04, 3901.041, 3901.19 to 3901.26, 3901.38, 3901.381
to 3901.3814, 3901.40, 3901.45, 3901.46, 3902.01 to 3902.14,
3923.282, 3923.30, 3923.301, 3923.38, 3923.581, 3923.63, 3923.71,
3923.80, 3924.031, 3924.032, and 3924.27 of the Revised Code.
(C) A multiple employer welfare arrangement created pursuant
to sections 1739.01 to 1739.22 of the Revised Code shall solicit
enrollments only through agents or solicitors licensed pursuant to
Chapter 3905. of the Revised Code to sell or solicit sickness and
accident insurance.
(D) A multiple employer welfare arrangement created pursuant
to sections 1739.01 to 1739.22 of the Revised Code shall provide
benefits only to individuals who are members, employees of
members, or the dependents of members or employees, or are
eligible for continuation of coverage under section 1751.53 or
3923.38 of the Revised Code or under Title X of the "Consolidated
Omnibus Budget Reconciliation Act of 1985," 100 Stat. 227, 29
U.S.C.A. 1161, as amended.
Sec. 1751.01. As used in this chapter:
(A)(1) "Basic health care services" means the following
services when medically necessary:
(a) Physician's services, except when such services are
supplemental under division (B) of this section;
(b) Inpatient hospital services;
(c) Outpatient medical services;
(d) Emergency health services;
(e) Urgent care services;
(f) Diagnostic laboratory services and diagnostic and
therapeutic radiologic services;
(g) Diagnostic and treatment services, other than
prescription drug services, for biologically based mental
illnesses;
(h) Preventive health care services, including, but not
limited to, voluntary family planning services, infertility
services, periodic physical examinations, prenatal obstetrical
care, and well-child care;
(i) Routine patient care for patients enrolled in an eligible
cancer clinical trial pursuant to section 3923.80 of the Revised
Code;
(j) Diabetes self-management education, medical nutrition
therapy, and equipment, supplies, and medication, as provided in
section 1751.69 of the Revised Code.
"Basic health care services" does not include experimental
procedures.
Except as provided by divisions (A)(2) and (3) of this
section in connection with the offering of coverage for diagnostic
and treatment services for biologically based mental illnesses, a
health insuring corporation shall not offer coverage for a health
care service, defined as a basic health care service by this
division, unless it offers coverage for all listed basic health
care services. However, this requirement does not apply to the
coverage of beneficiaries enrolled in medicare pursuant to a
medicare 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 medicaid recipients, or to
the coverage of participants of the children's buy-in program, 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.
(2) A health insuring corporation may offer coverage for
diagnostic and treatment services for biologically based mental
illnesses without offering coverage for all other basic health
care services. A health insuring corporation may offer coverage
for diagnostic and treatment services for biologically based
mental illnesses alone or in combination with one or more
supplemental health care services. However, a health insuring
corporation that offers coverage for any other basic health care
service shall offer coverage for diagnostic and treatment services
for biologically based mental illnesses in combination with the
offer of coverage for all other listed basic health care services.
(3) A health insuring corporation that offers coverage for
basic health care services is not required to offer coverage for
diagnostic and treatment services for biologically based mental
illnesses in combination with the offer of coverage for all other
listed basic health care services if all of the following apply:
(a) The health insuring corporation submits documentation
certified by an independent member of the American academy of
actuaries to the superintendent of insurance showing that incurred
claims for diagnostic and treatment services for biologically
based mental illnesses for a period of at least six months
independently caused the health insuring corporation's costs for
claims and administrative expenses for the coverage of basic
health care services to increase by more than one per cent per
year.
(b) The health insuring corporation submits a signed letter
from an independent member of the American academy of actuaries to
the superintendent of insurance opining that the increase in costs
described in division (A)(3)(a) of this section could reasonably
justify an increase of more than one per cent in the annual
premiums or rates charged by the health insuring corporation for
the coverage of basic health care services.
(c) The superintendent of insurance makes the following
determinations from the documentation and opinion submitted
pursuant to divisions (A)(3)(a) and (b) of this section:
(i) Incurred claims for diagnostic and treatment services for
biologically based mental illnesses for a period of at least six
months independently caused the health insuring corporation's
costs for claims and administrative expenses for the coverage of
basic health care services to increase by more than one per cent
per year.
(ii) The increase in costs reasonably justifies an increase
of more than one per cent in the annual premiums or rates charged
by the health insuring corporation for the coverage of basic
health care services.
Any determination made by the superintendent under this
division is subject to Chapter 119. of the Revised Code.
(B)(1) "Supplemental health care services" means any health
care services other than basic health care services that a health
insuring corporation may offer, alone or in combination with
either basic health care services or other supplemental health
care services, and includes:
(a) Services of facilities for intermediate or long-term
care, or both;
(b) Dental care services;
(c) Vision care and optometric services including lenses and
frames;
(d) Podiatric care or foot care services;
(e) Mental health services, excluding diagnostic and
treatment services for biologically based mental illnesses;
(f) Short-term outpatient evaluative and crisis-intervention
mental health services;
(g) Medical or psychological treatment and referral services
for alcohol and drug abuse or addiction;
(h) Home health services;
(i) Prescription drug services;
(k) Services of a dietitian licensed under Chapter 4759. of
the Revised Code;
(l) Physical therapy services;
(m) Chiropractic services;
(n) Any other category of services approved by the
superintendent of insurance.
(2) If a health insuring corporation offers prescription drug
services under this division, the coverage shall include
prescription drug services for the treatment of biologically based
mental illnesses on the same terms and conditions as other
physical diseases and disorders.
(C) "Specialty health care services" means one of the
supplemental health care services listed in division (B) of this
section, when provided by a health insuring corporation on an
outpatient-only basis and not in combination with other
supplemental health care services.
(D) "Biologically based mental illnesses" means
schizophrenia, schizoaffective disorder, major depressive
disorder, bipolar disorder, paranoia and other psychotic
disorders, obsessive-compulsive disorder, and panic disorder, as
these terms are defined in the most recent edition of the
diagnostic and statistical manual of mental disorders published by
the American psychiatric association.
(E) "Children's buy-in program" has the same meaning as in
section 5101.5211 of the Revised Code.
(F) "Closed panel plan" means a health care plan that
requires enrollees to use participating providers.
(G) "Compensation" means remuneration for the provision of
health care services, determined on other than a fee-for-service
or discounted-fee-for-service basis.
(H) "Contractual periodic prepayment" means the formula for
determining the premium rate for all subscribers of a health
insuring corporation.
(I) "Corporation" means a corporation formed under Chapter
1701. or 1702. of the Revised Code or the similar laws of another
state.
(J) "Emergency health services" means those health care
services that must be available on a seven-days-per-week,
twenty-four-hours-per-day basis in order to prevent jeopardy to an
enrollee's health status that would occur if such services were
not received as soon as possible, and includes, where appropriate,
provisions for transportation and indemnity payments or service
agreements for out-of-area coverage.
(K) "Enrollee" means any natural person who is entitled to
receive health care benefits provided by a health insuring
corporation.
(L) "Evidence of coverage" means any certificate, agreement,
policy, or contract issued to a subscriber that sets out the
coverage and other rights to which such person is entitled under a
health care plan.
(M) "Health care facility" means any facility, except a
health care practitioner's office, that provides preventive,
diagnostic, therapeutic, acute convalescent, rehabilitation,
mental health, mental retardation, intermediate care, or skilled
nursing services.
(N) "Health care services" means basic, supplemental, and
specialty health care services.
(O) "Health delivery network" means any group of providers or
health care facilities, or both, or any representative thereof,
that have entered into an agreement to offer health care services
in a panel rather than on an individual basis.
(P) "Health insuring corporation" means a corporation, as
defined in division (I) of this section, that, pursuant to a
policy, contract, certificate, or agreement, pays for, reimburses,
or provides, delivers, arranges for, or otherwise makes available,
basic health care services, supplemental health care services, or
specialty health care services, or a combination of basic health
care services and either supplemental health care services or
specialty health care services, through either an open panel plan
or a closed panel plan.
"Health insuring corporation" does not include a limited
liability company formed pursuant to Chapter 1705. of the Revised
Code, an insurer licensed under Title XXXIX of the Revised Code if
that insurer offers only open panel plans under which all
providers and health care facilities participating receive their
compensation directly from the insurer, a corporation formed by or
on behalf of a political subdivision or a department, office, or
institution of the state, or a public entity formed by or on
behalf of a board of county commissioners, a county board of
mental retardation and developmental disabilities, an alcohol and
drug addiction services board, a board of alcohol, drug addiction,
and mental health services, or a community mental health board, as
those terms are used in Chapters 340. and 5126. of the Revised
Code. Except as provided by division (D) of section 1751.02 of the
Revised Code, or as otherwise provided by law, no board,
commission, agency, or other entity under the control of a
political subdivision may accept insurance risk in providing for
health care services. However, nothing in this division shall be
construed as prohibiting such entities from purchasing the
services of a health insuring corporation or a third-party
administrator licensed under Chapter 3959. of the Revised Code.
(Q) "Intermediary organization" means a health delivery
network or other entity that contracts with licensed health
insuring corporations or self-insured employers, or both, to
provide health care services, and that enters into contractual
arrangements with other entities for the provision of health care
services for the purpose of fulfilling the terms of its contracts
with the health insuring corporations and self-insured employers.
(R) "Intermediate care" means residential care above the
level of room and board for patients who require personal
assistance and health-related services, but who do not require
skilled nursing care.
(S) "Medicaid" has the same meaning as in section 5111.01 of
the Revised Code.
(T) "Medical record" means the personal information that
relates to an individual's physical or mental condition, medical
history, or medical treatment.
(U) "Medicare" means the program established under Title
XVIII of the "Social Security Act" 49 Stat. 620 (1935), 42 U.S.C.
1395, as amended.
(V)(1) "Open panel plan" means a health care plan that
provides incentives for enrollees to use participating providers
and that also allows enrollees to use providers that are not
participating providers.
(2) No health insuring corporation may offer an open panel
plan, unless the health insuring corporation is also licensed as
an insurer under Title XXXIX of the Revised Code, the health
insuring corporation, on June 4, 1997, holds a certificate of
authority or license to operate under Chapter 1736. or 1740. of
the Revised Code, or an insurer licensed under Title XXXIX of the
Revised Code is responsible for the out-of-network risk as
evidenced by both an evidence of coverage filing under section
1751.11 of the Revised Code and a policy and certificate filing
under section 3923.02 of the Revised Code.
(W) "Panel" means a group of providers or health care
facilities that have joined together to deliver health care
services through a contractual arrangement with a health insuring
corporation, employer group, or other payor.
(X) "Person" has the same meaning as in section 1.59 of the
Revised Code, and, unless the context otherwise requires, includes
any insurance company holding a certificate of authority under
Title XXXIX of the Revised Code, any subsidiary and affiliate of
an insurance company, and any government agency.
(Y) "Premium rate" means any set fee regularly paid by a
subscriber to a health insuring corporation. A "premium rate" does
not include a one-time membership fee, an annual administrative
fee, or a nominal access fee, paid to a managed health care system
under which the recipient of health care services remains solely
responsible for any charges accessed for those services by the
provider or health care facility.
(Z) "Primary care provider" means a provider that is
designated by a health insuring corporation to supervise,
coordinate, or provide initial care or continuing care to an
enrollee, and that may be required by the health insuring
corporation to initiate a referral for specialty care and to
maintain supervision of the health care services rendered to the
enrollee.
(AA) "Provider" means any natural person or partnership of
natural persons who are licensed, certified, accredited, or
otherwise authorized in this state to furnish health care
services, or any professional association organized under Chapter
1785. of the Revised Code, provided that nothing in this chapter
or other provisions of law shall be construed to preclude a health
insuring corporation, health care practitioner, or organized
health care group associated with a health insuring corporation
from employing certified nurse practitioners, certified nurse
anesthetists, clinical nurse specialists, certified nurse
midwives, dietitians, physician assistants, dental assistants,
dental hygienists, optometric technicians, or other allied health
personnel who are licensed, certified, accredited, or otherwise
authorized in this state to furnish health care services.
(BB) "Provider sponsored organization" means a corporation,
as defined in division (I) of this section, that is at least
eighty per cent owned or controlled by one or more hospitals, as
defined in section 3727.01 of the Revised Code, or one or more
physicians licensed to practice medicine or surgery or osteopathic
medicine and surgery under Chapter 4731. of the Revised Code, or
any combination of such physicians and hospitals. Such control is
presumed to exist if at least eighty per cent of the voting rights
or governance rights of a provider sponsored organization are
directly or indirectly owned, controlled, or otherwise held by any
combination of the physicians and hospitals described in this
division.
(CC) "Solicitation document" means the written materials
provided to prospective subscribers or enrollees, or both, and
used for advertising and marketing to induce enrollment in the
health care plans of a health insuring corporation.
(DD) "Subscriber" means a person who is responsible for
making payments to a health insuring corporation 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
insuring corporation.
(EE) "Urgent care services" means those health care services
that are appropriately provided for an unforeseen condition of a
kind that usually requires medical attention without delay but
that does not pose a threat to the life, limb, or permanent health
of the injured or ill person, and may include such health care
services provided out of the health insuring corporation's
approved service area pursuant to indemnity payments or service
agreements.
Sec. 1751.69. (A) As used in this section:
(1) "Equipment, supplies, and medication" includes both of
the following, when determined to be medically necessary:
(a) Nonexperimental equipment, single-use medical supplies,
and related devices approved by the United States food and drug
administration for the treatment and management of diabetes;
(b) Nonexperimental medication, insulin, glucagons, and
insulin syringes for controlling blood sugar approved by the
United States food and drug administration for the treatment and
management of diabetes.
(2) "Medical nutrition therapy" means nutritional diagnostic,
therapeutic, and counseling services for the purpose of diabetes
disease management provided by a dietitian licensed under Chapter
4759. of the Revised Code or a nutrition professional pursuant to
a physician's referral.
(3) "Diabetes self-management education" means an interactive
and ongoing process prescribed by a physician involving a patient
with diabetes and the physician or other professional with
expertise in diabetes. "Diabetes self-management education"
includes assessment and identification of the patient's diabetes
needs and management goals, education and behavioral intervention
directed toward helping the patient attain self-management goals,
and evaluation of the patient's progress in attaining
self-management goals.
(B)(1) Notwithstanding section 3901.71 of the Revised Code,
each individual or group health insuring corporation policy,
contract, or agreement that covers basic health care services and
is delivered, issued for delivery, or renewed in this state shall
provide benefits for medical nutrition therapy and diabetes
self-management education expenses, when determined to be
medically necessary.
(2) Notwithstanding section 3901.71 of the Revised Code, each
individual or group health insuring corporation policy, contract,
or agreement that covers basic health care services and is
delivered, issued for delivery, or renewed in this state shall
provide benefits for the expenses of medically necessary diabetes
medication, equipment, and supplies unless the insured person is
covered by an employer-provided group supplemental benefit policy
that provides comparable benefits for these expenses. Regardless
of whether the benefits are provided through the policy, contract,
or agreement that covers basic health care services or a
supplemental benefit policy, the copayment and deductible amounts
for the benefits shall not exceed those for other medication,
equipment, and supplies for which benefits are provided by the
policy, contract, or agreement. If the benefits are provided as
part of the policy, contract, or agreement that covers basic
health care services, the copayments and deductibles for the
expenses shall be no higher than they would be if the benefits
were provided through a supplemental benefit policy.
(C) All of the following apply to the provision of benefits
for the expenses of diabetes self-management education and medical
nutrition therapy:
(1) The benefits shall cover the expenses of diabetes
self-management education and medical nutrition therapy only if
the education is determined to be medically necessary and is
prescribed by a physician or other individual whose professional
practice established by licensure under the Revised Code includes
the authority to prescribe the education.
(2) During the first twelve-month period immediately after a
patient begins to receive diabetes self-management education, the
benefits shall cover the expenses of ten hours of education, which
may include medical nutrition therapy in a program based on the
standards for diabetes self-management education as outlined in
the American diabetes association's standards of care.
(3) In each year following the provision of coverage under
division (C)(2) of this section, the benefits shall cover the
expenses of two hours of diabetes self-management education, of
which one hour may be used for medical nutrition therapy, as an
annual maintenance program for the patient, if the education is
medically necessary and prescribed by a physician or other
individual whose professional practice established by licensure
under the Revised Code includes the authority to prescribe the
education. Any coverage provided for the expenses of a required
medical examination shall not reduce the coverage provided for the
expenses of the patient's annual education maintenance program
described in this section.
(4) The benefits shall cover the expenses of any diabetes
self-management education determined to be medically necessary,
whether provided during home visits, in a group setting, or by
individual counseling.
(5) The benefits shall cover the expenses of diabetes
self-management education only if the education is provided by an
individual with expertise in diabetes care whose professional
practice established by licensure under the Revised Code includes
the authority to provide the education. The benefits shall cover
the expenses of medical nutrition therapy only if the therapy is
provided by a dietitian licensed under Chapter 4759. of the
Revised Code unless the patient's health plan does not include a
dietitian in its network of providers.
(D) A health insuring corporation that offers coverage for
basic health care services is not required to offer coverage for
diabetes self-management education and medical nutrition therapy
in combination with the offer of coverage for all other listed
basic health care services if all of the following apply:
(1) The health insuring corporation submits documentation
certified by an independent member of the American academy of
actuaries to the superintendent of insurance showing that incurred
claims for diabetes self-management education and medical
nutrition therapy for a period of at least six months
independently caused the health insuring corporation's costs for
claims and administrative expenses for the coverage of basic
health care services to increase by more than one per cent per
year.
(2) The health insuring corporation submits a signed letter
from an independent member of the American academy of actuaries to
the superintendent of insurance opining that the increase in costs
described in division (D)(1) of this section could reasonably
justify an increase of more than one per cent in the annual
premiums or rates charged by the health insuring corporation for
the coverage of basic health care services.
(3) The superintendent of insurance makes the following
determinations from the documentation and opinion submitted
pursuant to divisions (D)(1) and (2) of this section:
(a) Incurred claims for diabetes self-management education
and medical nutrition therapy for a period of at least six months
independently caused the health insuring corporation's costs for
claims and administrative expenses for the coverage of basic
health care services to increase by more than one per cent per
year.
(b) The increase in costs reasonably justifies an increase of
more than one per cent in the annual premiums or rates charged by
the health insuring corporation for the coverage of basic health
care services.
Any determination made by the superintendent under this
division is subject to Chapter 119. of the Revised Code.
Sec. 3923.71. (A) As used in this section:
(1) "Equipment, supplies, and medication" includes both of
the following, when determined to be medically necessary:
(a) Nonexperimental equipment, single-use medical supplies,
and related devices approved by the United States food and drug
administration for the treatment and management of diabetes;
(b) Nonexperimental medication, insulin, glucagons, and
insulin syringes for controlling blood sugar approved by the
United States food and drug administration for the treatment and
management of diabetes.
(2) "Medical nutrition therapy" means nutritional diagnostic,
therapeutic, and counseling services for the purpose of diabetes
disease management provided by a dietitian licensed under Chapter
4759. of the Revised Code or a nutrition professional pursuant to
a physician's referral.
(3) "Diabetes self-management education" means an interactive
and ongoing process prescribed by a physician involving a patient
with diabetes and the physician or other professional with
expertise in diabetes. "Diabetes self-management education"
includes assessment and identification of the patient's diabetes
needs and management goals, education and behavioral intervention
directed toward helping the patient attain self-management goals,
and evaluation of the patient's progress in attaining
self-management goals.
(B)(1) Notwithstanding section 3901.71 of the Revised Code,
each individual or group policy of sickness and accident insurance
that is delivered, issued for delivery, or renewed in this state
and each public employee benefit plan that is established or
modified in this state, shall provide benefits for medical
nutrition therapy and diabetes self-management education expenses,
when determined to be medically necessary.
(2) Notwithstanding section 3901.71 of the Revised Code, each
individual or group policy of sickness and accident insurance that
is delivered, issued for delivery, or renewed in this state and
each public employee benefit plan that is established or modified
in this state, shall provide benefits for the expenses of
medically necessary diabetes medication, equipment, and supplies
unless the insured person is covered by an employer-provided
supplemental benefit policy that provides comparable benefits for
these expenses. Regardless of whether the benefits are provided
through the policy or plan, or a supplemental benefit policy, the
copayment and deductible amounts for the benefits shall not exceed
those for other medication, equipment, and supplies for which
benefits are provided by the policy or plan. If the benefits are
provided as part of the policy or plan, the copayments and
deductibles for the expenses shall be no higher than they would be
if the benefits were provided through a supplemental benefit
policy.
(C) All of the following apply to the provision of benefits
for the expenses of diabetes self-management education and medical
nutrition therapy:
(1) The benefits shall cover the expenses of diabetes
self-management education and medical nutrition therapy only if
the education is determined to be medically necessary and is
prescribed by a physician or other individual whose professional
practice established by licensure under the Revised Code includes
the authority to prescribe the education.
(2) During the first twelve-month period immediately after a
patient begins to receive diabetes self-management education, the
benefits shall cover the expenses of ten hours of education, which
may include medical nutrition therapy in a program based on the
standards for diabetes self-management education as outlined in
the American diabetes association's standards of care.
(3) In each year following the provision of coverage under
division (C)(2) of this section, the benefits shall cover the
expenses of two hours of diabetes self-management education, of
which one hour may be used for medical nutrition therapy, as an
annual maintenance program for the patient, if the education is
medically necessary and prescribed by a physician or other
individual whose professional practice established by licensure
under the Revised Code includes the authority to prescribe the
education. Any coverage provided for the expenses of a required
medical examination shall not reduce the coverage provided for the
expenses of the patient's annual education maintenance program
described in this section.
(4) The benefits shall cover the expenses of any diabetes
self-management education determined to be medically necessary,
whether provided during home visits, in a group setting, or by
individual counseling.
(5) The benefits shall cover the expenses of diabetes
self-management education only if the education is provided by an
individual with expertise in diabetes care, whose professional
practice established by licensure under the Revised Code includes
the authority to provide the education. The benefits shall cover
the expenses of medical nutrition therapy only if the therapy is
provided by a dietitian licensed under Chapter 4759. of the
Revised Code unless the patient's health plan does not include a
dietitian in its network of providers.
(D) An insurer or public employee benefit plan is not
required to provide benefits for diabetes self-management
education and medical nutrition therapy under this section if all
of the following apply:
(1) The insurer or plan submits documentation certified by an
independent member of the American academy of actuaries to the
superintendent of insurance showing that incurred claims for
diabetes self-management education and medical nutrition therapy
for a period of at least six months independently caused the
insurer's or plan's costs for claims and administrative expenses
for all covered services to increase by more than one per cent per
year.
(2) The insurer or plan submits a signed letter from an
independent member of the American academy of actuaries to the
superintendent of insurance opining that the increase in costs
described in division (D)(1) of this section could reasonably
justify an increase of more than one per cent in the annual
premiums or rates charged by the insurer or plan for all covered
services.
(3) The superintendent of insurance makes the following
determinations from the documentation and opinion submitted
pursuant to divisions (D)(1) and (2) of this section:
(a) Incurred claims for diabetes self-management education
and medical nutrition therapy for a period of at least six months
independently caused the insurer's or plan's costs for claims and
administrative expenses for all covered services to increase by
more than one per cent per year.
(b) The increase in costs reasonably justifies an increase of
more than one per cent in the annual premiums or rates charged by
the insurer or plan for the coverage of all covered services.
Any determination made by the superintendent under this
division is subject to Chapter 119. of the Revised Code.
(E) This section does not apply to the offer or renewal of
any individual or group policy of sickness and accident insurance
that provides coverage for specific diseases or accidents only, or
to any hospital indemnity, medicare supplement, medicare, tricare,
long-term care, disability income, one-time limited duration
policy of not longer than six months, or other policy that offers
only supplemental benefits.
Section 2. That existing sections 1739.05 and 1751.01 of the
Revised Code are hereby repealed.
Section 3. Section 1751.69 of the Revised Code shall apply
only to policies, contracts, and agreements that are delivered,
issued for delivery, or renewed in this state on or after the
effective date of this act; and section 3923.71 of the Revised
Code shall apply to policies of sickness and accident insurance on
or after the effective date of this act in accordance with section
3923.01 of the Revised Code and to plans that are established or
modified in this state on or after the effective date of this act.
Section 4. (A) There is hereby created the Small Business
Health Care Affordability Task Force. The Task Force shall
commence its organizational meeting not later than thirty days
after the effective date of this section.
(B)(1) The Task Force members shall consist of all of the
following:
(a) Three members of the House of Representatives, two of
whom are appointed by the Speaker of the House of Representatives
and one of whom is appointed by the Minority Leader of the House
of Representatives;
(b) Three members of the Senate, two of whom are appointed by
the President of the Senate and one of whom is appointed by the
Minority Leader of the Senate.
(2) The Task Force may, at its organizational meeting,
appoint up to five additional members to the Task Force who
represent small business employers or employees or who are
otherwise relevant to the duties of the Task Force. A member
appointed by the Task Force shall not be a member of the General
Assembly.
(C) The Speaker of the House of Representatives and the
President of the Senate shall each designate one member appointed
under division (B)(1) of this section to serve as a co-chair of
the Task Force.
(D) The Task Force shall do all of the following:
(1) Study the potential benefits of state tax incentives for
small businesses that provide health insurance coverage for
employees;
(2) Study potential state incentives for businesses to offer
health wellness and disease prevention programs;
(3) Review employer health insurance tax incentives and
wellness programs in other states and analyze whether such state
policies would encourage greater affordability of
employer-provided health insurance coverage and support employers
in maintaining and expanding the workforce in Ohio;
(4) Consider federal legislation regarding the provision of
health insurance by small businesses, including the proposed
"Healthy Workforce Act of 2009" and "Small Business Health Options
Program Act of 2009," and the potential impact of such federal
legislation on Ohio's small businesses;
(5) Study the cost and feasibility of applying mandated
health benefits as defined in section 3901.71 of the Revised Code
to the Medicaid program.
(E) The Task Force shall report its findings and any
recommendations to the Speaker of the House of Representatives,
Minority Leader of the House of Representatives, President of the
Senate, Minority Leader of the Senate, and Governor not later than
six months following the initial organizational meeting of the
Task Force.
(F) On submission of the report required under division (E)
of this section, the Task Force shall cease to exist.
Section 5. Section 1751.01 of the Revised Code is presented
in this act as a composite of the section as amended by both Am.
Sub. H.B. 562 and Sub. S.B. 186 of the 127th General Assembly. The
General Assembly, applying the principle stated in division (B) of
section 1.52 of the Revised Code that amendments are to be
harmonized if reasonably capable of simultaneous operation, finds
that the composite is the resulting version of the section in
effect prior to the effective date of the section as presented in
this act.
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