Youngstown Daily Legal News

Health cost transparency bill designed to fix previous version

KEITH ARNOLD
Special to the Legal News
Published: December 22, 2017

A Republican lawmaker has proposed a fix to the hamstrung provision of the 2015 Bureau of Workers' Compensation budget that was to have implemented cost transparency for scheduled health care services and those requiring insurance pre-authorization.

Recently, Rep. Stephen Huffman of Tipp City pitched House Bill 416 to members of the House Insurance Committee which is intended to elucidate the troublesome language that prompted a challenge in the Williams County Court of Common Pleas.

"This legislation was created in light of the issues with the current transparency section of the code," Huffman said. "By clarifying what the insurer and provider must provide to the patient and utilizing the prior authorization process, I believe that this language will be much more enforceable for stakeholders while still greatly benefiting patients."

Specifically, HB 416 would repeal the existing provisions that require specified health care facilities and professionals to provide a reasonable, good faith estimate of various costs before products, services, or procedures are provided.

In their place, the bill would enact a system that requires health care providers to provide reasonable, good faith estimates for scheduled services and health plan issuers to provide reasonable, good faith estimates for services for which the patient's health care provider seeks pre-authorization.

Huffman characterized the proposed new system as "more workable" while still beneficial to patients.

"Price transparency has been a major topic in discussions to reduce healthcare costs across the nation," the lawmaker said. "Similar to any other transaction, a consumer wants to know what they should anticipate paying for a service or product.

"While the healthcare industry and the pricing of services are certainly complex, patients deserve to have information regarding their care readily available to them."

Yosef Schiff, an analyst for the Ohio Legislative Service Commission, noted that the ongoing litigation precluded the current law never from going into effect.

"By court order, the statute is restrained from enforcement while the lawsuit is pending," Schiff wrote for the commission. "Shortly after the statute's enactment, Community Hospitals and Wellness Centers, the Ohio Hospital Association, and other healthcare provider groups filed suit in the (common pleas court).

"They sought judgment that the statute is unconstitutional and void, and preliminary and permanent injunctions prohibiting enforcement of the statute."

The court subsequently barred implementation or enforcement of the law until after an injunction ruling. A hearing on the preliminary injunction is scheduled for March 15.

"HB 416 would require a provider, upon request, to give a 'good faith' cost estimate of a service or procedure that is scheduled at least seven days in advance," Huffman said during sponsor testimony. "This estimate will include the amount the provider expects to receive as payment from the health plan, the amount that the patient will be required to pay, and, if applicable, notification that the provider is out of network for the patient.

"If the scheduled service requires a prior authorization, then the responsibility will shift to the insurer to provide a cost estimate, in writing, directly to the patient or the patient's representative once the prior authorization request is approved."

Patients - both insured and uninsured - would have the opportunity to request and review what their medical procedures will cost, according to the bill's language.

"Transparency is an essential component for empowering patients to make wise decisions regarding their care," the lawmaker continued. "As healthcare costs continue to rise and Ohio looks for ways to reduce costs and make meaningful reforms to the industry, we must implement common-sense policies to benefit patients."

A patient still would be responsible for payment of an administered health care service or procedure even if he does not receive an estimate before receiving that service or procedure, according to the bill.

HB 416 was not scheduled a second hearing as of publication.

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