Judge Issues Order To Delay Ohio's Health Care Price Transparency Law
(December 22, 2016) With agreement of all parties, involved, Judge JT Stelzer of the Common Pleas Court of Williams County this afternoon issued a 30-day temporary restraining order (TRO), preventing Ohio's new Price Transparency Law from going into effect, January 1.
The Ohio Osteopathic Association joined the Ohio Hospital Association, Ohio State Medical Association and several other organizations in filing a lawsuit earlier in the day asking for the TRO to prevent the State of Ohio from implementing the new law due to its complexity and difficult to implement language. The lawsuit points out that the transparency requirement was inserted without debate in HB 52, which had the unrelated single purpose of making appropriations for the Bureau of Workers Compensation.
Beginning in 2017, the transparency law requires all medical service providers to furnish patients with a written, reasonable, good-faith estimate in advance of services for all nonemergency products, services, or procedures. Information that must be provided includes all of the following:
- The amount the provider will charge the patient or the consumer's health plan issuer for the product, service, or procedure;
- The amount the health plan issuer intends to pay for the product, service, or procedure; and
- The difference, if any, that the consumer or other party responsible for the consumer's care would be required to pay to the provider for the product, service, or procedure.
The act requires any health plan issuer contacted by a provider to provide the cost information to the provider within a "reasonable time." The act required the appointment of a "Health Services Price Disclosure Study Committee to work with the Medicaid Director to adopt rules for the implementation of the act's requirements related to health services cost estimates. The rules, which have not been adopted, were required to address both of the following: (1) How a cost estimate is to be provided to a consumer; and (2) The definition of "emergency products, services, or procedures.
Although providers, in good faith negotiations, have proposed a number of alternatives and limitations for the rules, agreement has not been reached and the Ohio General Assembly let the current implementation date stand. Providers requested a six month delay to complete the rule-making process, but lawmakers did not respond. Although there are no penalties in the law for non-compliance per se, failure to provide a good faith estimate upon request would place providers in violation of the law and subject them to possible civil actions by patients who do not receive the information they request. Health care providers subject to the law include:
- Nursing Homes and Residential Care Facilities
- Dentists and Dental Hygienists
- Optometrists and Optical Dispensers
- Physicians and Limited Practitioners licensed by the Medical Board
- Hearing Aid Dealers
- Speech-Language Pathologists and Audiologists
- Occupational Therapists, Physical Therapists, and Athletic Trainers
- Counselors, Social Workers, and Marriage and Family Therapists
The Kasich administration and providers have been struggling to promulgate rules, but consensus has been difficult due to the ambiguity and impracticality of some of the provisions. The State, therefore, agreed to a 30-day delay and the Court has entered a TRO that is in effect until at least January 21, 2017. This means that providers have protection from the law’s effects as of January 1, until some further action is taken or the TRO expires. The parties are expected to be in discussions over the next 30 days to either prepare for the next stage of the litigation or work out a solution.