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Surprise Billing
Surprise Billing

Governor DeWine signed House Bill 388 into law on January 7, 2021. This law protects patients from receiving surprise medical bills for emergency care or, in certain circumstances, unexpected out-of-network care. Primarily, the law prohibits the practice of balance billing in these instances, leaving any price negotiation to be handled between the health provider and the health plan. The Ohio Department of Insurance (ODI) is responsible for administering and enforcing many provisions of this law beginning in January 2022.

Stakeholder Engagement Process

The department intends to conduct a robust stakeholder engagement process to solicit ideas on the development of rules associated with implementation of House Bill 388. The stakeholder feedback process will begin March 2021. ODI will then formally submit rules to the Common Sense Initiative (CSI) and the Joint Committee on Agency Rule Review (JCARR). During the formal rule making process, members of the public will also have opportunities to provide input on the proposed rules through formal public comment periods with CSI and JCARR.

Your Feedback is Requested!

At this time, the department is seeking comments related to rules and implementation of the law within the state. The department has identified in the information below areas that, at minimum, will need addressed in rulemaking. Please email comments to surprisebilling@insurance.ohio.gov

Statutory Citation Text
R.C. 3902.51(A)(3)(c)  Within the period of time specified by the superintendent of insurance in rule, the provider, facility, emergency facility, or ambulance shall either notify the health plan issuer of its acceptance of the reimbursement or seek to negotiate reimbursement under division (B)(2) of this section. Failure to timely notify the issuer of an intent to negotiate shall be considered acceptance of the issuer's reimbursement.
R.C. 3902.52(G) Documents and other evidence submitted to an arbitrator under this section are confidential, not public records for the purposes of section 149.43 of the Revised Code, and shall not be released except as authorized pursuant to this division. If release of the evidence is required pursuant to a court order, the arbitrator shall release the evidence pursuant to the court order but shall redact from the evidence released information that constitutes intellectual property, trade secrets, or information requiring redaction pursuant to a rule adopted by the superintendent of insurance.
R.C. 3902.52(H) As used in this section, "provider" includes a practice of providers to the extent permitted by rules adopted by the superintendent of insurance under division (D) of section 3902.54 of the Revised Code including but not limited to rules adopted regarding the maximum number of providers 
in a practice.
R.C. 3902.53(A)(2) The superintendent of insurance may adopt rules pursuant to division (D) of section 3902.54 of the Revised Code specifying situations in which sections 3901.38 to 3901.3814 of the Revised Code apply during periods of negotiation under section 3902.51 of the Revised Code.
R.C. 3902.54(A)

(1) The superintendent of insurance shall contract with a single arbitration entity to perform all arbitrations described in section 3902.52 of the Revised Code. The superintendent shall ensure that the arbitration entity, any arbitrators the arbitration entity designates to conduct an arbitration, and any officer, director, or employee of the arbitration entity do not have any material, professional, familial, or financial connection with any of the following:

(a) The health plan issuer involved in a dispute;
(b) An officer, director, or employee of the health plan issuer;
(c) A provider, facility, emergency facility, ambulance, medical group, or independent practice organization involved with the service in question;
(d) The development or manufacture of any principal drug, device, procedure, or other therapy in dispute;
(e) The covered person who received the service that is the subject of a dispute or the covered person's immediate family.

(2) The superintendent shall require the arbitration entity to do all of the following:

(a) Utilize arbitrators who are knowledgeable and experienced in applicable principles of contract and insurance law;
(b) Ensure that the arbitrators have access to appropriate specialists including certified coding specialists, physicians, nurses, other clinicians, and health insurance experts as necessary to render a determination;
(c) Utilize a secure electronic portal for the submission, processing, and management of arbitration applications;
(d) Perform all arbitrations under section 3902.52 of the Revised Code on a flat fee basis.

R.C. 3902.54(D) The superintendent of insurance shall adopt rules pursuant to Chapter 119. of the Revised Code as necessary to implement sections 3902.50 to 3902.54 of the Revised Code. Rules adopted by the superintendent may relate to the definitions of "provider," "facility," "emergency facility," and "ambulance." The requirements of section 121.95 of the Revised Code do not apply to rules adopted in accordance with this division.