OHIO

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The Ohio SBL became effective April 1, 2021. Ohio Revised Code 3902.50 – 3902.54. The relevant provisions of the Ohio law include:

• A requirement that reimbursement for emergency and inadvertent treatment be at the greatest of 1) the median in-network rate, 2) the usual method used by the health plan to pay out-of-network providers, such as UCR, and 3) the Medicare rate.
• An arbitration process if after 30 days the parties cannot agree.
• Arbitration within 1 year of the service date.
• A provision allowing the bundling of up to 15 claims.
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Regrading bifurcation, according to CMS,

Ohio does not have an applicable All-Payer Model Agreement that would determine the out-of-network rate. Based on CMS research and CMS communications with Ohio Department of Insurance staff, CMS understands that ORC 3902.50 – 3902.54 are specified state laws that will apply for purposes of determining the out-of-network rate with respect to emergency services and non-emergency services by nonparticipating providers at in-network facilities. The federal independent dispute resolution process under section 2799A-2(b) of the PHS Act and 45 CFR 149.520 will apply for purposes of determining the out-of-network rate with respect to services furnished to individuals in an insured group health plan, or group or individual health insurance coverage in Ohio by nonparticipating providers of air ambulance services. The Ohio Department of Insurance will enforce the outcome of the federal independent dispute resolution process for such cases in Ohio.

Letter from CMS to Governor of Ohio, dated February 17, 2021.