Bill Text: OH SB137 | 2009-2010 | 128th General Assembly | Introduced
Bill Title: To specify that the Ohio prompt payment law applies to payment of claims by Medicaid managed care organizations for health care services provided to Medicaid managed care participants.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2009-06-16 - To Health, Human Services, & Aging [SB137 Detail]
Download: Ohio-2009-SB137-Introduced.html
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Senator Miller, R.
To amend sections 3901.38, 3901.383, and 3901.3814 | 1 |
and to repeal section 5111.178 of the Revised Code | 2 |
to specify that the Ohio prompt payment law | 3 |
applies to payment of claims by Medicaid managed | 4 |
care organizations for health care services | 5 |
provided to Medicaid managed care participants. | 6 |
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 3901.38, 3901.383, and 3901.3814 of | 7 |
the Revised Code be amended to read as follows: | 8 |
Sec. 3901.38. As used in this section and sections 3901.381 | 9 |
to 3901.3814 of the Revised Code: | 10 |
(A) "Beneficiary" means any policyholder, subscriber, member, | 11 |
employee, or other person who is eligible for benefits under a | 12 |
benefits contract. | 13 |
(B) "Benefits contract" means a sickness and accident | 14 |
insurance policy providing hospital, surgical, or medical expense | 15 |
coverage, or a health insuring corporation contract or other | 16 |
policy or agreement under which a third-party payer agrees to | 17 |
reimburse for covered health care or dental services rendered to | 18 |
beneficiaries, up to the limits and exclusions contained in the | 19 |
benefits contract. | 20 |
(C) "Hospital" has the same meaning as in section 3727.01 of | 21 |
the Revised Code. | 22 |
(D) "Medicaid managed care organization" means a managed care | 23 |
organization that has a contract with the department of job and | 24 |
family services pursuant to section 5111.17 of the Revised Code. | 25 |
(E) "Provider" means a hospital, nursing home, physician, | 26 |
podiatrist, dentist, pharmacist, chiropractor, or other health | 27 |
care provider entitled to reimbursement by a third-party payer for | 28 |
services rendered to a beneficiary under a benefits contract. | 29 |
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otherwise accept responsibility for payment for health care | 31 |
services rendered to a beneficiary, or arrange for the provision | 32 |
of health care services to a beneficiary. | 33 |
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(1) An insurance company; | 35 |
(2) A health insuring corporation; | 36 |
(3) A labor organization; | 37 |
(4) An employer; | 38 |
(5) An intermediary organization, as defined in section | 39 |
1751.01 of the Revised Code, that is not a health delivery network | 40 |
contracting solely with self-insured employers; | 41 |
(6) An administrator subject to sections 3959.01 to 3959.16 | 42 |
of the Revised Code; | 43 |
(7) A health delivery network, as defined in section 1751.01 | 44 |
of the Revised Code; | 45 |
(8) A medicaid managed care organization; | 46 |
(9) Any other person that is obligated pursuant to a benefits | 47 |
contract to reimburse for covered health care services rendered to | 48 |
beneficiaries under such contract. | 49 |
Sec. 3901.383. (A) A provider and a third-party payer may do | 50 |
either of the following: | 51 |
(1) Enter into a contractual agreement under which time | 52 |
periods shorter than those set forth in section 3901.381 of the | 53 |
Revised Code are applicable to the third-party payer in paying a | 54 |
claim for any amount due for health care services rendered by the | 55 |
provider; | 56 |
(2) Enter into a contractual agreement under which the timing | 57 |
of payments by the third-party payer is not directly related to | 58 |
the receipt of a claim form. The contractual arrangement may | 59 |
include periodic interim payment arrangements, capitation payment | 60 |
arrangements, or other periodic payment arrangements acceptable to | 61 |
the provider and the third-party payer. Under a capitation payment | 62 |
arrangement, the third-party payer shall begin paying the | 63 |
capitated amounts to the beneficiary's primary care provider not | 64 |
later than sixty days after the date the beneficiary selects or is | 65 |
assigned to the provider. Under any other contractual periodic | 66 |
payment arrangement, the contractual agreement shall state, with | 67 |
specificity, the timing of payments by the third-party payer. | 68 |
(B) | 69 |
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third-party payer, including a third-party payer that provides | 72 |
coverage under the medicaid program, shall not enter into a | 73 |
contractual arrangement under which time periods longer than those | 74 |
provided for in paragraph (c)(1) of 42 C.F.R. 447.46 are | 75 |
applicable to the third-party payer in paying a claim for any | 76 |
amount due for health care services rendered by the provider. | 77 |
Sec. 3901.3814. (A) Sections 3901.38 and 3901.381 to | 78 |
3901.3813 of the Revised Code do not apply to the following: | 79 |
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Chapters 3935. and 3937. of the Revised Code; | 81 |
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administrators, as defined in section 3959.01 of the Revised Code, | 83 |
to the extent that federal law supersedes, preempts, prohibits, or | 84 |
otherwise precludes the application of any provisions of those | 85 |
sections to the plan and its administrators; | 86 |
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medicare advantage program operated under Title XVIII of the | 88 |
"Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as | 89 |
amended; | 90 |
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tricare program offered by the United States department of | 103 |
defense | 104 |
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children's buy-in program established under sections 5101.5211 to | 106 |
5101.5216 of the Revised Code. | 107 |
(B) The application of sections 3901.38 to 3901.3814 of the | 108 |
Revised Code to medicaid managed care organizations neither | 109 |
affects the department of job and family services' authority | 110 |
under section 5111.01 of the Revised Code to act as the single | 111 |
state medicaid agency nor affects the department's authority to | 112 |
enter into contracts with managed care organizations under section | 113 |
5111.17 of the Revised Code. | 114 |
Section 2. That existing sections 3901.38, 3901.383, and | 115 |
3901.3814 and section 5111.178 of the Revised Code are hereby | 116 |
repealed. | 117 |