Gov. Mike DeWine in July signed a new state operating budget but not before vetoing 25 items from the two-year spending plan, including several critical healthcare-related matters that physician groups had opposed.
Two of the more pressing issues of late in healthcare relate to surprise billing and price transparency. Elected leaders took on both issues in the state budget but settled on language that would have been problematic for physicians and drew widespread opposition from the medical community.
On surprise billing, lawmakers attempted to reign in unexpected medical bills sent to patients for out-of-network care that they likely believed was part of their in-network insurance plans. After a compromise between the Ohio House and Senate, legislators decided to require out-of-network physicians be paid whatever the in-network rate is under the patient’s plan.
Physician groups opposed that idea because it does not allow for physicians to negotiate a better, sometimes more appropriate, reimbursement rate. DeWine, hearing the concerns of the medical community, chose to veto the language. He did, however, call on lawmakers and physician groups to continue working on the issue.
On price transparency, lawmakers sought to require physicians provide an itemized price list for the cost of a medical procedure prior to delivering the service – including determining the patients deductible, co-pay, and other out of pocket expenses for ongoing care. After hearing the objections of the physician community, the budget ultimately required the pricing check list only if a patient requested the information for a non-emergency medical situation.
Medical organizations opposed, saying that the language in the budget bill was still too similar to a 2017 state law that was never implemented after the Ohio Hospital Association, Ohio State Medical Association, Ohio Ophthalmological Society, and others sued to block the law as unworkable.
DeWine agree with medical groups and decided to veto the price transparency language from the budget but said that addressing the issue should remain a priority.
The budget did contain a provision for telemedicine/telehealth requiring private insurance companies to offer coverage parity. This means that for any medical service an insurer provides coverage for during an in-person patient visit, that same coverage must be extended for a telehealth visit. The law does not require payment parity, meaning the rate a physician is reimbursed could be different for an in-person and telehealth visit for the same purpose.