Celebrating Budget Wins for Health Care Consumers and Plans

Another busy biennial Ohio state budget season is over, and I want to say how grateful OAHP is for the attention and support of our partners in the General Assembly. Thanks to their willingness to have conversations with us on language around health care, the budget provides some important wins for patients, plans and providers alike.

First, the facility fee provision prevents primary care practices owned or operated by a hospital or hospital system from charging self-pay patients or third-party payors a facility fee as if the care had been delivered in a hospital. This eliminates costs that do nothing to improve quality of care, and that helps keep health care affordable and accessible for everyone.

We’re also appreciative of language addressing provider payments, crafted with help from the Ohio Department of Insurance. It clears up some discrepancies around payment methods and makes the process easier and more effective.

Through the rest of the summer, we hope to continue the conversation around bills that will receive attention in the fall:

• Two bills addressing prior authorization need attention because they could limit insurers’ ability to use this important tool for ensuring care is appropriate, effective and affordable. It’s important to note the recent commitment that insurance plans nationwide have made to streamline and simplify prior authorization requirements.
• A number of bills would impose mandates that could raise health care costs and thus reduce accessibility.
• House Bill 229, focused on PBMs, bears watching to ensure it doesn’t impose excessive burdens. We’ll be working with the Ohio Chamber of Commerce and the Pharmaceutical Care Management Association to recommend appropriate language.

Again, we appreciate the opportunity to work with lawmakers on behalf of health care consumers and plans, and we’re looking forward to further conversations soon.