Bill Text: OH HB123 | 2013-2014 | 130th General Assembly | Comm Sub

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Regarding health care peer review committee proceedings and Medicaid coverage of telehealth services.

Spectrum: Slight Partisan Bill (Republican 24-9)

Status: (Passed) 2014-05-20 - Effective Date [HB123 Detail]

Download: Ohio-2013-HB123-Comm_Sub.html

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As Reported by the Senate Medicaid, Health and Human Services Committee

130th General Assembly Regular Session 2013-2014

Am. Sub. H. B. No. 123

Representatives Gonzales, Wachtmann 

Cosponsors: Representatives Adams, J., Brenner, Henne, McClain, Williams, Young, Bishoff, Brown, Schuring, Anielski, Antonio, Baker, Boose, Buchy, Budish, Burkley, Duffey, Hackett, Hill, Johnson, Letson, Phillips, Romanchuk, Sears, Sprague Speaker Batchelder 

Senator Tavares 

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A BILL

To amend sections 2305.25 and 2305.252 and to enact

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section 5164.94 of the Revised Code regarding

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health care peer review committee proceedings and

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Medicaid coverage of telehealth services.

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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 2305.25 and 2305.252 be amended and	5
section 5164.94 of the Revised Code be enacted to read as	6
follows:	7

Sec. 2305.25. As used in this section and sections 2305.251	8
to 2305.253 of the Revised Code:	9

(A)(1) "Health care entity" means an entity, whether acting	10
on its own behalf or on behalf of or in affiliation with other	11
health care entities, that conducts as part of its regular	12
business activities professional credentialing or quality review	13
activities involving the competence of, professional conduct of,	14
or quality of care provided by health care providers, including	15
both individuals who provide health care and entities that provide	16
health care.	17

(2) "Health care entity" includes any entity described in	18
division (A)(1) of this section, regardless of whether it is a	19
government entity; for-profit or nonprofit corporation; limited	20
liability company; partnership; professional corporation; state or	21
local society composed of physicians, dentists, optometrists,	22
psychologists, or pharmacists; oraccountable care organization;	23
other health care organization; or combination of any of the	24
foregoing entities.	25

(B) "Health insuring corporation" means an entity that holds	26
a certificate of authority under Chapter 1751. of the Revised	27
Code. "Health insuring corporation" includes wholly owned	28
subsidiaries of a health insuring corporation.	29

(C) "Hospital" means eitherany of the following:

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(1) An institution that has been registered or licensed by	31
the department of health as a hospital;	32

(2) An entity, other than an insurance company authorized to	33
do business in this state, that owns, controls, or is affiliated	34
with an institution that has been registered or licensed by the	35
department of health as a hospital;	36

(3) A group of hospitals that are owned, sponsored, or	37
managed by a single entity.	38

(D) "Incident report or risk management report" means a	39
report of an incident involving injury or potential injury to a	40
patient as a result of patient care provided by health care	41
providers, including both individuals who provide health care and	42
entities that provide health care, that is prepared by or for the	43
use of a peer review committee of a health care entity and is	44
within the scope of the functions of that committee.	45

(E)(1) "Peer review committee" means a utilization review	46
committee, quality assessment committee, performance improvement	47
committee, tissue committee, credentialing committee, or other	48
committee that does either of the following:	49

(a) Conducts professional credentialing or quality review	50
activities involving the competence of, professional conduct of,	51
or quality of care provided by health care providers, including	52
both individuals who provide health care and entities that provide	53
health care;	54

(b) Conducts any other attendant hearing process initiated as	55
a result of a peer review committee's recommendations or actions.	56

(2) "Peer review committee" includes all of the following:

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(a) A peer review committee of a hospital or long-term care	58
facility or a peer review committee of a nonprofit health care	59
corporation that is a member of the hospital or long-term care	60
facility or of which the hospital or facility is a member;	61

(b) A peer review committee of a community mental health	62
center;	63

(c) A board or committee of a hospital, a long-term care	64
facility, or other health care entity when reviewing professional	65
qualifications or activities of health care providers, including	66
both individuals who provide health care and entities that provide	67
health care;	68

(d) A peer review committee, professional standards review	69
committee, or arbitration committee of a state or local society	70
composed of members who are in active practice as physicians,	71
dentists, optometrists, psychologists, or pharmacists;	72

(e) A peer review committee of a health insuring corporation	73
that has at least a two-thirds majority of member physicians in	74
active practice and that conducts professional credentialing and	75
quality review activities involving the competence or professional	76
conduct of health care providers that adversely affects or could	77
adversely affect the health or welfare of any patient;	78

(f) A peer review committee of a health insuring corporation	79
that has at least a two-thirds majority of member physicians in	80
active practice and that conducts professional credentialing and	81
quality review activities involving the competence or professional	82
conduct of a health care facility that has contracted with the	83
health insuring corporation to provide health care services to	84
enrollees, which conduct adversely affects, or could adversely	85
affect, the health or welfare of any patient;	86

(g) A peer review committee of a sickness and accident	87
insurer that has at least a two-thirds majority of physicians in	88
active practice and that conducts professional credentialing and	89
quality review activities involving the competence or professional	90
conduct of health care providers that adversely affects or could	91
adversely affect the health or welfare of any patient;	92

(h) A peer review committee of a sickness and accident	93
insurer that has at least a two-thirds majority of physicians in	94
active practice and that conducts professional credentialing and	95
quality review activities involving the competence or professional	96
conduct of a health care facility that has contracted with the	97
insurer to provide health care services to insureds, which conduct	98
adversely affects, or could adversely affect, the health or	99
welfare of any patient;	100

(i) A peer review committee of any insurer authorized under	101
Title XXXIX of the Revised Code to do the business of medical	102
professional liability insurance in this state that conducts	103
professional quality review activities involving the competence or	104
professional conduct of health care providers that adversely	105
affects or could affect the health or welfare of any patient;	106

(j) A peer review committee of the bureau of workers'	107
compensation or the industrial commission that is responsible for	108
reviewing the professional qualifications and the performance of	109
providers conducting medical examinations or file reviews for the	110
bureau or the commission;	111

(k) Any other peer review committee of a health care entity.

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(F) "Physician" means an individual authorized to practice	113
medicine and surgery, osteopathic medicine and surgery, or	114
podiatric medicine and surgery.	115

(G) "Sickness and accident insurer" means an entity	116
authorized under Title XXXIX of the Revised Code to do the	117
business of sickness and accident insurance in this state.	118

(H) "Tort action" means a civil action for damages for	119
injury, death, or loss to a patient of a health care entity. "Tort	120
action" includes a product liability claim, as defined in section	121
2307.71 of the Revised Code, and an asbestos claim, as defined in	122
section 2307.91 of the Revised Code, but does not include a civil	123
action for a breach of contract or another agreement between	124
persons.	125

(I) "Accountable care organization" means such an	126
organization as defined in 42 C.F.R. 425.20.	127

Sec. 2305.252.  Proceedings and records within the scope of a	128
peer review committee of a health care entity shall be held in	129
confidence and shall not be subject to discovery or introduction	130
in evidence in any civil action against a health care entity or	131
health care provider, including both individuals who provide	132
health care and entities that provide health care, arising out of	133
matters that are the subject of evaluation and review by the peer	134
review committee. No individual who attends a meeting of a peer	135
review committee, serves as a member of a peer review committee,	136
works for or on behalf of a peer review committee, or provides	137
information to a peer review committee shall be permitted or	138
required to testify in any civil action as to any evidence or	139
other matters produced or presented during the proceedings of the	140
peer review committee or as to any finding, recommendation,	141
evaluation, opinion, or other action of the committee or a member	142
thereof. Information	143

Information, documents, or records otherwise available from	144
original sources are not to be construed as being unavailable for	145
discovery or for use in any civil action merely because they were	146
produced or presented during proceedings of a peer review	147
committee, but the information, documents, or records are	148
available only from the original sources and cannot be obtained	149
from the peer review committee's proceedings or records. An	150
The release of any information, documents, or records that were	151
produced or presented during proceedings of a peer review	152
committee or created to document the proceedings does not affect	153
the confidentiality of any other information, documents, or	154
records produced or presented during those proceedings or created	155
to document them. Only the information, documents, or records	156
actually released cease to be privileged under this section.	157

Nothing in this section precludes health care entities from	158
sharing information, documents, or records that were produced or	159
presented during proceedings of a peer review committee or created	160
to document them as long as the information, documents, or records	161
are used only for peer review purposes.	162

An individual who testifies before a peer review committee,	163
serves as a representative of a peer review committee, serves as a	164
member of a peer review committee, works for or on behalf of a	165
peer review committee, or provides information to a peer review	166
committee shall not be prevented from testifying as to matters	167
within the individual's knowledge, but the individual cannot be	168
asked about the individual's testimony before the peer review	169
committee, information the individual provided to the peer review	170
committee, or any opinion the individual formed as a result of the	171
peer review committee's activities. An	172

An order by a court to produce for discovery or for use at	173
trial the proceedings or records described in this section is a	174
final order.	175

Sec. 5164.94.  (A) As used in this section, "telehealth	176
service" means a health care service delivered to a patient	177
through the use of interactive audio, video, or other	178
telecommunications or electronic technology from a site other than	179
the site where the patient is located.	180

(B) The department of medicaid shall establish	181
standards for medicaid payments for health care services the	182
department determines are appropriate to be covered by the medicaid	183
program when provided as telehealth services. The standards shall	184
be established in rules adopted under section 5164.02 of the	185
Revised Code.	186

Section 2. That existing sections 2305.25 and 2305.252 of the	187
Revised Code are hereby repealed.	188