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| To amend section 3963.04 of the Revised Code to | 1 |
| specify that a material amendment to a health care | 2 |
| contract does not become part of the contract | 3 |
| unless agreed upon by both parties. | 4 |
| Section 1. That section 3963.04 of the Revised Code be | 5 |
| amended to read as follows: | 6 |
| Sec. 3963.04. (A)(1) If an amendment to a health care | 7 |
| contract is not a material amendment, the contracting entity | 8 |
| shall provide the participating provider notice of the amendment | 9 |
| at least fifteen days prior to the effective date of the | 10 |
| amendment. The contracting entity shall provide all other | 11 |
| notices to the participating provider pursuant to the health | 12 |
| care contract. | 13 |
| (2) A material amendment to a health care contract shall | 14 |
| occur only if the contracting entity provides to the | 15 |
| participating provider the material amendment in writing and | 16 |
| notice of the material amendment not later than ninety days prior | 17 |
| to the effective date of the material amendment. The notice shall | 18 |
| be conspicuously entitled "Notice of Material Amendment to | 19 |
| Contract." | 20 |
| (3) If within fifteen days after receiving the material | 21 |
| amendment and notice described in division (A)(2) of this | 22 |
| section, the participating provider objects in writing to the | 23 |
| material amendment, and there is no resolution of the | 24 |
| objection, either party may terminate the health care contract | 25 |
| upon written notice of termination provided to the other party | 26 |
| not later than sixty days prior to the effective date of the | 27 |
| material amendment. | 28 |
| (4) If the participating provider does not object to the | 29 |
| material amendment in the manner described in division (A)(3) of | 30 |
| this section, the material amendment shall be effective as | 31 |
| specified in the notice described in division (A)(2) of this | 32 |
| section. | 33 |
| (5) If the participating provider objects to the material | 34 |
| amendment in the manner described in division (A)(3) of this | 35 |
| section, and there is no resolution, and neither party terminates | 36 |
| the health care contract, the material amendment shall not become | 37 |
| part of the existing health care contract. | 38 |
| (B)(1) Division (A) of this section does not apply if the | 39 |
| delay caused by compliance with that division could result in | 40 |
| imminent harm to an enrollee, if the material amendment of a | 41 |
| health care contract is required by state or federal law, rule, | 42 |
| or regulation, or if the provider affirmatively accepts the | 43 |
| material amendment in writing and agrees to an earlier effective | 44 |
| date than otherwise required by division (A)(2) of this section. | 45 |
| (2) This section does not apply under any of the following | 46 |
| circumstances: | 47 |
| (a) The participating provider's payment or compensation is | 48 |
| based on the current medicaid or medicare physician fee schedule, | 49 |
| and the change in payment or compensation results solely from a | 50 |
| change in that physician fee schedule. | 51 |
| (b) A routine change or update of the health care contract is | 52 |
| made in response to any addition, deletion, or revision of any | 53 |
| service code, procedure code, or reporting code, or a pricing | 54 |
| change is made by any third party source. | 55 |
| For purposes of division (B)(2)(b) of this section: | 56 |
| (i) "Service code, procedure code, or reporting code" means | 57 |
| the current procedural terminology (CPT), current dental | 58 |
| terminology (CDT), the healthcare common procedure coding system | 59 |
| (HCPCS), the international classification of diseases (ICD), or | 60 |
| the drug topics redbook average wholesale price (AWP). | 61 |
| (ii) "Third party source" means the American medical | 62 |
| association, American dental association, the centers for medicare | 63 |
| and medicaid services, the national center for health statistics, | 64 |
| the department of health and human services office of the | 65 |
| inspector general, the Ohio department of insurance, or the Ohio | 66 |
| department of job and family services. | 67 |
| (C) Notwithstanding divisions (A) and (B) of this section, a | 68 |
| health care contract may be amended by operation of law as | 69 |
| required by any applicable state or federal law, rule, or | 70 |
| regulation. Nothing in this section shall be construed to require | 71 |
| the renegotiation of a health care contract that is in existence | 72 |
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before | 73 |
| time that the contract is renewed or materially amended. | 74 |
| Section 2. That existing section 3963.04 of the Revised Code | 75 |
| is hereby repealed. | 76 |