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Legislative Summary: Out-of-Network Billing & other OSMA Wins from the Lame Duck Session


After weeks of significant legislative activity and some unexpected additional session dates for both the House and the Senate, the 133rd General Assembly inched closer to finishing work for the year this week. With a few issues still outstanding, the House and the Senate left open the option to return to session next week.


Dozens of key OSMA issues progressed across the finish line as the Lame Duck Session closed. Here is a summary of the work on OSMA’s major legislative issues:

Surprise Billing:

The issue of “surprise” billing has been on OSMA's advocacy agenda for several years, as our advocacy team has worked with a coalition of health care groups and other interested parties at the state level toward a reasonable and efficient solution for Ohio’s physicians and their patients. At first we had serious concerns about House Bill 388—mainly due to its establishment of a statutory rate cap for physician reimbursements and for its potential to tip the balance too far in favor of insurers in the contracting process. Fortunately, OSMA raised the voices of the physician community to advocate for changes, and in spring 2020, a new version of the bill was crafted with compromise language included to help alleviate physician concerns.


This new version of the bill was accepted and it went to the House floor, where it passed with a favorable vote. HB 388 then moved into the Senate in the fall and passed the Senate this week. It will now heads to the governor’s desk to be signed into law.

With the unexpected passage of surprise billing language by the federal government in the end of the year spending and COVID package, OSMA will be working with AMA and other groups to see if any changes need to be made to the Ohio bill to streamline our process and align more closely both proposals.

APRN Scope of Practice:

In mid-November, OSMA got word that there could be a vote in the House Health Committee on HB 177, legislation that would grant APRNs the authority to practice independently and without any physician supervision. OSMA has opposed this issue in its various legislative iterations over the last several years, as our association believes that terminating the standard care arrangement between physicians and APRNs could fragment care delivery by fundamentally changing the current team-based care model.

OSMA’s government relations team sent out a call to action which resulted in an extraordinary response—over 450 physicians, residents, and medical students all over the state reached out to their legislators to express their concerns and to urge them not to support HB 177. Due to our tireless advocacy, the bill was removed from the committee agenda and was not voted on after all. Thankfully, our grassroots advocacy defeated this legislation in the short-term, but we expect that this issue will resurface again in the future as it has for several consecutive general assemblies in Ohio. OSMA’s government relations team will keep working to ensure patients around the state stay protected and team-based, physician-led care remains in place.

Mental Health Parity:

During the lame duck proceedings, provisions from mental health parity legislation supported by OSMA (SB 254/HB 443) were included as an amendment in SB 284, an unrelated bill. OSMA is so thankful that with our advocacy work, we helped this happen and SB 284 passed in the House in the first week of December. The provisions related to mental health parity that were included in SB 284 will bring Ohio into alignment with the Federal Parity Law (also known as the Mental Health Parity and Addiction Equity Act of 2008) and enact certain compliance requirements to help with proper parity enforcement.

This means that insurers will be required to cover treatment for mental health conditions and substance use disorder no more restrictively than treatments for physical illnesses and ailments of the body. This will help our state improve efforts to help those who need it access affordable and timely treatment for substance use disorders, as well as obtain necessary mental health treatment, which far too many patients are unable to access.

Prohibit Death Penalty if Mentally Ill at Time of Offense:

HB 136, another bill supported by OSMA, finally made it across the finish line this year after close to five years of advocacy. This legislation will make certain defendants ineligible for the death penalty if the defendant had a serious mental illness at the time of the offense. Under the bill, defendants would be eligible for the exemption from the death penalty if said serious mental illness impaired their capacity to exercise rational judgment, conform to the law, or appreciate the nature, consequences, or wrongfulness in relation to their conduct at the time of the crime. The bill also requires that a person previously sentenced to death who proves they had a serious mental illness at the time of the offense be re-sentenced to life imprisonment without parole.


It is an unfortunate reality that many individuals with mental illness are unable to access adequate and effective treatments for their conditions, for numerous and complex reasons that are often out of the individual’s control. For some serious mental illnesses, even access to treatment cannot be expected to result in a complete resolution of the individual’s impairments. OSMA was pleased to advocate for the passage of HB 136.

COVID-19 & Capital Bill:

Late amendments added to SB 310, a facilities spending measure, would shift funds to boost the state’s finances and assist hospitals, and move significant financial burden from state and local entities to the federal government. The bill has been moved through both the House and Senate and effectively functions as a miniature budget update. Additionally, SB 310 adjusts the Hospital Upper Payment Limits line item and Medicaid services federal line item by $700 million combined in order to anticipate the hospital and federal funds spent in this fiscal year.

PTSD Coverage for First Responders:

A substitute version of HB 308 advanced across the finish line, signaling the near-end of a gridlock over post-traumatic stress disorder coverage for first responders that has persisted for several years. The initial proposal, supported by OSMA, would have provided coverage through the Bureau of Worker’s Compensation, but the updated version would create a program based out of the state Office of Budget and Management that will investigate and implement a robust, financially stable system. The legislation would establish a state post-traumatic stress disorder fund, establish an actuarial estimate of its expected costs, and report this to the General assembly by October of 2021. The goal is for the legislature to then take the final months of 2021 to get the fund set up and running for the 2022 year.

Dyslexia:

HB 436, which will establish the Ohio Dyslexia Committee and provide new resources to our education system related to the identification of and appropriate assistance for children with dyslexia, also made it across the finish line in the last remaining days of lame duck. OSMA supported this legislation, believing that is it essential that Ohio continues to strive to support children with dyslexia and other learning disabilities so that these children will have the equal opportunity to succeed as they grow up. Having made it through both chambers, HB 436 will become law with the governor’s signature.

Prohibit Step Therapy for Stage IV Cancer Drugs:

SB 252 which will also be signed into law will prohibit "fail first" coverage of drugs used to treat stage four advanced metastatic cancer. This means that health plans will not be allowed to make coverage of drugs prescribed to treat stage four advanced metastatic cancer or associated conditions dependent upon failure to successfully respond to a different drug or a history of failing to respond to a different drug.


OSMA supported SB 252 as a logical and empathetic proposal for Ohio’s cancer patients and the physicians treating their condition. Our association believes that physicians should always have the authority to use the most effective, personalized and best (according to their professional judgment) treatment plans in the effort to fight advanced cancers in patients. “Fail first” policies utilized by insurers can disrupt critically-needed treatment efforts and cause dangerous delays in appropriate treatment. Time is of particular importance in the treatment of advanced cancers and any delay in obtaining treatment that works best for the patient is a substantial risk. This will spare cancer patients the additional burden of “fail first” policies as they navigate a physically, emotionally, and financially draining diagnosis.

Radiological Services:

OSMA advocated and supported SB 236 which would provide necessary state-level flexibility regarding regulation of radiation generating equipment; and remove existing barriers to the delivery of radiology services in Ohio by permitting radiographers and nuclear medicine technologists to more efficiently deliver services. While the final version of SB 236 did not make it across the finish line, the entirety of the bill was included in an unrelated bill, HB 210, and will ultimately be signed into law.

Looking ahead:

The 134th General Assembly will convene for its first sessions in the New Year. It is expected that some of the legislative proposals that did not make it all the way through the process from the prior General Assembly will be reintroduced.

OSMA is proud to represent you and advocate on your behalf. Despite the disruptions and unexpected challenges of the COVID-19 pandemic in 2020, we are happy to report that we have made significant advocacy strides this year. On top of the work that we have been able to accomplish this year, we have laid the groundwork that will help us achieve more in 2021. We will continue to push for meaningful change for physicians and the practice of medicine in Ohio in the coming year.


As far as leadership goes, Senator Matt Huffman (R-Lima) has been unanimously elected to serve as Senate President for the 134th General Assembly, and further Senate leadership includes Senator Jay Hottinger (R-Newark) as President Pro Tempore, Senator Kirk Schuring (R-Canton) as Majority Floor Leader, and Senator Rob McColley (R-Napoleon) as Majority Whip.


Key Minority Leadership members in the Ohio Senate will include Senators Kenny Yuko (D-Richmond Heights) as Minority Leader, Cecil Thomas (D-Avondale) as Assistant Minority Leader, Nickie Antonio (D-Lakewood) as Assistant Minority Whip and Tina Maharath (D-Canal Winchester) as Assistant Minority Whip.


Speaker of the Ohio House Bob Cupp will continue to serve into the new general assembly as Speaker of the House along with Representatives Tim Ginter (R-Salem) as Speaker Pro Tempore, Bill Seitz (R-Green Township) as Majority Floor Leader, Rick Carfagna (R-Genoa Township) as Assistant Floor Leader, Don Jones (R-Freeport) as Majority Whip and Cindy Abrams (R-Harrison) as Assistant Majority Whip.


Key Minority Leadership members in the Ohio House will include Representatives Emilia Sykes (D-Akron) as Minority Leader, Kristin Boggs (D-Columbus) as Assistant Minority Leader, Paula Hicks-Hudson (D-Toledo) as Minority Whip, Richard Brown (D-Canal Winchester) as Assistant Minority Whip, and Phil Robinson (D-Solon) as Caucus Chair.

The House Health Committee will most likely continue under the leadership of current Chairman, Representative Scott Lipps (R-Franklin) who has been instrumental in the progress of our legislative initiatives. The Senate Health Committee will lose its current Chairman in term limited Senator Dave Burke (R-Marysville) but with two physicians as Senators now in the Ohio Senate, it is anticipated both will have key positions on the Senate Health Committee next year.

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