Will You Have To Provide Price Estimates To All Of Your Patients?

    We are monitoring the potential implementation of a health-care-price-transparency statute that will affect all Ohio health care providers and their patients if it goes into effect.

    The statute requires health care providers to disclose a good-faith price estimate in writing to a patient before performing any non-emergency medical procedures, tests or services. The estimate must include: (1) the amount the provider will charge the patient or the patient’s health plan issuer, (2) the amount the health plan issuer intends to pay for the product, service or procedure, and (3) the difference, if any, that the patient would be required to pay. This law imposes a massive and unnecessary administrative burden on providers.

    The law was supposed to go into effect on January 1, 2017, but a combination of missed procedural deadlines and a lawsuit have halted its implementation. The legislature passed O.R.C. 5162.80 in June 2015 as part of a Bureau of Workers’ Compensation appropriations bill without a hearing, prior notice, or input from the affected health care industry. The statute mandates that the Medicaid Director adopt rules to implement the legislation, and the Director was legally obligated to promulgate those rules by July 1, 2016 but failed to do so. In addition, a committee was formed to determine whether or not implementation of the statute was feasible, but it failed to file a report by the December 2015 deadline.

    After unsuccessful efforts to work with legislators to amend the language of the statute after it passed, the Ohio Hospital Association (OHA), the Ohio State Medical Association (OSMA) and several other healthcare provider groups joined together to file a lawsuit on December 22, 2016. The plaintiffs are seeking a preliminary injunction to block the new statute on the grounds that it is an unworkable mandate on physicians and health systems and a threat to efficient medical care for patients. The Williams County Common Pleas Court issued a thirty day temporary restraining order preventing the law from taking effect on January 1, 2017. A preliminary injunction hearing was scheduled for January 20, 2017 but has been rescheduled for March 17, 2017. As its name implies, a temporary restraining order has a limited duration. But the court’s rescheduling order states that the temporary restraining order will remain in place until it rules on the plaintiffs’ motion for preliminary injunction. This order ensures that the status quo is maintained and no implementation or enforcement of the statute can occur until that time.

    Stay tuned for updates.