Legislative Wrap-Up
131st General Assembly
The 131st Ohio General Assembly concluded its legislative work in the early morning hours of Friday,
December 9. OAHP was actively engaged with legislators throughout the lame duck session, monitoring
several bills potentially impacting our industry. The following is a summary of these priority issues and their
respective status at the legislature's conclusion.
THE FOLLOWING MEASURES WERE EITHER PASSED OR AMENDED INTO OTHER BILLS THAT RECEIVED
LEGISLATIVE APPROVAL.
HOUSE BILL 505 (Huffman, Pelanda)
Legislation allowing for the substitution of an interchangeable biological product for a prescribed biological product
under circumstances and conditions.
While supporting much of HB 505's content and scope, OAHP remained concerned with a particular provision that would
allow the Ohio Pharmacy Board to exclude the interchangeability of an FDA approved drug without any clear criteria for
that exclusion. Such language was included in the House passed version to address a constitutional issue that LSC
raised.
OAHP expressed its concerns with the bill's sponsor, as well as the pharmaceutical industry, seeking an approach that
would ensure the constitutional integrity of the bill while inserting general criteria for the Board. OAHP developed
several approaches and draft language for the pharmaceutical industry to review; however, PhRMA raised issues with
each approach put forward and, in the end, aggressively lobbied the members of the Committee to oppose any
amendment that would provide criteria for the Board.
Several additional modifications were made to the bill during lame duck, including:

Senate Bill 129 Change. The Senate Health and Human Services Committee accepted Senator Gardner’s
amendment to revise Senate Bill 129’s 10 calendar day turn-around time for non-urgent requests. The
amendment that was approved was “the industry preference” among the potential options under consideration.
The inserted language:
o changed the response trigger to the date a plan receives a PA request;
o maintained response times for urgent and non-urgent PA requests; and
o eliminated the 72 hour provider response requirement

An amendment adding a new HMO product to Federal Employees Health Benefit offerings.

An amendment requested of the Ohio Medical Board relating to physician assistant supervision agreements.
This section of the law was passed with an emergency clause.
SENATE BILL 273 (Bacon)
Legislation to require insurers to make an annual disclosure to the Superintendent of Insurance on the company’s
corporate governance policies and practices (CGAD).
The measure is based on NAIC's Corporate Governance Annual Disclosure model act and is intended to provide the Ohio
Department of Insurance with a written summary of an insurer or insurance group’s corporate governance structure,
policies and practices.
12/9/16
SENATE BILL 319 (Eklund)
The “Opiate MBR;” legislation would implement a series of provisions concerning the purchase, prescribing and
distribution of opiates.
OAHP had maintained close communication with the bill's sponsor and key legislators since the bill's introduction in the
first half of 2016. The Association testified before both the Senate and House, commending the legislature on taking
positive steps forward, while also advocating for the CDC‘s guidelines on prescribing opioids for chronic pain to be
amended into the legislation. The guidelines did not make their way into the bill, however, OAHP plans to continue
these advocacy efforts into the next General Assembly.
OAHP and its member plans proved successful fending off two potentially negative amendments to SB 319 during the
House Finance Subcommittee process. Those potential changes were:

a push was made by some stakeholders to delay the carve-in of behavioral health services into Medicaid
managed care by a period of two years. Such a delay would have negated more than 18 months of collaborative
work on behalf of the health plans, the provider and advocate communities, and the Kasich Administration; and

an effort to fold House Bill 248, Rep. Robert Sprague's measure to require health plans to prove access to abuse
deterrent formulas (ADFs). OAHP and member plans were vocal in educating about the health cost increases
that would come from such a mandate and the belief that such a move would lead to a number of unintended
consequences.
However, the following changes were made during SB 319 consideration before the House:



an amendment requiring insurers to utilize prior authorization or utilization review tools when opioid analgesics
are prescribed for chronic pain (effective January 1, 2018);
o exceptions to this include: hospice services, treatment of terminally ill patients, and treatment of those
with cancer or a history of cancer. (Note the exception for “history of cancer” was added as an
amendment to the substitute bill.)
language reflecting House Bill 325, which encourages pregnant women to seek addiction treatment; and
language concerning a PBM-Health Plan relationship, including:
o a requirement that PBMs disclose in aggregate to health plans any differences between the amount paid
to a pharmacy and the amount charged to a plan sponsor;
o requires such aggregated disclosures by PBMs to occur within ten days of a PBM entering a contract
with a plan, or on a quarterly basis; and
o provides exemption to ERISA and Medicare Part D plans.
OAHP has been in communication with Rep. Sprague, who advocated for the prior authorization/chronic condition
amendment, and communicated our concerns with the operational challenges of implementing the exceptions for the
prior authorization requirement. Rep. Sprague has committed to working with OAHP and its member plans to address
operational issues in the next legislative session.
SENATE BILL 332 (Jones and Tavares)
Legislation to implement certain recommendations contained in the Commission on Infant Mortality's March 2016
report.
OAHP's Medicaid managed care plans continue to be among the State’s closest allies in combatting infant mortality in
Ohio’s communities. OAHP maintained its position as a stakeholder and interested party throughout deliberations
around SB 332.
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During the lame duck session, the Ohio House made a handful of changes to Senators Jones and Tavares' as-introduced
Senate version. These changes included:

changing the definition of a qualified community hub as a central clearinghouse for a network of community
care coordination agencies that meets the following requirements:
o Demonstrates to the Director of Health that is uses an evidence-based, pay for performance community
care coordination model (endorsed by the federal Agency for Healthcare Research and Quality, the
National Institutes of Health, and The Centers for Medicare and Medicaid Services);
o Demonstrates that has achieved or is engaged in achieving certification from a national hub certification
program; and
o Has a plan that is approved by the Director of Medicaid specifying how the hub ensures children receive
appropriate screenings and EPSDT services.

requiring ODH to establish the Stillborn Education Program;

requiring ODM to report fee-for-service and each managed care plan’s performance on reducing the stillbirth
rate within the ODM Infant Mortality report card; and

clarifying that progesterone therapy is for pregnant women. The bill continues to require managed care plans to
use a uniform prior authorization form for progesterone therapy that is not longer than one page if prior
approval is required.
HOUSE BILL 350 (Grossman, Terhar)
Legislation mandating that certain health plans provide coverage for autism spectrum disorder.
The mandate presented by HB 350 did not align with the current autism coverage mandates in the individual and small
group market. The legislation, like all health care coverage mandates, will likely result in upward pressure on the overall
costs of health insurance. As a result, OAHP partnered with the Ohio Chamber of Commerce and the National Federation
of Independent Businesses (NFIB) to oppose the legislation.
A modified version of the autism mandate was amended into a mortgage foreclosure measure, House Bill 463 (Dever),
that quickly became a "Christmas tree" during the lame duck session. When compared to its as-introduced version, the
amended autism language was narrower in scope in that it:
 better aligns with the individual and small group mandate (via Governor Kasich’s December 2012 letter to CMS
defining “habilitative services” for purposes of Ohio’s benchmark plan.)
 reduces the specified coverage age from 21 years to 14 years old;
 allows health plans to use prior authorization for autism services; and
 narrows the providers authorized to diagnose/recommend treatment to developmental pediatricians or
psychologists trained in autism.
Through joint efforts, the opponents of the autism mandate succeeded in advocating for language that requires the
Ohio Department of Insurance to compile a comprehensive report detailing the costs associated with all the health care
mandates that are currently effective in law. This report will be compiled and released within a period of two years.
Additionally, language was included in the uncodified section of the bill, asserting that it "is the intent of the General
Assembly to implement a two-year moratorium on any new health care mandates impacting individual and group health
insurance plans" that are not subject to ERISA, and that the General Assembly hopes to develop potential tax credits
that offset additional employer costs associated with health care mandates.
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THE FOLLOWING MEASURES DID NOT PASS, NOR WERE THEY APPROVED AS PART OF ANOTHER BILL
RECEIVING PASSAGE.
HOUSE BILL 34 (Boose, Retherford)
Legislation to enter Ohio into the Interstate Health Care Compact.
OAHP Position: Opposed
In a surprising move, the Senate decided to entertain this bill during the lame duck session. OAHP engaged the Senate
Government Oversight Committee chairman during the last week of session to register opposition. Such engagement
efforts proved successful, as the bill did not receive a vote on the Senate floor.
HOUSE BILL 95 (DeVitis) and HOUSE BILL 275 (Schuring)
Legislation that would prohibit health plans from extending discounts to consumers for non-covered dental and vision
services.
OAHP Position: Opposed
HB 275 died in House committee, while HB 95 never received a first hearing before Senate Insurance Committee.
SENATE BILL 351 (LaRose)
Legislation to require Ohio’s insurance entities to share claims utilization data with small group policyholders.
OAHP Position: Opposed
The legislation was introduced but never received a first hearing.
HOUSE BILL 248 (Sprague, Antonio) and SENATE BILL 357 (Hite)
Legislation mandating health insurance entities to cover opioid analgesic deterrent technology.
OAHP Position: Opposed
As noted in the update for Senate Bill 319, OAHP fended off efforts to amend HB 248's ADF mandate into SB 319. This
effort was only made successful through the persistent and effective legislative advocacy of OAHP and its member plans.
SENATE BILL 243 (Lehner, Tavares)
Legislation to adopt requirements related to step therapy protocols implemented by health plans and the Ohio
Department of Medicaid.
OAHP Position: Opposed
The measure received a third committee hearing during the lame duck session, but was never voted out of Senate
Medicaid Committee. OAHP provided written testimony in opposition of the bill.
**OAHP will continue to keep member plans updated should any of these measures be reintroduced during the 132nd
General Assembly. **
**Note: The topic of price transparency was not re-visited as part of official legislative business during the lame duck
session. OAHP will continue to monitor activity around this topic and will report any and all activity to member plans as
needed.**
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