July 24, 2019

Ohio Governor Vetoes Out-Of-Network Provisions

Ohio Gov. Mike DeWine signed HB 166, a general operating budget bill, into law July 18 after vetoing provisions concerning out-of-network care.

DeWine’s veto was based on concerns about potential duplications between state and pending federal surprise billing legislation.

In his veto statement, DeWine wrote “As the federal government develops these efforts and others, it is important that the state not place duplicative or burdensome regulations on health care providers, as these compliance costs will inevitability be passed on to the citizens of this State as consumers of health care.”

The omitted provisions would have required health plan issuers to reimburse out-of-network providers for unanticipated out-of-network care when the services are provided to an enrollee at a facility in their network and when the services would be covered by a provider in the enrollee’s network. The reimbursement required to be paid to an out of-network emergency provider would have been the greater of the amount negotiated with in-network emergency facilities for the service and a usual, customary and reasonable amount.