Youngstown Daily Legal News

Bill would broaden state's health care prompt pay law

TIFFANY L. PARKS
Special to the Legal News
Published: March 24, 2014

A piece of proposed legislation that would require Medicaid-managed care organizations to follow Ohio’s existing prompt pay law has gained some movement in the General Assembly.

The bill, Senate Bill 100, is sponsored by Sen. Charleta Tavares, D-Bexley.

The measure was filed into the legislature in April and had its first hearing before the Senate Insurance and Financial Institutions committee last month.

“In the late 1990s the issue of prompt payment gained substantial exposure due to health care provider activism for payment reform and lawsuits,” Tavares said in sponsor testimony.

“Without legislative oversight, providers experienced challenges with cash flow and could not anticipate payment within a predictable period.”

Tavares said Ohio was one of the states to enact prompt pay legislation in 2002.

“Through the Ohio Department of Job and Family Services, the state contracts with Medicaid-managed care organizations to coordinate care using a network of providers, pay claims and facilitate case management activities such as helping to schedule appointments,” she said.

While noting that managed-care organizations are performing the duties of an insurer and are registered with the Ohio Department of Insurance, Tavares said they do not have to follow the state’s prompt pay law.

“These companies currently follow federal law, which requires 90 percent of claims to be paid within 30 days of receipt and 99 percent of claims must be paid within 90 days,” she said.

“Ohio’s law goes further to ensure claims are paid promptly.”

The state requires a claim to be paid or denied no later than 30 days of receipt and an additional 15 days are allowed if supporting documents are needed for the claim.

The provisions apply to claims that are submitted electronically.

“To ensure continued service to patients, health care providers need to maintain financial security,” Tavares said. “Providers who serve patients whose benefits are managed by a Medicaid-managed care organization deserve assurance that they will be compensated for services in a timely manner.”

Tavares said she understands that many of the providers are now meeting prompt pay standards.

“This legislation will help assist smaller primary care physicians, pharmacies and other health care centers with meeting their financial demands,” she said.

“These are some of the providers who are seeking to serve one of Ohio’s most vulnerable populations and will likely suffer financial ramifications if payment is not received promptly.”

SB 100 is co-sponsored by Democratic Sens. Capri Cafaro and Edna Brown.

The bill has not been scheduled for additional hearings.

[Back]