Page 8 - OPTA Access March 2018

Legislative & Payment Policy Report
Legislative Report: Updates & Insights
Amanda Sines and Mikayla Pollitt – Government Advantage Group
Physical Therapists Practice Act Legislation Given Legislative Hearings (current as of time of publication)
Legislation to update the practice act for physical therapists was introduced by Representative Bill Reineke (R- Tif n) and Representative Theresa Gavarone (R – Bowling Green) at
the beginning of the 132nd Ohio General Assembly House Bill 131 was assigned to the House Health and Aging committee Representative Gavarone, joint sponsor of this legislation, serves as the Health and Aging committee vice-Chairwoman House Bill 131 would do two important things for the practice of Physical Therapy
• Clarify that “physical therapy” includes determining
a diagnosis in order to treat a person’s physical impairments, functional limitations, and physical disabilities; determining a prognosis; and determining a plan of therapeutic intervention, and
• Add that physical therapy includes ordering x-rays that are performed and interpreted by a physician
OPTA representatives met with OSMA and bill sponsors on January 9, 2018 to discuss three potential amendments to address remaining concerns OSMA acknowledges that the proposed amendments move the bill in a favorable direction for the association OPTA representatives continue to work with sponsors and committee members on this legislation
Price Transparency
Representative and practicing physician Steve Huffman (R – Tipp City), has introduced House Bill 416 to address healthcare price transparency HB 416 provides that beginning June 1, 2018 a healthcare provider must, on the request of a patient
or the patient’s representative, provide to that individual a
reasonable, good faith estimate of the cost for each scheduled service Under the bill “scheduled service” means a health care service or procedure that a patient or the patient’s representative has scheduled at least seven days before the service or procedure is to occur
The estimate may be given in writing, electronically, or verbally and must include the following:
• If the patient is insured, the estimate shall specify the amount the healthcare provider expects to receive as payment from the patient’s health plan issuer for each scheduled service
• The estimate shall specify the amount that the patient or party responsible for the patient’s care will be required to pay to the healthcare provider for each scheduled service
• The estimate shall include a disclaimer that the information provided is only an estimate based on facts available at the time the estimate was prepared and that other required health care items, services, or procedures could change the estimate
• If applicable and known to the healthcare provider at the time the estimate is given, the estimate shall include a noti cation that the provider is out-of- network for the patient
The estimate required must be based on information available at the time the estimate is provided and need not take into account any information that subsequently arises, such as unexpected additional services or procedures
These requirements would not apply in either of the following circumstances:
1 The patient is insured and the health plan issuer fails to supply the necessary information to the health care provider within 48 hours of the provider’s request to the issuer for that information In that case, the health care provider may notify the patient or the patient’s representative of the health plan issuer’s failure
2 The scheduled service the patient is to receive requires preauthorization from the patient’s health plan issuer In that case, section 3726 03 of the Revised Code applies
The legislation also provides that the patient is responsible for payment of the healthcare service or procedure even if they do not receive a cost estimate House Bill 416 is being considered by the House Insurance Committee
BWC Comments Submitted
The OPTA, in conjunction with OOTA, submitted a letter to the Ohio Bureau of Workers’ Compensation in regards to Ohio Administrative Code 4123-6-33 OAC 4123-6-33 provides standards for governing reimbursement for health and behavior
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Legislative & Payment Policy Report