Ban health care reimbursement reduction based on certain factors

As Introduced

136th
General Assembly

Regular
Session
H. B. No. 429

2025-2026

Representative Hoops

To
amend section 3901.385 of the Revised Code
to
prohibit third-party payers from reducing reimbursement to health
care providers based on certain factors.

BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section
1.
That
section 3901.385 of the Revised Code be amended to read as follows:

Sec.
3901.385.
A
third-party payer shall not do
either

any

of
the following:

(A)
Engage in any business practice that unfairly or unnecessarily delays
the processing of a claim or the payment of any amount due for health
care services rendered by a provider to a beneficiary;

(B)
Refuse to process or pay within the time periods specified in section
3901.381 of the Revised Code a claim submitted by a provider on the
grounds the beneficiary has not been discharged from the hospital or
the treatment has not been completed, if the submitted claim covers
services actually rendered and charges actually incurred over at
least a thirty-day period
;

(C)
Reduce the reimbursement made to a provider for the provision of a
covered health care service based on any of the following:

(1)
The third-party payer's own description of what is included in that
service outside of the most current CPT code in effect, as published
by the American medical association, the most current ICD-10 code in
effect, as published by the United States department of health and
human services, the most current CDT code in effect, as published by
the American dental association, or the most current HCPCS code in
effect, as published by the United States centers for medicare and
medicaid services;

(2)
The third-party payer's own description of what is included in the
diagnosis code submitted on the claim outside of guidelines
established by entities responsible for the code set, including the
centers for disease control and prevention's national center for
health statistics;

(3)
That the provider billed for additional health services, including
outpatient surgery, on the same date as the covered service
.

Section
2.
That
existing section 3901.385 of the Revised Code is hereby repealed.