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 That existing section 3901.385 of the Revised Code is hereby repealed.