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HB 219

Establish network adequacy standards for health insurers

136th Legislature (2025-2026) Introduced by Kellie Deeter

HB 219 mandates Ohio health insurers maintain adequate provider networks meeting geographic accessibility standards to ensure patient access to affordable, in-network care.

Referred to committee
#commerce #insurance
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Bill Summary · HB 219

Legislative bill overview

HB 219 establishes minimum network adequacy standards that health insurers operating in Ohio must meet, requiring them to maintain sufficient healthcare provider networks to ensure reasonable patient access. The bill sets specific requirements for the geographic distribution and availability of in-network providers across various medical specialties.

Why is this important

Network adequacy directly affects patients' ability to access affordable care—inadequate networks force enrollees to travel long distances for care or use out-of-network providers at higher costs. This is particularly critical in rural Ohio areas where provider shortages are common, and sets baseline requirements that insurers must follow rather than allowing them to operate with minimal provider networks.

Potential points of contention

  • Insurer compliance costs: Carriers may argue that stricter network standards increase operational expenses, potentially leading to higher premiums for consumers or reduced insurer participation in the Ohio market
  • Rural provider reality: Rural areas may struggle to meet standards due to limited provider availability, creating a gap between regulatory requirements and practical feasibility
  • Definition specificity: Without clear definitions of what constitutes "adequate" networks (travel time limits, wait times, specialty coverage ratios), enforcement and compliance measurement could be inconsistent or subject to dispute

Compiled from official sources — confirm details with the bill’s official record.

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