Bill
SB 429
SB 429 aims to prevent third-party payers from reducing provider reimbursements based on improper factors, protecting provider revenue and patient access.
SB 429 (136th General Assembly) – Ohio
Overview
SB 429 seeks to protect health care providers from reimbursement reductions by third-party payers based on certain criteria. The bill amends Section 3901.385 of the Revised Code to prohibit third-party payers from reducing payments to health care providers on the basis of specific factors. The introduced version indicates a policy focus on preserving fair reimbursement levels for providers and limiting payer-driven adjustments that are not tied to the quality, cost, or nature of services performed.
Primary purpose and intent
- Prohibit certain reimbursement reductions: The bill aims to prevent third-party payers (e.g., insurers, managed care organizations, or other payers) from lowering provider reimbursements using defined factors.
- Ensure stability of provider payments: By restricting reductions, the bill seeks to protect physicians, clinics, hospitals, and other health care providers from unexpected or arbitrary pay cuts that could affect access to care and the financial viability of practices.
Key provisions (as introduced)
- Statutory modification: The bill would add or amend language in Ohio Revised Code Section 3901.385 to delineate prohibited grounds for reimbursement reductions by third-party payers.
- Scope of prohibited factors: While the exact factors are not enumerated in the provided summary, the intent is to prohibit reductions based on factors outside of the service delivered, patient-specific considerations, or contractually permissible terms. The precise list of prohibited factors would be defined in the enacted text.
- Compliance and enforcement framework: The bill would establish expectations for third-party payers to comply with the new prohibition, potentially including remedies or penalties for noncompliance (specific enforcement mechanisms are not detailed in the introduced text provided).
Who would be affected
- Health care providers: Physicians, hospitals, clinics, and other entities that receive reimbursement from third-party payers for covered services.
- Third-party payers: Insurance companies, managed care plans, and any organization responsible for paying a claim for a health care service under Ohio health coverage.
- Health care practices and networks: Provider groups and hospital systems may experience changes in contract administration and revenue cycle processes to ensure reimbursements are not reduced under prohibited criteria.
Procedural and timeline aspects
- Status: Introduced in the Ohio House on April 27, 2026; primary sponsor James M. Hoops (R), with a House co-sponsor Kyle Koehler.
- Committees: Referred to the House Insurance Committee; typical progression would be committee consideration, potential amendment, then floor action in the House, followed by Senate consideration if passed.
- Next steps: If advanced, the bill would move through corresponding Senate committees and floor votes, with potential amendments. Final passage would require conformity between House and Senate versions before sending to the Governor for signature.
Notes
- The current text is “as introduced,” and the precise list of prohibited factors and any enforcement provisions would be clarified in the enacted bill text or committee substitute.
- The bill falls under subjects of Commerce, Insurance, and Health Care, indicating a regulatory approach impacting payer-provider financial relationships.
This summary highlights the bill’s stated goal to curb reimbursement reductions by third-party payers based on unallowable criteria, thereby protecting provider revenue and patient access to care.
Compiled from official sources — confirm details with the bill’s official record.
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