Cleveland Law Library Weblog

Bill Requires 24 Hour Emergency Care in New Hospitals

SB 120 would require new hospitals to provide 24 hour emergency room care, even if such care is available in nearby hospitals.  Some doctors feel that the legislation is an effort by hospital lobbyists to stop physicians from owning and operating their own hospitals.  Supporters of the bill say the bill will prevent private for-profit hospitals from offering only the most profitable services, leaving the unprofitable services to nonprofit hospitals.  Some hospitals are exempt, namely, long-term acute care hospitals, alcohol and chemical dependency hospitals, rehabilitation hospitals and psychiatric hospitals.

The bill would also require hospitals to maintain Medicaid and Medicare provider agreements.

Bill would Require New Hospitals to Have 24-hour Emergency Rooms by Anthony Gottschlich, Dayton Daily News, Apr. 13, 2007; Ohio Regulation of Specialty Hospitals , Bricker & Eckler. 

Bills of Interest

More bills of interest recently introduced include:

HB 81 HPV VACCINATION: To require that girls entering the sixth grade be vaccinated against  HPV.  (See article:  Ohio Bill Requires HPV Shots for Girls by Harlan Spector, The Plain Dealer, March 1, 2007.) HB83 SORN LICENSE PLATES: To create a SORN Law license plate.  (see article:  Sex Offenders Might Get Special License Plates by Eve Mueller, 10TV.com, Feb. 28, 2007) HB86 NONTHERAPEUTIC ABORTION: To prohibit the state offering, sponsoring, or endorsing a health insurance policy that covers nontherapeutic abortion.

New Regulations for Physicians Regarding Terminating Physician/Patient Relationship

The Ohio State Medical Board issued a new regulation, Ohio Admin. Code 4731-27-01, which creates rules for physicians when a doctor-patient relationship is terminated.  There are also rules for when a practice closes.   For more details, see:  Ohio State Medical Board Issues A New Rule Governing Termination of the Physician-Patient Relationship by The Health Care Department of Bricker & Eckler, L.L.P., Feb., 2007. 

If Insurer Does Not Ask on Application, Insured Need Not Tell

Under federal common law, an insured does not have a duty to disclose symptoms or medical history information not requested by an insurer.   Metropolitan Life Ins. Co. v. Conger (Jan. 16, 2007), Sixth Circuit App. No. 06-5009. 

Taft Says He Will Sign Mental Health Parity Bill

According to a report by WKSU News, Governor Taft said he will sign the mental health parity bill, SB 116.  The bill requires health insurers who offer coverage for "basic health care services" to offer coverage for biologically based mental illnesses.  Companies may opt out if premiums are increased more than 1%, due to the costs of mental health parity.   Larger self-insured companies are, by federal law, exempt from state laws such as this one.   Governor To Sign Mental Health Bill by Jo Ingles, WKSU News, Dec. 28, 2006; Mental Health Parity Bill Sent to Governor Taft, ODMH Connections, Dec. 2006. 

Update:  Taft signed this bill on Dec. 29, 2006.  See Governor's Press Release, 10/29/06. 

New Ohio Law for Small Business Health Care Benefit Plans

The governor signed HB 5, "to permit small employers to offer health care plans without benefits otherwise required by statute, to provide for the operation of health savings accounts consistent with federal laws, and to limit the amount of copayments and deductibles paid by persons insured by health benefit plans". The law will allow small employers to participate in collective purchasing arrangements for health care.  Additionally, a system is created to regulate discount medical plan organizations.  See Governor's Press Release, 12/22/06; Ohio Health Care Initiatives by Chuck Kallendorf, Cincinnati Law Library Blog. 

Final HIPAA Regulations on NonDiscrimination

Final HIPPA regulations were issued concerning nondiscrimination provisions, including specific regulations on nondiscrimination in employee wellness programs. See 71 FR 75014.  Generally, the HIPAA nondiscrimination provisions provide that group health plans and group health insurers may not discriminate against a participant or beneficiary based on any health factor of a participant or beneficiary.  The supplemental information in the Federal Register section compares the prior interim and proposed regulations to the final regs.

The effective date of the regulations is February 12, 2007.  The regs apply to plan years beginning on or after July 1, 2007.

Source:  Final HIPPA Nondicriminatory/Wellness Program Rules by Chuck Kallendorf, Cincinnati Law Library Blog, Dec. 12, 2006. 

Resources for Setting Up a Concierge Medical Practice

A concierge medical practice, also called a boutique medical practice,  involves patients paying  a retainer to receive medical care over a certain period.  Benefits to patients may include no waiting for appointments, house calls, periodic wellness checkups and generally more personal attention.  Conversion to a concierge practice, if not done properly, may lead to allegations of abandonment.  There are also issues of how a concierge practice can comply with Medicare requirements.

Here are some articles which may be helpful in setting up a concierge practice: Warner, Norcross and Judd, L.L.P. Articles, including Legal Issues Involved in Concierge Medical Practices by John R. Marquis, March 2005; Retainer Medicine, May 16, 2006 (On the Washington State Insurance Commissioner's page); The Steady Creep Towards Concierge Medicine by Joseph V. Geraci, Brown McCarroll LLP, Nov. 14, 2005; The Legal Risks of Boutique Medicine by Steven M. Goldstein, Sacks-Tierney, P.A., July 2003;  Download retainer_practices_discussion_paper.doc , by the American Academy of Family Physicians, 2006; How to Set Up a Concierge Practice by Wayne J. Guglielmo,  Medical Economics, Aug. 22, 2003.  

There are forms available for a fee on the web, including patient contracts:  Concierge or Retainer Medical Practice - How to Evaluate and Start a Retainer Practice , 2004, Health Care Intelligence Network; Concierge or Retainer Medical Practice - How to Evaluate and Start A Retainer Practice 2006 by Apollo Managed Care Consultants.   

Hospital Reporting Act Makes Cost and Quality Info Available on the Web

A new Ohio law, H.B. 197, requires hospitals to submit quality of care and cost information to the Ohio Department of Health.  The Department of Health will make the information available on its website.  Ohio Gets Hospital Reporting Law , United Press International, Aug. 9, 2006.  See also: Hospital Data Reporting Law Passed by Chad W. Helmick, Schottenstein, Zox & Dunn, Aug. 11, 2006. 

Teachers Win $7.8 Million in Fraud Suit Against Pharmacy Benefit Manager

The State Teachers Retirement System sued Merck and its subsidiary Medco Health Systems for fraud and breach of fiduciary duty while managing the retired teachers' pharmacy benefit plan.  STRS alleged that the defendants overcharged for certain drugs and dispensing fees and wrongfully withheld manufacturer's rebates. See Ohio Attorney General's Press Release, Petro Wins $7.8 Million Verdict Against Merck, Medco For Defrauding Teachers’ Pension System Dec. 20, 2005;  Jury Awards $7.8M in Teachers' Fraud Suit Times Daily, December 20, 2005.  To view documents in the case go to: Board of the State Teachers Retirement System of Ohio vs. Medco Health Solutions, Inc. , Hamilton County Common Pleas Court Case No A 0309929.