State Codes and Statutes

Statutes > Ohio > Title39 > Chapter3963 > 3963_11

3963.11 Prohibited conduct by contracting entities.

(A) No contracting entity shall do any of the following:

(1) Offer to a provider other than a hospital a health care contract that includes a most favored nation clause;

(2) Enter into a health care contract with a provider other than a hospital that includes a most favored nation clause;

(3) Amend an existing health care contract previously entered into with a provider other than a hospital to include a most favored nation clause.

(B) This section shall not go into effect until three years after the effective date of this section.

(C) As used in this section:

(1) “Contracting entity,” “health care contract,” “health care services,” “participating provider,” and “provider” have the same meanings as in section 3963.01 of the Revised Code.

(2) “Most favored nation clause” means a provision in a health care contract that does any of the following:

(a) Prohibits, or grants a contracting entity an option to prohibit, the participating provider from contracting with another contracting entity to provide health care services at a lower price than the payment specified in the contract;

(b) Requires, or grants a contracting entity an option to require, the participating provider to accept a lower payment in the event the participating provider agrees to provide health care services to any other contracting entity at a lower price;

(c) Requires, or grants a contracting entity an option to require, termination or renegotiation of the existing health care contract in the event the participating provider agrees to provide health care services to any other contracting entity at a lower price;

(d) Requires the participating provider to disclose the participating provider’s contractual reimbursement rates with other contracting entities.

Effective Date: 2008 HB125 06-25-2008

State Codes and Statutes

Statutes > Ohio > Title39 > Chapter3963 > 3963_11

3963.11 Prohibited conduct by contracting entities.

(A) No contracting entity shall do any of the following:

(1) Offer to a provider other than a hospital a health care contract that includes a most favored nation clause;

(2) Enter into a health care contract with a provider other than a hospital that includes a most favored nation clause;

(3) Amend an existing health care contract previously entered into with a provider other than a hospital to include a most favored nation clause.

(B) This section shall not go into effect until three years after the effective date of this section.

(C) As used in this section:

(1) “Contracting entity,” “health care contract,” “health care services,” “participating provider,” and “provider” have the same meanings as in section 3963.01 of the Revised Code.

(2) “Most favored nation clause” means a provision in a health care contract that does any of the following:

(a) Prohibits, or grants a contracting entity an option to prohibit, the participating provider from contracting with another contracting entity to provide health care services at a lower price than the payment specified in the contract;

(b) Requires, or grants a contracting entity an option to require, the participating provider to accept a lower payment in the event the participating provider agrees to provide health care services to any other contracting entity at a lower price;

(c) Requires, or grants a contracting entity an option to require, termination or renegotiation of the existing health care contract in the event the participating provider agrees to provide health care services to any other contracting entity at a lower price;

(d) Requires the participating provider to disclose the participating provider’s contractual reimbursement rates with other contracting entities.

Effective Date: 2008 HB125 06-25-2008


State Codes and Statutes

State Codes and Statutes

Statutes > Ohio > Title39 > Chapter3963 > 3963_11

3963.11 Prohibited conduct by contracting entities.

(A) No contracting entity shall do any of the following:

(1) Offer to a provider other than a hospital a health care contract that includes a most favored nation clause;

(2) Enter into a health care contract with a provider other than a hospital that includes a most favored nation clause;

(3) Amend an existing health care contract previously entered into with a provider other than a hospital to include a most favored nation clause.

(B) This section shall not go into effect until three years after the effective date of this section.

(C) As used in this section:

(1) “Contracting entity,” “health care contract,” “health care services,” “participating provider,” and “provider” have the same meanings as in section 3963.01 of the Revised Code.

(2) “Most favored nation clause” means a provision in a health care contract that does any of the following:

(a) Prohibits, or grants a contracting entity an option to prohibit, the participating provider from contracting with another contracting entity to provide health care services at a lower price than the payment specified in the contract;

(b) Requires, or grants a contracting entity an option to require, the participating provider to accept a lower payment in the event the participating provider agrees to provide health care services to any other contracting entity at a lower price;

(c) Requires, or grants a contracting entity an option to require, termination or renegotiation of the existing health care contract in the event the participating provider agrees to provide health care services to any other contracting entity at a lower price;

(d) Requires the participating provider to disclose the participating provider’s contractual reimbursement rates with other contracting entities.

Effective Date: 2008 HB125 06-25-2008