Ohio Code 3963.11 – Prohibited conduct by contracting entities
(A) No contracting entity shall do any of the following:
Terms Used In Ohio Code 3963.11
- Another: when used to designate the owner of property which is the subject of an offense, includes not only natural persons but also every other owner of property. See Ohio Code 1.02
- Contract: A legal written agreement that becomes binding when signed.
- Contracting entity: means any person that has a primary business purpose of contracting with participating providers for the delivery of health care services. See Ohio Code 3963.01
- Health care contract: means a contract entered into, materially amended, or renewed between a contracting entity and a participating provider for the delivery of basic health care services, specialty health care services, or supplemental health care services to enrollees. See Ohio Code 3963.01
- Health care services: means basic health care services, specialty health care services, and supplemental health care services. See Ohio Code 3963.01
- Participating provider: means a provider that has a health care contract with a contracting entity and is entitled to reimbursement for health care services rendered to an enrollee under the health care contract. See Ohio Code 3963.01
- Provider: means a physician, podiatrist, pharmacist, dentist, chiropractor, optometrist, psychologist, physician assistant, advanced practice registered nurse, occupational therapist, massage therapist, physical therapist, licensed professional counselor, licensed professional clinical counselor, hearing aid dealer, orthotist, prosthetist, home health agency, hospice care program, pediatric respite care program, or hospital, or a provider organization or physician-hospital organization that is acting exclusively as an administrator on behalf of a provider to facilitate the provider's participation in health care contracts. See Ohio Code 3963.01
(1) Offer to a provider a health care contract that includes a most favored nation clause;
(2) Enter into a health care contract with a provider that includes a most favored nation clause;
(3) Amend or renew an existing health care contract previously entered into with a provider so that the contract as amended or renewed adds or continues to include a most favored nation clause.
(B) 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.