Advocacy Update McKenzie Davis The Success Group. Ohio MGMA

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1 Advocacy Update 2018 McKenzie Davis The Success Group Ohio MGMA

2 Overview 2018 Policy Update Payor/Insurance General Legislative General Regulatory 2019 Policy Preview Budget/Medicaid Other healthcare focus 2018 Election Preview Political Impact on Policy Process

3 Payer/Insurance Topics Current legislation/regulations Implementation of existing laws Medicaid administration Mergers

4 Current Payer/Insurance Legislation HB 450 Insurance Mandates Supported by Chamber and NFIB OSMA opposed HB 479 Pharmacy Benefit Managers HB 546 Telemedicine Parity Tried in the budget now stand alone bill HB 72/SB 56 Step Therapy HB 416 Price Transparency Lawsuit still pending issues isn t going away

5 Current Payer/Insurance Regulation Aetna Letter To ODI Response meeting with company provider support changes Anthem ER Policy External Appeal

6 Payer/Insurance Implementation Existing Laws Prior Authorization Law Fully Implemented in 2018 Insurers must have a web based system to accept PA requests Faster turnaround times for PA requests 48 hours for urgent matters and 10 calendar days for non urgent matters Faster turnaround times for appeals 48 hours for urgent matters and 10 calendar days More clarity when an insurer responds to PA requests: electronic receipt, specific reasons for denial, other information can be requested Contact ODI and OSMA or Specialty Society if process isn t being followed

7 Payer/Insurance Medicaid Administration Expansion Continues For Now Ohio has applied for work requirement waiver Change in Pharmacy Benefit Managers (PBM) Policy On Line MCO Complain Process Each complaint is tracked and response provided Allows for overall review of issues Scroll to bottom to click on form Payment Reform Continues Primary Care Episodes

8 Payer/Insurance Mergers Aetna/CVS Vertical Integration where does it lead AMA and OSMA sent letter opposing merger to DOJ Waiting for DOJ decision

9 General Legislative Pending HB 7 Tort Reform Passed in House Pending in Senate HB 273 Maintenance of Certification Pending in House HB 559 Immunizations Scope of Practice HB 131 PTs diagnosing and ordering imaging HB 326 Psychologists prescribing SB 256 Physician Assistants HB 191 CRNAs prescribing and independent practice Nurses just introduced another independent practice bill

10 General Regulatory Pending Medical Marijuana More than 200 doctors are now certified Waiting for manufacturers and dispensers to come on line Pharmacy Board finalizing certification process Opioid Prescribing Ohio leads the nation in OARRS checks 30% decrease in prescribing over the last 5 years OARRS now has a tab that allows you to review missed checks in the previous month ICD 10 First four now required on all controlled substances as of June 2018 In Office Compounding Rules are being redrafted

11 2019 Policy Review Budget Year Big Impact on Medicaid Expansion yes or no Medicaid Physician Spending (reforms?) New Players in Medicaid Managed Care Space Other Health Care Legislative Hot Topics Price Transparency Scope of Practice Insurance Reforms/Mandates Other Regulatory Reforms Medical Marijuana Opioid Prescribing Insurance Department Oversight (new administration)

12 Election Preview Impact on Policy Governor s Race Medicaid Expansion Boards Departments (Insurance, health, etc.) Attorney General Mergers/Drug Companies/Etc. Supreme Court Uphold Tort Reform House/Senate Size of majorities will impact policy work Medicaid, etc. Doctor in Legislature Scope of Practice/Insurance Regulation