03/29/2023

Advocacy Update

 

In addition to the pending optometric laser surgery bill, there is additional activity at the state level impacting ophthalmology practices, including these details below.

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Increase Medicaid Reimbursement for physicians – State Budget

Governor DeWine has proposed a significant increase in the Medicaid budget for physician fees. The details of how the increase will be applied across the fee schedule will be determined after the budget passes—but as introduced, it proposes more than $100 million a year in new spending. The OOS will be working with OSMA and other specialty societies to advocate that this new spending remains in the budget as it makes its way through the Ohio House and Senate.

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Prior Authorization Reform – HB 130 Gold Card

Prior Authorization reform continues to be a high priority for OOS and the practice of medicine across Ohio. OOS—along with OSMA—is strongly advocating for HB 130, which, if passed, would create a Prior Authorization Gold Card, where providers who consistently adhere to evidence-based medicine will be exempted from certain prior authorization requirements.

Additionally, OOS and organized medicine are working with policymakers on other insurance reform efforts including:

• Eliminating automatic downcoding.
• Restricted take-backs of paid claims.
• Reducing minimum time frame for prior authorization approvals and appeals.

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Telehealth Rules

After several months of review, the State Medical Board of Ohio finalized telehealth rules, which became effective on February 28, 2023.

Key elements include:

• Standard of care: The rules require that telehealth services meet the standard of care of an in-person visit, and that it meets the standard of care for that patient’s condition.
  
  
• Prescribing controlled substances: The rules provide specific guidelines as to when it is and is not lawful to prescribe.
  
  
• Documentation/requirements for in-person visits, etc: The rules also outline what information must be documented in the patient’s medical file during a telehealth visit, when a telephone call is permitted as a telehealth service, when physicians must require an in-person visit rather than a telehealth visit, and when physicians can utilize remote monitoring devices as telehealth services. It also contains the criteria that physician assistants, with delegated prescriptive authority, must meet for purposes of telehealth care.