Health Care Lawyers & Attorneys : Schottenstein Zox & Dunn Law Firm : Strategic Planning, Managed Care, Insurance : Columbus, Cleveland, Cincinnati, Central Ohio

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Ohio HealthCare Simplification Act creates a new Chapter 3963 in Ohio Revised Code.  ORC 3963.04 is the provision governing material amendments to a health care contract.  Under ORC 3963.04, if an amendment to a health care contract is not a material amendment, the contracting entity is only required to give providers a notice of amendment at least 15 days prior to the effective date of the amendment.   

For a material amendment, the contracting entity must provide the participating provider the material amendment in writing at least 90 days prior to the effective date of the material amendment. The notice shall be conspicuously entitled “Notice of Material Amendment to Contract.” 

The provider must object within 15 days if it does not accept the material amendment. If the parties cannot resolve the objection, either party may terminate the health care contract.  If the participating provider does not object to the material amendment in the manner described above, the material amendment shall be effective. 

The issue is whether the material amendment will become effective if the parties cannot reach a resolution on the provider’s objection. 

Some payors have taken the position that if the parties cannot resolve their differences, the proposed material amendment becomes effective.  

This has caused confusion to some providers. In some cases, it has even taken away the benefit of providers' original contract provision.  Nor is it clear if this interpretation is consistent with the legislative intent of ORC 3963.04.   Many in the industry agree that this issue would benefit from clarification from the Ohio Department of Insurance.