Ohio § 3941.47

§ 3941.47.

(A) As used in this section, “ median price ” means the median price charged to the mutual insurance company during the twelve

months preceding the notice of intention to discontinue the contract by all other

hospitals providing a similar service or services in the same county and the contiguous

counties. (B) Any mutual insurance company which merged or consolidated with a hospital service

association may not discontinue before January 1, 1990, the contractual relationship

which was in effect between the hospital service association and any hospital, pursuant

to Chapter 1739. 1 of the Revised Code, unless the hospital fails to participate in cost management

programs provided by the mutual insurance company to its insureds, or the hospital

is not operated in a cost effective manner, or the hospital offers services to insureds

of the mutual insurance company which, in the exercise of its business judgment, the

mutual insurance company believes are priced more expensively than is in the best

interests of its policyholders.  In determining whether a hospital's prices are more expensive than is in the best

interests of its policyholders, the mutual insurance company may conclusively base

its decision on the following criterion:  whether the price the hospital charges the

mutual insurance company for a service or services provided to insureds of the mutual

insurance company is greater than the median price.  The mutual insurance company shall, at least ninety days prior to the proposed effective

date set forth in a notice of intent to discontinue a contract with a hospital, notify

in writing the hospital and the superintendent of insurance of the intention to discontinue

the contract.  The notice of intention to discontinue a contract shall include the median price.  In determining whether to discontinue the contract of a hospital, the mutual insurance

company shall, in the exercise of its business judgment, determine the hospital's

price on a case-mix adjusted basis, including, where appropriate, giving reasonable

and uniform credit for a portion of a hospital's reasonable charity care and medical

education expense. In applying the conclusive price criterion, the mutual insurance company shall not

discontinue any hospital's contract prior to January 1, 1990, if that hospital's price

is at or below the median price, or the hospital agrees within ninety days from the

date of receipt of a notice of intention to discontinue the contract, to provide services

to policyholders of the mutual insurance company at a price, adjusted for case mix,

including where appropriate, giving reasonable and uniform credit for a portion of

a hospital's reasonable charity care and medical education expenses, not greater than

the median price. A discontinuance pursuant to this section shall not be effective until the next annual

renewal date of the contract between the mutual insurance company and the hospital

or on the thirty-first day of December if the contract has no expiration date. If a hospital receives a notice of intention to discontinue as provided in this section,

it may appeal the decision to the superintendent of insurance within thirty days from

the date it receives notice of the discontinuance.  The superintendent shall, within thirty days after receipt of notice of appeal,

hold a hearing upon proper notice.  The superintendent shall, within twenty days after the hearing, issue an order approving

or disapproving the discontinuance.  All final orders and decisions of the superintendent are subject to judicial review

as provided in Chapter 119. of the Revised Code. 1

 So in original;  RC Chapter 1739. repealed by 1987 S 124, eff. 10-1-87;  new RC Ch

1739 enacted by 1992 H 689, eff. 4-9-93.