Ohio § 3963.04

§ 3963.04.

(A)(1) If an amendment to a health care contract is not a material amendment, the contracting

entity shall provide the participating provider notice of the amendment at least fifteen

days prior to the effective date of the amendment.  The contracting entity shall provide all other notices to the participating provider

pursuant to the health care contract. (2) A material amendment to a health care contract shall occur only if the contracting

entity provides to the participating provider the material amendment in writing and

notice of the material amendment not later than ninety days prior to the effective

date of the material amendment.  The notice shall be conspicuously entitled “Notice of Material Amendment to Contract.” (3) If within fifteen days after receiving the material amendment and notice described

in division (A)(2) of this section, the participating provider objects in writing

to the material amendment, and there is no resolution of the objection, either party

may terminate the health care contract upon written notice of termination provided

to the other party not later than sixty days prior to the effective date of the material

amendment. (4) If the participating provider does not object to the material amendment in the manner

described in division (A)(3) of this section, the material amendment shall be effective

as specified in the notice described in division (A)(2) of this section. (B)(1) Division (A) of this section does not apply if the delay caused by compliance with

that division could result in imminent harm to an enrollee, if the material amendment

of a health care contract is required by state or federal law, rule, or regulation,

or if the provider affirmatively accepts the material amendment in writing and agrees

to an earlier effective date than otherwise required by division (A)(2) of this section. (2) This section does not apply under any of the following circumstances: (a) The participating provider's payment or compensation is based on the current medicaid

or medicare physician fee schedule, and the change in payment or compensation results

solely from a change in that physician fee schedule. (b) A routine change or update of the health care contract is made in response to any

addition, deletion, or revision of any service code, procedure code, or reporting

code, or a pricing change is made by any third party source. For purposes of division (B)(2)(b) of this section: (i) “ Service code, procedure code, or reporting code ” means the current procedural terminology (CPT), current dental terminology (CDT),

the healthcare common procedure coding system (HCPCS), the international classification

of diseases (ICD), or the drug topics redbook average wholesale price (AWP). (ii) “ Third party source ” means the American medical association, American dental association, the centers

for medicare and medicaid services, the national center for health statistics, the

department of health and human services office of the inspector general, the Ohio

department of insurance, or the Ohio department of medicaid. (C) Notwithstanding divisions (A) and (B) of this section, a health care contract may

be amended by operation of law as required by any applicable state or federal law,

rule, or regulation.  Nothing in this section shall be construed to require the renegotiation of a health

care contract that is in existence before June 25, 2008, until the time that the contract

is renewed or materially amended.