May 19, 2026 · Insurance Committee · 16,992 words · 18 speakers · 138 segments
Committee to order.
Mr. Friend, will you please call the roll?
Chair Lampton. Here.
Vice Chair Craig. Here.
Ranking Member Hall. Aye.
Representatives Barhorst. Here.
Cockley. Here.
Representative Daniels is excused. Representatives Dieter.
Here. Jerroles.
Here. John.
King. Here.
Lorenz. Here.
Peterson.
And Sweeney.
We have a quorum present. We'll proceed as a full committee. Members, the minutes from the previous meeting are on the iPads. We'd like to accept those minutes without objection. Hearing no objections, the minutes are approved. I now call forward House Bill 652 for its fourth hearing. The chair recognizes Representative Lorenz for a motion.
Chairman, I move to amend House Bill 652 with Amendment No. 2374.
The amendment is in order. Representative Lorenz, would you please explain the amendment?
Thank you, Mr. Chairman. This amendment specifies that the bill's requirements are not to be construed as creating any right of private action to be brought as a class or individually.
The amendment has been distributed to the members of the committee and is available. We'd like to approve the amendment without objection. Hearing no objection, the amendment is accepted. This now concludes the fourth hearing on House Bill 652. I would like to call forward Senate Bill 306 for its first hearing, sponsored testimony. The chair recognizes Vice Chair Craig for a motion.
Chairman, I move to accept 3224-3 as a substitute bill to Senate Bill 306.
Vice Chair Craig, would you please explain the sub-bill?
The substitute bill was the result of negotiations with multiple interested parties. It makes several changes to the provisions of the bill relating to repair facilities and towing companies, and it also sets parameters for the creation of investment advisor insurance agent licenses. Thank you.
The substitute bill of comp doc have been distributed to the members of the committee and are available. We'd like to approve this sub bill without objection. Hearing no objection, the sub bill is accepted. At this time, we bring forward the Senator George Lang for sponsor testimony. Senator, welcome to the committee. The floor is yours.
Chairman Lampton, Vice Chair Craig Raking, Member Halls, and members of the House Insurance Committee, thank you for the opportunity to provide sponsor testimony on Substitute Senate Bill 306, a measure that seeks to update Ohio's insurance statute. Chairman Lampton, I'd like to point out that the meeting did start five minutes late, and I'm not going to throw anybody under the bus, but somebody sitting over here made the comment, if this was in the Senate, the meeting would be over by now. And I'm not going to say who, because I'm not going to disparage anybody, but I just wanted to let the chairman know that. Chairman, every General Assembly for the last three or four now, I have had the honor of carry in this legislation, which is literally the most boring piece of legislation you will ever have. Before me, it was Bob Hackett. Bob Hackett carried this legislation for many, many, many GAs, and I believe before him it was Hottinger, Jay Hottinger. But all jokes aside the purpose of this is merely to update the code bring it into the modern times if you will There are often revisions needed every general assembly to ensure our state protects its precious insurance industry, that the industry remains competitive among all other states and is attractive for prospective investment. That is what Senate Bill 306 seeks to do. Senate Bill 306 introduces six main updates to our state's insurance laws. In this bill, I will briefly touch on e-signature. Senate Bill 306 clarifies that any signature requirement placed on an insurer may be accomplished electronically. This provision was drafted in consultation with the department. Repair Shop Consumer Protections. This bill adds a variety of consumer protections prohibiting repair shops from holding vehicles from customers, including preventing a repair shop from making a consumer sign a contract that restricts equitable and statutory mechanisms to retrieve the vehicle. Towing Updates The bill also revises the towing statute with necessary technical changes regarding actions brought under the existing statute. The changes help to modernize and clarify actions for the benefit of consumers. Special Purpose Financial Captives. Senate Bill 306 codifies existing permitted practice to promote transparency. This language is also written in consultation with the Ohio Department of Insurance. Unaffiliated Agent License. This update will allow an unaffiliated agent to sell, solicit, or negotiate variable life and variable annuity products without a line of authority under the agent statute, and was written again in consultation with both the industry and the department. Continued updates to the assigned risk plan. Lastly, Senate Bill 306 provides continued updates to the assigned risk plan, including strengthened anti-fraud measures, codified provisions of the plan manual to strengthen compliance, and clarify that fraud against the plan is a violation of the insurance fraud criminal statute. In Ohio, we are very, very fortunate to have a robust and competitive insurance marketplace that is critical to our overall economic production and competitiveness. It's one of the biggest industries in Ohio, one of the biggest employers in Ohio, and we're the number three state in America for insurance companies to be headquartered in, and I know there are several people on this committee that are active in the industry. The changes contained within this bill will help ensure that Ohio remains a premier state for insurance, which will continue to yield the benefits for both businesses and consumers, and help ensure Ohio is the most business-friendly state in the country. Mr. Chairman, thank you again for allowing me to present sponsored testimony on this most entertaining and boring bill, and I would be happy to entertain any questions.
Thank you very much for your testimony, Senator. Do we have any questions from the committee? Well, Senator Lang, I do appreciate your promptness and certainly apologize for the tardiness of the chair and the committee starting. I hope we didn't upset your day too badly. I'm not going to throw anybody under the bus, but it was somebody back here.
Okay.
Well, thank you, Senator. It's great to see you and appreciate your sponsor testimony this morning. And give Valerie my best I will sir Thank you Well this will conclude the first hearing on Senate Bill 306 We now call forward House Bill 699 for its first hearing Sponsor testimony Testifying, we have Representatives Manira Abdahali and Crystal Lett.
Thank you.
Welcome to committee. The floor is yours.
Thank you, Chair. I, for one, was relieved that we were late. Good morning, Chair Lambton, Vice Chair Craig, Ranking Member Hall, and all members of the House Insurance Committee. Thank you for the opportunity to provide sponsored testimony on House Bill 699 alongside my colleague, Representative Crystal Lett. I'm truly excited to provide testimony on this bill because this bill is a culmination of the dedication of advocates in this space and the vulnerability and strength of the stories people have shared with me. The concept of this bill was brought forward to me by Samantha Davis, an Ohioan who struggled with chronic and debilitating illness. She's actually here today. I did not expect her to show up, which is amazing. She is someone who struggled and experienced almost every difficulty one can face from our health care system. Instead of despairing and focusing on self-preservation, she dedicates herself to ensuring others do not experience the same thing. You'll hopefully be hearing from her soon in this committee to tell her story and share her expertise. House Bill 699 is a fairly simple bill. It would require each health benefit plan that covers prescription drugs to cover any drug prescribed to treat a covered person's disease, disorder, or condition if the drug is FDA-approved and recognized for treatment. And the health benefit plan does not expressly exclude coverage for the disease, disorder, or condition. Some of us are familiar with the experience of an employer's health plan choosing to stop coverage for certain medication. We recently experienced that change, and I'm sure some of you who had medication that was not covered anymore know exactly what Ohioans feel that face this. At its core, this bill is simple. Medically necessary treatment decisions should be made by doctors and patients, not insurance companies. Across Ohio, patients are being trapped in endless appeals and delays, even when their physician recommends evidence-based treatments supported by peer-reviewed medical literature and accepted standards of care. For cancer patients, these delays can mean disease progression while waiting for authorization. For diabetics, like myself, it can mean losing access to medication that keep blood sugar stable and prevent hospitalization. For families dealing with rare diseases, it can mean watching a loved one deteriorate while insurers hide behind technicalities and outdated coverage rules. No patient should have to become sicker just to prove they deserve care. Opponents may claim this bill increases costs, but denying timely treatment does not eliminate costs. It shifts them downstream into emergency rooms, hospital stays, disability, and long-term complications that are far more expensive for families and the healthcare system alike. And again, this legislation does not require coverage for experimental drugs. It applies to FDA-approved medications supported by recognized medical compendia and peer-reviewed scientific evidence. Doctors should not have to wait years for insurance policies to catch up with medical science, and patients should not need a law degree, endless appeals, or personal wealth to access medically accepted treatments. We should not force Ohioans into crisis care because insurers delayed treatment. To close, House Bill 699 is a common sense patient protection bill that restores trust in the doctor-patient relationship and ensures that insurance oversight or undersight does not detrimentally affect patient care. I respectfully urge your support and I look forward to any questions you have. Before that, I will pass it over to my colleague, Crystal Lett. Thank you so much.
Chair Lambton, Vice Chair Craig, Ranking Member Hall, and distinguished members of the House Insurance Committee thank you for the opportunity to provide testimony on House Bill 699 today I proud to support this legislation because when a doctor prescribes an FDA medication that is medically necessary a patient should be able to access it without months of delays, denials, and appeals. The health and well-being of our constituents must come before efforts by health plan issuers to reduce costs. And this issue is deeply personal to me. When my son was born, our family waited more than eight months for our health plan to approve a medication that is considered the standard of care for his condition. During that time, we lived with constant uncertainty about whether he would receive the treatment he needed to grow and develop. Fortunately, the pharmaceutical company provided the medication through a bridge program. Without that support, my son could have and would have missed critical developmental milestones, and the long-term cost to his health and to the healthcare system would have been far greater than the cost of covering the medication in the first place. Even after the initial approval, our insurer continued to challenge the specific formulation and delivery system prescribed by his physician. The medication our doctor recommended was the only FDA-approved treatment for his specific condition, yet we were forced to navigate repeated denials, appeals, and unnecessary administrative hurdles. Unfortunately, as you've just heard, our experience is not unique. Patients and physicians across Ohio face similar obstacles every single day. Processes such as formulary exceptions and step therapy are intended to manage costs, but when used inappropriately, they can delay effective treatment and place patients at risk. Families should not be forced to endure ineffective therapies simply to prove that the medication their doctor originally prescribed was the right choice. House Bill 699 streamlines this process by requiring health plans to cover FDA-approved prescription drugs prescribed for covered conditions, along with the medically necessary services needed to administer them. This bill is putting patients first. It is about reducing unnecessary barriers, improving affordability, and ensuring that Ohioans can access the treatments they need when they need them. I respectfully ask for your support of House Bill 699, and we'll be happy to answer any questions. Thank you.
Thank you very much for your testimony this morning. Do we have questions from the committee? Ranking Member Hall?
Thank you, Chair. Through the Chair, thanks, Rep. Abdullahi, for being here today. Certainly appreciate you coming to testify. Very supportive of what I think the bill is trying to do. I think what I struggle with is, I guess, two things. One rep let you use a scenario where there was a singular drug available, right? That is a different situation than scenarios where there are multiple drugs or what we call me to drugs on the same class, right? Whether it be something as simplistic as a blood pressure medication or or a medication used to treat high cholesterol. There can be multiple drugs in those classes. And so certainly in the scenario that you outlined, when there is one drug available, Mike, that should be very that should be simplified. I'm with you on that. I think where I struggle though is this idea of covering any drug that is prescribed because again, if I've got eight, nine drugs in a category, all of those drugs are gonna have different pharmacokinetic profiles and different sort of therapeutic levels of efficacy, right? And so an individual physician is not always going to know, for example, the ins and outs of the kinetics of eight or nine different drugs in a class. That's part of what P and T committees are to do within the context of managed care companies. Now, certainly, you know, PA and step therapies, they are there to help manage costs, no doubt about that. But they're also there to make sure that we have the right and most therapeutically effective medications on a given formulary. Now, there's this whole other rebate thing we can kind of get into, which I think corrupts that process a bit, you know. But all told, what concerns me is the cover-any-drug component of this. In your scenario, I'm with you. I guess the question that I'm getting to here is can you unpack for me, when you say cover-any-drug, would you be proposing then that an insurance company, that their P&T committee would no longer have the ability to basically make a decision or determination based upon evidence that one or two drugs in a class of eight or nine are better than some of the others for treating their class of patient. And that's a loaded question.
It is a loaded question, but thank you for that. And I'm happy to defer that to when we have a proponent and opponent come in. We can do that there, too. Thank you so much to the chair, to the representative. I think part of that would be answered by the experts. but I'll give a quick example from my scenario. I take insulin, and there are four or five types of long-acting insulin. I've tried probably four or five of them. However, one or two work very well from my diabetes. Everyone is different. So when my doctor prescribes this version of long-acting insulin over the other, and my insurance company, which happened to me before, said, no, we can't cover this one, we have to cover the other one. That makes my treatment harder, And that happens to many patients, and we have examples that we can keep going on that. So we're not intending to limit all these technicalities that you mentioned that I have no idea about. I'm not an insurance expert. I can't even name what you just said. However, we are trying to maintain the trust in the doctor that they know what is right for the patient. The bill says that medically necessary drugs for the patient. And I'm happy to go over those technicalities as well with you and with the experts, But that is just kind of an explanation of what we're trying to avoid, where the doctor deems a drug medically necessary for a patient, this particular type of drug, and then the insurer denies it.
Yeah.
Follow-up?
Yeah, follow-up. Yeah, so I appreciate that. So I think the idea there is that's a reformation of how PA and step therapy works. That's distinctly different than saying let's cover – putting in a requirement that you cover any drug. So that's the nuance there that's there. So, um, but certainly sympathetic to what you're saying there, I'm actually in agreement with you. I just think, I think that there's a, uh, a, a more surgical way of getting at what you're trying to get at and look forward to having, uh, more conversations and maybe helping assist in that way. So, yeah.
Representative Gerald's.
Thank you, chair. Uh, thank you, uh, representative Abdullahi and representative left for the bill. I think, and if you can just, this is a very simple question. If you really boil down this bill, it really is providing personal choice for patients to decide what best medication works best for them.
Is that yes or no? Yes, the patient and the doctor, yes. That's all I got.
Thank you.
Okay. Do we have any additional questions from committee? Yes, Representative King.
Thank you, Chair, and thank you for bringing forward this bill and being with us today. So I am looking through the bill analysis, and on the second page it does talk about the application of mandated health benefits So I just curious how do you respond to the concerns that the mandated coverage increases cost to the small business owner They're already dealing with inflation, employee cost, and cost to materials, and that this will force some of them to make the difficult decision that they can no longer afford to provide health care for their businesses. So just curious, how do you respond to the concerns with the mandated coverage?
Through the chair to the representative, we understand that there are complications in that, and that certainly we want to support small businesses. We do not want them to have to fold or choose not to provide coverage to their employees. The responsible thing to do for the insurance companies would to absorb that cost and not pass it on to the consumers. I think a lot of these insurance plans are recording record profits and therefore could absorb some of their profits in order to provide better coverage for the people that they claim to be caring about and caring for. I think it's very possible that they would then go on to pass those costs along to consumers. I think we should fight back against that. They can afford to increase their coverage. they do not need to pass that cost along to consumers. That is a choice, in my opinion.
Follow-up? Yes, thank you. So just...
Your mic went off.
There you go. There you go. Sorry, thank you. Just want to clarify. So you believe that this cost of adding this benefit, mandated benefit, should be absorbed by the insurance company themselves. Is that what I heard you say?
Yes.
Okay. Thank you.
Any additional questions from the committee? All right, seeing none, thank you very much for your sponsored testimony this morning. This will conclude the first hearing of House Bill 699. And now call forward House Bill 792 for its first hearing, sponsored testimony. And this morning we have Representative Jim Thomas and David Thomas. They are not related. Or are they? You be the judge. Right, that's true. Welcome to committee, gentlemen. The floor is yours.
Good morning, Chair Lampton, Vice Chair Craig, Ranking Member Hall, and members of the House Insurance Committee. Thank you for the opportunity to testify in House Bill 792. The intent of this bill is to ease the regulatory burden on insurance agents and allow them to do what they do best, helping clients. We are seeking to modify the insurance framework regarding surplus lines while maintaining an informed and protected marketplace. Most insurance coverage in Ohio is written through the admitted market. However, certain specialized or hard-to-place coverages are only available through surplus lines. These policies are not backed by the Ohio Insurance Guarantee Association, but are often the only choice for these coverages. Under current law, agents must obtain five declinations from admitted carriers before accessing the surplus lines market. The purpose of this rule is to assure there is no Ohio Insurance Guarantee Association option. However, insurance agents often know the market and that their search will begin with surplus lines Unfortunately obtaining the declination letters is sometimes a weeks formality HB 792 makes two primary changes The first is reducing the declination requirement from five carriers to one, and the second is authorizing the Ohio Department of Insurance to create and maintain an export list for coverages that are unavailable in the admitted market. Obtaining one declination letter maintains the requirement for agents to show their due diligence. This letter provides evidence to the Ohio Department of Insurance that the market is not providing a policy for this demand. Insurance agents will still be required to obtain a signed statement from the insured, acknowledging that in the event of the insolvency of the insurer, the insured is not entitled to any benefits or proceeds from the OIGA. As for the second part of this bill, introducing an export list, we are hoping to join more than 20 states, including Utah, Michigan, Pennsylvania, West Virginia, and Delaware. These lists help regulators identify coverages that are not realistically available in the admitted market and allow agents to place those risks more efficiently in the surplus lines market. The use of an export list permits agents to avoid this one remaining declination notice. Importantly, HB 792 gives ODI flexibility to maintain and update the export list as market conditions evolve. I now turn it over to my joint sponsor, Representative David Thomas.
Thank you, Chair, Vice Chair, Ranking Member, members of the Insurance Committee for the opportunity to testify today on House Bill 792. Certainly want to thank my joint sponsor, Representative Thomas. He has a brother named David Thomas, so ironically, sometimes he calls him for tax questions by accident, So we have a lot of fun. Yes, it has happened. But he gave an excellent overview of House Bill 792. And I only want to essentially add or wish to share that should the committee wish with proponent testimony, I think that'll be really enlightening for you all to hear directly from those in the front lines how this bill will benefit them, help them really cut some of that unnecessary red tape that they're experiencing currently. In closing, we really appreciate the work that the Ohio Department of Insurance has done with us on this bill and their willingness to sit down with us, form compromises, and make this bill into a better piece of legislation than when we started. Their recommendations are included in the language that you have before you, largely dealing with the creation of the export list which companies will handle with more unique types of coverage and can be used directly than by the agents. We have placed language suggested by ODI to limit their liability and their burden as well which will encourage companies to comply with the list, use it, which helps really everyone involved. Now, this is not our world, but we have enjoyed dabbling in it. And with that, we would love to answer any questions should you have it.
Thank you, gentlemen. Do we have any questions from the committee? Wow, he's so excited he's leaving.
well as as a as an agent and a and a not a question but a comment i'm i'm very glad that this is being brought forward i appreciate you guys uh doing this um in a lot of cases agencies don't represent five companies they may only represent represent one if they're captive or two or three. And so getting five declinations is very, very difficult and very cumbersome. So I'm glad to see you gentlemen bringing this forward.
Do we have any questions from the committee All right Seeing none this will conclude our first hearing of House Bill 792 Thank you I now call forward House Bill 757 for its second hearing, proponent testimony. And with us today we have Brad Nail on behalf of Airbnb.
Brad, good to see you this morning. Welcome to committee. The floor is yours. Thank you, Mr. Chairman, Chairman Lampton, Vice Chair Craig, Ranking Member Hall, members of committee. Thank you for the opportunity to provide proponent testimony on House Bill 757, addressing rental home marketplace guarantees. Thank you to Representative Daniels for sponsoring the bill, and my name is Brad Nail here on behalf of Airbnb. This bill is based on an in-coil model that was thoughtfully developed with input from stakeholders that included rental home marketplaces like Airbnb, insurers and insurance trade groups, and state regulators. We are proud that through the leadership of Chairman Lampton, the model law was adopted with bipartisan support at in-coil. And as bills have been filed in the states this year, based on that model law, those bills have also received broad bipartisan support. In short-term rental transactions impacted by this bill, the guest or the renter of the property is contractually responsible for paying the host or the owner for any damage that occurs during their stay. And many times the guest satisfies that requirement. They pay those costs directly to the owner. But in those cases where the guest does not satisfy this requirement, the rental home marketplace, in our case Airbnb, agrees through the guarantee to pay the host for the damages. We then make the decision whether to continue pursuing the guest for those costs. We think this is an important feature of the service that we provide because it gives hosts peace of mind that they can recover damages without unreasonable difficulty or delay. Uh, this also prevents the host from, from having to make a homeowner's claim, uh, in an instance where in most cases the claim damages would be below their deductible anyway. So we think that there's benefits to keeping those claims out of the insurer's realm. House Bill 757 accomplishes two important public policy goals. First, it clarifies that the guarantees provided by rental home marketplaces are not insurance. And secondly, it requires important practices and provisions to protect consumers and ensure the solvency of those guarantees. On the first point, the Ohio statutes do not currently address these specific types of guarantees. There are other similar arrangements like a rental car damage waiver, different types of warranties, different service contracts that are recognized in the statutes that do similar things to this. And while current case law we think supports the designation of these guarantees as separate and distinct from the transaction of insurance, it will be helpful for the legislature to provide clarity on that issue for the long term. On the question of consumer protections, the bill provides a framework under which the rental home marketplace must operate so that consumers and operators understand their rights and their responsibilities. The bill requires that any guarantee must be backstopped by a reimbursement insurance policy. In the event that the guarantor is unable to fulfill its obligations under the guarantee, the consumer will have access to that insurance policy to be made whole. Also, the bill classifies these requirements. guarantees as consumer transactions subject to the Consumer Sales Practices Act, providing regulatory enforcement when that is necessary. And finally, the bill requires transparency in the disclosure of terms and conditions that affect the guarantee, so consumers are adequately informed about it. So we think that House Bill 757 is an important step in recognizing and providing guardrails around a practice that is beneficial to consumers and that fills a need in a developing industry and we urge the committee support and with that Mr. Chairman I'm happy to take
any questions. Thank you very much for your testimony. Representative Barhorst.
Through the chair, thank you Chairman. Thank you for your testimony Mr. Nail. I kind of see your bill as a way to allow a pathway into the subrogation of a claim which I think is beneficial and then I see you have the ultimate enforcement if there's problem renters they probably aren't just one or two times are in your system and then you have the ability to collect or suspend memberships or however that works. Is that accurate with the subrogation and then how you're going to cover the bridge between and you know make the renter that's rented the property whole? Through the chair to Representative
Barhorst. Yes I think I think you're right there. The subrogation component it's really once we have made that owner whole then we make the determination whether it's worth continuing to pursue the renter. But in all cases, even outside of guarantee, these are platforms that are built on trust. And so when you have a guest or a renter who has not fulfilled their obligations in that way, you're absolutely correct that there are other mechanisms that we have in place to make sure that they don't do that to other people.
Thank you. That all makes sense.
Okay. Representative King?
Thank you, Chair, and thank you for being with us. Rep Barhorse kind of stole my question there, but I represent two lakes in my district, and so I'm just curious what other states have passed similar legislation, because this is a big deal, especially in tourism and lake-related properties. So just curious what other states have passed similar legislation. Thank you.
Through the chair to Representative King, there are about 24 states that have an exemption already in their statutes that is not specific to rental home marketplaces, but that does cover this type of transaction as well. Subsequent to the passage of the model at NCOIL, Georgia this year has passed a bill substantially similar to this. Minnesota has passed this bill. It's still going to be pending in a couple of other states. And really all of the states just about that surround Ohio do already have some type of exemption. Kentucky, Indiana, West Virginia, and states like Texas, the larger states, they typically do already have this exemption.
Okay. Representative Sweeney.
Thank you, Chair. Thanks for being here today. What if we were to categorize this as insurance, what would that practically mean for the ability to do this? So if I'm understanding it's basically not spoken to, and you just wanted to clarify that it's not insurance. But if it like what could you explain what the concern would be? What would be triggered if that were in fact deemed that and do any states do in fact consider this insurance?
Through the chair to Representative Sweeney we would be introducing another party into the transaction It would be an insurer that we introducing into the transaction now and there would be premium required calculated premium It introduces quite a bit of complexity into what is right now a very simple transaction In Airbnb case we don't actually even charge for this. The cost of this program is just baked into the base price. There are – the only state that has pursued this in terms of trying to classify it as insurance was – well, aggressively was Washington, and we reached an agreement with Washington, a settlement agreement with Washington on that. So no other states than them.
Follow-up? Yes, please. Mm-hmm. Thank you, Chair. Um, so are there any limitations in terms of, you say that you currently cover this, you know, you don't want to add a third party. Is there any, so is it just Airbnb then determines up to this certain amount or is there any concern of, you know, whatever the circumstances are that that doesn't qualify for this guarantee? who, what kind of guardrails is that just totally on Airbnb to kind of set that reality? And would there be any situation in which a homeowner that this would not qualify under, like is there any gap that would exist if we didn't have an insurer part of it?
Sure, through the chair. In Airbnb's case, we cover damages up to $3 million, But I think what you're hinting at is correct, that it's really up to the online market, the rental home marketplace to determine what that is going to be. But in every case, whatever it is that's determined that's going to be covered by the guarantee will have to be backstopped by the reimbursement insurance policy. So there will still be an insurance policy sitting in the background that will cover that in case that the marketplace does not fulfill it.
One more follow-up. And if there was a disagreement between the renter and you, what is that process in place? And is that, again, completely up to Airbnb to determine an appeals process or the rights of the owner of the house to dispute that in terms of whether or not they're stuck only getting half reimbursed? Or, you know, I'm sure there's arguments of was it them or the renter? How do you prove that? Absolutely. Just when it comes to disputes, how is that determined, and are there any gaps that would exist? There are other companies outside of Airbnb that maybe a possible bad actor could maybe leave some renters kind of open to liability that they might not be aware of. Sure. Through the chair, the Airbnb, I'll speak specifically to Airbnb and then more broadly.
We do have a very robust appeals process to try to settle any disputes like that. And I think we've had tremendous success because I don't believe we've had any complaints at all, any consumer complaints here in Ohio that have risen to the level that they need action. In the bill itself, to try to safeguard those types of protections, that's where the fact that it falls under the Consumer Sales Practice Act, I think, comes into play and provides some real regulatory oversight in case you had a bad actor who wasn't fulfilling this. This is something that we have already been doing for quite a while, and so we do have that history there, but I could understand your question. If a different actor came in, we would want them to be subject to those practices.
And just a short clarifying question. Okay. I'm just not overly familiar with the Consumer Sales Protection Act, so is that a federal act and if that is then the guiding regulatory what agency like if somebody has a complaint like if it was determined as insurance the Ohio Department of Insurance would be able to kind of be that regulator under that act Who would Ohioans who have a concern be able to go to to enforce that act? Thank you.
Through the chair, I would point you to lines 106 through 110 in the bill. that they're deemed to be consumer transactions for the purposes of the Ohio statutes. So this would be subject to the Ohio statutes on consumer transactions.
And then further, where does the complaint go?
The complaint goes, in that case, I can't remember if it's the AG's office. I'll have to find that answer for you.
Thank you.
Vice Chair Craig?
We like to have fun here. Thank you, Brad. Thank you, Chairman. Just a couple questions. The first one, and I think we've discussed a little bit in our conversations before, but if you go to rent an Airbnb, sometimes there's other activities that you can also purchase on that platform. would those types of activities also be included in this bill?
Through the chair, thank you, Vice Chair. Did he just assume you were going to ask a question? Is that what happened? The ranking member loves to ask questions, and I was just shocked that he was not before me. The answer to your question is that it is limited to property. It is limited to property.
Okay, thank you. And then one follow-up question. Obviously, there's been nationwide movement on this legislation, right? It's national model. It's to my knowledge that DOIs have expressed some concerns in some states. I think our department here has been working through some of the challenges, right, that it's not an insurance product, and just making sure it's explicitly stated that way when folks purchase this. Can you explain a little bit about your conversations with our DOI here and how you work to address their concerns?
Thank you. Through the chair, yes, we actually started the conversations with the DOI here back in the fall when we thought that we might introduce a bill, worked with them on making sure that they're comfortable with the language, mending any of the language before it was filed to make sure that we had them at a comfort level, and we do believe that we have them comfortable with the language here, exactly for the reasons that you expressed, clarity for consumers and making sure that everyone understands the transaction.
Thank you. Any follow-up? Any other questions from committee? He's good. Thank you. Thank you for your testimony this morning. And next up we have Matt McLaren on behalf of the Ohio Chamber of Commerce. Matt, welcome to committee, and the floor is yours.
Thank you, Chair. Chair Lampton, Vice Chair Craig, Ranking Member Hall, Honorable Members of the House Insurance Committee, thank you for the opportunity to provide testimony in support of House Bill 757 today, which would enact the rental home marketplace guarantee. I'm Matt McLaren. I'm the Director of Travel and Tourism Policy for the Ohio Chamber. Ohio Chamber represents over 8,000 businesses across the state. Our mission is to aggressively champion free enterprise, economic competitiveness, and growth for the benefit of all Ohioans. We support House Bill 757 because it provides clarity related to the rental home marketplace guarantees offered by online rental platforms operating in Ohio such as Airbnb as you just heard Vrbo and others This is important so that all consumers providers platforms, and regulators understand their responsibility. We're modernizing the code to make that happen. The rental home marketplace has become a major part of Ohio's growing tourism industry. The tourism industry in the state of Ohio is a $57 billion industry. According to Airbnb, be their properties contribute about $1 billion of that, right, the amount spent by guests, their properties, in a year. Now, many rental home marketplaces, their platforms offer guarantees that provide the property owners who use their platforms a reimbursement for the major damages caused by the guests to their home when they rent through their platform. House Bill 757 requires that any company offering these guarantees back them with a reimbursement insurance policy issued by an authorized or surplus lines insurer. This bill will treat those guarantees as a consumer transaction governed by the Ohio Consumer Sales Protection Act. And to the representative's question, to the prior witness, that would allow complaints to be filed through the Attorney General's office. We thank Representative Jack Daniels for introducing this important piece of legislation, which will modernize Ohio's laws regarding rental place marketplace transactions. We stand ready to work with all of you, and I'd be happy to answer any questions.
Thank you very much for your testimony. You have any questions from the committee? Vice Chair Craig.
Thanks, Chairman. Thanks, Matt, for being here. I know you had just mentioned, and I know just asked Brad, sort of the conversation right about who's actually the regulating entity. And I understand, you know, complaints would go to the AG's office. I think we've come across situations, though, where similar types of situations, right, where the department does not have authority and are referring some of these complaints to the AG's office, and we don't really hear much follow-up since then, right? And I get it's an investigation. I get, you know, they've got to keep that confidential. But has there been conversations with the AG's office on if they are equipped enough to handle, once again, another form of complaints that would be new coming to them? And I guess are they ready to kind of be the enforcer here? Yeah.
Through the chair, to Vice Chair Craig. I have not engaged the Attorney General's office to ask him that question. I would be happy to reach out to him. I could also talk to some of the partners in this bill and also the sponsor of the bill to see if they've reached out, and I'll get back to you on that.
Thank you. Any additional questions from the committee? Very good. Seeing none, thank you for your testimony this morning.
Thank you.
This will conclude the second hearing of House Bill 757. And at this time, we'd like to call House Bill 724 forward for its second hearing. proponent testimony. In person, we have Teresa Lample on behalf of the Ohio Council of Behavioral Health and Family Services Providers. Teresa, welcome to committee. The floor is yours.
Good morning, Chair Lampton, Vice Chair Craig, Ranking Member Hall, and members of the House Insurance Committee. Thank you for the opportunity to testify as a proponent today on House Bill 724. I'm Teresa Lample. I'm CEO of the Ohio Council of Behavioral Health and Family Services Providers. We're a statewide trade and advocacy organization that represents over 175 businesses that employ over 40,000 people who serve about 2.5 million Ohioans who need behavioral health needs. I'm here today to offer our strong support for this legislation that would establish coverage for an annual behavioral health well check for children and adults. THIS BILL REPRESENTS A CRITICAL STEP FORWARD IN ADDRESSING OHIO'S EFFORTS TO IMPLEMENT AND STRENGTHEN THE MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT AS WELL AS TO EXTEND and behavioral health access in a common sense and effective manner. I want to thank our sponsors for this legislation, RepSalvo and White, as well as the Department of Insurance for their leadership. This bill is the culmination of many years of work across sectors in the provider community, patient advocates, as well as businesses, recognizing the impact of mental health and substance use and prevention and treatment in Ohio. As I'm sure this committee already knows, the demand for mental health and substance use services is unrelenting. It is nearly one in four U.S. adults' reports experiencing a mental health condition every year. Our children experience even higher rates of mental health and substance use conditions. Yet we know that access to care is challenged. About 43 percent on average are able to access the services that they need. While that data is discouraging, as a health care perspective, it also has a harmful economic effect. Each year, the United States forfeits about $300 billion from its gross domestic product from costs associated with untreated mental health and substance use disorders. These staggering deficits result not only in direct costs like medical expenses, which we typically think about, but also from lost productivity, lost wages, reduced labor supply, and employee turnover or student absenteeism. The economic toll of untreated mental health and substance use disorders is staggering, with wide-ranging effects on the labor market outcomes, productivity, and overall economic growth. As an example, an Ohio State study found that the opioid epidemic costs Ohio about $6.6 to $8.8 billion a year. That's what we spend on K-12 education in this state. So while we usually think of mental health and substance use in terms of health care, and some of my colleagues that come after will speak more about that, I also want to talk about the significant impact on businesses across all employment sectors. Untreated mental health issues lead to high rates of absenteeism, decreased productivity, reduced participation in the workforce, and unemployment. What this translates to is that workers with mild mental health illnesses miss an average of 9.3 hours a week. If you have a serious mental health condition, it's 12.5 hours. And if you're a family caregiver, we're looking at 32.5 hours per week on average is what is spent managing family members' conditions. We also know that in addition to this, about 53% of working parents report that they miss a day of work every month just to attend to their child's mental health or substance use needs. So we have a significant impact, and if left unaddressed, this also contributes to higher rates of homelessness, substance use, crime, incarceration, all of which we know strain local resources and federal resources as well. We believe this bill is sound public policy and would strategically and cost-effectively support broader access to critically important behavioral health services. An annual behavioral health well check for adult and children creates an opportunity for us to intervene early, to review risk and protective factors, to make referrals for care when appropriate, and to connect individuals for support before a health crisis ensues, just like we do with physical health conditions. Investing in screening and early intervention normalizes brain health as essential health and is an effective wellness strategy that benefits our students and our workforce. The return on investment in behavioral health care is substantial. Studies have shown us that for every dollar you spend in mental health treatment, there's an average return of $4 in improved health and productivity. That's a return on investment I'll take any day. By supporting House Bill 724 the General Assembly would make a critical investment in the health and wellness of Ohio children families and support employers seeking a healthy productive workforce Expanding mental health and substance use care through an annual well check is simply common sense and a wise economic strategy. I thank you for your time, and I'm happy to answer any questions.
Thank you very much for your testimony. Do we have any questions from the committee? If you don't mind, I'm just sort of curious. So this first wellness visit, what's it look like in reality? This person's coming in. Are they saying, I think I have a problem, I don't, or I just want to wrap with you for a little bit? What's the time? Is it an hour? Is it a half hour? Can I walk us through a little bit of what that looks like, please?
Sure. So thank you for that question, Chair. it's going to look a little different for each person because it can be individualized. But what we know is that when we can screen for people, we live in an era where a lot of people don't feel okay. We know depression is the leading cause of disability in our country and worldwide. Anxiety is number two. And so when people don't feel okay, we know that it impacts their overall physical health and wellness. And so what this is is really an opportunity for people to come in and have an assessment of are they really okay, do they have a condition that should be treated, or sometimes it's just saying what you're experiencing is typical and here's some additional resources. We know that sometimes this annual well visit, one visit can help a person feel like they can manage and what they're doing and how they're living is okay. It also can mean that we think about other lifestyle or behavioral changes that could help the individual. So sometimes it's a short visit, 15, 20 minutes. Sometimes it's 30 minutes. It could become a full assessment, which could be an hour. So it's really dependent on the severity of the person as they present.
Okay, thank you. Leader John?
Thank you, Chair. Thank you for being here with us. So in your response to the Chair, you said that we live in an era of? To me, that indicates that the mental health conditions of our residents has deteriorated. Would you agree with that?
Through the chair, to the representative, I think the data has shown that in Ohio and across the country, we've seen rising rates of mental health, depression, and substance use. The General Assembly has made significant investments in the last few years to help us create more opportunities for treatment. And so because we have seen those deteriorations, we know that this is a wise investment, that if we can help people's brain be healthy, we also know that reduces their overall physical health burden as well.
Follow-up? Follow-up? So if this is new, somewhat new, data showing that mental health is deteriorating, to me there's a cause. There's a cause and effect. we spent a lot of money on treatment of, which is a good thing. But what are we doing to stop the cause?
So to the chair, to the representative, I think that's the purpose of this bill is to take a preventative approach to be able to allow people to come in and say, do I have a condition or are there other things I can be doing? So this is an early intervention so that we're not seeing people spiral down into chronic health conditions that then require a lot more treatment and a lot more intensity The intent here is a preventative visit to identify early when we can intervene early and prevent a whole lot of other costs both on the behavioral health side and their physical health.
Follow-up. Vice Chair Craig. Yes, I'll dig in. Thank you, Teresa, for being here. Thanks, Chair. I'll dig into a little bit of what Leader John was mentioning. I understand the prevention part of this, which we've got to be better at. My concern is primary care physicians, you know, should they not already be screening for behavioral health? And pediatric, right, this should be part of the annual visit already. And if we want to actually address the stigma of not treating behavioral health different than physical health, why would we not want to encourage the screening of both together?
So, to the chair, to the representative, a couple of my colleagues who do integrated care will be able to speak to that more clearly. What I would say is primary care right now is screening for a whole range of things. The screening that we get in primary care is usually a two-question response around depression, and that's it. And so there isn't then something that usually follows up with this. What this gives is an opportunity to look more deeply at the whole range of behavioral health conditions, which many times are driving physical health conditions that people present for, you know, stomach pain, sleep issues, other physical health conditions, but the etiology that's driving it is an underlying mental health condition. So what this does is creates an opportunity to specifically screen for and address those, that wider range of behavioral health that just simply can't be done in a 15-minute well visit for a child or adult.
Follow-up? I'll stop.
Okay. Ranking Member Hall?
Thank you, Chair. So first off, thank you. So through the Chair, thank you for bringing this forward. I'm sorry, bringing forward your testimony today. I think that there's some confusion, though, around this topic, right? I mean, they're, you know, obviously I think the vice chair's question around, you know, so we have the Medicare annual wellness visit, right? That's covered under Medicare Part B, and that's included as a part of your coverage. And as a part of that screening, there's sort of that cognitive component of it as well, right? And then we sort of have the PHQ-2, which can become the PHQ-9 in the primary care setting that's only basically looking for really depression, right? And then we have sort of the mental health annual wellness visit, which has multiple domains that are much more expansive. And so my worry is that I think there's the danger of us conflating these different items, and there's certainly overlap that's there. I guess my question is I wanted to give you an opportunity to really expound how would you differentiate the annual, an annual mental health visit? How would you differentiate that for us from a Medicare covered annual one versus the primary care? That's that's that's my first question. And my follow up, I'll just get it out. I can't share would be, you know, in the Medicare space, the payers, while they don't mandate that you do the annual one visit, they they create financial incentives for providers to do it. Right. So with that in mind. And I being a bit provocative here right But would you be so daring us to suggest that perhaps we would create some sort of maybe not mandatory but some sort of system where we incentivize everyone to have these done Because you may think you okay and you may realize you not okay right You may say I'm not depressed, but you may have other modalities or other conditions that maybe you haven't given much thought to that maybe is flushed out, if you will, through a mental health wellness exam. So I'll pause here, but those are my two questions.
Through the chair to the representative, thank you for your questions. So I'll start by saying, so part of this is, you know, this creates an annual mental health wellness check that can be done in primary care. It can be done in other settings as well. So behavioral health providers can also do these settings. So someone can call and say, I want to make sure I can get a checkup from the neck up. I can make sure that my brain is working the best that it can, particularly when it comes to our children, particularly when it comes to, you know, I've talked about the impact on working-aged adults. So it's a different entryway that creates a continuum for people to be able to access services. And again, many times we know one visit, and there's science that shows sometimes one visit can really bounce a person back into their own resiliency and their skills, and they may not need ongoing treatment. But if they do, we're catching it early, and we're being able to get that person the care they need before they spiral into failing in school, losing a job, spiraling out of control, losing families and members and relationships. So that's the bigger picture. Your second question around incentives. Part of this is that the impetus of this work is also to create opportunities in Ohio to make sure that we're fully looking at mental health parity and the Addiction Equity Act. We still don't treat mental health on par with physical health conditions, and that's part of what we're trying to do here is say let's create an opportunity for people, when that's their primary issue, to be able to get that as a screening, which is different from saying it's one component of a 15- or 20-minute well visit that's done by primary care. We know for some people, they're not going to walk in a primary care office for lots of reasons. And so this creates another opportunity to create that continuum for people to get care. Follow-up?
Any additional questions?
Yes, Leader John. Thank you, Chair. So just a follow-up to your answer there. If individuals are not walking into a doctor's office, what makes you think they're going to walk into an office for a behavioral health meeting?
meeting appointment? So to the chair, sometimes people realize that their doctors are not the specialists in treating mental health conditions. And while we have still a lot of work to do in stigma, we've reduced stigma in many communities, and particularly our young people are way more interested in prevention and mental well-being and mental wellness. So again, this is just creating other opportunities for people to go where they're comfortable to seek care and to understand if they need further treatment from a preventative approach.
Follow up? So I would go back to the vice chair's comment. I mean, I'll be honest with you. There's, when it comes to medical, there's nobody I feel more comfortable with than the family doc that has been our family doc for 25 years. I find it difficult to believe that somebody is going to feel more comfortable going in and talking about their mental health well-being with someone they don't know. I have a situation in my family where the... was a mental health issue. We did not hesitate, did not hesitate to contact our family doctor who's been our doctor for decades to discuss it. So I kind of go back to what the vice chair was talking about as far as this feels to me like something that should be part of your family doctor discussion. It has been in my family, and I just struggle to understand how someone is going to feel more comfortable with someone they don't know, don't have a history with, doesn't understand everything that is going on in their lives, really, because family docs, if you're going on a regular basis, do. I find, I I just struggled to understand how they would feel more comfortable in that setting. I don't know if there's an answer to that or not.
To the chair and to the representative, I appreciate your comment and the question that's there. And many of us do have relationships with family doctors, and that's who we see. And sometimes we're comfortable asking, and sometimes we're not. And sometimes it's been also the relationship and the comfort level of the physician. This is intended to be an adjunct to that if it's done in primary care. So there's another opportunity. But there's a lot of people who don't have a family doctor who are using urgent care, for example, or emergency rooms. This creates a different opportunity to say, let's get them into care in a preventative way in a different space. This could be done in primary care. This can be done in a behavioral health setting. And it's just, again, creating an opportunity that wherever people are comfortable, they can get the care that they need. They can get that screening, and we can get them connected before we spiral into much more expensive types of care. Ranking Member Hall?
Yeah, thank you, Chair. I just have sort of a comment, and maybe for you to comment as well. You know, as I've said before, like I work in healthcare. It's my day job, right? And some of the challenges that we see in this particular space is that, And first off, I want to recognize the majority leader's comments. I would agree with her that ideally you have a PCP that you have a good relationship with. I know that's a challenge for everybody. Not all of us have that. And there are primary care docs out there that will tell you that they don't have the time to have the lengthy conversation that goes along with this. because the reimbursement rates are subpar, to say the least, when compared to if I'm a PCP, I could have billed three acute visits in the time it took me to have one mental health conversation, and I'm getting paid less, right? And that's just the reality of what happens. And so one of the things I like about this bill is that it creates sort of an alternative placement, right, where you can go and where the model is designed to have longer appointments. and there's a more ready acceptance of the lower reimbursement rate that you're going to get for the increased time, right? Physicians don't always want to spend that kind of time, especially primary care docs. Again, I've seen it every day, right? There are a lot that do, but there are plenty who would rather not spend that kind of time because they're impacting what they get paid. And a lot of these docs are paid. You eat what you kill, basically, is how they get reimbursed, right? I mean, so one thing that's not here that I would have loved to have talked about is how do we increase the reimbursement rates that way we incentivizing primary care docs to want to have these conversations more often than they currently do But I leave that for another day and let you comment on that
Through the chair to the representative, thank you for bringing that up. And certainly that's been one of the biggest challenges of enforcement of the Mental Health Parity and Addiction Equity Act is compensation. is compensation. We know that on average behavioral health is paid about 80% of what primary care is paid, and primary care is not a big winner in the medical payment scheme per se. So that is, you know, part of this is just a starting point of we, it's more about patient care and access and prevention, and again, it's kind of creating that continuum. And I think some of my colleagues who do integrated care work will be able to speak to that as well.
Very good. Well, thank you very much for your testimony this morning.
Thank you.
Next up we have Don Schiffbauer on behalf of the Rivian Mental Health and Recovery. Don, welcome to committee. The floor is yours.
Thank you very much. Good afternoon. And I appreciate the discussion that happened with my colleague, Teresa, and hoping to field some of those questions after my testimony. My name is Don Schiffbauer, excuse me, I'm sorry. Chairman Lipton, Vice Chair Craig, Ranking Member Hall, and members of the House Insurance Committee. Thanks again for the opportunity to provide testimony on House Bill 24. My name is Don Schiff-Bauer, and I'm the CEO for Rivian Mental Health and Recovery. And we provide integrated, comprehensive health care to individuals up in Lorain County. House Bill 724 represents a meaningful step toward aligning behavioral health care with the standards and expectations already established in physical medicine. Excuse me. Medicare has three billing codes, and I will preface this, I am not a billing expert, and that are established for physical medicine. And those billing codes are G0438, G0439, and G0468, each designed to support preventative, proactive care. These codes allow for healthcare providers to deliver initialized, personalized prevention plan, subsequent annual wellness visits, and wellness visits within federally qualified health centers. These codes exist because prevention works. They exist because early detection saves lives. And they exist because health plans understand that high quality and high value healthcare begins with a simple annual check-in. We know that individuals living with behavioral health disorders die on average 25 years earlier than those without. Some assume that it's due to suicide or overdose, but the data tells a different story. Most premature deaths among people with behavioral health conditions are caused by untreated or underdiagnosed chronic health care conditions such as diabetes, hypertension, undetected or undiagnosed coronary artery disease, obesity and poor dental health, and other preventable and manageable conditions. At Rivian Mental Health and Recovery, we see this reality every day. Nearly 40% of our clients either haven't seen their primary health care provider or don't have a primary health care provider. These are individuals who are already engaged with us for behavioral health services, yet remain disconnected from some of the basic medical care. House Bill 724 gives health plans the ability to offer a behavioral health annual well check, mirroring the preventative structure already in place for physical health. It's not a new concept. Like my colleague said before me, it's parity. And as part of our own employee benefit program at Rivian we require to complete an annual wellness visit to some of those incentives that you spoke about earlier It identifies risks early and it allows our health partner to partner with us before small problems escalate into expensive crises Health plans do this because it's good care and it's also high-value care. Early detection prevents emergency visits, hospitalizations, and the progression of chronic disease. House Bill 724 extends that same logic to behavioral health. In 2023, 20% of the national expenditures were for direct physician services, yet individuals with behavioral health conditions accounted for nearly 50% of those people. It's not because behavioral health care is expensive. It's because behavioral health care conditions often co-occur with untreated physical health conditions driving up costs. Today, more than half, 50 million adults live with a mental illness. More than half receive no treatment largely due to lack of access. This bill creates another doorway. It gets them on a path to healthy living. It connects individuals to appropriate therapy and treatment, and annual behavioral wellness checks link them to medical providers who can address chronic physical conditions. And most importantly, it helps to close that 25-year gap. House Bill 724 is not just policy change. It's simply another way for this legislature, as it has done over the last several years, to tear down barriers to care and kick stigma in the teeth. It's a chance to intervene earlier, to prevent suffering, and to save lives. And after I had submitted the testimony, we worked with our insurance broker, OneDigital, to identify some data points. And they provided this to me. When Medicare created the dedicated annual wellness visit at no cost, uptake grew from 1.4% in 2011 to over 60% by 2022. and behavioral health well checks are likely to follow the same trajectory. In a sample of 256 employers covering more than 230,000 lives, behavioral health medications ranked second amongst top pharmacy cost drivers. While behavioral health care does not exist in the top 10 medical conditions by spend, this reflects a system that identifies and treats behavioral health conditions downstream through medication rather than upstream through preventative screening, precisely the gap that this annual behavioral wellness check can close. For those reasons and on behalf of my agency, I respectfully urge your support of House Bill 724. Once again, thank you for the opportunity to provide testimony on House Bill 724, and I'm happy to take any questions that you may have.
Thank you very much for your testimony. Representative King.
Thank you, Chair, and thank you, Don, for being here. I'm going to ask you the same question that I had asked another witness earlier. This is an unfunded mandate, and so how do you address the concern or respond to the concern that this mandated coverage is going to negatively impact our small businesses who are already struggling to provide health care for their employees? I mean, I guess, how do you see that impacting our small businesses? Thank you. Through the chair to Representative King.
As, I guess, depending on how you look at it, you know, there are a lot of agencies that are part of the Ohio Council, which we're a part of, that can be considered small businesses. Small businesses, I think, will need to work with their insurance brokers to weigh the cost benefit of including that wellness check. But what we know as a business is that it leads to greater utilization and detection for some of our millennials that are more apt to do preventive services But I would say that small businesses would probably need to work with their insurance brokers to identify whether or not that's going to be inappropriate. Now, to your question about being mandate, I want to refer to what Representative Hall talked about earlier. Maybe it's not a mandate. Maybe it is to offer additional incentives. But either way, what we would like to see come out of this is to have some type of funding mechanism or incentive for individuals to have access to an annual behavioral wellness check.
Follow up. Thank you, Chair. It is a mandate. I'm looking at the bill analysis, and it is a mandate, so small businesses won't have an option whether to opt out or not. In addition, with the analysis, it states that required coverage under the bill is considered a mandated health benefit that is in addition to the current essential benefits in the Affordable Care Act. Then the state may be required to pay for the potential costs associated with the coverage. Again, it goes back to the cost. Do you share any concerns what that may be, the impact to the state, to our small businesses? At what point do we just say, you know, leave this to the market because we're going to force our small businesses to make that decision? They either can provide benefits or they can't. In that case, there would be no coverage for employees.
I think speaking on behalf of our business, we would find benefit in this program to be offered to the people that we're serving, not just because we're a comprehensive mental health agency, but because we know that there is such a strong propensity
or co-occurring diagnosis of mental health disease or behavioral health disease with undiagnosed physical conditions that this could be a step in the right direction to help detect that and drive down cost net for the industry. Any other? Yes, Ranking Member Hall.
Yeah, through the chair to the witness. So I'm certainly sensitive to my colleagues' concerns about the cost of small businesses. You know, are you aware, is there any sort of analysis that you're aware of? And maybe this is a question maybe for another witness, but are you aware of any analysis that has looked at what the cost would be, right? So whenever you require or mandate a new coverage, right, or service, that is going to impact the PMPM, right? If you have enough members, the PMPM can be very small, right? It can be $0.35 to PMPM, right? But it would also be $15, $17 PMPM as well, right? Is there any information out there on maybe other states that have maybe done something similar and that can provide any insight as to what the PMPM increase was? That's sort of my first question. And then my second sort of question slash comment through the chair is, and I don't know that we've have, I think the first witness sort of was walking through sort of the numbers and talking about the ROI on this. You know, I think the other question that small businesses have to ask themselves is what is the cost of them not providing coverage for this, right? I mean, with regard to days missed, you know, employees will sometimes they will take sick days when they're not really sick in the way that we think about sick, right? They're having a physical element that may be a function of a mental element or condition, right? So what is the actual cost to small businesses to not providing coverage like this? I think I think the cost benefit, I think it's very, I think it's a fair question that we have to be able to ask ourselves. And I think, you know, the ideal was that we'd have more data to have this conversation, again, as to what sort of happens in the states.
You know, the reason why I mentioned the incentive piece earlier, I want to just be very clear about this. I mentioned that earlier because CMS and the payers that require the annual witness, The reason why they are providing an additional financial incentive to bill for the service is because they've long recognized that they want to catch these conditions up front because it's far cheaper to catch it up front than to not catch it. And now you're in the ED. And we can say whether you're insured or not, the ED, we're all paying for increased ED costs, right? So if we don't have something like this and these patients end up in the ED down the road with more severe conditions, MTALA requires that to be paid for. So someone's going to bear that burden. I think the argument that can be made in your comment on this, I think the argument that can be made is that from a public policy standpoint and a cost-sharing standpoint, it's cheaper to society to have this covered than opposed to pushing it at a much higher cost in other forms where the cost is small business, cost through ED. Just a message in your comment on that. Thank you.
Through the chair to Representative Hall. I'm really excited about your question. You're right, we are asking for more cheddar up front for the service. But there will be a net reduction in overall cost of care. And I will also say this, having spent my background, I'm a registered nurse, my background's cardiology, I spent the majority of my career in the hospital setting. When I came to the behavioral health care setting and asked about your quality dashboard, your metrics on how you know that you're doing a good job, you heard crickets. Behavioral health is not there yet. So some of the data you're asking for, we as an industry are doing, some of the state organizations, including the Ohio Council, are doing that groundwork to establish those metrics so that we can accurately identify what's beneficial. But the PMPM is going to go up initially. The intent is to have a net reduction in PMPM over time. We know that as Rivian Mental Health and Recovery because we're part of a clinically integrated network, and we signed up one of our first shared savings plans with one of the eight MCOs, where our goal is to drive down PMPM. We're doing that right now because we've opened the second behavioral health emergency room up in Lorain County. We're still billing the same outpatient codes, making sure, you know, if we can bill for an hour of psychotherapy, I'm not sure how many people in an emergency want to sit for an hour of psychotherapy. But what I can tell you is this. Anecdotally, from the hospitals, they are seeing a decrease in behavioral health admission utilization of their emergency rooms. We've had almost 70 police drop-offs. And since October, we've had 1,600 visits and over about 1,100 unique clients. This is a model that is, I would say, not untested, but not utilized in the state of Ohio, but it's being utilized elsewhere. and I would equate the annual behavioral health wellness visit to that same space. We've not done this before, but we see the impact that behavioral health urgent cares and crisis recovery centers are having an impact and advocating for that enhanced reimbursement, like you mentioned, to support sustainability but also to have a net reduction in costs. Very good. Thank you.
Vice Chair Craig?
Thank you, Chairman. Thank you for being here. So I first start by saying I don think you going to get anyone on this committee disagreeing with the importance of early screening That needs to be stated I think what we trying to get at is how we make this the most efficient as possible And part of my questioning, and I didn't want to get Teresa down too far of a rabbit trail, but I'll go down that rabbit trail with you, is we have a workforce shortage issue. We have already long wait times to try and get into providers, no matter what field you're in. Even primary care docs, some are taking new patients, right? Like this has been a growing problem. And so when I see this, I think why would we add a whole separate visit when we can try and put it into one? And if that means we have to come up with another CPT code to add into that visit so you guys get billed accordingly, fine, but how do we make the most out of time already allocated for an annual wellness visit? And that's what I'm trying to get at is folks are already not going to the doctor because of wait times, because of physician shortages, because of provider shortages. So that's kind of where my thought process is. And I kind of wanted to just hear from you as to, you know, do you guys see this provider shortage, what are you doing to address it, and how would you combat that, creating a whole separate visit on top of what annual visits are already occurring?
Sure. Through the chair to Representative Craig, I appreciate the question. Nobody will agree with you more about the workforce shortage out there. What I can say is that agencies need to think about what their patient workflow or clinical flow is to address access issues. We had an access issue, but we modified operations. What you heard from my colleague, Teresa Lample, was it can be a separate visit, but it also can be included in the primary care visit. Now, I've got mad respect for my doc back home. He's great. I've been with him for probably 10 years. I got two questions about behavioral health, and it was from an MA while he or she was looking down at the computer screen and not looking up. All right, when you have a suspected cardiac condition, you have a screening by your primary care physician, but as soon as that thing pops positive, they're not doing comprehensive echoes and EKGs and cardiac CTs. They're consulting a cardiologist. This screening can be included within the primary care visit, but it needs to be done so in a manner that is meaningful. Now, my doc, I was one of 40 patients that day. He's there eight hours. That's five an hour with no breaks. So to your point about some type of code or even a modifier just to recognize the extra time it takes. And maybe it's not done by the physician. Maybe they have a mental health professional in there with them so that while after you've been roomed and you're waiting there for 20, 30, 40 minutes because of inefficient workflow, it can happen at that time as well. So yes, I agree with you there's a workforce shortage, but I really do think it falls upon the provider or the provider agency to figure out how to revise their workflow to capture the ability to do that screening. Follow-up? Representative Gerrolds?
Thank you, Chair, and thank you so much for coming and presenting and testifying today I guess I have a possibly a couple of questions In my time in the behavioral health system you know we talked a lot about trying to remove the bifurcation between physical health and behavioral health and actually really work in a seamless way to really look at this person as a whole person. And when I read this bill, and I do love the tenet of it. I actually agree with some of the remarks that were made today, not necessarily on a cost side, but on the process side of how do we, knowing that there are individuals who, for a number of reasons, would rather speak to their doctor about their heart problem, but not speak to a behavioral health specialist about their head problem. And how are we going to really get to a place where people begin to really see this as one in the same, that your head problem and your heart problem are the same thing? And what I'm trying to figure out is this licensed behavioral health individual, are they coming in on the back end of, so for example, If you plan out this routine annual checkup, the doctor sees you, and then that hospital then has a behavioral specialist that comes in after to provide a checkup, a wellness check on that individual. I really am trying to get the flow of me as a patient. How am I going to have a seamless transition to really assess my full body? in one annual visit. That is what I'm trying to get to, and I'm trying to figure out does this bill get to that or get to the heart of that. Thank you.
Through the chair to Representative Gerald. You're right. We have a unique opportunity to capitalize on the courage that that person made to seek services. So we don't want to send them down this hallway or to this agency. Regarding the workflow about how this annual wellness visit occurs. I think that's up to each individual agency. I think that part of the bill is to establish the expectation, whether or not Rivian Mental Health and Recovery or Acme Behavioral Health chooses to provide that service up front, have the physician do it, have a qualified mental health specialist or a counselor do it. I think that's up to each individual agency as long as we're meeting the tenets of that. And then to your first question, I would, I heard that there are, and I appreciate the relationship that people have with their primary care provider. I am one of those people. I can tell Dr. M pretty much anything, and I have. But I can tell you that there are 1,600 visits since October that have felt otherwise. Almost 40% of those patients that have accessed behavioral health at the behavioral health emergency room, our first time to behavioral health. They're not comfortable talking about it. The black and brown community is not comfortable talking about it. And we need to make sure that there's a space where we have people that have an environment that has no barriers, people that look like them, people that speak their language to be able to do that. This annual wellness visit just allows another opportunity. It's not meant to be a substitute if you have a good relationship with your primary care provider, but the reality is there are individuals out there that don't, and this is another doorway for them to be able to access that.
Follow Yes Thank you Chair You know I appreciate your answer you know and I reading Teresa remarks as well that I had to step out for a second on And I think on the face value I like the bill because I think it opening the door for folks to actually assess their mental health needs And you're right. I mean, we are seeing unprecedented numbers of individuals who have suicide ideation, depression, those who make a plan, complete suicide, all the things. We're seeing that in Ohio. And so the need is there. What I'm trying to figure out is does this bill, if enacted, move me as a patient who normally, because of all the stigma, barriers, what have you, will I be more prone to go and get a wellness check simply because it is mandated by law that we can offer it? or are there other ways in which we can create a seamless process by which when I'm going to get my physical checkup, that mental health component is baked into it and it changes the mindset of the patient that is not a behavioral health checkup. It is a physical checkup of your entire body. And it's really trying to get to a place where we are looking at the full person, much like what the system really wants to see, in my honest opinion, and really getting their end statute. And so that is kind of what I'm trying to unpack because these folks, even if they're mandated to supply this wellness check, it doesn't mean that they're going to go. And so how do we begin to unstigmatize the field, the feelings, ultimately move people to action to
actually get their minds checked out? Sure. And through the chair to Rep. Gerald's. I agree with you. I think I go back to the fact that there's an opportunity to eliminate the stigma associated with the behavioral health annual wellness check to incorporate it into that annual wellness visit, which I think I just went to mine a couple of months ago. The other thing I will say is, and I apologize, I lost your second question. I'll say a question. I apologize. I lost my train of thought. I did have an answer for it, though. I'm so sorry. Quite all right. Any additional questions from the committee? Very good. Seeing none, thank you very much, Don, for your testimony this morning. Thank you very much. Appreciate having you. Next up, we have Tony Coder on behalf of the Ohio Suicide Prevention Foundation. Tony, welcome to committee. The floor is yours.
Excellent. Thank you, Chair Lampton. Chair Lampton, Vice Chair Craig, Ranking Member Hall and members of the House Insurance Committee, thank you for allowing me to testify as a proponent of House Bill 724. My name is Tony Coder and I'm the CEO of the Ohio Suicide Prevention Foundation. We are a 501c3 nonprofit that works with individuals, families and communities on suicide prevention and postvention. We are not treatment providers, but try to prevent suicide by working across the continuum in prevention and postvention efforts. Our efforts to care for people who are severely mentally ill and who suffer from suicidality are becoming increasingly more difficult for many reasons. These include, but are not limited to, shortage of treatment providers and sufficient funding for prevention, increasing numbers of people in crisis, and the lack of 24-7 crisis services, which is especially evident in rural communities. The latest ODH, Ohio Department, statistics show 1,834 people die by suicide in 2024, nearly five people every day. Also, according to ODH, Ohio emergency rooms see about 25 to 30 suicide attempts and nearly 220 visits for suicide ideation every day. Almost 81 percent of suicide's deaths are adult men, and among young people, suicide remains the second leading cause of death for kids ages 10 to 14. These statistics do paint a story of the magnitude of this issue of people who are struggling with mental health and ending up in crisis situations, emergency rooms, and potentially suicide attempts and suicide deaths. Like any other health issue, early screening and identification can help avert a crisis and save lives. As a highly effective screening tool, colonoscopy screenings can prevent up to 68% of colorectal cancer deaths, and there are other examples in my testimony. A study by Keith Houghton, he is a suicide researcher from Oxford in the UK, asked suicide attempt survivors an important question. He asked how much time passed between the time you decided to complete suicide and when you attempted. One in four survivors said less than five minutes. 70% said less than an hour. So as we're thinking about suicide and how to stop it, my job is to put myself out of business. That's what I want to have happen. If I've got an hour, that's a really, really tight time frame. If I've got five minutes, that's nearly an impossibility. Prevented health screenings can save lives and money by detecting serious conditions early when treatment is easier and less expensive. One of the most frustrating parts of my position is hearing questions from family members who have lost a loved one to suicide. What did we miss? What did we not see? What did we not do? Many individuals who have lost loved ones to suicide share a sense of numbness. They struggle with the lack of answers about why their loved one died by suicide. And these questions were at the front of my mind when I received a call a week ago yesterday. I was called by a community member in southeast Ohio about what OSPF could do in a rural county that was experiencing a tragic series of events. I was told about a teenager who died by suicide in mid-April, a 16-year-old young man. This young person was described as someone with a great sense of humor, who was athletic, loved the outdoors, was a wrestler, played baseball, hardly the outward picture of someone with mental health issues. Then, just a few weeks later, this young person's father also died by suicide, overcome by grief. And if that wasn't enough, on the same day that his father died, the teen's wrestling teammate also died. The only thing we could do, that I can do, is help that community heal. And as I think about these tragedies and I tried to trudge through their week, I did wonder how we could have caught this before that teen died by suicide and whether we could have avoided these deaths. With hindsight being 20-20, perhaps if a screening had occurred, we could have caught something and provided this seemingly outwardly happy person with help with the struggles that they were internally dealing with. And this is my hope for House Bill 724 that we can identify issues when they small and not in a state of crisis and they ending up in emergency rooms I urge you to support House Bill 724 to help save lives I appreciate the opportunity to testify and welcome any questions. Thank you.
Thank you very much, Tony, for your testimony. Do you have any questions from our remaining committee members? Seeing none, thank you very much for your testimony this morning. Finally, we bring up Cody Hostetler on behalf of the Nationwide Children's Hospital. Thank you so much. Cody, welcome to committee. The floor is yours.
Thank you. Chair Lampton, Vice Chair Craig, Ranking Member Hall, members of the Insurance Committee, thank you for hearing my testimony. I'm actually going to truncate my testimony because I want some time to respond to the questions that you guys have already asked. But I will say that we cannot simply treat our way out of this problem. We need approaches that reach families early, and few have the research behind it, like annual behavior health well-child checks. Research shows that in childhood, these improve both child and parent mental health. They increase immunization rates. They lower rates of obesity. They improve school readiness and more. I can tell you as a pediatric primary care psychologist that I see the consequence of not having this benefit every single day. I've had countless parents come to me during their child's mental health crisis and say, We delayed seeking help. We weren't sure how much it was going to cost. We weren't sure it was needed. And we really didn't want our child labeled. And unfortunately, we have created a system where children must be symptomatic enough for a diagnosis in order for insurance to help them access care. In contrast, I think about the father who brought his six-month-old son to the doctor's office. He didn't know what he ate. He didn't know if or when he slept. He also didn't even know the child's birthday. So while the medical team was frantically trying to call the mother to get some of this information, I was teaching the father how to connect with his son through a simple game of catching his son's noises and facial expressions and making them back to him. The father actually returned to the next medical visit, and he asked to see me during that visit. He became tearful because he said, I wonder if my dad would have stuck around if somebody would have taught him that. See, he was thinking, I can't connect with this kid. Prior to that, this father said, I couldn't imagine why my dad would leave a baby. And then as a father who didn't know how to change diapers or feed his kid, he was starting to lose that context. He was starting to say, now I understand why my dad left. I feel useless here. But now he had a way of connecting with his son. And in fact, when he came back for yet another medical visit, he told the pediatrician, nobody's giving this baby a vaccine until I talk to Dr. Cody. To which the pediatrician said, the psychologist? This is a vaccine. What are you talking about? So for this family, behavioral health care had become routine, right? We were together building a foundation that fostered resilience, it responded to challenges, and it prevented crises. But without this bill, that kind of proactive care remains unattainable for most families. I'm also asking to support this bill as a father. Like every parent, even as a pediatric mental health expert, I quietly wonder whether I'm doing enough and whether my son is truly okay. I know there are going to be moments in his life where this world feels overwhelming. This bill would give me and my wife an opportunity to seek guidance in those challenging times and give my son and all of our children a better chance to grow into healthy, resilient and productive adults. This is not a radical idea. Seven states have passed similar legislation, several more in the process. This bill gives Ohio families an opportunity to access behavioral health care before their children reach crisis without financial burden or fear of labeling. So I respectfully ask you to support HB 724 and help make behavioral health care routine and accessible to all Ohioans And I look forward to answering your questions Thank you very much for your testimony Do we have any questions from the committee
I think we've questioned everybody out. I would love to answer some of the questions that we've already answered if I can. All right, Rep. Gerald's, have at it.
Yeah, thank you. Thank you, Chair, and thank you for your testimony today. I do want to just, I think, unpack, and the ranking member and I were talking about this off mute, what is it, off the record, on mute about the bill. And here's what I believe currently. The behavioral system, when it comes to data sharing, when it comes to the stigma that still exists, when it comes to a lot of the unfortunate realities that still kind of prevents individuals from seeing their mental and behavioral health needs at the same level as their physical health. In order for that, my belief of theory of change to work is we have to shift and make it almost as if physical and behavioral health are in the same lane. And I'm struggling a little bit with this bill partly because it is an added benefit that someone have to then go out, get their behavioral health wellness check, and then maybe go and get a physical check. And what we know to be true is many people don't get their physical checks already. It will be even harder for them to get their mental health or wellness check. And so help me unpack how we get people. If this thing passed and got into law, how would it move the needle for people to actually get served and to get the support that they deserve?
Absolutely. Through the chair to the representative. Thank you for that question. This bill would allow us to do it in conjunction with that primary care visit. That's what I spend my day doing. That's what I'll go back to doing this afternoon. When a family comes into their primary care medical visit, as a psychologist, I can join that visit and do the behavior health part of that check. And why that is important is although pediatricians can screen, they routinely tell us that they do not have the training to respond to that positive screen. So what do they do? They send a referral to a specialty mental health clinician. And what does that mean? And every single kid who screens positive gets funneled into the specialty system, and we can't keep up with that level of demand because they can't treat it. And there's not enough pediatricians out there. We have access problems for them to do all of this work. They would need seven and a half additional hours per day to provide all the guidance to families that they're supposed to give during that well-child check. They're not trained. They don't have the time. And so what happens is they send them all to us in a separate system that families don't trust, that families don't know, to get care that they don't understand, right, that they then also now have to pay for. And so what this would do is it would allow the folks who are comfortable in their pediatric office to speak with a mental health clinician and for that clinician to get paid for that service, but for it to be a covered benefit, just like the well visit to the family, right. For the families who are more comfortable going to a specialty mental health provider, this would also allow them to go see a mental health provider out in the community if that happened to be a place that was more comfortable. So this is not an either or thing. We have drafted the bill to be covered as a same day visit with the primary care office visit. And that is what I do every single day. We work with families together in conjunction with the pediatrician to be able to work efficiently We can do these visits quickly and have a really high impact improving those immunization rates reducing ED visits improving relationships between families and the medical system Follow I just got one more follow So
on that note, again, if this bill passes, I as a patient come in, is there data being collected on any of these individuals? Because part of the challenge is that we really don't have a clear scope of the prevalence of behavioral health need across Ohio. And so I do agree that having a wellness check would provide that qualitative and quantitative data that we need to show that this is something that we should continually invest in. Um, does this, do you believe that this bill gets to getting that data? Um, I'm assuming that's because the system is not, we don't have one system yet. Systems may not talk to one another. So we still may be left in the, in the dark, if you will, in terms of the actual real prevalence of behavioral health need in the state of Ohio, even if this bill doesn't D pass. So I agree that this is a good thing to do. What I'm trying to frame out is how does this actually get us to get people served? And then how do we use that data to, hopefully on the provider end, show proof that there is more need out there that we need to support here in the legislature?
Yeah, through the chair. I think the evidence we have on need is pretty overwhelming. You know, 50% of kids are gonna meet criteria for a diagnosis before they graduate. One in five kids, my kid's a kindergartner in a class of 25. Five of his peers will seriously consider suicide before they graduate. The time between symptom onset and treatment is nine years. One in three high schoolers in Ohio tell us that they feel hopeless and sad most days of the year. Half of kindergartners are entering kindergarten ready to learn. We already have an overwhelming amount of evidence about the need. And I do think this would give us more data to continue to support that. But importantly, I cannot imagine, as a researcher who has looked at this my whole career, I cannot imagine a single more transformative thing than this bill. Because what this bill does is it allows us to get in and build a foundation early. It is not a screening. I think that is one of the miscommunications that have been happening during this hearing. It's not a screening. We screen enough. This is an intervention. This is a way of building wellness, building health. And that is why kids enter school more ready when they have access to this. This is why rates of obesity reduce when kids have access to this. Why kids are more likely to get their immunizations on time. Why their symptoms improve or get prevented in the first place. Because this allows us to not just screen and refer to an already overwhelmed system because we know the need is high. This allows us to actually do something about it in advance and prevent those problems and to provide early treatment early and be able to provide the data like you're talking about so we can actually speak to the extent to which we're caring and supporting these families and preventing those negative outcomes in the long run. Very good.
All righty. Well, thank you very much for your testimony this morning. We appreciate you being here. Thank you. I will also note that we have 12 additional proponent testimonies that were submitted. This concludes the second hearing on House Bill 724. We have any further business to be brought forth to the committee? Seeing none, we are adjourned.