9.901 Health care plans to be designed by school employees health care board.
9.901 Health care plans to be designed by school employees health care board.
(A)(1) All health care benefits provided to persons employed by the public school districts of this state shall be provided by health care plans that contain best practices established pursuant to this section by the school employees health care board. Twelve months after the release of best practices by the board all policies or contracts for health care benefits provided to public school district employees that are issued or renewed after the expiration of any applicable collective bargaining agreement must contain best practices established pursuant to this section by the board. Any or all of the health care plans that contain best practices specified by the board may be self-insured. As used in this section, a “public school district” means a city, local, exempted village, or joint vocational school district, and includes the educational service centers associated with those districts but not charter schools.
(2) As used in this section:
(a) A ” health care plan” includes group policies, contracts, and agreements that provide hospital, surgical, or medical expense coverage, including self-insured plans. A ” health care plan” does not include an individual plan offered to the employees of a public school district, or a plan that provides coverage only for specific disease or accidents, or a hospital indemnity, medicare supplement, or other plan that provides only supplemental benefits, paid for by the employees of a public school district.
(b) A “health plan sponsor” means a public school district, a consortium of public school districts, or a council of governments.
(B) The school employees health care board is hereby created. The school employees health care board shall consist of the following twelve members and shall include individuals with experience with public school district benefit programs, health care industry providers, and health care plan beneficiaries:
(1) Four members appointed by the governor, one of whom shall be representative of nonadministrative public school district employees;
(2) Four members appointed by the president of the senate, one of whom shall be representative of nonadministrative public school district employees;
(3) Four members appointed by the speaker of the house of representatives, one of whom shall be representative of nonadministrative public school district employees.
A member of the school employees health care board shall not be employed by, represent, or in any way be affiliated with a private entity that is providing services to the board, an individual school district, employers, or employees in the state of Ohio.
(C)(1) Members of the school employees health care board shall serve four-year terms, but may be reappointed, except as otherwise specified in division (B) of this section.
A member shall continue to serve subsequent to the expiration of the member’s term until a successor is appointed. Any vacancy occurring during a member’s term shall be filled in the same manner as the original appointment, except that the person appointed to fill the vacancy shall be appointed to the remainder of the unexpired term.
(2) Members shall receive compensation fixed pursuant to division (J) of section 124.15 of the Revised Code and shall be reimbursed from the school employees health care fund for actual and necessary expenses incurred in the performance of their official duties as members of the board.
(3) Members may be removed by their appointing authority for misfeasance, malfeasance, incompetence, dereliction of duty, or other just cause.
(D)(1) At the first meeting of the board after the first day of January of each calendar year, the board shall elect a chairperson and may elect members to other positions on the board as the board considers necessary or appropriate. The board shall meet at least nine times each calendar year and shall also meet at the call of the chairperson or four or more board members. The chairperson shall provide reasonable advance notice of the time and place of board meetings to all members.
(2) A majority of the board constitutes a quorum for the transaction of business at a board meeting. A majority vote of the members present is necessary for official action.
(E) The school employees health care board shall conduct its business at open meetings; however, the records of the board are not public records for purposes of section 149.43 of the Revised Code.
(F) The school employees health care fund is hereby created in the state treasury. The board shall use all funds in the school employees health care fund solely to carry out the provisions of this section and related administrative costs.
(G) The school employees health care board shall do all of the following:
(1) Adopt and release a set of standards that shall be considered the best practices to which public school districts shall adhere in the selection and implementation of health care plans.
(2) Require that the plans the health plan sponsors administer make readily available to the public all cost and design elements of the plan;
(3) Work with health plan sponsors through educational outlets and consultation;
(4) Maintain a commitment to transparency and public access of its meetings and activity pursuant to division (E) of this section;
(5) Promote cooperation among all organizations affected by this section in identifying the elements for the successful implementation of this section;
(6) Promote cost containment measures aligned with patient, plan, and provider management strategies in developing and managing health care plans;
(7) Prepare and disseminate to the public an annual report on the status of health plan sponsors’ effectiveness in making progress to reduce the rate of increase in insurance premiums and employee out of pocket expenses, as well as progress in improving the health status of school district employees and their families.
(H) The sections in Chapter 3923. of the Revised Code regulating public employee benefit plans are not applicable to the health care plans designed pursuant to this section.
(I) The board may contract with one or more independent consultants to analyze costs related to employee health care benefits provided by existing public school district plans in this state. The consultants may evaluate the benefits offered by existing health care plans, the employees’ costs, and the cost-sharing arrangements used by public school districts either participating in a consortium or by other means. The consultants may evaluate what strategies are used by the existing health care plans to manage health care costs. Based on the findings of the analysis, the consultants may submit written recommendations to the board for the development and implementation of successful best practices and programs for improving school districts’ health care plans.
(J) The public schools health care advisory committee is hereby created under the school employees health care board. The committee shall make recommendations to the school employees health care board related to the board’s accomplishment of the duties assigned to the board under this section. The committee shall consist of eighteen members. The governor shall appoint two representatives each from the Ohio education association, the Ohio school boards association, and a health insuring corporation licensed to do business in Ohio and recommended by the Ohio association of Health Plans. The speaker shall appoint two representatives each from the Ohio association of school business officials, the Ohio federation of teachers, and the buckeye association of school administrators. The president of the senate shall appoint two representatives each from the Ohio association of health underwriters, an existing health care consortium serving public schools, and the Ohio association of public school employees. The initial appointees shall serve until December 31, 2007; subsequent two-year appointments, to commence on the first day of January of each year thereafter, and shall be made in the same manner. A member shall continue to serve subsequent to the expiration of the member’s term until the member’s successor is appointed. Any vacancy occurring during a member’s term shall be filled in the same manner as the original appointment, except that the person appointed to fill the vacancy shall be appointed to the remainder of the unexpired term. The advisory committee shall elect a chairperson at its first meeting after the first day of January each year who shall call the time and place of future committee meetings in addition to the meetings that are to be held jointly with the school employees health care board. Committee members are not subject to the conditions for eligibility set by division (B) of this section for members of the school employees health care board.
(K) The board may adopt rules for the enforcement of health plan sponsors’ compliance with the best practices standards adopted by the board pursuant to this section.
(L) Any districts providing health care plan coverage for the employees of public school districts shall provide nonidentifiable aggregate claims data for the coverage to the school employees health care board, without charge, within sixty days after receiving a written request from the board. The claims data shall include data relating to employee group benefit sets, demographics, and claims experience.
(M)(1) The school employees health care board may contract with other state agencies for services as the board deems necessary for the implementation and operation of this section, based on demonstrated experience and expertise in administration, management, data handling, actuarial studies, quality assurance, or for other needed services. The school employees health care board may contract with the department of administrative services for central services until such time the board deems itself able to obtain such services from its own staff or from other sources. The board shall reimburse the department of administrative services for the reasonable cost of those services.
(2) The board shall hire staff as necessary to provide administrative support to the board and the public school employee health care plan program established by this section.
(N) Not more than ninety days before coverage begins for public school district employees under health care plans containing best practices prescribed by the school employees health care board, a public school district’s board of education shall provide detailed information about the health care plans to the employees.
(O) Nothing in this section shall be construed as prohibiting public school districts from consulting with and compensating insurance agents and brokers for professional services.
(P)(1) Pursuant to Chapter 117. of the Revised Code, the auditor of state shall conduct all necessary and required audits of the board. The auditor of state, upon request, also shall furnish to the board copies of audits of public school districts or consortia performed by the auditor of state.
Effective Date: 09-29-2005; 03-30-2006; 2007 HB119 09-29-2007