Ohio House Bill HB429

Ohio 2025-2026 Regular Session

• Filed/Introduced: 8/6/26
• Introduced: 8/28/25

Caption

To amend section 3901.385 of the Revised Code to prohibit third-party payers from reducing reimbursement to health care providers based on certain factors.

Summary

HB429 would amend Ohio Revised Code section 3901.385 to place additional limits on how third-party payers, such as insurers and other health benefit administrators, may process and pay claims for health care services. The bill keeps existing prohibitions on unfair delays in claim processing and on refusing to pay claims for services actually rendered, and it adds a new prohibition against reducing reimbursement based on a payer’s own interpretation of what a service or diagnosis code includes beyond the applicable national coding standards. More specifically, the bill would bar reimbursement reductions that rely on a payer’s internal description of a covered service or diagnosis code instead of the current CPT, ICD-10, CDT, or HCPCS coding systems and the guidance of the entities responsible for those code sets. It would also prohibit reducing payment simply because a provider billed additional health services, including outpatient surgery, on the same date as the covered service. The bill repeals the existing version of section 3901.385 and replaces it with the revised language.

Impact

HB429 would directly affect Ohio insurance and health payment practices by restricting third-party payers’ ability to downcode, bundle, or otherwise reduce provider reimbursement based on interpretations outside recognized coding standards. It would strengthen provider payment protections under section 3901.385 of the Revised Code and could increase reimbursement levels for physicians, hospitals, dentists, and other health care providers when claims are coded according to accepted national systems. The bill would also likely limit payer audit and payment-adjustment practices tied to same-day billing and internal claim-review policies.

Sentiment

The bill appears to be provider-friendly and aimed at addressing concerns about insurer payment reductions and claim-processing practices. Because there are no committee transcripts or recorded votes available, there is no documented opposition or support in the provided materials, but the bill’s framing suggests it is intended to protect health care providers from reimbursement cuts and administrative delays. Its introduction-only status indicates it had not yet advanced far enough in the process to generate a recorded legislative debate in the materials provided.

Contention

The main point of contention is likely to be the balance between protecting providers from underpayment and preserving payer flexibility to review claims for coding accuracy, medical necessity, and billing integrity. Health care providers would likely support the bill because it limits reimbursement reductions based on payer-specific interpretations, while insurers and other third-party payers may object that it constrains their ability to manage costs and prevent overbilling. The same-day billing restriction and the prohibition on using payer-created descriptions outside official coding guidance are the most likely flashpoints.