A fledgling state administrative body is expected to approve its first set of rules next month, in anticipation of starting the formal legal process to establish the rules as law in June.

A fledgling state administrative body is expected to approve its first set of rules next month, in anticipation of starting the formal legal process to establish the rules as law in June.

The Ohio School Employees Health Care Board, established two years ago by the General Assembly, was given the responsibility to adopt Best Practices that all Ohio school districts must satisfy to offer health care to employees.

The four Best Practices to be acted upon include a requirement that school boards offer employee wellness programs, adopt "disease state management" programs for insured populations, provide access to specialty networks and conduct dependent eligibility audits.

During extensive discussions April 17, members of the board and its advisory committee debated whether the Best Practices standards would be general and hortatory or specific and mandatory.

The board's newly hired executive director, Bruce Gilbert, made clear that he believed they should be mandatory.

"For better or worse, our charge as a board has been to develop Best Practice standards of universal applicability, notwithstanding the fact that we have large districts and small, urban and suburban, which makes it extraordinarily difficult to say this particular thing should be included and this particular thing should not be included," Gilbert said. "Change is always difficult, and change in attitude is even more difficult, but the fact of the matter is, under the enabling legislation, assuming that the board is able to enunciate Best Practices, 'no' is not an option."

Board member Louis Goorey said that the board would face difficult practical and philosophical questions about what it could mandate.

"You're talking about behavior modification, but you're also getting at something we're going to have to wrestle with, a balance between what is good health, what is good practice, what is mandated, what is individual rights," Goorey said. "(Do we) mandate that nobody smokes, period? Are you going to measure how many Big Macs somebody eats a week?

There are some thorny issues we're going to have to deal with."

Board member Ken Blood, also a school board member in the East Muskingum Local district, said it was important to give local districts flexibility.

"From where I sit, too often school districts are told exactly what to do in such a scripted way that there's no opportunity for creativity and innovation," Blood said.

Dawn Lemley, treasurer of the Eastland-Fairfield Career and Technical Center, agreed.

"I would hope for more vagueness (in the required standards)," Lemley said.Scott DiMauro, former Worthington Education Association president, said there was a danger of Best Practices being more specific than the insurance market would bear.

"If standards are so specific, it could put the district in a difficult position when it comes to procuring a plan. It might force them to go to a more expensive plan," DiMauro said.

Lemley said her district already had been turned down by some insurers.

"You're gambling on the idea that those carriers are going to decide that school districts in the state of Ohio as their buying power are worth that change," Lemley said. "I'm not sure the answer would be yes."

Blood compared a suggested requirement that districts prove yearly actuarial improvement in their insured populations to Adequate Yearly Progress in federal education law.

"I would be concerned about asking districts to have an AYP for the health of their employees," Blood said. "If the assumptions is best practices will result in improved health, I'd rather support that, as opposed to requiring districts on an annual basis to show that the health of their employees is improving. We don't want to go down that road."

Mark Schwendeman, from the Ohio Association of Health Care Underwriters, said it is practical to compel insured populations to comply with rules established by the health care provider.

"It amazes me that we have a discussion of incentives; the incentive is the opportunity to have health care," Schwendeman said. "We get 95 percent to 100 percent compliance, because if you don't do them, the employer says you're not eligible for health care. That's the incentive."

Jim Timlin, of the Ohio Department of Education, rejected such an approach.

"No," Timlin said. "We won't go there."

Gilbert said it could be that each district would be left to make its own determination of how coercive its incentives would be. He also noted that the School Employees Health Care Board had significant power. First, he said, the board could exert pressure on districts by publishing health care statistics that showed whether a given district was keeping up with its peers.

"When it comes time for levies, that will be brought up," Gilbert said. "There is a public perception aspect that should not be overlooked."

Gilbert also said it was a question whether school employees could be offered health care at all if the School Employees Health Care Board did not approve it, noting that the statutory language is mandatory.

"What if you're not a health care plan that contains Best Practices established by the board?" he asked. "Can you offer benefits to public school employees? I'm not sure you can. While we might lack the ability to fine, and we might lack the ability to be as mandatory as some people would like, that's statute, and that's mandatory language. The fact of the matter is there are opportunities to enforce compliance."