Bill > HB214

This bill requires Medicaid and health insurers in Ohio to improve transparency and efficiency in their prior authorization processes. Specifically, starting in 2027, health insurers and Medicaid must publicly report comprehensive data about prior authorization requests, including approval rates, denial rates, appeal outcomes, and average processing times. The bill also introduces a new exemption mechanism where healthcare providers who consistently submit high-quality prior authorization requests (with at least 90% approval rates and a minimum of 20 requests in a year) can be temporarily exempt from prior authorization requirements for specific services or medications. The bill mandates that prior authorization requests be processed electronically, with specific timelines for responses (48 hours for urgent care and 10 calendar days for non-urgent requests), and establishes a streamlined appeal process for denied requests. Prior authorization approval for chronic condition medications would typically be valid for 12 months, with some exceptions for controlled substances and specific medication types. These changes aim to reduce administrative burdens on healthcare providers, improve patient care, and increase transparency in the healthcare authorization process.

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https://www.legislature.ohio.gov/legislation/136/hb214