Bill > HB220

This bill amends Ohio's health insurance, sickness and accident insurance, and Medicaid prior authorization requirements to improve the process for healthcare providers and patients. The bill establishes several key provisions for health insurers, including requiring electronic submission of prior authorization requests, mandating response times for such requests (48 hours for urgent care and 10 calendar days for non-urgent services), and establishing a streamlined appeal process. For chronic conditions, insurers must now honor prior authorization approvals for approved drugs for up to 12 months, with some exceptions for specific types of medications. The bill also prohibits retroactive denials of prior authorizations in most cases, requires insurers to provide clear reasons for denials, and mandates that insurers disclose prior authorization requirements to healthcare practitioners at least 30 days in advance. Additionally, the bill introduces requirements for identifying the clinical peer who evaluates appeals and ensures that no fees are charged for appealing adverse prior authorization determinations. These changes aim to make the prior authorization process more transparent, efficient, and less burdensome for healthcare providers and patients across health insurance and Medicaid programs in Ohio.

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https://www.legislature.ohio.gov/legislation/136/hb220