The bill amends sections of the Revised Code to enhance the prior authorization requirements for health insurance and Medicaid programs. It introduces new definitions, including "chronic condition," "clinical peer," and "prior authorization requirement," to clarify terminology related to health care services. Key provisions mandate that health insuring corporations provide electronic access to prior authorization forms and respond to requests within specified timeframes—48 hours for urgent care and 10 calendar days for non-urgent requests. Additionally, the bill establishes a streamlined appeal process for adverse prior authorization determinations, ensuring evaluations are conducted by a clinical peer without any associated fees.

Significant insertions include requirements for health insuring corporations to honor prior authorization approvals for dosage changes of approved drugs and to prevent retroactive denials for mental health or substance use disorder treatments under certain conditions. The bill also emphasizes the importance of electronic communication in the prior authorization process, aiming to improve efficiency and transparency. Furthermore, it specifies that prior authorization approvals for chronic conditions must be valid for up to twelve months, with clear guidelines for dosage changes and retrospective reviews. Overall, these amendments are designed to improve access to necessary health care services while ensuring that practitioners and patients are well-informed throughout the prior authorization process.

Statutes affected:
As Introduced: 1751.72, 3923.041, 5160.34