The bill amends sections of the Revised Code to improve the prior authorization process for health insurance and Medicaid programs. It requires health insuring corporations and the Department of Medicaid to allow healthcare practitioners to access prior authorization forms electronically and mandates timely responses to requests—48 hours for urgent care and 10 calendar days for non-urgent requests. The legislation introduces a streamlined appeal process for adverse determinations, ensuring that appeals are evaluated by a qualified clinical peer. Additionally, it establishes a twelve-month approval period for prior authorizations related to chronic conditions and allows changes in dosage for approved drugs to be honored under existing approvals.

Significantly, the bill prohibits retroactive denial of prior authorizations for mental health or substance use disorder treatments under specific conditions and prevents denials based on unintentional errors in claims. It also emphasizes transparency by requiring insurers to disclose new prior authorization requirements to healthcare practitioners and maintain updated listings on their websites. The bill repeals existing sections of the Revised Code that conflict with these new provisions, thereby modernizing the regulatory framework governing prior authorizations in Ohio's medical assistance programs and enhancing access to necessary healthcare services.

Statutes affected:
As Introduced: 1751.72, 3923.041, 5160.34