The bill amends sections 1751.72, 3923.041, and 5160.34 of the Revised Code to enhance the prior authorization requirements for health insurance and Medicaid programs. It introduces new definitions such as "chronic condition," "clinical peer," and "prior authorization requirement," which clarify the terminology used in health care services. Key provisions include mandates for health insuring corporations to allow electronic access to prior authorization forms, respond to requests within specified timeframes (48 hours for urgent care), and establish a streamlined appeal process for adverse determinations. The bill also requires that prior authorization approvals for chronic conditions be honored for up to twelve months and prohibits retroactive denials unless fraudulent information is involved.

Additionally, the bill emphasizes transparency by requiring insurers to disclose new prior authorization requirements to health care practitioners and maintain an updated list on their websites. It also includes provisions to prevent retroactive denials of prior authorizations for mental health and substance use disorder treatments, as long as specific conditions are met. The Department of Medicaid is similarly required to allow electronic access to prior authorization forms and respond to requests within designated timeframes. The bill repeals existing sections of the Revised Code that are superseded by these new provisions, thereby modernizing the legal framework governing prior authorization in Ohio's medical assistance programs.

Statutes affected:
As Introduced: 1751.72, 3923.041, 5160.34