The bill amends sections of the Revised Code to enhance the prior authorization requirements for health insurance and Medicaid programs. Key updates include the introduction of new definitions such as "chronic condition," "clinical peer," and "prior authorization requirement," which clarify the terminology used in health care services. It mandates that health insuring corporations provide electronic access to prior authorization forms for health care practitioners and respond to urgent care requests within 48 hours. Additionally, the bill establishes a streamlined appeal process for adverse determinations, ensuring that appeals are reviewed by qualified clinical peers.

Significantly, the bill requires health insuring corporations to honor prior authorization approvals for chronic conditions for up to twelve months, prohibits retroactive denials except in cases of fraud, and mandates that practitioners be informed of new prior authorization requirements at least 30 days in advance. It also ensures that no fees are charged for appealing adverse determinations and that clear information about prior authorization requirements is available on insurers' websites. The bill aims to improve transparency and efficiency in the prior authorization process, ultimately enhancing access to necessary health care services for individuals covered under these plans.

Statutes affected:
As Introduced: 1751.72, 3923.041, 5160.34
As Reported By House Committee: 1751.72, 3923.041, 5160.34
As Passed By House: 1751.72, 3923.041, 5160.34