The bill amends sections of the Revised Code related to the Medicaid program and health insurers' prior authorization requirements, specifically sections 1751.72, 3923.041, and 5160.34, while enacting section 5160.341. It mandates that health insuring corporations provide data on prior authorization requests, including approval and denial rates, and the time taken for decisions, starting January 1, 2027. Health insurers are required to make this data available to healthcare practitioners and submit annual reports to the Department of Insurance, which will publish the findings. Additionally, the bill introduces an exemption from prior authorization for healthcare providers or groups with a high approval rate (at least 90%) for their prior authorization requests over the previous year, provided they submitted a minimum of twenty requests.

The bill also establishes specific timelines for health insuring corporations to respond to prior authorization requests—48 hours for urgent care and 10 days for non-urgent requests—and outlines conditions under which prior authorizations for chronic conditions must be honored for up to twelve months. It emphasizes the importance of electronic communication for submitting and processing prior authorization requests and includes provisions to ensure that any conflicting contractual arrangements are unenforceable. Furthermore, the bill streamlines the appeal process for adverse prior authorization determinations and requires timely reviews, ensuring transparency and accountability in the prior authorization process while reducing administrative burdens on healthcare providers.

Statutes affected:
As Introduced: 1751.72, 3923.041, 5160.34