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 average time taken for decisions, with a requirement to make this data available to healthcare practitioners starting January 1, 2027. The bill also introduces an exemption from prior authorization for healthcare providers or groups that maintain a high approval rate (at least 90%) for their requests, provided they submitted a minimum of twenty requests in the previous year. This aims to streamline the process for reliable providers, reducing administrative burdens and improving access to healthcare services.

Additionally, the bill 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 electronic communication for submitting and processing requests to enhance efficiency. The bill also includes provisions for a twelve-month approval period for certain prescription drugs and mandates that insurers disclose new prior authorization requirements to healthcare practitioners at least thirty days in advance. Overall, these changes are designed to improve transparency, accountability, and efficiency in the prior authorization process for healthcare services.

Statutes affected:
As Introduced: 1751.72, 3923.041, 5160.34