The bill amends the Revised Code to enhance the prior authorization requirements for Medicaid and health insurance, focusing on improving transparency and efficiency. It mandates health insurers to report data on prior authorization practices, including approval and denial rates, average decision times, and extended review percentages, starting January 1, 2027. Additionally, 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, will be exempt from prior authorization requirements for a minimum of twelve months. The bill also establishes specific timelines for insurers to respond to requests, emphasizing electronic communication and outlining conditions for honoring prior authorizations for chronic conditions.

Moreover, the bill introduces a streamlined appeal process for adverse prior authorization determinations and requires insurers to disclose new prior authorization requirements to healthcare practitioners at least thirty days in advance. It clarifies definitions related to prior authorization and sets guidelines for the duration and revocation of approvals. The bill aims to reduce administrative burdens on healthcare providers while ensuring timely access to necessary medical services for patients. It also repeals existing sections of the Revised Code that may conflict with these new provisions, thereby consolidating and clarifying the prior authorization process.

Statutes affected:
As Introduced: 1751.72, 3923.041, 5160.34