PRIOR AUTHORIZATION LEGISLATION CLEARS MAJOR HURDLE HB 220 VOTED OUT OF HOUSE INSURANCE COMMITTEE IN UNANIMOUS VOTE

The following information was released by the Ohio State Medical Association (OSMA):

OSMA is excited to report that House Bill 220, one of a series of insurance reform proposals we have been spearheading support for in the Ohio Legislature, was voted unanimously out of the House Insurance Committee Tuesday morning. The bill now heads to the House floor for a full House vote. This is a huge step in the legislative process and means that this legislation has cleared its first major hurdle in the path to becoming Ohio law!

As a reminder, HB 220, which is sponsored by Rep. Heidi Workman (R-Rootstown), is intended to streamline the prior authorization process by cleaning up several obstacles to patient care that OSMA members have frequently reported experiencing in their day-to-day work:

Retroactive denials: HB 220 would ensure that retroactive denial can only occur in the event of non-covered benefits or lack of coverage at the time of service. This includes prohibition of retroactive denials of prior authorization for mental health or substance use disorder treatments.

Peer-to-peer reviews: This legislation would hold insurers accountable in the peer-to-peer review process by requiring that prior authorization appeals be between a healthcare provider and a clinical peer, and that the clinical peer (plan clinician) making adverse determinations provide identifying information including their specialty and relevant qualifications.

Appeals: HB 220 would prohibit health insurers from charging a fee for appealing an adverse prior authorization determination.

Dosage adjustments in drug prior authorizations for chronic illness treatment: Current law dictates that most drug treatments prescribed for maintenance of a chronic condition are subject to a prior authorization approval with a duration of 12 months. Under HB 220, insurers must honor an existing drug prior authorization approval if the provider prescribes a change in dosage of the approved drug.

These represent meaningful changes to the prior authorization process which will lessen the burden on physicians and their patients.

OSMA will continue to advocate for HB 220 alongside the other insurance reform legislation we are supporting in this general assembly. Please stay tuned for more updates as HB 220 moves toward a vote on the House floor!