Ohio House Passes Prior Authorization Reform to Reduce Delays and Improve Patient Care

State Representative Heidi Workman (R-Rootstown) today announced that the Ohio House passed House Bill 220 – legislation aimed at improving the prior authorization process and reducing delays in patient care by requiring insurers and Medicaid to honor certain existing approvals for prescription medications.

“House Bill 220 is about putting patients back at the center of health care,” said Workman. “For too long, unnecessary prior authorization hurdles have delayed care and created confusion for both patients and providers. This bill brings common-sense reforms by ensuring approvals are honored, strengthening clinical review standards, and reducing bureaucratic barriers so Ohioans can get the care they need, when they need it.”

If enacted, House Bill 220 would do the following:

• Require health insuring corporations, sickness and accident insurers, public employee benefit plans (collectively, “health insurers”), and the Department of Medicaid (ODM) to honor a prior authorization approval if a provider prescribes a change in dosage of the approved drug.
• Require that the specialty and relevant qualifications of the clinical peer, who is required by continuing law to review prior authorization appeals, be identified. 
• Prohibit health insurers from charging a fee for appealing an adverse prior authorization determination. 
• Prohibit health insurers and ODM from retroactively denying a prior authorization for mental health or substance use disorder treatment. 
• Specify that the bill’s provisions apply to private insurance policies issued on or after the first day of January following the effective date of the bill.

House Bill 220 now advances to the Ohio Senate for consideration.