Senate Bill 129–Prior Authorization Bill–Clears the Ohio Senate

Senate Bill 129—the Prior Authorization Reform Act bill—which will make positive reforms to the prior authorization system—has cleared the Ohio Senate. The Ohio State Medical Association, the Academy of Medicine of Cleveland & Northern Ohio (AMCNO) and several other medical and healthcare organizations from around the state provided support for this legislation and worked to achieve passage of SB 129 in the Ohio Senate before the end of 2015. 

Prior authorizations have disrupted the physician-patient relationship and often lead to a delay in diagnosis and treatment of the patient’s condition. They also cause a significant administrative burden on the physician’s practice and result in little to no improvement in the quality of care. SB 129 would change this process.

These changes will significantly help physicians and patients in our state. Ohio would join roughly 15 other states that have enacted similar meaningful changes and would be one step closer to providing better care and access to patients.

This bill would impose the following changes upon Ohio’s current prior authorization (PA) process:

  1. Insurers must have a web-based system to receive PA requests.
  2. Insurers must disclose all PA rules to providers.
  3. Enrollees of the health plan must receive basic information about which drugs and services will require prior authorization.
  4. Faster timeframes for prior authorization decisions for urgent/non-urgent situations. 
  5. Allows a provider to request a “retrospective review” for unanticipated procedures that were performed during an authorized procedure, with some limitations. 
  6. A prohibition on retroactive denials regarding coverage or medical necessity, as long as the procedure was performed within 60 days of receiving an authorization.

The legislation is now in the Ohio House, and testimony will begin on the bill in January. The AMCNO will continue to offer our support for the bill.

The Pollen Line is now closed. See you in the spring!

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