Prior Authorization Standards Bill Passes Ohio Senate

By: Executive Director Keith Kerns, Esq.

Ohio’s healthcare providers and patients scored a victory in the Ohio General Assembly this week before the state legislature broke for its holiday break.  Senate Bill 129, a measure supported by the Ohio Optometric Association, Ohio State Medical Association and other provider groups, passed the Ohio Senate by unanimous vote.  If adopted the bill will establish common standards for health care prior authorization requests, including the establishment of time-frames in which third party payers must respond to requests.

Specifically, SB 129 would:

  • Require insurers to accept electronic submissions of prior authorization requests,
  • Require insurers to respond to prior authorization requests within 5 days and within one day for requests of an urgent nature,
  • Create a streamlined appeal process when a prior authorization request is denied.   The appeals process would first allow the provider to appeal to the individual who made the initial determination and then appeal to a panel that includes a clinical peer.  Finally, the provider may seek an external review if necessary.  The bill also creates expedited time frames which must be followed in the appeals process,
  • Require insurers to provide advance notice of any changes to the prior authorization process including providing detailed instructions should new information be required, and
  • Create a process to handle prior authorizations of new medical procedures and for medications for chronic conditions.

SB 129 was introduced by Sen. Randy Gardner (R-Bowling Green) in March.  The OOA testified in support of the bill last month before the Ohio Senate Insurance Committee.  The bill will now move to the House for consideration.  To learn more about OOA legislative priorities, please visit: OOA Advocacy Page

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