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07/24/2025

Fall Advocacy Preview & Insurance Reform — We Need Your Help!

 

Call to Action:

As you know, OSMA launched a major insurance reform campaign this year to put patients' interests over insurance companies—keeping medical decision-making in the hands of physicians, and shedding light on the massive burdens put on our healthcare system and providers by insurance companies.

A slate of legislation we are supporting aims to bring much-needed transparency to the insurmountable power insurers have gained in the healthcare system, putting decisions about medical care back in the hands of the people who should be making them: expert physicians who are best at caring for their patients.

HOW YOU CAN HELP:

This fall, the process of legislative hearings will continue for these proposals. We need your stories, examples, and testimonies to help us illustrate to legislators how crucial these reforms are to improving patient care in Ohio.

If you have helpful examples, data, or stories regarding any of the issues below, please email them to OSMA’s Advocacy team!

Email Kelsey >

In your email, please also indicate if you would like to be added to a list of contacts to potentially testify (with OSMA help and guidance) at the Statehouse in a hearing, and if so, for which issues/bills.

It is imperative that our elected officials hear your powerful evidence showing how the hurdles of the insurance industry negatively impact you, your practice, and the patients receiving your care.

Insurance Reform Issues in our Campaign include:

Sponsors: Sen. Beth Liston (D-Dublin) and Sen. Terry Johnson (R-McDermott)

Prohibits insurers from making mid-year drug formulary changes in order to avoid abrupt and unwarranted treatment changes that disrupt a physician’s ability to exercise their medical expertise to help their patients.

 

Sponsor: Sen. Bill Blessing (R-Colerain Twp.)

Changes Ohio’s current 24-month insurer takeback timeframe, decreasing it to the same timeframe given to a provider to submit a claim, and also prohibit insurers from changing these timeframes during a contract period.

 

Sponsor: Sen. Al Cutrona (R-Canfield)

Requires insurer transparency regarding their use of AI tools in prior authorization determinations, and ensure that determinations are made through review of individual merits of claims by licensed clinical professionals.

 

Sponsor: Sen. Susan Manchester (R-Waynesfield)

Prohibits automatic downcoding of claims for all providers, including limitations on reimbursement for time spent with patients. Also strengthens Ohio’s prudent layperson standard in order to protect Ohioans from unexpected medical bills due to their insurer denying claims for emergency care after the care has been sought and provided.

 

Sponsors: Sen. Susan Manchester (R-Waynesfield) and Sen. Beth Liston (D-Dublin)

Would require health insurers to count amounts paid by or on behalf of covered individuals toward deductibles and cost-sharing requirements.

 

Sponsor: Rep. Andrea White (R-Kettering)

Requires health benefit plan and Medicaid program coverage of biomarker testing under medically-appropriate circumstances.

 

Sponsors: Rep. Dontavius Jarrells (D-Columbus) and Rep. Mark Johnson (R-Chillicothe)

Requires health insurers to cover preventive screenings for certain men at high-risk for developing prostate cancer.

 

Sponsor: Rep. Kevin Miller (R-Newark)

Establishes an exemption of prior authorization requirements and creates a system that rewards healthcare providers who consistently receive a high prior authorization approval rate for a specific service or treatment in a 12-month period. Also includes data collection provisions mirroring federal CMS requirements set to go into effect in 2027, which will require insurers to share program metrics (e.g.: percentage of urgent and non-urgent requests approved, denied, and approved after appeal) on their public websites and with ODI on an annual basis.

 

Sponsor: Rep. Kellie Deeter (R-Norwalk)

Establishes standards for creation and maintenance of networks by insurers and assure the adequacy, adequacy, accessibility, transparency and quality of healthcare services offered under a network plan.

 

Sponsor: Rep. Heidi Workman (R-Rootstown)

Ensures retroactive denial can only occur for non-covered benefits or lack of coverage at the time of service. Requires prior authorization appeals to be between the healthcare provider and a clinical peer, and require identification of the clinical peer (plan clinician) making adverse determinations. Also prohibits insurers from charging providers to appeal rejected claims, and allows providers to adjust medication dosages during the year for a prior approved 12-month prior authorization.

 

Sponsors: Rep. Jean Schmidt (R-Loveland) and Rep. Josh Williams (R-Sylvania Twp.)

Requires coverage of diagnostic breast examinations and prohibits health insurers and the Medicaid program from imposing cost-sharing requirements on covered breast or cervical cancer screenings and examinations.

 

Sponsor: Rep. Jean Schmidt (R-Loveland)

Shifts the responsibility of collecting a patient’s cost-sharing amount—copays, deductibles, and coinsurance—from physicians to health insurers.

 

 

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