Last week, we reported that the House Insurance Committee had unanimously passed HB 220 and sent it to the full House for a floor vote. OSMA has been supporting HB 220 since last spring, alongside a slate of other key insurance reform initiatives, and is pleased that our advocacy efforts have helped this legislation successfully advance through the Ohio House.

As a reminder, this legislation, which is sponsored by Rep. Heidi Workman (R-Rootstown), would streamline the prior authorization process by:

• Ensuring that retroactive denials can only occur in the event of non-covered benefits or lack of coverage at the time of service.
  
  
• Holding 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.
  
  
• Prohibiting insurers from charging a fee for appealing an adverse prior authorization determination.
  
  
• Requiring insurers to honor an existing 12-month drug prior authorization approval for a maintenance medication to treat a chronic condition if the provider prescribes a change in dosage of the approved drug.

Now that HB 220 has made it through the Ohio House, this legislation must continue its path by making its way through the Ohio Senate. OSMA will continue to advocate for its passage through the legislative process and report on every step in that journey.

Stay tuned for more advocacy updates from the OSMA Government Relations team!