04/17/2025
OSMA Announces Advocacy Campaign in Support of Insurance Reform Legislation
On the first of this month, elected officials in the Ohio House and Senate introduced eight new legislative proposals that prioritize patient interests over insurance companies and support keeping medical decision-making in the hands of physicians, where it belongs. OSMA is proud to be actively supporting this series of insurance reform initiatives, all of which aim to shed light on the extreme burden insurers are placing on our healthcare system.
The following bills seek to stop the disruption to patient care caused by insurance companies, which can lead to delays and denials of medically-necessary and even life-saving treatments.
House Bill 214 – Prior Authorization “Gold Card”
(Rep. Kevin Miller, R-Newark)
Would create a system that rewards healthcare providers who consistently receive a prior authorization approval rate for a specific service or treatment in a 12-month period by establishing a “gold card” exemption from prior authorization requirements. Also contains data sharing requirements which mirror federal CMS requirements set to go into effect in 2027. Insurers would be required to share certain program metrics, such as rates of approval/denial/approval after appeal of urgent and non-urgent requests, with the Ohio Department of Insurance and publicly on their websites.
Senate Bill 160 – Non Medical Switching
(Sen. Terry Johnson, R-McDermott, and Sen. Beth Liston, D-Dublin)
Would prohibit insurers from non-medical switching, or making mid-year drug formulary changes which force patients to undergo abrupt and unwarranted treatment changes.
Senate Bill 165 – Automatic Downcoding
(Sen. Susan Manchester, R-Waynesfield)
Contains prohibitions on downcoding for all providers, including prohibitions on limitations on reimbursement for time spent with patients. Would also strengthen 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.
House Bill 219 – Network Adequacy
(Rep. Kellie Deeter, R-Norwalk)
Would require the Ohio Department of Insurance to create network adequacy standards for commercial plans.
Senate Bill 162– Takebacks/Clawbacks
(Sen. Bill Blessing, R-Colerain Twp.)
Would change 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. Would also prohibit insurers from charging a provider for appealing a determination of overpayment.
Senate Bill 166– No Fees for EFTs
(Sen. Nathan Manning, R-North Ridgeville)
Would prohibit insurers from imposing any charge, fee, or other payment requirement (including through withholding from payment), on any healthcare provider for electronic fund transfers or remittance advice transactions.
House Bill 220 – Prior Authorization
(Rep. Heidi Workman, R-Rootstown)
Would strengthen existing Ohio prior authorization laws passed in 2018 by ensuring retroactive denials only occur in the event of non-covered benefits or lack of coverage at the time of service, requiring identification of clinical peer conducting peer review in adverse determinations, prohibiting insurers from charging providers for appeals, and requiring insurers to account for dosage adjustments in drug prior authorizations to treat chronic conditions.
Senate Bill 164– Transparency in Health Plan Use of AI
(Sen. Al Cutrona, R-Canfield)
Would require insurer transparency in their use of AI tools in prior authorization determinations, specifically by requiring insurers to disclose use of AI and ensuring that prior authorization determinations are made through review of individual merits of claims by licensed clinical professionals.
OSMA is thankful to the legislative sponsors of these bills as well as Senator and physician, Dr. Stephen Huffman, for leading this initiative.
OSMA MEMBERS: We need every physician’s voice! Together, we can push these reforms forward and protect your ability to care for patients.