Complete Story
05/29/2025
Prior Authorization Fix Legislation Receives Testimony in Ohio House
The House Insurance Committee convened again Tuesday morning following the holiday weekend, and Representative Heidi Workman (R-Rootstown) provided sponsor testimony in support of HB 220, legislation which seeks to clarify and strengthen existing laws in Ohio concerning prior authorization.
In particular, HB 220:
- Bolsters existing Ohio law regarding retroactive denial to ensure that once a prior authorization is approved and the care is delivered, insurers cannot later deny payment for that approved service.
HB 220 simply requires that once prior authorization is approved, the insurer cannot later deny payment/approval on the back end.
- Tightens peer-to-peer review standards to require that only appropriately credentialed physicians—in the same specialty—can conduct reviews and must respond promptly.
The American Medical Association reports that only 16% of physicians say the “peers” conducting reviews on behalf of insurers often or always have the proper clinical qualifications. This legislation makes sure that peer reviewers are in the same specialty and have relevant training for the case they are reviewing, and sets clear timeframes for peer review determinations to be made.
- Requires insurers to not invalidate a 12-month prior authorization for a chronic disease medication based on a dosage adjustment.
When insurance companies require a new prior authorization process based on a dosage adjustment to a chronic disease medication, this leads to dangerous delays and additional hassles which can force patients to ensure ineffective alternative medications and face deterioration in their condition in the meantime.
- Prohibits insurers from charging physicians and other providers for appealing a denial.
This is an emerging practice by insurers which has caused great concern. Insurers would not be allowed to charge any fees to providers for appealing denied claims.
HB 220 is a critical proposal on OSMA’s advocacy agenda, and as Rep. Workman told the Committee, this legislation will help to re-center physicians and their patients at the center of health care. Our members all over the state tell us that they cannot keep up with the impossible, burdensome demands that insurers are placing upon them, and not only do these hassles contribute to burnout and stress, but lead to lack of access to care and even permanent harm to patients. HB 220 is a key part of the solution for reducing the negative impact of prior authorization on patient care in Ohio.
We appreciate Rep. Workman’s support of this meaningful reform to prior authorization. If you have questions or would like to get involved in advocating for HB 220 or other insurance reforms, email info@osma.org or call our office at 614-527-6762.