Insurance Reform

Insurance Reform

Prioritizing Patients & Healthcare Providers Over Insurers

OSMA is thrilled to be leading a major campaign in support of a series of legislative proposals that seek 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.

The insurance reform legislation we are supporting (see details below) will bring much-needed transparency to the insurmountable power insurers have gained in the healthcare system.

Recent Sponsor Testimonies

6/17/2025: 
Non-Medical Switching Legislation Receives Testimony in Ohio Senate

5/29/2025: 
Prior Authorization Fix Legislation Receives Testimony in Ohio House

5/20/2025:
Prior Authorization Gold Card Legislation Receives Testimony in Ohio House

5/8/2025:
Network Adequacy Bill Receives Testimony in Ohio House

News & Resources


4/17/2025:
OSMA Announces Advocacy Campaign in Support of Insurance Reform Legislation

4/02/2025:
OSMA applauds Ohio House and Senate for prioritizing patients and healthcare providers over insurers 

5/08/2025:
Are Insurance Companies Automatically Downcoding Your Claims?

 

 

–––––––––––––––––––
We need your support!

Interested in sharing your experiences with legislators or testifying?
If you have meaningful data or examples to illustrate the burdens insurers are placing upon you, your practice, and your patients, we need to hear from you. Your stories will support our advocacy for these legislative initiatives. 

Get in Touch & Share Your Story >   

OSMA is thrilled to see commitment by members of both the House and Senate to put patients' interests over insurance companies. Here are the initiatives:

No Fees for EFTs

VICTORY: SB 166  •  SPONSOR: Sen. Nathan Manning (R-North Ridgeville)  •  April 1, 2025

  • Language prohibiting health plans for charging providers a fee for delivering payments via check or for electronic transmission of funds was included in the state budget legislation (HB 96) signed into law by Governor DeWine.

  • This budget language inclusion successfully achieves the goal of SB 166, separate legislation we were supporting, sponsored by Sen. Nathan Manning (R-North Ridgeville).

Prior Authorization “Gold Card”

HB 214  •  SPONSOR: Rep. Kevin Miller (R-Newark) 

  • Would exempt healthcare providers who consistently receive a high prior authorization approval rate for a specific service or treatment in a 12-month period from prior authorization requirements for that service/treatment.

  • Also includes data collection provisions mirroring federal CMS requirements set to go into effect in 2027, which will require insurers to share program metrics on their public websites and with ODI on an annual basis.

Non-Medical Switching

SB 160  •  SPONSOR: Sen. Terry Johnson (R-McDermott) and Sen. Beth Liston (D-Dublin)

  • Would prohibit 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.

Automatic Downcoding & Prudent Layperson

SB 165  •  SPONSOR: Sen. Susan Manchester (R-Waynesfield)

  • Would prohibit downcoding for all providers, including prohibition of limitations on reimbursement for time spent with patients.

  • Would 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.

Network Adequacy

HB 219  •  SPONSOR: Rep. Kellie Deeter (R-Norwalk)

  • Would establish 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.

  • Would require insurers to maintain and follow access plans that consist of policies and procedures for assuring the ongoing sufficiency of provider networks.

  • Would establish requirements for written agreements between insurers and participating providers regarding the standards, terms and provisions under which the participating provider will provide covered services to covered patients.

Takebacks/Clawbacks

SB 162  •  SPONSOR: 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 prohibit insurers from charging a provider for appealing a determination of overpayment.

Prior Authorization: Retroactive Denials, Peer to Peer, Appeals

HB 220  •  SPONSOR: Rep. Heidi Workman (R-Rootstown)

  • Would ensure retroactive denial can only occur for non-covered benefits or lack of coverage at the time of service.

  • Would require 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.

  • Would also prohibit insurers from charging providers to appeal rejected claims.

  • Would require insurers to account for dosage adjustments in drug prior authorizations to treat chronic conditions.

Transparency in Health Plan Use of AI

SB 164  •  SPONSOR: Sen. Al Cutrona (R-Canfield)

  • Would require 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.

Copay Accumulators

SB 207 •  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.

Collection of Copays

HB 390 •  SPONSOR: Rep. Jean Schmidt (R-Loveland)

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

 

Biomarker Testing

HB 8 •  SPONSOR: Rep. Andrea White (R-Kettering)

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

 

Prostate Cancer Screening

HB 33 •  SPONSOR: Rep. Dontavius Jarrells (D-Columbus) and Rep. Mark Johnson (R-Chillicothe)

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

 

Breast Cancer Screening and Examination

HB 271 •  SPONSOR: Rep. Jean Schmidt (R-Loveland) and Rep. Josh Williams (R-Sylvania Twp.)

  • Would require 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.