Senate Bill (SB) 129, a bill that significantly reforms Ohio’s prior authorization processes, passed the Ohio General Assembly on May 25 and is on its way to the governor’s office to be signed into law. Governor John Kasich is expected to sign the bill into law.
The Ohio Academy of Family Physicians strongly supported SB 129. OAFP Past President Sarah Sams, MD, testified before the House Insurance Committee detailing patient examples that illustrated why reforms were so needed. OAFP President Tom Houston, MD, had earlier submitted written, supportive testimony to the Senate Insurance Committee.
Prior authorization is a process that requires physician offices to ask for permission from a patient’s insurance company before prescribing certain medications or performing medical treatment. But, too often, insurance carriers later renege or drop coverage once medical services have begun.
- Ensures that prior authorization requirements or restrictions are listed on the health insurer’s website
- Allows physicians and other health care professionals and patients to obtain prior authorizations through a web-based system
- Ensures that any new or future prior authorization requirements are disclosed prior to the new requirement being implemented
- Guarantees that once a prior authorization has been approved, the insurer will not retroactively deny the service based upon previously approved medical necessity or coverage criteria
- Guarantees a faster turnaround on prior authorization requests and a streamlined appeals process in the event a prior authorization is denied.