To amend sections 1751.72, 3923.041, and 5160.34 of the Revised Code regarding health insurance and Medicaid program prior authorization requirements.
HB220 would revise Ohio law governing prior authorization for health insurance, public employee benefit plans, and Medicaid. The bill requires covered entities to accept prior authorization requests electronically, sets response deadlines of 48 hours for urgent care and 10 calendar days for non-urgent requests, and requires denials or incomplete-request responses to include specific reasons or missing information. It also requires electronic receipts for submissions, public posting of prior authorization requirements, advance notice of new requirements, and a streamlined appeal process with no appeal fee.
The bill also creates a longer approval period for certain drugs used to treat chronic conditions: a prior authorization approval for an approved drug would generally last up to 12 months, subject to eligibility, medical evidence, and exceptions for certain medications such as controlled substances, opioids, benzodiazepines, and drugs with shorter typical treatment periods. It further limits retroactive denials after approval, including for mental health and substance use disorder treatment, except in cases of fraudulent or materially incorrect information, and allows retrospective review when a related service was not known to be needed at the time of the original authorized service. The bill applies these requirements to health insuring corporations, sickness and accident insurers, public employee benefit plans, and Medicaid, while excluding several categories of limited or supplemental coverage.
In practical terms, HB220 would impose new administrative and timing requirements on insurers, managed care plans, and Medicaid administrators, while giving providers and patients more predictable prior authorization decisions and stronger protections against post-service denials. It would also make contrary contract terms unenforceable and treat repeated violations as an unfair and deceptive insurance practice, giving the superintendent of insurance and the Medicaid director rulemaking authority to implement the changes.
The available voting history suggests the bill has been well received in the House, with unanimous favorable passage in committee and a strong floor vote of 84-11. No committee transcript was provided, so there is no recorded debate to indicate detailed arguments for or against the measure. Overall, the bill appears to have broad support for reducing prior authorization delays and increasing transparency, though the exceptions for controlled substances and the administrative burden on payers are likely the main areas where concerns could arise.
The main point of contention in the text itself is the balance between faster, more transparent approvals and the need for utilization management, especially for drugs requiring ongoing review or involving controlled substances. The bill preserves insurer and Medicaid program discretion in several areas, but it limits that discretion by setting deadlines, requiring explanations, and restricting retroactive denials. Supporters are likely providers, patients, and advocates for access to care; opponents or cautious stakeholders would likely be insurers, pharmacy benefit managers, and managed care organizations concerned about cost control and operational flexibility.
HB220 would amend sections 1751.72, 3923.041, and 5160.34 of the Revised Code to standardize and tighten prior authorization rules across health insuring corporations, sickness and accident insurers, public employee benefit plans, and Medicaid. It would require electronic submission and response systems, impose response deadlines, mandate notice and disclosure of prior authorization rules, create an appeal process, and limit retroactive denials after approval. It would also establish a 12-month prior authorization approval period for certain chronic-condition drugs, subject to exceptions, and authorize rulemaking by the insurance superintendent and Medicaid director.
The bill’s available vote history indicates strong support, with unanimous favorable committee action and a decisive House passage of 84-11. Because no committee transcript is available, there is no direct record of floor or committee debate, but the vote pattern suggests broad agreement with the bill’s goal of reducing prior authorization delays and improving transparency. Any opposition appears limited and likely centered on administrative burden, cost, and the scope of mandated coverage procedures.
The main areas of contention are likely the bill’s limits on insurer and Medicaid utilization management versus the desire to preserve flexibility to review medical necessity and control costs. Specific pressure points include the 12-month approval requirement for chronic-condition drugs, the prohibition on retroactive denials except for fraud or materially incorrect information, the requirement to explain denials and incomplete requests, and the ban on appeal fees. Insurers, managed care organizations, and pharmacy benefit managers would likely be the most affected parties on the cost and operations side, while providers and patients would benefit from faster decisions and more predictable coverage.