A bill that will significantly reform Ohio’s prior authorization rules is heading to Gov. John Kasich’s desk, who is expected to sign it into law within the next few weeks.
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. As ACG members know, insurance carriers will often later deny or drop these medical services once commenced.
The “Insurers-prior authorization requirements” bill (SB 129) makes the following changes:
- Ensures that prior authorization requirements or restrictions are listed on the health insurer’s website;
- allows providers and patients to obtain prior authorization through a web-based system;
- ensures that any new or future prior authorization requirements are disclosed prior to the new requirement being implemented;
- requires 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; and,
- requires a faster turnaround on prior authorization requests and a streamlined appeals process in the event a prior authorization is denied.
Remember to contact your ACG Governor on important state and local issues impacting you and your practice
The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows that are elected from the membership of a particular state or region. There are currently 76 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps the College make certain it is meeting the evolving needs of the membership.
David G. Mangels, MD, FACG Ashley L. Faulx, MD, FACG
ACG Governor for Southern Ohio ACG Governor for Northern Ohio