01/29/2016

Prior Authorization Reform Clears Senate

Though the bill does not directly affect EM physicians, Ohio ACEP supports positive healthcare reforms that limit administrative burdens and prevent delays in treatment

Senate Bill 129—introduced by Sens. Capri Cafaro (D – Hubbard) and Randy Gardner (R – Bowling Green)—has unanimously passed the Ohio Senate. Though SB 129 will not directly impact emergency physicians, the bill would make important reforms to the prior authorization system, prevent disruption in the physician-patient relationship, and avert delays in diagnosis and treatment.

SB 129 would make several improvements to the prior authorization system by:

• Creating a web-based system for submitting prior authorization requests;
• Establishing timeframes for responding to prior authorization requests;
• Prohibiting insurers from retroactively denying coverage for a prior authorization after it has been approved;
• Ensuring new or future prior authorization requirements are disclosed to the provider community at least 60 days in advance;
• Creating a streamlined appeals process in the case a prior authorization is denied

Ohio ACEP supports our physician colleagues’ efforts to reform prior authorization. The next stop for SB 129 is the Ohio House, where it has been assigned to the House Insurance Committee for consideration.