03/17/2026
Prior Authorization Legislation Clears Major Hurdle
HB 220 Voted Out of House Insurance Committee in Unanimous Vote
OSMA is excited to report that House Bill 220, one of a series of insurance reform proposals we have been spearheading support for in the Ohio Legislature, was voted unanimously out of the House Insurance Committee Tuesday morning. The bill now heads to the House floor for a full House vote. This is a huge step in the legislative process and means that this legislation has cleared its first major hurdle in the path to becoming Ohio law!
As a reminder, HB 220, which is sponsored by Rep. Heidi Workman (R-Rootstown), is intended to streamline the prior authorization process by cleaning up several obstacles to patient care that OSMA members have frequently reported experiencing in their day-to-day work:
- Retroactive denials: HB 220 would ensure that retroactive denial can only occur in the event of non-covered benefits or lack of coverage at the time of service. This includes prohibition of retroactive denials of prior authorization for mental health or substance use disorder treatments.
- Peer-to-peer reviews: This legislation would hold insurers accountable in the peer-to-peer review process by requiring that prior authorization appeals be between a healthcare provider and a clinical peer, and that the clinical peer (plan clinician) making adverse determinations provide identifying information including their specialty and relevant qualifications.
- Appeals: HB 220 would prohibit health insurers from charging a fee for appealing an adverse prior authorization determination.
- Dosage adjustments in drug prior authorizations for chronic illness treatment: Current law dictates that most drug treatments prescribed for maintenance of a chronic condition are subject to a prior authorization approval with a duration of 12 months. Under HB 220, insurers must honor an existing drug prior authorization approval if the provider prescribes a change in dosage of the approved drug.
These represent meaningful changes to the prior authorization process which will lessen the burden on physicians and their patients.
Also in the House Insurance Committee on Tuesday:
House Bill 579 had its first hearing, during which sponsor Rep. Jean Schmidt (R-Loveland) gave sponsor testimony. As a reminder, HB 579 is a companion bill to Senate Bill 164 (sponsored by Sen. Al Cutrona (R-Canfield). These proposals both aim to require insurer transparency regarding their use of AI tools in prior authorization determinations, and to ensure that determinations are made through review of individual merits of claims by licensed clinical professionals. Now that HB 579 has had its first hearing, OSMA will be prepared for the opportunity to provide supportive testimony in the next step of the process, which is a proponent testimony hearing.