Advocacy Update—Insurance Reform

The Ohio Legislature continues to consider a large swath of legislative proposals pertaining to health insurance reform, with many of these bills going through hearings in House and Senate Committees this fall. This slate of legislation is supported by a large coalition of medical and health care organizations, including OGS.

The very first hearings held in each chamber for a legislative proposal are sponsor hearings, in which the sponsor or sponsors of the bill introduce their legislation to the members of the Committee that bill is assigned to, and make the case for their legislation’s necessity. It is an important first step and represents the first hurdle in every piece of legislation’s journey.

There were recent sponsor hearings for HB 390, HB 429, SB 164, and SB 165 in the last few months. Now, proponent hearings, where the supporters of these bills can provide testimony, can soon follow in the New Year.

In the last several months before the legislators took a break for the holidays, there have also been proponent hearings on the following:

HB 219: Network Adequacy

• To establish standards for both the creation and maintenance of insurance networks and assure the adequacy, accessibility, transparency, and quality of health care services being offered under a commercial network plan.

HB 220: Prior Authorization

• Would streamline the prior authorization process by prohibiting retroactive denials of prior authorization, except in the instance of a non-covered benefit or lack of coverage at the time of service.

• Would require peer-to-peer reviews to be between the practitioner requesting the service in question and a clinical peer, and that peer must identify themselves, including specialty and relevant qualifications.

• Builds on current Ohio law requiring drug prior authorizations for maintenance medications to treat a chronic condition to be considered valid for a year, by requiring that year-long prior authorization to account for dosage adjustments.

SB 160: Non-Medical Switching

• Would prohibit the practice of “non-medical switching” (when the insurer requires a patient to switch from their current medication to a different one for reasons unrelated to the patients’ health, or for “non-medical” reasons) in the middle of a plan year.

SB 162: Takebacks

• Would limit the timeframe for insurance takebacks, creating fairness and financial stability for healthcare providers.

SB 207: Copay Accumulators

• Would require health insurers to count amounts paid by or on behalf of covered individuals toward deductibles and cost-sharing requirements.

• We hope these insurance reform proposals will shed light on the massive burdens that insurance companies are putting on our healthcare system, as well as the negative impacts of those burdens on physicians and their patients.

---

Find out more information about the full list of insurance reform legislation, and read or watch videos of the testimonies from the legislative committee hearings by visiting OSMA’s Insurance Reform page.