06/15/2016

Senate Bill 129 Insurers - Prior Authorization Requirements

Governor John Kasich signed SB 129 (Gardner-R Bowling Green) into law on Monday, June 13^th, which provides timelines for insurers (including Managed Care and Medicaid) to respond to prior authorization requests by providers for services, drugs and medical devices. The response timelines stipulated in the bill are 24 hours for emergency requests, 48 hours for urgent requests, and 10 calendar days for all other request.  Additionally, it requires insurers to honor a 12 month prior approval for drugs for chronic conditions with certain exclusions.  It also stipulates the electronic methods by which prior authorization requirements can be submitted, stored, and responded. It establishes that no prior authorizations may be retroactively denied after they have already been granted to a patient. LeadingAge Ohio joined numerous health care organizations to provide input on the bill. Certain provisions of the bill take effect January 1, 2017. Click here for the bill analysis.

Who is affected by SB 129?

The provisions of SB 129 will impact the following Ohioans:

1. Individuals receiving healthcare coverage through an employer-sponsored plan that is not covered by ERISA
   
   
2. Individuals receiving healthcare coverage through Ohio Medicaid
   
   
3. Individuals receiving healthcare coverage through other private or commercial coverage that is not covered by ERISA

The provisions of SB 129 will not impact the following Ohioans:

1. Individuals receiving healthcare coverage through Medicare or Medicare Advantage
   
   
2. Individuals receiving healthcare coverage through the Health Insurance Exchange
   
   
3. Individuals receiving healthcare coverage through an employer-sponsored plan that is governed by ERISA (self-insured)
   
   
4. Individuals who are uninsured