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OH HB218
Bill
Status
12/26/2011
Primary Sponsor
Christina Hagan
Click for details
AI Summary
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Replaces specific drug compendia references with compendia adopted by U.S. Department of Health and Human Services under 42 U.S.C. 1395x(t)(2) for determining off-label drug coverage in health insurance policies.
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Establishes comprehensive external review process under new Chapter 3922 allowing covered persons to appeal adverse benefit determinations involving medical judgments through independent review organizations assigned by the superintendent of insurance.
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Creates three types of external reviews: standard reviews (30 days), expedited reviews (72 hours for urgent medical conditions), and reviews for experimental/investigational treatments with specific clinical reviewer qualifications and decision-making procedures.
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Requires health plan issuers to establish internal appeal processes compliant with federal Affordable Care Act regulations before external reviews can be requested, with expedited internal appeals available for serious medical conditions.
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Repeals previous external review sections (1751.831, 1751.84-88, 3901.80-84, 3923.66-70, 3923.75-79) and transfers superintendent's contractual coverage review authority to new process under Chapter 3922.
Legislative Description
To use the compendia adopted by the United States Department of Health and Human Services to determine whether an insurer may exclude coverage for off-label drug usage and to revise the external review process used by health plan issuers.
US Dept of HHS compendia-use in excluding coverage for off-label drugs
Last Action
Effective Date
12/26/2011