OH HB130

Requires health insuring corporations, sickness and accident insurers, and medical assistance programs to grant exemptions from prior authorization requirements for health care services, devices, or drugs if they approve at least 80 percent of requests from a provider for that service during the previous 12 months.

Exemptions must last a minimum of 12 months and insurers cannot require providers to request an exemption; providers must receive written notice including exemption dates if granted.

Requires insurers and programs to publish prior authorization data on their public websites including provider specialty, type of authorization, indication for use, denial reasons, appeal results, and response times.

Allows providers to request evidence supporting denial of exemptions (limited to one request per calendar year per service) and to appeal exemption denials; insurers may only revoke exemptions if less than 80 percent of randomly selected claims would have been approved based on medical necessity.

Series of violations of these requirements constitute unfair and deceptive practices under Ohio insurance law; superintendent of insurance may adopt rules to implement requirements.