OH HB214

Requires health insuring corporations, sickness and accident insurers, public employee benefit plans, and Medicaid to report prior authorization data annually by March 31, beginning in 2027, including approval/denial rates, appeal outcomes, and average processing times

Mandates prior authorization exemptions for healthcare providers with at least 90% approval rates who submitted at least 20 prior authorization requests for a specific service, device, or drug in the preceding 12 months

Exemptions must last at least 12 months and can only be revoked after review of 20 random claims shows less than 90% would have been approved based on medical necessity

Exemption denials or revocations must be made by a licensed healthcare provider in the same or similar specialty as the provider being evaluated, and providers may appeal such decisions

Reports must be published on the Department of Insurance website and submitted to the General Assembly