06/15/2023

OSMA Provides Key Supportive Testimony for Ohio Prior Authorization “Gold Card” Bill

Last week, OSMA presented proponent testimony in a hearing in the House Insurance Committee in support of House Bill 130, the prior authorization “gold card” legislation.

As a reminder, HB 130 was introduced in the Ohio House in March 2023 by Rep. Kevin Miller (R-Newark), and is one of OSMA’s major legislative advocacy priorities this year. The bill, if enacted, would create an exemption system that rewards Ohio healthcare providers who consistently receive a prior authorization approval rate of 80% or more for a specific service, device, or drug in the prior 12-month period. These providers would receive a “gold card” exempting them from the burden of prior authorization for that specific service, device, or drug.

On Wednesday, June 7, OSMA’s VP of Advocacy, Monica Hueckel, was on hand in the House Insurance Committee to provide testimony on behalf of OSMA. In her testimony, she detailed the hassles of prior authorization and told committee members about how OSMA consistently hears from members with concerns about how prior authorization is currently broadly applied and the negative impact it has upon their ability to provide efficient, high quality, day-to-day care to their patients:

“Many practices and institutions in Ohio and nationwide find themselves having to hire full-time staff members solely to work on prior authorizations in order to have any hope of staying afloat and keeping up with the amount of work the process requires. As also reported in the AMA’s Prior Authorization Physician Survey, physicians and their staff spend more than 13 hours per week on prior authorizations.”

Dr. Robert Stone followed up OSMA’s testimony with a supportive testimony on behalf of Central Ohio Primary Care (COPC), providing a clinical look at prior authorization’s impact on patient care specifically from the primary care perspective.

“Primary care physicians advocate for their patients and find the current system very frustrating in that important care is at a minimum delayed and at worst left undone. For companies like COPC, which works in the population health / value based care space, physicians are already incentivized to provide great care and avoid waste. So, prior authorization programs only impede care and serve no other purpose for this group. Even for groups which are not incentivized for value, however, prior authorization simply delays needed care,” Dr. Stone explained.

Dr. Derek McClellan (also present on behalf of COPC), Dr. Stone, and Monica Hueckel then took several questions from members of the committee.

26 additional written testimonies were provided to the committee in support of HB 130, many from other health care organizations and providers throughout the state.

After the hearing, Monica Hueckel was also featured in a piece by WKYC out of Cleveland, for which she was interviewed about prior authorization and about HB 130.

This hearing is a key step in HB 130’s legislative journey, and OSMA is thrilled to have cleared this hurdle and to be moving forward in the legislative process before the legislators leave for summer recess. Your OSMA advocacy team will continue to do important groundwork for this legislation in the coming summer months and pick up with the direct advocacy efforts when the elected officials return this fall.

RESOURCES:

Watch the hearing in archive format >

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To date, more than 30 Ohio healthcare associations, organizations, and practices have signed on to support House Bill 130. OSMA is looking forward to continuing our work with this coalition of provider and patient groups to support passage of this critically important legislation.