On Monday, June 13, Ohio Governor John Kasich signed Senate Bill 129, an important piece of prior authorization legislation, into law. The bill, sponsored by Senators Capri Cafaro and Randy Gardner:
- ensures that prior authorization requirements or restrictions are listed on the health insurer’s website and allows providers and patients to obtain prior authorization through a web-based system;
- ensures that any new or future prior authorization requirements are disclosed prior to the new requirement being implemented;
- requires that once a prior authorization has been approved, the insurer will not retroactively deny the service based upon previously approved medical necessity or coverage criteria; and
- requires a faster turnaround on prior authorization requests and a streamlined appeals process in the event a prior authorization is denied.
Ohio arthritis Advocates have actively supported this bill for two years making legislative visits to share their stories about the long waits associated with prior authorization practices. It was one of the priority issues at the recent Joint Advocacy and Access Day with the Ohio Association of Rheumatology (OAR) on April 21 in Columbus.
For Nikki Domer and her family, passage of this bill was personal. Nikki’s 6-year-old daughter has lived with juvenile rheumatoid arthritis for the past four years. Their insurance company was very slow to decide if it would cover the needed medications, delaying treatment for no apparent reason and unnecessarily risking her daughter’s health. Nikki and her other daughter, Payton, participated in the April 21 legislative visits.
When the bill passed, Nikki was overwhelmed with emotion. “I have tears of joy. Seriously! I cried for a good five minutes,” said Nikki. “To see something so many of us have worked so hard for, not just for us, but for everyone who needs treatment, and see it passed, is monumental. This is a huge step up for our healthcare system, and now, patients will be able to get the treatment they need in a timely manner.”
Payton and Nikki also participated in the 2016 Advocacy Summit this past March. The 2017 Advocacy Summit will be held March 6-7 in Washington, DC. For more information about the 2017 Summit or the Foundation’s Advocate program, go to www.Arthritis.org/Advocate.