Continuity of Stabilizing Treatment Act
Policy Brief
Overview
The Continuity of Stabilizing Treatment Act is a state-level legislative proposal designed to ensure uninterrupted access to medically necessary stabilizing treatment within Ohio-regulated health plans.
The proposal establishes a continuity-first sequencing standard, allowing clinically necessary stabilizing therapy to begin immediately while administrative review proceeds. This approach preserves insurer oversight while preventing treatment delays that may contribute to avoidable clinical deterioration.
The Act operates entirely within Ohio’s insurance regulatory authority and does not apply to self-funded employer plans governed by federal ERISA law.
The Problem
Utilization review and prior authorization processes play an important role in managing healthcare costs and ensuring medical necessity. However, when administrative approval is required before stabilizing treatment begins, patients may experience delays in care during medically vulnerable periods.
In time-sensitive clinical contexts, treatment interruption can contribute to:
• Emergency department utilization
• Hospitalization or higher-acuity medical intervention
• Avoidable escalation of healthcare costs
Patients receiving treatment from insurer-credentialed in-network providers reasonably rely on continuity of prescribed therapy. Administrative delays may unintentionally disrupt stabilization when prompt treatment is clinically necessary.
The Policy Solution
The Continuity of Stabilizing Treatment Act introduces a treat-first / review-later sequencing standard for narrowly defined stabilizing care.
Key provisions include:
Immediate access for continuity-critical medications
Medications that, if delayed or interrupted, pose a predictable risk of physiological destabilization may be dispensed immediately.
Post-dispensing utilization review preserved
Insurers retain the authority to review medical necessity after treatment initiation.
Patient protection from recoupment disputes
Patients are protected from retroactive financial liability resulting solely from insurer-provider administrative disputes.
Oversight by the Ohio Department of Insurance
The Department will monitor compliance and issue implementation guidance.
Structural Safeguards
The proposal is narrowly tailored to maintain insurer oversight while preventing unintended expansion of coverage obligations.
The Act:
• Applies only to treatment prescribed by in-network providers
• Preserves medical necessity standards and utilization review authority
• Does not mandate coverage of elective or non-medically necessary services
• Does not expand underlying benefit mandates
• Maintains insurer-provider contractual reconciliation processes
Expected Benefits
A continuity-first sequencing model may:
• Reduce avoidable treatment delays
• Improve patient stability during medically vulnerable periods
• Decrease emergency department utilization related to treatment interruption
• Maintain predictable insurance market operations
• Preserve insurer utilization management authority
Legislative Scope
The Act applies only to health plans regulated under Ohio insurance law, including:
• Fully insured commercial health plans
• Marketplace plans
• Medicaid managed care plans
Self-funded employer plans governed by federal ERISA law are not affected.
Full Legislative Proposal
The complete legislative draft of the Continuity of Stabilizing Treatment Act is available in the Public Reason Institute Policy Library.