This bill amends Section 514F.8 of the Iowa Code to establish new requirements for utilization review organizations regarding prior authorizations. It mandates that these organizations respond to urgent requests within 48 hours and nonurgent requests within 10 calendar days, extending to 15 calendar days in cases of complexity or high volume. Additionally, organizations must notify health care providers of receipt of prior authorization requests within 24 hours and are required to conduct annual reviews of services requiring prior authorization, eliminating those that are routinely approved and do not justify the administrative costs involved. Complaints about compliance can be directed to the insurance division, which will notify organizations of any complaints received, and these complaints will not be considered public records.

Furthermore, the bill requires all health carriers that issue health benefit plans in Iowa to implement a pilot program by January 15, 2026, which exempts certain health care providers, including primary care providers, from specific prior authorization requirements. Health carriers must provide detailed information about the exemption program on their websites, including eligibility criteria and the services exempted. By January 15, 2027, carriers must report to the commissioner of insurance on the program's results, including cost analyses, recommendations for future actions, feedback from providers, and an assessment of administrative costs related to the program.

Statutes affected:
Introduced: 514F.8