This bill amends Section 514F.8 of the Iowa Code to establish new requirements for utilization review organizations regarding prior authorization requests from health care providers. It mandates that organizations provide determinations for urgent requests within 48 hours and for nonurgent requests within 10 calendar days, with a possible extension to 15 calendar days under certain circumstances. Additionally, organizations must notify providers of receipt of prior authorization requests within 24 hours and conduct annual reviews of their authorization processes, reporting their findings to the commissioner of insurance. The report must include detailed statistics on approval and denial rates for both urgent and nonurgent requests, as well as the average and median response times.

Furthermore, the bill requires organizations to review all health care services that require prior authorization and eliminate those requirements for services that are routinely approved, indicating that such requirements do not effectively promote health care quality or reduce costs. Organizations must submit annual reports detailing the results of these reviews, including the number of prior authorizations evaluated and eliminated. The commissioner of insurance is tasked with summarizing and analyzing this information for the general assembly. Complaints regarding compliance with the new regulations can be directed to the insurance division, which will notify organizations of any complaints received, and these complaints will not be considered public records.

Statutes affected:
Introduced: 514F.8