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 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 authorization requests within 24 hours and conduct an annual review of their prior authorization processes, submitting detailed reports to the commissioner of insurance that include approval and denial statistics, as well as average processing times.

Furthermore, the bill requires utilization review organizations to annually assess all health care services requiring 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. The findings from this review must also be reported to the commissioner, who will compile a summary report for the general assembly. Complaints regarding compliance with these new regulations can be directed to the insurance division, which will inform organizations of any complaints received, with the stipulation that such complaints will not be considered public records.

Statutes affected:
Introduced: 514F.8