House File 303 amends Section 514F.8 of the Iowa Code to establish new requirements for utilization review organizations regarding prior authorization requests from health care providers. The bill mandates that these organizations provide determinations for urgent requests within 48 hours and nonurgent requests within 10 to 15 calendar days, depending on the complexity of the request. Additionally, organizations must notify providers of receipt of prior authorization requests within 24 hours and conduct annual reviews of their prior authorization processes. The findings from these reviews, including approval and denial rates, must be reported to the commissioner and published on a publicly accessible internet site.

Furthermore, the bill requires utilization review organizations to eliminate prior authorization requirements for services that are routinely approved, indicating that such requirements do not significantly enhance health care quality or reduce costs. Annual reports detailing the evaluations of prior authorizations, including the number of requests evaluated and eliminated, must also be submitted to the commissioner. Complaints regarding compliance with these new regulations can be directed to the insurance division, which will notify the organizations of any noncompliance issues, with such complaints remaining confidential and not considered public records.

Statutes affected:
Introduced: 514F.8
Enrolled: 514F.8