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. Specifically, it mandates that 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 providers of receipt of prior authorization requests within 24 hours and are required to conduct annual reviews of health care services that require 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 handle them confidentially.

Furthermore, the bill requires health carriers to implement a pilot program by January 15, 2026, that exempts certain health care providers, including primary care providers, from specific prior authorization requirements. 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, and feedback from providers. This initiative aims to streamline the prior authorization process and reduce unnecessary administrative burdens on health care providers.

Statutes affected:
Introduced: 514F.8