This bill establishes a framework for prior authorization exemptions for certain health care providers in Iowa. It mandates that health carriers grant exemptions to providers for specific health care services if the carrier has approved at least 95% of the provider's prior authorization requests during the most recent evaluation period. The bill defines key terms such as "exemption," "evaluation," and "evaluation period," and requires health carriers to conduct evaluations of contracted providers at least once every three months to determine their eligibility for exemptions. Providers do not need to request an exemption to qualify, and health carriers must notify providers of their exemption status within five calendar days.

Additionally, the bill outlines the process for rescinding exemptions, including the conditions under which a carrier may deny or rescind an exemption based on retrospective reviews of claims. Providers have the right to appeal adverse exemption determinations, and the bill stipulates that carriers cannot retroactively deny claims based on rescinded exemptions unless specific conditions are met. The legislation is set to apply to all health benefit plans issued or renewed in Iowa on or after January 1, 2027.