The "Idaho Prior Authorization Reform Act" introduces significant changes to the prior authorization processes in health insurance by adding a new chapter to Title 41 of the Idaho Code. The bill aims to improve transparency and efficiency, ensuring that prior authorization does not disrupt the provider-patient relationship or the medical judgment of healthcare professionals. Key provisions include the requirement for health insurance issuers to maintain and publicly disclose a comprehensive list of services requiring prior authorization, provide timely notifications regarding approvals or adverse determinations, and implement standardized electronic prior authorization processes by July 1, 2026. Additionally, the bill establishes guidelines for expedited prior authorizations and mandates the use of evidence-based clinical review criteria.

Furthermore, the legislation sets forth new regulations for urgent health care services, requiring health insurance issuers to notify enrollees and their healthcare providers of decisions within 24 hours of receiving necessary information. It also mandates detailed notifications for adverse determinations, including reasons for denial and appeal instructions, with appeals reviewed by qualified physicians not involved in the initial decision. The bill includes provisions for the revocation of prior authorizations, continuity of care for 90 days under new plans, and annual reporting requirements for health insurance issuers, along with penalties for non-compliance. An emergency clause is included, making the act effective from July 1, 2026.