The "Idaho Prior Authorization Reform Act" introduces a new chapter to Title 41 of the Idaho Code, aimed at safeguarding the healthcare provider-patient relationship from excessive third-party interference and ensuring that prior authorization processes do not hinder medical judgment. The Act applies to all health benefit plans and issuers, with certain exemptions, and establishes requirements for prior authorization, including the obligation for health insurance issuers to maintain and clearly disclose a list of services requiring prior authorization, as well as to provide timely notifications of any changes.

Additionally, the bill mandates the implementation of a prior authorization application programming interface (API) by January 1, 2027, to enhance electronic communication between healthcare providers and insurers. It sets forth specific timelines for decision-making, requiring issuers to notify enrollees and providers of decisions within seven calendar days for standard requests and within 72 hours for expedited requests. The legislation also outlines the review and appeal process for adverse determinations, prohibits the revocation of prior authorizations under certain conditions, and requires periodic reviews of prior authorization practices by health insurance issuers. Overall, the Act aims to streamline the prior authorization process and improve the quality of care for patients in Idaho.