Bill Text: IA HF2488 | 2023-2024 | 90th General Assembly | Amended
Bill Title: A bill for an act relating to prior authorizations and exemptions by health benefit plans and utilization review organizations. (Formerly HSB 641.)
Spectrum: Committee Bill
Status: (Engrossed - Dead) 2024-04-01 - Fiscal note. [HF2488 Detail]
Download: Iowa-2023-HF2488-Amended.html
House
File
2488
-
Reprinted
HOUSE
FILE
2488
BY
COMMITTEE
ON
COMMERCE
(SUCCESSOR
TO
HSB
641)
(As
Amended
and
Passed
by
the
House
February
29,
2024
)
A
BILL
FOR
An
Act
relating
to
prior
authorizations
and
exemptions
by
1
health
benefit
plans
and
utilization
review
organizations.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
Section
514F.8,
Code
2024,
is
amended
by
adding
1
the
following
new
subsections:
2
NEW
SUBSECTION
.
1A.
a.
A
utilization
review
organization
3
shall
respond
to
a
request
for
prior
authorization
from
a
4
health
care
provider
as
follows:
5
(1)
Within
forty-eight
hours
after
receipt
for
urgent
6
requests.
7
(2)
Within
ten
calendar
days
after
receipt
for
nonurgent
8
requests.
9
(3)
Within
fifteen
calendar
days
after
receipt
for
10
nonurgent
requests
if
there
are
complex
or
unique
circumstances
11
or
the
utilization
review
organization
is
experiencing
an
12
unusually
high
volume
of
prior
authorization
requests.
13
b.
Within
twenty-four
hours
after
receipt
of
a
prior
14
authorization
request,
the
utilization
review
organization
15
shall
notify
the
health
care
provider
of,
or
make
available
to
16
the
health
care
provider,
a
receipt
for
the
request
for
prior
17
authorization.
18
NEW
SUBSECTION
.
2A.
A
utilization
review
organization
19
shall,
at
least
annually,
review
all
health
care
services
for
20
which
the
health
benefit
plan
requires
prior
authorization
and
21
shall
eliminate
prior
authorization
requirements
for
health
22
care
services
for
which
prior
authorization
requests
are
23
routinely
approved
with
such
frequency
as
to
demonstrate
that
24
the
prior
authorization
requirement
does
not
promote
health
25
care
quality,
or
reduce
health
care
spending,
to
a
degree
26
sufficient
to
justify
the
health
benefit
plan’s
administrative
27
costs
to
require
the
prior
authorization.
28
NEW
SUBSECTION
.
3A.
Complaints
regarding
a
utilization
29
review
organization’s
compliance
with
this
chapter
may
be
30
directed
to
the
insurance
division.
The
insurance
division
31
shall
notify
a
utilization
review
organization
of
all
32
complaints
regarding
the
utilization
review
organization’s
33
noncompliance
with
this
chapter.
All
complaints
received
34
pursuant
to
this
subsection
shall
not
be
considered
public
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records
for
purposes
of
chapter
22.
1
Sec.
2.
PRIOR
AUTHORIZATION
EXEMPTION
PROGRAM.
2
1.
On
or
before
January
15,
2025,
all
health
carriers
3
that
deliver,
issue
for
delivery,
continue,
or
renew
a
health
4
benefit
plan
in
this
state
on
or
after
January
1,
2025,
and
5
that
require
prior
authorizations,
shall
implement
a
pilot
6
program
that
exempts
a
subset
of
participating
health
care
7
providers,
at
least
some
of
whom
shall
be
primary
health
care
8
providers,
from
certain
prior
authorization
requirements.
9
2.
Each
health
carrier
shall
make
available
on
the
health
10
carrier’s
internet
site
for
each
health
benefit
plan
that
the
11
health
carrier
delivers,
issues
for
delivery,
continues,
or
12
renews
in
this
state,
details
about
the
health
benefit
plan’s
13
prior
authorization
exemption
program,
including
all
of
the
14
following
information:
15
a.
The
health
carrier’s
criteria
for
a
health
care
provider
16
to
qualify
for
the
exemption
program.
17
b.
The
health
care
services
that
are
exempt
from
prior
18
authorization
requirements
for
health
care
providers
who
19
qualify
under
paragraph
“a”.
20
c.
The
estimated
number
of
health
care
providers
who
are
21
eligible
for
the
program,
including
the
health
care
providers’
22
specialties,
and
the
percentage
of
the
health
care
providers
23
that
are
primary
care
providers.
24
d.
Contact
information
for
the
health
benefit
plan
for
25
consumers
and
health
care
providers
to
contact
the
health
26
benefit
plan
about
the
exemption
program,
or
about
a
health
27
care
provider’s
eligibility
for
the
exemption
program.
28
3.
On
or
before
January
15,
2026,
each
health
carrier
29
required
to
implement
a
prior
authorization
exemption
30
program
pursuant
to
subsection
1
shall
submit
a
report
to
the
31
commissioner
of
insurance
that
contains
all
of
the
following:
32
a.
The
results
of
the
exemption
program,
including
an
33
analysis
of
the
costs
and
savings
of
the
exemption
program.
34
b.
The
health
benefit
plan’s
recommendations
for
continuing
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H.F.
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or
expanding
the
exemption
program.
1
c.
Feedback
received
by
each
health
benefit
plan
from
2
health
care
providers
and
other
interested
parties
regarding
3
the
exemption
program.
4
d.
An
assessment
of
the
administrative
costs
incurred
by
5
each
of
the
health
carrier’s
health
benefit
plans
to
administer
6
and
implement
prior
authorization
requirements
under
the
7
exemption
program.
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