Bill Text: IA HSB650 | 2021-2022 | 89th General Assembly | Introduced

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Bill Title: A bill for an act relating to reimbursement for health care services provided after receipt of a prior authorization, and including applicability provisions.(See HF 2399.)

Spectrum: Committee Bill

Status: (Introduced - Dead) 2022-02-14 - Committee report approving bill, renumbered as HF 2399. [HSB650 Detail]

Download: Iowa-2021-HSB650-Introduced.html

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House Study Bill 650 - Introduced
HOUSE FILE _____
BY (PROPOSED COMMITTEE
ON COMMERCE BILL BY
CHAIRPERSON LUNDGREN)
A BILL FOR
An Act relating to reimbursement for health care services
provided after receipt of a prior authorization, and
including applicability provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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H.F. _____
Section 1. NEW SECTION . 514F.8 Preauthorizations ——
reimbursement.
1. For purposes of this section:
a. “Covered person” means a policyholder, subscriber,
enrollee, or other individual participating in a health benefit
plan.
b. “Facility” means the same as defined in section 514J.102.
c. “Health benefit plan” means the same as defined in
section 514J.102.
d. “Health care professional” means the same as defined in
section 514J.102.
e. “Health care provider” means a health care professional
or a facility.
f. “Health care services” means services provided by a
health care provider for the diagnosis, prevention, treatment,
cure, or relief of a health condition, illness, injury, or
disease. “Health care services” includes dental care services,
pharmaceutical products or services, and the provision of
durable medical equipment.
g. “Health carrier” means the same as defined in section
514J.102.
h. “Prior authorization” means a determination by a
utilization review organization that a specific health care
service proposed by a health care provider for a covered person
is medically necessary or medically appropriate, and the
determination is made prior to the provision of the health care
service to the covered person, and, if applicable, includes a
utilization review organization’s requirement that a covered
person or a health care provider notify the utilization review
organization prior to receiving or providing a specific health
care service.
i. “Utilization review” means a set of formal techniques
designed to monitor the use of, or evaluate the medical
necessity, appropriateness, efficacy, or efficiency of, health
care services. Techniques may include but are not limited to
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H.F. _____
case management, preadmission review, pretreatment review, and
prior authorization.
j. “Utilization review organization” means an entity that
performs utilization review, including a health carrier that
meets the requirements established for accreditation set by the
utilization review accreditation commission or the national
committee on quality assurance and that performs utilization
review for the health carrier’s health benefit plans.
2. a. A utilization review organization shall not revoke,
or impose a limitation, condition, or restriction on, a prior
authorization after the date on which a health care provider
provides a health care service to a covered person per the
prior authorization.
b. A health carrier shall reimburse a health care provider
at the contracted reimbursement rate for a health care service
provided by the health care provider to a covered person per
a prior authorization.
3. A prior authorization for a specific health care service
for a covered person shall be valid for the specific health
care service for not less than one year from the date that
the covered person’s health care provider receives the prior
authorization from a utilization review organization.
4. The commissioner may adopt rules pursuant to chapter 17A
as necessary to administer this chapter.
Sec. 2. APPLICABILITY. This Act applies January 1, 2023, to
health benefit plans that are delivered, issued for delivery,
continued, or renewed in this state on or after that date.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
This bill is related to reimbursement for health care
services provided after receipt of a prior authorization.
The bill prohibits a utilization review organization from
revoking, or imposing a limitation, condition, or restriction
on a prior authorization after the date on which a health care
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H.F. _____
provider provides a health care service to a covered person
per the prior authorization. The bill requires a health
carrier to reimburse a health care provider at the contracted
reimbursement rate for a health care service provided by
the provider to a covered person per a prior authorization.
“Covered person”, “health benefit plan”, “health care
provider”, “health care services”, “health carrier”, “prior
authorization”, “utilization review”, and “utilization review
organization” are defined in the bill.
The bill provides that a prior authorization for a specific
health care service for a specific covered person shall be
valid for not less than one year from the date that the covered
person’s health care provider receives the prior authorization
from a utilization review organization.
The commissioner of insurance may adopt rules as necessary
to administer the bill.
The bill applies to health benefit plans that are delivered,
issued for delivery, continued, or renewed in this state on or
after January 1, 2023.
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