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Amendments › HF 2635

Amendment S-5067 to HF 2635

Relating to health carriers standards of conduct; utilization review organizations, artificial intelligence, audits, and prior authorizations; certificate of need processes; and including applicability provisions

Adopted · March 4, 2026

Filed March 4, 2026 in the Senate by Sen. Kara Warme (R)

What it changes

  1. Page 1, after line 2 by inserting: “Sec. ___. Section 514F.8, subsection 1, Code 2026, is amended by adding the following new paragraph: NEW PARAGRAPH . 0b. “Downgrade” means a decision by a utilization review organization to change an expedited or urgent request for prior authorization to a standard determination, or otherwise modify a health care service that is the subject of a request for prior authorization to a lower-level health care service.”
  2. Page 2, after line 20 by inserting: “
  3. A health care provider may opt-in to receive electronic delivery of notices and audit determinations from a utilization review organization. A utilization review organization may determine the method by which a health care provider may opt-in.”
  4. Page 2, line 21, by striking “
  5. ” and inserting “
  6. ”
  7. Page 3, line 6, by striking “
  8. ” and inserting “
  9. ”
  10. Page 3, line 8, by striking “
  11. ” and inserting “
  12. ”
  13. Page 3, by striking lines 12 and
  15. Page 4, after line 4 by inserting: “Sec. ___. Section 514F.8, Code 2026, is amended by adding the following new subsection: NEW SUBSECTION . 6A. a. A health care provider shall submit all requests for prior authorization to a health carrier electronically using a standards-based application programming interface, or another form of electronic submission, supported by the health carrier that is compliant with federal interoperability regulations. b. This subsection applies to a request for prior authorization made on or after July 1,
  16. ”
  17. Page 6, by striking lines 25 through 27 and inserting “shall include the qualified reviewer’s board certifications, specialty expertise, and educational background, excluding any personal identifiable information.”
  18. Page 7, by striking lines 1 through 3 and inserting “clinical peer’s board certifications, specialty expertise, and educational background, excluding any personal identifiable information.”
  19. Page 8, after line 29 by inserting: “b. “Emergency medical condition” means the same as defined in 42 C.F.R. §438.114.”
  20. Page 8, line 30, by striking “b.” and inserting “c.”
  21. Page 8, line 32, by striking “c.” and inserting “d.”
  22. Page 8, line 34, by striking “d.” and inserting “e.”
  23. Page 9, line 1, by striking “e.” and inserting “f.”
  24. Page 9, line 3, by striking “f.” and inserting “g.”
  25. Page 12, after line 5 by inserting: “Sec. ___. NEW SECTION . 249A.6 Prior authorization —— requests.
  26. A health care provider submitting a request for prior authorization to a managed care organization shall submit the request electronically using a standards-based application programming interface, or another form of electronic submission, supported by the managed care organization, that is compliant with federal interoperability regulations.
  27. This section applies to a request for prior authorization made on or after July 1,
  28. ”
  29. By renumbering as necessary.

Official amendment (PDF) · In the Bill Book