Relating to prior authorizations and exemptions by health benefit plans and utilization review organizations

Sponsored by the House Commerce Committee

Official bill page Lobbyist declarations One-pager to print

Where it is now

Done: IntroducedFebruary 13, 2024
Skipped: SubcommitteeSkipped
Done: House committeeFebruary 29, 2024
Done: Passes the HouseFebruary 29, 202495–0
Done: Senate committeeMarch 18, 2024
Done: Passes the SenateMarch 26, 202447–1
Stopped: To the GovernorDied when the General Assembly ended
Next: Signed into law

Died when the session ended The General Assembly adjourned on April 19, 2024. Bills that didn’t pass both chambers died. What’s a funnel?

What’s in it

This bill relates to prior authorizations and exemptions by health benefit plans and utilization review organizations. The bill requires a utilization review organization (organization) to respond to a request for prior authorization (authorization) from a health care provider (provider) within hours after receipt for urgent requests or within calendar days for nonurgent requests, unless there are complex or unique circumstances, or the organization is experiencing an unusually high volume of authorization requests, then an organization must respond within calendar days.

Read the full explanation

Within hours after receipt of an authorization request, the organization shall notify a provider of, or make available, a receipt for the authorization request. The bill requires an organization to annually review all health care services for which authorization is required and to eliminate authorization requirements for health care services for which authorization requests are so routinely approved that the authorization requirement is not justified as it does not promote health care quality or reduce health care spending. Complaints regarding an organization’s compliance with the bill may be directed to the insurance division, and the insurance division shall notify an organization of all complaints. Complaints received under the bill shall not be considered public records. The bill requires, on or before January 15, 2025, all health carriers (carriers) that deliver, issue for delivery, continue, or renew a health benefit plan (plan) in this state on or after January 1, 2025, to implement a pilot program that exempts a subset of participating providers, including primary health care providers, from certain authorization requirements. Each carrier shall make available for each plan details about the plan’s authorization exemption requirements on the carrier’s internet site, including the carrier’s criteria for a provider to qualify for the exemption program, the health care services that are exempt from authorization requirements, the estimated number of providers who are eligible for the program, including the providers’ specialties and the percentage of the providers that are primary care providers, and contact information for consumers and providers to contact the plan about the exemption program or a provider’s eligibility for the exemption program. On or before January 15, 2026, each carrier required to implement an authorization exemption program (program) under the bill shall submit to the commissioner of insurance a report containing the results of the program, including an analysis of the costs and savings of the program, the plan’s recommendations for continuing or expanding the program, feedback received by each plan, and an assessment of the administrative costs incurred by each of the carrier’s plans to administer and implement authorization requirements under the program.

From the explanation printed with the bill as introduced, written by the Legislative Services Agency. Amendments adopted later aren’t reflected. Full bill text

Senate subcommittee

Named March 6, 2024. On March 11, 2024 it recommended amendment and passage. [].

Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part

Fiscal note

Cost: up to $340,000 Compare with other bills

Division I may increase costs to the State of Iowa Insurance Plan and the BOR Insurance Plans beginning in CY 2025. Increased costs to the BOR Insurance Plans are estimated to be minimal. 1%, which would reflect a $340,000 increase. The duration of the pilot programs required by the Division is not known; therefore, the duration of potential costs cannot be determined at this time.

Insurance, Prior Authorizations · April 1, 2024
Insurance, Prior Authorizations · February 28, 2024

Nonpartisan cost estimates from the Legislative Services Agency’s Fiscal Services Division. The newest is first. Reading a fiscal note

Iowa Code it changes

Amends§514F.8

Read from the bill as introduced. Each links to every bill touching that chapter of the Iowa Code. How the Code works

Lobbying

13 for · 3 against · 7 undecided · Who →

Family tree

Where this legislation came from and where it went: earlier tries, the versions it moved through this Assembly, and later bills built on it.

90th General Assembly

HF 2488Passed a chamber

Picked up later

HF 303Became law91st GA

Earlier and later bills are matched by wording or an identical title; check the text to be sure it’s the same idea.

Similar bills

HF 303 Relating to prior authorization and utilization review organizations
91st General Assembly · Signed by Governor
Nearly identical
SF 562 Relating to utilization review organizations, prior authorizations and exemptions, medical…
91st General Assembly · In committee
Similar

Matched by the wording of each bill’s explanation, or an identical title. Companion bills and renumbered versions of this bill aren’t listed; they’re the same bill.