What changed in HF 303

2 passages reworded, 16 added and 13 removed; 7 of 38 unchanged.

Removed AddedIntroduced textText as passedAmendments

Compares wording only. The printed bills also mark changes to existing law with strikes and underlines, which aren’t shown here.

Section 1. Section 514F.8, Code 2025, is amended by adding the following new subsections:

NEW SUBSECTION. 1A.

a. A utilization review organization shall respond provide a determination to a request for prior authorization from a health care provider as follows:

(1) Within forty-eight hours after receipt for urgent requests.

b. Within twenty-four hours after receipt of a prior authorization request, the utilization review organization shall notify the health care provider of, or make available to the health care provider, a receipt for the request for prior authorization.

c. A utilization review organization shall conduct an annual review and submit the findings in a report to the commissioner pursuant to the reporting procedures and deadlines established by the commissioner. The commissioner shall publish, within sixty calendar days of receipt, the report on a publicly accessible internet site. The annual report shall include all of the following:

(1) The total number of, and percentage of, urgent prior authorization requests that the utilization review organization approved, aggregated for all health care services and items.

(2) The total number of, and percentage of, urgent prior authorization requests that the utilization review organization denied, aggregated for all health care services or items.

(3) The total number of, and percentage of, nonurgent prior authorization requests that the utilization review organization approved, aggregated for all health care services or items.

(4) The total number of, and percentage of, nonurgent prior authorization requests that the utilization review organization denied, aggregated for all health care services or items.

(5) The total number of, and percentage of, nonurgent prior authorization requests that were complex or involved unique circumstances that the utilization review organization approved, aggregated for all health care services or items.

(6) The average and median time that elapsed between the submission of a prior authorization request and a determination by the utilization review organization for the prior authorization request, aggregated for all health care services or items.

(7) The average and median time that elapsed between the submission of an urgent prior authorization request and a determination by the utilization review organization for the urgent prior authorization request, aggregated for all health care services or items.

(8) The average and median time that elapsed between the submission of a nonurgent prior authorization request and a determination by the utilization review organization for the urgent prior authorization request, aggregated for all health care services or items.

NEW SUBSECTION. 2A.

NEW SUBSECTION. 2A. a. A utilization review organization shall, at least annually, review all health care services for which the health benefit plan requires prior authorization and shall eliminate prior authorization requirements for health care services for which prior authorization requests are routinely approved with such frequency as to demonstrate that the prior authorization requirement does not promote health care quality, or reduce health care spending, to a degree sufficient to justify the health benefit plan’s administrative costs to require the prior authorization.

b. A utilization review organization shall submit an annual report containing the findings of the review conducted under paragraph “a” to the commissioner pursuant to the reporting procedures and deadlines established by the commissioner. The commission shall publish, within sixty days of receipt, the report on a publicly accessible internet site. The annual report shall include all of the following:

(1) The total number of prior authorizations the utilization review organization evaluated as part of the annual review.

(2) The number of prior authorizations the utilization review organization eliminated as a result of the annual review, and the reason for the elimination.

(3) A list of prior authorizations that had at least eighty percent of requests approved in the previous twelve months for a specific health care service covered by a health benefit plan, but which prior authorizations were retained due to medical or scientific evidence, as defined in section 514J.102, that justified continuing such requirement.

(4) The total number of prior authorization requests submitted in the previous twelve months for each eliminated prior authorization, and the total number of health care providers that submitted a request for prior authorization in the previous twelve months for each eliminated prior authorization requirement.

(5) For each health care service for which prior authorization was eliminated under subparagraph (2), the report shall include data regarding any increase or decrease of ten percent or greater in the average number of claims submitted per health care provider for that health care service compared to the twelve months immediately preceding the elimination of the prior authorization.

NEW SUBSECTION. 3A. Complaints regarding a utilization review organization’s compliance with this chapter may be directed to the insurance division. The insurance division shall notify a utilization review organization of all complaints regarding the utilization review organization’s noncompliance with this chapter. All complaints received pursuant to this subsection shall not be considered public records for purposes of chapter 22.

Sec.

2. PRIOR AUTHORIZATION EXEMPTION PROGRAM.

1. On or before January 15, 2026, all health carriers that deliver, issue for delivery, continue, or renew a health benefit plan in this state on or after January 1, 2026, and that require prior authorizations, shall implement a pilot program that exempts a subset of participating health care providers, at least some of whom shall be primary health care providers, from certain prior authorization requirements.

2. Each health carrier shall make available on the health carrier’s internet site for each health benefit plan that the health carrier delivers, issues for delivery, continues, or renews in this state, details about the health benefit plan’s prior authorization exemption program, including all of the following information:

a. The health carrier’s criteria for a health care provider to qualify for the exemption program.

b. The health care services that are exempt from prior authorization requirements for health care providers who qualify under paragraph “a”.

c. The estimated number of health care providers who are eligible for the program, including the health care providers’ specialties, and the percentage of the health care providers that are primary care providers.

d. Contact information for the health benefit plan for consumers and health care providers to contact the health benefit plan about the exemption program, or about a health care provider’s eligibility for the exemption program.

3. On or before January 15, 2027, each health carrier required to implement a prior authorization exemption program pursuant to subsection 1 shall submit a report to the commissioner of insurance that contains all of the following:

a. The results of the exemption program, including an analysis of the costs and savings of the exemption program.

b. The health benefit plan’s recommendations for continuing or expanding the exemption program.

c. Feedback received by each health benefit plan from health care providers and other interested parties regarding the exemption program.

d. An assessment of the administrative costs incurred by each of the health carrier’s health benefit plans to administer and implement prior authorization requirements under the exemption program.