Bill Text: IA HF2488 | 2023-2024 | 90th General Assembly | Amended

Iowa House Bill 2488

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) 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 HF 2488 (4) 90 nls/ko/md

H.F. 2488 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 35 -1- HF 2488 (4) 90 nls/ko/md 1/ 3

H.F. 2488 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 35 -2- HF 2488 (4) 90 nls/ko/md 2/ 3

H.F. 2488 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. 8 -3- HF 2488 (4) 90 nls/ko/md 3/ 3