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IA SF231
IA SF231A bill for an act relating to prior authorization and utilization review organizations.(Formerly SSB 1016.)
summary
Introduced
02/10/2025
02/10/2025
In Committee
Crossed Over
Passed
Dead
Introduced Session
91st General Assembly
Bill Summary
This bill relates to prior authorization and utilization review organizations. The bill requires a utilization review organization (organization) to provide a determination to a request for prior authorization (authorization) from a health care provider (provider) within 48 hours after receipt for urgent requests or within 10 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 15 calendar days. Within 24 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 conduct an annual review and submit the findings in a report to the commissioner of insurance (commissioner). The requirements for the report are detailed in the bill. The bill also requires an organization to annually review all health care services for which a health benefit plan (plan) requires an authorization, 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. An organization shall submit an annual report containing the findings of both reviews to the commissioner, and shall include all of the information detailed in the bill. The commissioner shall submit an annual report to the general assembly containing a summary and analysis of the information in the reports. 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 received regarding the organization. Complaints received under the bill shall not be considered public records.
AI Summary
This bill addresses prior authorization processes for health insurance by establishing new requirements for utilization review organizations (UROs), which are entities that review and approve medical treatment requests. The bill mandates that UROs provide determinations for prior authorization requests within specific timeframes: 48 hours for urgent requests and 10 calendar days for non-urgent requests, with a 15-day extension allowed for complex cases or high request volumes. UROs must also acknowledge receipt of authorization requests within 24 hours. The legislation requires UROs to conduct annual reviews of their prior authorization practices, including detailed reporting to the insurance commissioner about approval and denial rates, processing times, and the effectiveness of existing prior authorization requirements. Specifically, UROs must identify and eliminate prior authorization requirements for healthcare services that are routinely approved, demonstrating that such requirements do not meaningfully improve healthcare quality or reduce spending. The bill also establishes a complaint mechanism where individuals can report URO non-compliance to the insurance division, with the stipulation that these complaints will not be considered public records. The overall goal is to streamline medical treatment approval processes, increase transparency, and reduce unnecessary administrative barriers in healthcare.
Sponsors (0)
No sponsors listed
Other Sponsors (1)
Health And Human Services (Senate)
Last Action
Withdrawn. S.J. 814. (on 04/16/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=SF231 |
| BillText | https://www.legis.iowa.gov/docs/publications/LGI/91/attachments/SF231.html |
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