Bill > H0841

This bill, titled the Idaho Prior Authorization Reform Act, aims to improve the process by which health insurance companies, referred to as "health insurance issuers," require pre-approval, known as "prior authorization," for certain medical services. The act seeks to protect the patient-provider relationship by preventing excessive interference from third parties and ensuring that prior authorization processes do not override the independent medical judgment of healthcare professionals. Key provisions include requiring issuers to publicly disclose all services needing prior authorization and the criteria used for these decisions, establishing a standardized electronic system for submitting prior authorization requests by January 1, 2027, and setting specific timeframes for decisions on standard requests (seven days) and urgent requests (72 hours). The bill also mandates that adverse determinations, where prior authorization is denied, must clearly explain the reasons and outline the appeal process, and that appeals must be reviewed by qualified medical professionals. Furthermore, it establishes rules for the duration of approvals, including longer periods for chronic conditions, and requires health insurance issuers to honor prior authorizations from previous insurers for at least 90 days when a patient switches plans. The Department of Insurance will oversee enforcement, with the ability to impose fines for violations, and health insurance issuers must report data on their prior authorization practices annually. An exemption is provided for issuers who require prior authorization for less than one percent of claims.

Agriculture and Natural Resources, Business and Industry

Ways and Means Committee (House)

https://legislature.idaho.gov/sessioninfo/2026/legislation/H0841/