Iowa House Bill HSB130

Iowa 2023-2024 Regular Session

• Introduced: 2/2/23
• Refer: 2/2/23

Caption

A bill for an act relating to prior authorization exemptions for certain health care providers for specific health care services.

Impact

The bill directly impacts the relationship between healthcare providers and health carriers by limiting the requirement for prior authorization for certain services. By establishing objective criteria for granting exemptions, HSB130 seeks to reduce administrative burdens on healthcare providers, potentially leading to quicker patient care. The implementation date for this law is set for January 1, 2024, after which all health benefit plans must adhere to the new regulations regarding prior authorizations.

Summary

House Study Bill 130 (HSB130) aims to streamline the prior authorization process for healthcare providers in Iowa by creating a framework for granting exemptions based on the approval rates of prior authorization requests. Under this bill, health carriers must provide an exemption to healthcare providers when at least 80% of their prior authorization requests are approved during the most recent evaluation period. This exemption mechanism is intended to simplify access to healthcare services for both providers and patients, ultimately improving healthcare delivery.

Contention

Notably, the bill includes provisions for the rescission of exemptions should a provider's claims fall below the specified standards. This raises concerns among some stakeholders who fear that the process of ongoing evaluations and potential rescissions could reintroduce obstacles that the bill seeks to eliminate. The necessity for health carriers to communicate clearly with providers about exemption statuses and the appeal processes may also present operational challenges, warranting careful monitoring to ensure a smooth transition to this new system.