March 15, 2018

Iowa Legislature Mulls Prior Authorization Bill

Iowa lawmakers are considering SB 1161, a proposal to hold health benefit plans to a higher degree of accountability and transparency when it comes to prior authorization process.

Health benefit plans operating in the state will be required to have their respective authorization review companies disclose their prior authorization criteria, including clinical review criteria, to patients, providers and general public. The bill would also create more stringent requirements for announcements of changes in the plan provisions and a more in-depth process for review of adverse coverage determinations.

SB 1161 also addresses medical review provisions and coverage of persons seeking services in emergency departments. If a utilization review entity fails to comply with the provisions of the bill, any health care service subject to prior authorization shall be deemed automatically preauthorized.

The bill is opposed by the insurance lobby and the proposal has already garnered the support of the Iowa Medical society and the Iowa Hospital Association.