Read the full stored bill text
STATE OF IOWA
KIM REYNOLDS
GOVERNOR
May 27, 2025
The Honorable Paul Pate
Secretary of State of Iowa
State Capitol
Des Moines, Iowa 50319
Dear Mr. Secretary,
I hereby transmit:
House File 303, an Act relating to prior authorization and utilization review
organizations.
The above House File is hereby approved on this date.
Sinc: ely
Ki
Governo
cc: Secretary of the Senate
Clerk of the House
STATE CAPITOL DES MOINES, IOWA 50319 515.281.5211 FAX 515.725.3527 WWW.GOVERNOR.I0WA.GOV
IN1111 tif 1 fil 171',IIIII1t11111111111I [fil IIIli111111111I111'll11lit Illllttl•
:IIIIIIIIIIIIIIIIIIIIII III IIE191111YYIYIIIIIIIIIIIIIIIIYIIIIIYYYYIIIIYvYYI III 11 IIIIIIIIIIIIIIIIYIIIIII9YII
\•/ . e
GLA NE1ZAL ASSEMBLY IIV:IIY7VIIIIIÜIl71VIIlY1VIVIViIIV7711Y11111111111111VVVVV!"I'J71VA11111VI111111111A•"!"78910YIIIIIIIIII IIIIIIflI111Y11V9V9!."A9A11111111i1II11V11111611@^.IIIIIIIIflIi111111VIC6V6 :". 1?IIIIIIIIIIYIII7YIIIf GV019".AV
1u°°'u-m ;i•.
•'/
House File 303
AN ACT
RELATING TO PRIOR AUTHORIZATION AND UTILIZATION REVIEW
ORGANIZATIONS.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
Section 1. Section 514F.8, Code 2025, is amended by adding
the following new subsections:
NEW SUBSECTION. 1A. a. A utilization review organization
shall provide a determination to a request for prior
authorization from a health care provider as follows:
( 1) Within forty-eight hours after receipt for urgent
requests.
( 2) Within ten calendar days after receipt for nonurgent
requests.
( 3) Within fifteen calendar days after receipt for
nonurgent requests if there are complex or unique circumstances
or the utilization review organization is experiencing an
unusually high volume of prior authorization requests.
b. Within twenty-four hours after receipt of a prior
authorization request, the utilization review organization
shall notify the health care provider of, or make available to
the health care provider, a receipt for the request for prior
authorization.
c. A utilization review organization shall conduct an annual
review and submit the findings in a report to the commissioner
pursuant to the reporting procedures and deadlines established
by the commissioner. The commissioner shall publish, within
House File 303, p. 2
sixty calendar days of receipt, the report on a publicly
accessible internet site. The annual report shall include all
of the following:
( 1) The total number of, and percentage of, urgent prior
authorization requests that the utilization review organization
approved, aggregated for all health care services and items.
( 2) The total number of, and percentage of, urgent prior
authorization requests that the utilization review organization
denied, aggregated for all health care services or items.
( 3) The total number of, and percentage of, nonurgent prior
authorization requests that the utilization review organization
approved, aggregated for all health care services or items.
( 4) The total number of, and percentage of, nonurgent prior
authorization requests that the utilization review organization
denied, aggregated for all health care services or items.
( 5) The total number of, and percentage of, nonurgent
prior authorization requests that were complex or involved
unique circumstances that the utilization review organization
approved, aggregated for all health care services or items.
( 6) The average and median time that elapsed between the
submission of a prior authorization request and a determination
by the utilization review organization for the prior
authorization request, aggregated for all health care services
or items.
( 7) The average and median time that elapsed between the
submission of an urgent prior authorization request and a
determination by the utilization review organization for the
urgent prior authorization request, aggregated for all health
care services or items.
( 8) The average and median time that elapsed between the
submission of a nonurgent prior authorization request and a
determination by the utilization review organization for the
urgent prior authorization request, aggregated for all health
care services or items.
NEW SUBSECTION. 2A. a. A utilization review organization
shall, at least annually, review all health care services for
which the health benefit plan requires prior authorization and
shall eliminate prior authorization requirements for health
care services for which prior authorization requests are
House File 303, p. 3
routinely approved with such frequency as to demonstrate that
the prior authorization requirement does not promote health
care quality, or reduce health care spending, to a degree
sufficient to justify the health benefit plan's administrative
costs to require the prior authorization.
b. A utilization review organization shall submit an annual
report containing the findings of the review conducted under
paragraph ' a - to the commissioner pursuant to the reporting
procedures and deadlines established by the commissioner. The
commission shall publish, within sixty days of receipt, the
report on a publicly accessible internet site. The annual
report shall include all of the following:
( 1) The total number of prior authorizations the
utilization review organization evaluated as part of the annual
review.
( 2) The number of prior authorizations the utilization
review organization eliminated as a result of the annual
review, and the reason for the elimination.
( 3) A list of prior authorizations that had at least eighty
percent of requests approved in the previous twelve months for
a specific health care service covered by a health benefit
plan, but which prior authorizations were retained due to
medical or scientific evidence, as defined in section 514J.102,
that justified continuing such requirement.
( 4) The total number of prior authorization requests
submitted in the previous twelve months for each eliminated
prior authorization, and the total number of health care
providers that submitted a request for prior authorization
in the previous twelve months for each eliminated prior
authorization requirement.
( 5) For each health care service for which prior
authorization was eliminated under subparagraph ( 2), the report
shall include data regarding any increase or decrease of ten
percent or greater in the average number of claims submitted
per health care provider for that health care service compared
to the twelve months immediately preceding the elimination of
the prior authorization.
NEW SUBSECTION. 3A. Complaints regarding a utilization
review organization's compliance with this chapter may be
House File 303, p. 4
directed to the insurance division. The insurance division
shall notify a utilization review organization of all
complaints regarding the utilization review organization's
noncompliance with this chapter. All complaints received
pursuant to this subsection shall not be considered public
records for purposes of chapter 22.
PAT GRASSLEY
Speaker of tffe House
AMY SINGUAIR
President of the Senate
I hereby certify that this bill originated in the House and
is known as House File 303, Ninety-first General Assembly.
-g:;• Approved Im 2 1 , 2025
MEG6AN NELSON
Chi C1-ß; of the House
Gov-rnor