IA HF2412

Health carriers must grant prior authorization exemptions to healthcare providers who have at least 95% of their prior authorization requests approved during a three-month evaluation period for specific health care services.

Health carriers are required to evaluate contracted providers at minimum once every three months to determine exemption eligibility, with initial evaluations beginning January 1, 2027.

Providers do not need to request an exemption; carriers must automatically notify qualifying providers within five calendar days, including the list of applicable health plans and services.

Exemptions can be rescinded if retrospective review of 5-20 randomly sampled claims shows the provider falls below the 95% approval threshold based on medical necessity criteria.

The bill creates new section 514F.10 establishing definitions and procedures for evaluation periods, exemption determinations, and the appeals process through independent review organizations.