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IA HF2635
Bill
Status
3/3/2026
Primary Sponsor
Health And Human Services
Click for details
AI Summary
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Prohibits utilization review organizations from using artificial intelligence as the sole basis for denying, delaying, or downgrading prior authorization requests for health care services based on medical necessity.
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Establishes audit timeline requirements: organizations must notify health care providers within 15 calendar days of selecting a claim for audit and complete determinations within 45 calendar days of receiving all documentation.
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Providers may appeal adverse audit determinations within 30 calendar days, and organizations must issue final decisions within 30 calendar days of receiving the appeal; violations result in mandatory claim approval plus 10% annual interest.
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Applies to individual and group health insurance, hospital/medical service contracts, HMO contracts, and public employee plans delivered or renewed on or after January 1, 2027.
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Effective date of July 1, 2026, with audit provisions applying to audits initiated on or after January 1, 2027.
Legislative Description
A bill for an act relating to health carriers standards of conduct; utilization review organizations, artificial intelligence, audits, and prior authorizations; certificate of need processes; and including applicability provisions. (Formerly HF 2438.) Effective date: 07/01/2026
Last Action
Message from House. S.J. 492.
3/9/2026