IA SF2421

Prohibits utilization review organizations from using artificial intelligence as the sole basis to deny, delay, or downgrade prior authorization requests for health care services based on medical necessity

Requires that prior authorization denials or downgrades be made by a "qualified reviewer" (physician in same/similar specialty) when the requesting provider is a physician, or by a "clinical peer" when the requesting provider is not a physician

Establishes a prior authorization exemption program allowing health carriers to exempt providers from prior authorization requirements for specific services based on approval rate history (minimum 90% approval rate over 12 months)

Mandates annual audits by health carriers of their prior authorization exemption programs and requires submission of audit results to the Insurance Commissioner

Applies to policies and contracts issued or renewed on or after January 1, 2026, with Division II provisions (exemption program and audits) taking effect January 1, 2027