HB 131 - Idaho Health Carrier External Review Act

• Revises definitions in the External Review Act including "adverse benefit determination," "final adverse benefit determination," "urgent care request," and "medically necessary" to align with current medical review standards

• Updates notice requirements for health carriers to inform covered persons of rights to external review, including information about expedited review for urgent care requests and authorization forms for medical records disclosure

• Modifies exhaustion requirements for internal grievance processes by allowing covered persons to request external review before exhausting internal appeals if the health carrier agrees or fails to follow proper procedures, or for urgent care requests

• Expands external review procedures to include standards for preliminary review eligibility determinations, independent review organization assignments on a random basis, and specific timelines for standard (42 days) and expedited (72 hours) reviews

• Requires health carriers to disclose in plan documents that external review decisions are final and binding on the carrier, with additional statements clarifying ERISA applicability and covered persons' potential judicial review rights