Senate Amendment to House File 303 H-1244 Amend House File 303, as passed by the House, as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < Section 1. Section 514F.8, Code 2025, is amended by adding 4 the following new subsections: 5 NEW SUBSECTION . 1A. a. A utilization review organization 6 shall provide a determination to a request for prior 7 authorization from a health care provider as follows: 8 (1) Within forty-eight hours after receipt for urgent 9 requests. 10 (2) Within ten calendar days after receipt for nonurgent 11 requests. 12 (3) Within fifteen calendar days after receipt for 13 nonurgent requests if there are complex or unique circumstances 14 or the utilization review organization is experiencing an 15 unusually high volume of prior authorization requests. 16 b. Within twenty-four hours after receipt of a prior 17 authorization request, the utilization review organization 18 shall notify the health care provider of, or make available to 19 the health care provider, a receipt for the request for prior 20 authorization. 21 c. A utilization review organization shall conduct an annual 22 review and submit the findings in a report to the commissioner 23 pursuant to the reporting procedures and deadlines established 24 by the commissioner. The commissioner shall publish, within 25 sixty calendar days of receipt, the report on a publicly 26 accessible internet site. The annual report shall include all 27 of the following: 28 (1) The total number of, and percentage of, urgent prior 29 authorization requests that the utilization review organization 30 approved, aggregated for all health care services and items. 31 (2) The total number of, and percentage of, urgent prior 32 authorization requests that the utilization review organization 33 denied, aggregated for all health care services or items. 34 (3) The total number of, and percentage of, nonurgent prior 35 -1- HF 303.1565.S (1) 91 mb 1/ 4 #1.

authorization requests that the utilization review organization 1 approved, aggregated for all health care services or items. 2 (4) The total number of, and percentage of, nonurgent prior 3 authorization requests that the utilization review organization 4 denied, aggregated for all health care services or items. 5 (5) The total number of, and percentage of, nonurgent 6 prior authorization requests that were complex or involved 7 unique circumstances that the utilization review organization 8 approved, aggregated for all health care services or items. 9 (6) The average and median time that elapsed between the 10 submission of a prior authorization request and a determination 11 by the utilization review organization for the prior 12 authorization request, aggregated for all health care services 13 or items. 14 (7) The average and median time that elapsed between the 15 submission of an urgent prior authorization request and a 16 determination by the utilization review organization for the 17 urgent prior authorization request, aggregated for all health 18 care services or items. 19 (8) The average and median time that elapsed between the 20 submission of a nonurgent prior authorization request and a 21 determination by the utilization review organization for the 22 urgent prior authorization request, aggregated for all health 23 care services or items. 24 NEW SUBSECTION . 2A. a. A utilization review organization 25 shall, at least annually, review all health care services for 26 which the health benefit plan requires prior authorization and 27 shall eliminate prior authorization requirements for health 28 care services for which prior authorization requests are 29 routinely approved with such frequency as to demonstrate that 30 the prior authorization requirement does not promote health 31 care quality, or reduce health care spending, to a degree 32 sufficient to justify the health benefit plan’s administrative 33 costs to require the prior authorization. 34 b. A utilization review organization shall submit an annual 35 -2- HF 303.1565.S (1) 91 mb 2/ 4

report containing the findings of the review conducted under 1 paragraph “a” to the commissioner pursuant to the reporting 2 procedures and deadlines established by the commissioner. The 3 commission shall publish, within sixty days of receipt, the 4 report on a publicly accessible internet site. The annual 5 report shall include all of the following: 6 (1) The total number of prior authorizations the 7 utilization review organization evaluated as part of the annual 8 review. 9 (2) The number of prior authorizations the utilization 10 review organization eliminated as a result of the annual 11 review, and the reason for the elimination. 12 (3) A list of prior authorizations that had at least eighty 13 percent of requests approved in the previous twelve months for 14 a specific health care service covered by a health benefit 15 plan, but which prior authorizations were retained due to 16 medical or scientific evidence, as defined in section 514J.102, 17 that justified continuing such requirement. 18 (4) The total number of prior authorization requests 19 submitted in the previous twelve months for each eliminated 20 prior authorization, and the total number of health care 21 providers that submitted a request for prior authorization 22 in the previous twelve months for each eliminated prior 23 authorization requirement. 24 (5) For each health care service for which prior 25 authorization was eliminated under subparagraph (2), the report 26 shall include data regarding any increase or decrease of ten 27 percent or greater in the average number of claims submitted 28 per health care provider for that health care service compared 29 to the twelve months immediately preceding the elimination of 30 the prior authorization. 31 NEW SUBSECTION . 3A. Complaints regarding a utilization 32 review organization’s compliance with this chapter may be 33 directed to the insurance division. The insurance division 34 shall notify a utilization review organization of all 35 -3- HF 303.1565.S (1) 91 mb 3/ 4

complaints regarding the utilization review organization’s 1 noncompliance with this chapter. All complaints received 2 pursuant to this subsection shall not be considered public 3 records for purposes of chapter 22. > 4 2. Title page, by striking lines 1 and 2 and inserting 5 < An Act relating to prior authorization and utilization 6 review organizations. > 7 -4- HF 303.1565.S (1) 91 mb 4/ 4