H-8154

   Amend House File 2635, as amended, passed, and reprinted by the House, as follows:
   1.  Page 1, after line 2 by inserting: 
   <Sec. ___.  Section 514F.8, subsection 1, Code 2026, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  0b.  “Downgrade” means a decision by a utilization review organization to change an expedited or urgent request for prior authorization to a standard determination, or otherwise modify a health care service that is the subject of a request for prior authorization to a lower-level health care service.>
   2.  Page 2, after line 20 by inserting: 
   <3.  A health care provider may opt-in to receive electronic delivery of notices and audit determinations from a utilization review organization. A utilization review organization may determine the method by which a health care provider may opt-in.>
   3.  Page 2, line 21, by striking <3.> and inserting <4.>
   4.  Page 3, line 6, by striking <4.> and inserting <5.>
   5.  Page 3, line 8, by striking <5.> and inserting <6.>
   6.  Page 3, by striking lines 12 and 13.
   7.  Page 4, after line 4 by inserting: 
   <Sec. ___.  Section 514F.8, Code 2026, is amended by adding the following new subsection:
   NEW SUBSECTION.  6A.  a.  A health care provider shall submit all requests for prior authorization to a health carrier electronically using a standards-based application programming interface, or another form of electronic submission, supported by the health carrier that is compliant with federal interoperability regulations. 
   b.  This subsection applies to a request for prior authorization made on or after July 1, 2027.>
   8.  Page 6, by striking lines 25 through 27 and inserting <shall include the qualified reviewer’s board certifications, specialty expertise, and educational background, excluding any personal identifiable information.>
   9.  Page 7, by striking lines 1 through 3 and inserting <clinical peer’s board certifications, specialty expertise, and educational background, excluding any personal identifiable information.>
   10.  Page 8, after line 29 by inserting: 
   <b.  “Emergency medical condition” means the same as defined in 42 C.F.R. §438.114.>
   11.  Page 8, line 30, by striking <b.> and inserting <c.>
   12.  Page 8, line 32, by striking <c.> and inserting <d.>
   13.  Page 8, line 34, by striking <d.> and inserting <e.>
   14.  Page 9, line 1, by striking <e.> and inserting <f.>
   15.  Page 9, line 3, by striking <f.> and inserting <g.>
   16.  Page 12, after line 5 by inserting: 
   <Sec. ___.  NEW SECTION.  249A.6  Prior authorization —— requests.
   1.  A health care provider submitting a request for prior authorization to a managed care organization shall submit the request electronically using a standards-based application programming interface, or another form of electronic submission, supported by the managed care organization, that is compliant with federal interoperability regulations.
   2.  This section applies to a request for prior authorization made on or after July 1, 2027.>
   17.  By renumbering as necessary.