Senate File 231 S-3014 Amend Senate File 231 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 respond to a request for prior authorization from a 7 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 NEW SUBSECTION . 2A. A utilization review organization 22 shall, at least annually, review all health care services for 23 which the health benefit plan requires prior authorization and 24 shall eliminate prior authorization requirements for health 25 care services for which prior authorization requests are 26 routinely approved with such frequency as to demonstrate that 27 the prior authorization requirement does not promote health 28 care quality, or reduce health care spending, to a degree 29 sufficient to justify the health benefit plan’s administrative 30 costs to require 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 -1- SF 231.592 (2) 91 (amending this SF 231 to CONFORM to HF 303) nls/ko 1/ 3 #1.

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 Sec. 2. PRIOR AUTHORIZATION EXEMPTION PROGRAM. 5 1. On or before January 15, 2026, all health carriers 6 that deliver, issue for delivery, continue, or renew a health 7 benefit plan in this state on or after January 1, 2026, and 8 that require prior authorizations, shall implement a pilot 9 program that exempts a subset of participating health care 10 providers, at least some of whom shall be primary health care 11 providers, from certain prior authorization requirements. 12 2. Each health carrier shall make available on the health 13 carrier’s internet site for each health benefit plan that the 14 health carrier delivers, issues for delivery, continues, or 15 renews in this state, details about the health benefit plan’s 16 prior authorization exemption program, including all of the 17 following information: 18 a. The health carrier’s criteria for a health care provider 19 to qualify for the exemption program. 20 b. The health care services that are exempt from prior 21 authorization requirements for health care providers who 22 qualify under paragraph “a”. 23 c. The estimated number of health care providers who are 24 eligible for the program, including the health care providers’ 25 specialties, and the percentage of the health care providers 26 that are primary care providers. 27 d. Contact information for the health benefit plan for 28 consumers and health care providers to contact the health 29 benefit plan about the exemption program, or about a health 30 care provider’s eligibility for the exemption program. 31 3. On or before January 15, 2027, each health carrier 32 required to implement a prior authorization exemption 33 program pursuant to subsection 1 shall submit a report to the 34 commissioner of insurance that contains all of the following: 35 -2- SF 231.592 (2) 91 (amending this SF 231 to CONFORM to HF 303) nls/ko 2/ 3

a. The results of the exemption program, including an 1 analysis of the costs and savings of the exemption program. 2 b. The health benefit plan’s recommendations for continuing 3 or expanding the exemption program. 4 c. Feedback received by each health benefit plan from 5 health care providers and other interested parties regarding 6 the exemption program. 7 d. An assessment of the administrative costs incurred by 8 each of the health carrier’s health benefit plans to administer 9 and implement prior authorization requirements under the 10 exemption program. > 11 2. Title page, by striking lines 1 through 2 and inserting 12 < An Act relating to prior authorizations and exemptions by 13 health benefit plans and utilization review organizations. > 14 ______________________________ MIKE KLIMESH -3- SF 231.592 (2) 91 (amending this SF 231 to CONFORM to HF 303) nls/ko 3/ 3 #2.