HSB 148 (LSB 2161YC (2) 85)

HOUSE FILE _____

BY  (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CHAIRPERSON MILLER)

A BILL FOR

An Act requiring the development and use of a standard form for prior authorization of prescription drug benefits.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  505.26  Prior authorization for prescription drug benefits —— standard form.
   1.  The commissioner shall develop, by rule, a standard prior authorization form for use by health carriers that require prior authorization for prescription drug benefits pursuant to a health benefit plan, by January 1, 2014.
   2.  Prior to development of the standard prior authorization form, the commissioner shall hold at least one public hearing to gather input in developing the standard form from interested parties.
   3.  The standard prior authorization form shall meet all of the following requirements:
   a.  Not exceed two pages in length.
   b.  Be available in an electronic format.
   c.  Be transmissible in an electronic format.
   4.  Health carriers shall use and accept the standard prior authorization form beginning on July 1, 2014. Health care providers shall use and submit the standard prior authorization form, when prior authorization is required by a health benefit plan, beginning on July 1, 2014.
   5.  If a health carrier fails to use or accept the standard prior authorization form or to respond to a health care provider request for prior authorization of prescription drug benefits within forty-eight hours of the health care provider’s submission of the form, the request for prior authorization shall be considered to be approved.
   6.  As used in this section:
   a.  “Facility” means an institution providing health care services or a health care setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory, and imaging centers, and rehabilitation and other therapeutic health settings.
   b.  “Health benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.
   c.  “Health care professional” means a physician or other health care practitioner licensed, accredited, registered, or certified to perform specified health care services consistent with state law. 
   d.  “Health care provider” or “provider” means a health care professional or a facility.
   e.  “Health care services” means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.
   f.  “Health carrier” means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit health service corporation, a plan established pursuant to chapter 509A for public employees, or any other entity providing a plan of health insurance, health care benefits, or health care services. “Health carrier” includes, for purposes of this section, an organized delivery system.
EXPLANATION
   This bill requires the development and use of a standard form to obtain prior authorization for prescription drug benefits under a health benefit plan. 
   The bill requires the commissioner of insurance to develop, by rule, a standard form by January 1, 2014. Before developing the form, the commissioner is required to hold at least one public hearing to obtain input from interested parties on the form. The form must not exceed two pages in length and must be available and transmissible in an electronic format.
   Health carriers are required to use and accept the standard prior authorization form, and health care providers are required to use and submit the form, beginning on July 1, 2014. If a health carrier fails to use or accept the standard form or to respond to a health care provider’s request for prior authorization of prescription drug benefits within 48 hours of the provider’s submission of the form, the request shall be considered to be granted.