Text: SSB1163            Text: SSB1165


Senate Study Bill 1164

SENATE FILE BY (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CHAIRPERSON RAGAN) A BILL FOR 1 An Act requiring the development and use of a standard form for 2 prior authorization of prescription drug benefits. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: TLSB 2161SC (2) 85 av/nh PAG LIN 1 1 Section 1. NEW SECTION. 505.26 Prior authorization for 1 2 prescription drug benefits == standard form. 1 3 1. The commissioner shall develop, by rule, a standard prior 1 4 authorization form for use by health carriers that require 1 5 prior authorization for prescription drug benefits pursuant to 1 6 a health benefit plan, by January 1, 2014. 1 7 2. Prior to development of the standard prior authorization 1 8 form, the commissioner shall hold at least one public hearing 1 9 to gather input in developing the standard form from interested 1 10 parties. 1 11 3. The standard prior authorization form shall meet all of 1 12 the following requirements: 1 13 a. Not exceed two pages in length. 1 14 b. Be available in an electronic format. 1 15 c. Be transmissible in an electronic format. 1 16 4. Health carriers shall use and accept the standard prior 1 17 authorization form beginning on July 1, 2014. Health care 1 18 providers shall use and submit the standard prior authorization 1 19 form, when prior authorization is required by a health benefit 1 20 plan, beginning on July 1, 2014. 1 21 5. If a health carrier fails to use or accept the standard 1 22 prior authorization form or to respond to a health care 1 23 provider request for prior authorization of prescription drug 1 24 benefits within forty=eight hours of the health care provider's 1 25 submission of the form, the request for prior authorization 1 26 shall be considered to be approved. 1 27 6. As used in this section: 1 28 a. "Facility" means an institution providing health care 1 29 services or a health care setting, including but not limited 1 30 to hospitals and other licensed inpatient centers, ambulatory 1 31 surgical or treatment centers, skilled nursing centers, 1 32 residential treatment centers, diagnostic, laboratory, and 1 33 imaging centers, and rehabilitation and other therapeutic 1 34 health settings. 1 35 b. "Health benefit plan" means a policy, contract, 2 1 certificate, or agreement offered or issued by a health carrier 2 2 to provide, deliver, arrange for, pay for, or reimburse any of 2 3 the costs of health care services. 2 4 c. "Health care professional" means a physician or other 2 5 health care practitioner licensed, accredited, registered, or 2 6 certified to perform specified health care services consistent 2 7 with state law. 2 8 d. "Health care provider" or "provider" means a health care 2 9 professional or a facility. 2 10 e. "Health care services" means services for the diagnosis, 2 11 prevention, treatment, cure, or relief of a health condition, 2 12 illness, injury, or disease. 2 13 f. "Health carrier" means an entity subject to the 2 14 insurance laws and regulations of this state, or subject 2 15 to the jurisdiction of the commissioner, including an 2 16 insurance company offering sickness and accident plans, a 2 17 health maintenance organization, a nonprofit health service 2 18 corporation, a plan established pursuant to chapter 509A 2 19 for public employees, or any other entity providing a plan 2 20 of health insurance, health care benefits, or health care 2 21 services. "Health carrier" includes, for purposes of this 2 22 section, an organized delivery system. 2 23 EXPLANATION 2 24 This bill requires the development and use of a standard form 2 25 to obtain prior authorization for prescription drug benefits 2 26 under a health benefit plan. 2 27 The bill requires the commissioner of insurance to develop, 2 28 by rule, a standard form by January 1, 2014. Before developing 2 29 the form, the commissioner is required to hold at least one 2 30 public hearing to obtain input from interested parties on the 2 31 form. The form must not exceed two pages in length and must be 2 32 available and transmissible in an electronic format. 2 33 Health carriers are required to use and accept the standard 2 34 prior authorization form, and health care providers are 2 35 required to use and submit the form, beginning on July 1, 2014. 3 1 If a health carrier fails to use or accept the standard form 3 2 or to respond to a health care provider's request for prior 3 3 authorization of prescription drug benefits within 48 hours of 3 4 the provider's submission of the form, the request shall be 3 5 considered to be granted. LSB 2161SC (2) 85 av/nh
Text: SSB1163            Text: SSB1165