Iowa SF231 regulates prior authorization and utilization review organizations by setting time limits for determinations and requiring annual reviews.

Iowa SF231 amends the Code to establish specific timelines for utilization review organizations to determine prior authorization requests. For urgent requests, organizations must provide a determination within 48 hours. For nonurgent requests, the determination must be made within ten calendar days, unless there are complex or unique circumstances or an unusually high volume of requests, in which case it must be made within fifteen calendar days. The bill also mandates annual reviews of prior authorization requirements to eliminate those that do not justify their administrative costs.

Iowa SF231 regulates prior authorization and utilization review organizations by setting time limits for determinations and requiring annual reviews.

Iowa SF231 amends the Code to establish specific timelines for utilization review organizations to determine prior authorization requests. For urgent requests, organizations must provide a determination within 48 hours. For nonurgent requests, the determination must be made within ten calendar days, unless there are complex or unique circumstances or an unusually high volume of requests, in which case it must be made within fifteen calendar days. The bill also mandates annual reviews of prior authorization requirements to eliminate those that do not justify their administrative costs.