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HF 303

A bill for an act relating to prior authorization and utilization review organizations.

2025-2026 Regular Session

HF 303 tightens prior-authorization rules: faster determinations, annual reviews to drop unnecessary PAs, more reporting and complaints channel, plus a carrier pilot.

Signed by Governor.
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Bill Summary · HF 303

Summary — HF 303 (signed May 27, 2025)

Subject: Prior authorization and utilization review organizations (health insurance)

Purpose / intent

HF 303 strengthens timelines, transparency, and oversight for utilization review organizations (UROs) and prior authorization (PA) processes used by health benefit plans. The law aims to speed determinations on PA requests, require annual reviews to eliminate unnecessary PAs, increase data reporting to the insurance commissioner (and the public), and provide a complaint channel to the insurance division.

Key provisions

  • Determination timelines (URO obligations)

    • Urgent PA requests: determination within 48 hours of receipt.
    • Non‑urgent PA requests: determination within 10 calendar days of receipt.
    • Non‑urgent (complex / unusually high volume): determination within 15 calendar days.
    • Receipt acknowledgement: URO must notify or make available a receipt to the requesting provider within 24 hours of receiving a PA request.

  • URO annual reporting (to insurance commissioner; commissioner must publish within 60 days)
    The annual report must include, aggregated for all services/items:

    • Total number and percentage of urgent PAs approved and denied.
    • Total number and percentage of nonurgent PAs approved and denied.
    • Total number and percentage of nonurgent PAs that were complex/unique and approved.
    • Average and median times from submission to determination: overall, for urgent requests, and for nonurgent requests.

  • Annual review to eliminate unnecessary prior‑authorizations

    • UROs must annually review all services subject to PA and eliminate PA requirements for services that are routinely approved with such frequency that the PA no longer justifies its administrative cost or does not meaningfully improve quality or reduce spending.
    • UROs must report findings to the commissioner (published within 60 days). Required report elements include:
    • Number of PAs evaluated and number eliminated (with reasons).
    • List of PAs with ≥80% approval in prior 12 months that were nevertheless retained due to supporting medical/scientific evidence.
    • For each eliminated PA: count of PA requests in prior 12 months and number of providers who submitted them.
    • For each eliminated PA: data on any ≥10% increase or decrease in average claims per provider comparing the 12 months after elimination to the 12 months before.

  • Complaints and confidentiality

    • Complaints about a URO’s compliance may be filed with the insurance division, which must notify the URO of complaints.
    • Complaints received under this provision are exempt from public disclosure under Iowa’s public records law (chapter 22).

  • Pilot exemption program (carrier requirements)

    • Carriers that deliver/issue/renew health plans on or after Jan 1, 2026 and that use PAs must implement a pilot program (by Jan 15, 2026) exempting a subset of participating providers (including primary care providers) from certain PA requirements.
    • Carriers must post program details online (eligibility criteria, services exempted, estimated number/ specialties of eligible providers, contact info).
    • By Jan 15, 2027 carriers must report to the commissioner on program results, including cost/savings analysis, administrative costs, feedback, and recommendations.

Who is affected

  • Utilization review organizations (primary compliance responsibilities).
  • Health carriers / health benefit plans (pilot program, posting and reporting duties).
  • Health care providers (PA timelines, potential exemption pilot; primary care explicitly included).
  • Patients/consumers (faster determinations, potential reduced administrative PA burden).
  • Iowa insurance commissioner / insurance division (receives reports, publishes findings, handles complaints).

Implementation / timeline highlights

  • Bill signed by Governor Kim Reynolds on May 27, 2025.
  • Key deadlines in statute: carrier pilot implementation by Jan 15, 2026; carrier pilot report by Jan 15, 2027; URO annual reports published by the commissioner within 60 days of receipt.

This law increases regulatory oversight and data transparency around prior authorization and creates a pathway to reduce unnecessary PA burdens.

Compiled from official sources — confirm details with the bill’s official record.

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