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HF 217

A bill for an act relating to prior authorization requirements for the treatment of cancer.

2025-2026 Regular Session Introduced by Sean Bagniewski and 7 co-sponsors

Prohibits prior authorization for cancer care services recommended by a provider and based on NCCN protocols, reducing delays for NCCN-guided treatments.

Introduced, referred to Health and Human Services.
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Bill Summary · HF 217

HF 217 – Summary

Overview

HF 217 is an introduced bill (February 6, 2025) that would restrict the use of prior authorization for cancer treatment. Specifically, it would prohibit a utilization review organization or a health carrier from requiring prior authorization for health care services that a covered person’s health care provider has recommended based on the National Comprehensive Cancer Network (NCCN) protocols.

Key Provisions

  • Adds a new subsection (3A) to Section 514F.8, Code 2025.
  • Prohibits requiring prior authorization for services that are:
    • recommended by a covered person’s health care provider, and
    • based on NCCN protocols.

Scope and Applicability

  • Applies to two types of entities:
    • Utilization review organizations (UROs)
    • Health carriers (health insurance plans)
  • The restriction targets cancer treatment decisions guided by NCCN guidelines; services not aligned with NCCN protocols could still be subject to prior authorization under existing rules.

Who Is Affected

  • Covered individuals receiving cancer treatment
  • Health care providers who treat cancer patients and reference NCCN protocols
  • Payers and administrative entities that perform prior authorization (UROs and health carriers)

Implications and Potential Impacts

  • Administrative relief: May reduce or eliminate delays caused by prior authorizations for NCCN-guided cancer care.
  • Consistency with evidence-based care: Ties payer determinations to widely recognized NCCN guidelines.
  • Potential gaps: The bill does not specify exceptions or override mechanisms for non-NCCN scenarios, emergencies, or payer-specific considerations beyond NCCN-based recommendations. Treatments not following NCCN protocols may still require prior authorization under existing law.
  • Financial impact: Could shift administrative costs and approval decisions, possibly affecting insurer workflows and patient access timelines.

Legislative History

  • Status: Introduced and referred to Health and Human Services.
  • Introduced: February 6, 2025.

Sponsors

  • Ehlert (primary)
  • B. Meyer (primary)
  • Brown-Powers (primary)
  • Srinivas (primary)
  • Bagniewski (primary)
  • Kressig (primary)
  • Cooling (primary)
  • Wichenda hl (primary)

Next Steps / Questions for Stakeholders

  • Will there be any carve-outs for exceptional cases (e.g., non-NCCN indications, off-label use, or urgent scenarios)?
  • How will NCCN protocol updates be handled to ensure timely payer alignment?
  • What enforcement or complaint mechanisms would apply if a payer does not comply with the provision?

This summary captures the bill’s core purpose, provisions, affected parties, and potential effects based on the introduced text.

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

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