Bill Text: IA SSB1164 | 2013-2014 | 85th General Assembly | Introduced
Bill Title: A study bill for an act requiring the development and use of a standard form for prior authorization of prescription drug benefits.
Spectrum: Unknown
Status: (N/A - Dead) 2013-02-13 - Human Resources: Wilhelm Chair,Bolkcom, and Johnson. [SSB1164 Detail]
Download: Iowa-2013-SSB1164-Introduced.html
Senate
Study
Bill
1164
-
Introduced
SENATE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
HUMAN
RESOURCES
BILL
BY
CHAIRPERSON
RAGAN)
A
BILL
FOR
An
Act
requiring
the
development
and
use
of
a
standard
form
for
1
prior
authorization
of
prescription
drug
benefits.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
NEW
SECTION
.
505.26
Prior
authorization
for
1
prescription
drug
benefits
——
standard
form.
2
1.
The
commissioner
shall
develop,
by
rule,
a
standard
prior
3
authorization
form
for
use
by
health
carriers
that
require
4
prior
authorization
for
prescription
drug
benefits
pursuant
to
5
a
health
benefit
plan,
by
January
1,
2014.
6
2.
Prior
to
development
of
the
standard
prior
authorization
7
form,
the
commissioner
shall
hold
at
least
one
public
hearing
8
to
gather
input
in
developing
the
standard
form
from
interested
9
parties.
10
3.
The
standard
prior
authorization
form
shall
meet
all
of
11
the
following
requirements:
12
a.
Not
exceed
two
pages
in
length.
13
b.
Be
available
in
an
electronic
format.
14
c.
Be
transmissible
in
an
electronic
format.
15
4.
Health
carriers
shall
use
and
accept
the
standard
prior
16
authorization
form
beginning
on
July
1,
2014.
Health
care
17
providers
shall
use
and
submit
the
standard
prior
authorization
18
form,
when
prior
authorization
is
required
by
a
health
benefit
19
plan,
beginning
on
July
1,
2014.
20
5.
If
a
health
carrier
fails
to
use
or
accept
the
standard
21
prior
authorization
form
or
to
respond
to
a
health
care
22
provider
request
for
prior
authorization
of
prescription
drug
23
benefits
within
forty-eight
hours
of
the
health
care
provider’s
24
submission
of
the
form,
the
request
for
prior
authorization
25
shall
be
considered
to
be
approved.
26
6.
As
used
in
this
section:
27
a.
“Facility”
means
an
institution
providing
health
care
28
services
or
a
health
care
setting,
including
but
not
limited
29
to
hospitals
and
other
licensed
inpatient
centers,
ambulatory
30
surgical
or
treatment
centers,
skilled
nursing
centers,
31
residential
treatment
centers,
diagnostic,
laboratory,
and
32
imaging
centers,
and
rehabilitation
and
other
therapeutic
33
health
settings.
34
b.
“Health
benefit
plan”
means
a
policy,
contract,
35
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_____
certificate,
or
agreement
offered
or
issued
by
a
health
carrier
1
to
provide,
deliver,
arrange
for,
pay
for,
or
reimburse
any
of
2
the
costs
of
health
care
services.
3
c.
“Health
care
professional”
means
a
physician
or
other
4
health
care
practitioner
licensed,
accredited,
registered,
or
5
certified
to
perform
specified
health
care
services
consistent
6
with
state
law.
7
d.
“Health
care
provider”
or
“provider”
means
a
health
care
8
professional
or
a
facility.
9
e.
“Health
care
services”
means
services
for
the
diagnosis,
10
prevention,
treatment,
cure,
or
relief
of
a
health
condition,
11
illness,
injury,
or
disease.
12
f.
“Health
carrier”
means
an
entity
subject
to
the
13
insurance
laws
and
regulations
of
this
state,
or
subject
14
to
the
jurisdiction
of
the
commissioner,
including
an
15
insurance
company
offering
sickness
and
accident
plans,
a
16
health
maintenance
organization,
a
nonprofit
health
service
17
corporation,
a
plan
established
pursuant
to
chapter
509A
18
for
public
employees,
or
any
other
entity
providing
a
plan
19
of
health
insurance,
health
care
benefits,
or
health
care
20
services.
“Health
carrier”
includes,
for
purposes
of
this
21
section,
an
organized
delivery
system.
22
EXPLANATION
23
This
bill
requires
the
development
and
use
of
a
standard
form
24
to
obtain
prior
authorization
for
prescription
drug
benefits
25
under
a
health
benefit
plan.
26
The
bill
requires
the
commissioner
of
insurance
to
develop,
27
by
rule,
a
standard
form
by
January
1,
2014.
Before
developing
28
the
form,
the
commissioner
is
required
to
hold
at
least
one
29
public
hearing
to
obtain
input
from
interested
parties
on
the
30
form.
The
form
must
not
exceed
two
pages
in
length
and
must
be
31
available
and
transmissible
in
an
electronic
format.
32
Health
carriers
are
required
to
use
and
accept
the
standard
33
prior
authorization
form,
and
health
care
providers
are
34
required
to
use
and
submit
the
form,
beginning
on
July
1,
2014.
35
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If
a
health
carrier
fails
to
use
or
accept
the
standard
form
1
or
to
respond
to
a
health
care
provider’s
request
for
prior
2
authorization
of
prescription
drug
benefits
within
48
hours
of
3
the
provider’s
submission
of
the
form,
the
request
shall
be
4
considered
to
be
granted.
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