Bill Text: IA SSB1165 | 2017-2018 | 87th General Assembly | Introduced
Bill Title: A bill for an act relating to requirements for prior authorization for services and prescription drugs provided under Medicaid managed care contracts.
Spectrum: Committee Bill
Status: (N/A - Dead) 2017-02-23 - Subcommittee: Greene, Segebart, and Ragan. [SSB1165 Detail]
Download: Iowa-2017-SSB1165-Introduced.html
Senate
Study
Bill
1165
-
Introduced
SENATE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
HUMAN
RESOURCES
BILL
BY
CHAIRPERSON
SEGEBART)
A
BILL
FOR
An
Act
relating
to
requirements
for
prior
authorization
for
1
services
and
prescription
drugs
provided
under
Medicaid
2
managed
care
contracts.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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_____
Section
1.
DEPARTMENT
OF
HUMAN
SERVICES
——
PRIOR
1
AUTHORIZATION
REQUIREMENTS
UNDER
MEDICAID
MANAGED
CARE
2
CONTRACTS.
3
1.
The
department
of
human
services
shall
adopt
rules
4
pursuant
to
chapter
17A
to
provide
all
of
the
following
5
relative
to
requirements
for
prior
authorization
of
6
prescription
drugs
and
services
under
a
Medicaid
managed
care
7
contract:
8
a.
Approval
from
the
Medicaid
managed
care
organization
9
shall
be
received
by
the
provider
submitting
the
prior
10
authorization
request
for
a
prescription
drug
or
service
within
11
the
following
periods,
as
applicable:
12
(1)
For
urgent
claims,
within
a
period
not
to
exceed
13
seventy-two
hours
from
the
time
the
Medicaid
managed
care
14
organization
receives
the
request.
15
(2)
For
nonurgent
claims,
within
a
period
not
to
exceed
16
five
days
from
the
time
the
Medicaid
managed
care
organization
17
receives
the
request.
18
b.
Emergency
claims
for
prescription
drugs
or
services
19
shall
not
require
prior
authorization
by
a
Medicaid
managed
20
care
organization.
21
c.
If
approval
is
received
by
a
provider
from
a
Medicaid
22
managed
care
organization
for
a
prior
authorization
request
for
23
a
prescription
drug
or
service
for
a
patient
who
is
in
stable
24
condition
as
verified
by
the
provider,
the
approved
prior
25
authorization
shall
be
valid
for
a
period
of
twelve
months
from
26
the
date
the
approval
is
received
by
the
provider.
27
d.
Any
change
by
a
Medicaid
managed
care
organization
in
a
28
requirement
for
prior
authorization
for
a
prescription
drug
or
29
service
shall
be
preceded
by
the
provision
of
sixty
days
prior
30
notice
to
all
affected
providers
before
the
effective
date
of
31
the
change.
32
2.
The
department
of
human
services
shall
require
any
33
Medicaid
managed
care
organization
under
contract
with
34
the
state
to
jointly
develop
and
utilize
the
same
prior
35
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S.F.
_____
authorization
review
process,
including
but
not
limited
to
1
shared
electronic
and
paper
forms,
subject
to
final
review
and
2
approval
by
the
department.
3
EXPLANATION
4
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
5
the
explanation’s
substance
by
the
members
of
the
general
assembly.
6
This
bill
relates
to
prior
authorization
requirements
under
7
Medicaid
managed
care
contracts.
8
The
bill
directs
the
department
of
human
services
(DHS)
9
to
adopt
rules
to
provide
all
of
the
following
relative
to
10
requirements
for
prior
authorization
of
prescription
drugs
and
11
services
under
a
Medicaid
managed
care
contract:
(1)
Approval
12
from
the
managed
care
organization
(MCO)
shall
be
received
13
by
the
provider
submitting
the
prior
authorization
request
14
for
a
prescription
drug
or
service
within
a
period
not
to
15
exceed
72
hours
from
the
time
the
MCO
receives
the
request
for
16
urgent
claims
and
within
a
period
not
to
exceed
five
days
for
17
nonurgent
claims;
(2)
No
requirement
for
prior
authorization
18
from
an
MCO
for
emergency
claims
for
prescription
drugs
or
19
services;
(3)
Once
approval
is
received
by
a
provider
for
a
20
prior
authorization
request
for
a
prescription
drug
or
service
21
for
a
patient
who
is
in
stable
condition
as
verified
by
the
22
provider,
the
approved
prior
authorization
shall
be
valid
for
a
23
period
of
12
months;
(4)
Any
change
by
an
MCO
in
a
requirement
24
for
prior
authorization
for
a
prescription
drug
or
service
25
shall
be
preceded
by
60
days
prior
notice
to
all
affected
26
providers
before
the
effective
date
of
the
change.
The
bill
27
also
requires
DHS
to
require
any
Medicaid
MCO
under
contract
28
with
the
state
to
jointly
develop
and
utilize
the
same
prior
29
authorization
review
process,
including
but
not
limited
to
30
shared
electronic
and
paper
forms,
subject
to
final
review
and
31
approval
by
DHS.
32
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