Bill Description: House Bill 841 would extensively reform and further regulate how the prior authorization process is conducted.
Rating: -7
Does it create, expand, or enlarge any agency, board, program, function, or activity of government? Conversely, does it eliminate or curtail the size or scope of government?
The proposed bill would open up a massive new regulatory space for the Department of Insurance to operate in, giving it significantly more control over prior authorizations and allowing it to enforce a substantial number of new regulations and prohibitions.
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Does it give government any new, additional, or expanded power to prohibit, restrict, or regulate activities in the free market? Conversely, does it eliminate or reduce government intervention in the market?
House Bill 841 would create a new section of Idaho Code, section 41-3505 which would require insurance providers to “make any current prior authorizations requirements and restrictions… conspicuously posted on its website or online portal to enrollees, health care professionals, and health care providers.” It would further require written notice to enrollees of new or amended requirements to prior authorization within sixty days, with certain exceptions.
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Further, section 41-3506 would require health insurance providers to “implement and maintain a prior authorization application programming interface (API)” with numerous subrequirements.
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Section 41-3507, 41-3508, 41-3509 would require certain notification timelines and information requirements for standard prior authorizations, expedited prior authorizations, and adverse determinations, respectively.
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Section 41-3510 thru 41-3515 would issue numerous requirements on who can review authorization claims, if and how revocations occur, how long approvals must stay active, that approvals must stay active for a certain period of time if a new plan is acquired, and guarantee an even longer period by which prior authorizations are valid for chronic conditions.
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Does it directly or indirectly create or increase penalties for victimless crimes or non-restorative penalties for non-violent crimes? Conversely, does it eliminate or decrease penalties for victimless crimes or non-restorative penalties for non-violent crimes?
Section 41-3516 would authorize fines of up to $10,000 dollars per violation for failures to comply with any agency authorized cease-and-desist order or a corrective action ordered by the agency. Many of these fines would be for simple paperwork errors or other frivolous violations, which either have no victim or are not restorative.
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Does it violate the principles of federalism by increasing federal authority, yielding to federal blandishments, or incorporating changeable federal laws into Idaho statutes or rules? Examples include citing federal code without noting as it is written on a certain date, using state resources to enforce federal law, and refusing to support and uphold the tenth amendment. Conversely, does it restore or uphold the principles of federalism?
This bill would incorporate several CMS standards and other federal requirements as a basis for standardizing prior authorization and the API that would make them accessible. The API shall “Conform to the applicable interoperability standards adopted by the centers for medicare and medicaid services (CMS) in the CMS interoperability and prior authorization final rule (CMS-0057-F), including health level 7 fast healthcare interoperability resources release 4.0.1 or a successor version adopted by CMS;”
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