IA SSB3118: A bill for an act relating to utilization review organizations' use of artificial intelligence, prior authorization determinations and exemptions, an… Verified

Senate Study Bill 3118 establishes guidelines for the use of artificial intelligence by utilization review organizations (UROs) in Iowa. It permits UROs to use AI algorithms for initial reviews of prior authorization requests but prohibits using AI as the sole basis for decisions to deny, delay, or downgrade requests based on medical necessity. The bill also mandates that any denial or downgrade must be made by a qualified reviewer or clinical peer, ensuring that human oversight is maintained in the decision-making process. The bill applies to requests for prior authorization made before January 1, 2027, if not finally determined by that date, with specific provisions for cancer-related screenings exempting them from prior authorization requirements if recommended by a healthcare professional. UROs must provide detailed written explanations for any adverse decisions, including the rationale and appeals process, to the requesting healthcare provider. The bill also empowers the commissioner of insurance to adopt rules for enforcement, ensuring that UROs are held accountable for their practices regarding AI use and prior authorization processes.