Iowa MGMA State Chapter Legislative Update
Prepared By: Ryon Rasmussen, Iowa MGMA State Chapter Legislative Liaison Date: 2/14/25
1. 2024 Legislative Updates
● New Legislation: Brief descriptions of laws or policies passed in 2024 that impact medical group management
○ HF 2099 – Regulation of PBMs:
• A pharmacy benefits manager shall not assess, charge, or collect any form of remuneration that passes from a pharmacy or a pharmacist in a pharmacy network to the pharmacy benefits manager, including but not limited to claim processing fees, performance-based fees, network participation fees, or accreditation fees
○ HF 2668 – Insurance Coverage of Biomarker Testing:
• A policy, contract, or plan providing for third-party payment or prepayment of medical expenses shall provide coverage for biomarker testing to diagnose, treat, appropriately manage, or monitor a disease or condition in a covered person when the biomarker testing has demonstrated clinical utility.
2. Legislation Effective January 1, 2025
● Description: Provide a summary of the legislation and its purpose.
○ HF 262 – Non-Medical Switching:
• A health carrier, health benefit plan, or utilization review organization shall not limit or exclude coverage of a prescription drug for any covered person who is medically stable on such drug as determined by the prescribing health care professional.
○ SF 477 - Licensure of Internationally Trained Physicians and Electronic Protected Health Information:
• The board shall grant a provisional license to practice medicine and surgery or osteopathic medicine and surgery in this state to an international physician with an offer for employment as a physician at a healthcare facility. However, the board shall not grant a license pursuant to this subsection to an international physician who does not possess a federal immigration status allowing the international medical graduate to practice as a physician in the United States or to an international physician who fails to obtain a passing score on the United States medical licensing examination.
• A health care provider or facility that maintains or transmits electronic protected health information shall disclose to the legal guardian of a minor the minor's electronic protected health information, with the following
exceptions:
• a. Electronic protected health information that relates to health care for which the minor is legally authorized to consent without the consent of a legal guardian.
• b. If disclosure of the electronic protected health information to a legal guardian is otherwise prohibited by state law or federal law, including federal statute, regulation, or centers for disease control and prevention guidelines.
3. What to Watch for in 2025
● New or Pending Legislation: Bills under consideration or policies expected to roll out later in 2025.
○ HF 61 - Medical Price Disclosures:
• Requires hospitals and health care providers to disclose the prices charged for the most common services in a document that is available electronically or on a website. Requires price information to be updated yearly. Requires an additional document on the prices for the 75 most common in-patient and outpatient services, updated quarterly.
○ HF 303 – Prior Auth:
• Requires a utilization review organization to respond to a request for prior authorization within 48 hours for urgent requests and 10 days for non-urgent requests, with some exceptions for unusual circumstances or a high volume of requests. Requires the provider to receive notice of the request within 24 hours. It requires the organization to review the requests and eliminate prior authorization for usually approved procedures. Authorizes complaints to be made to the Insurance Division. It requires providers to use prior authorization to implement an authorization exemption pilot program by 2026 and requires reports to the Insurance Commissioner.
○ 514F.7 - Step Therapy:
• A step therapy override exception shall be approved by a health carrier, health benefit plan, or utilization review organization if any of the following circumstances apply: (1) The prescription drug required under the step therapy protocol is contraindicated and likely to cause an adverse reaction to a covered person, decrease the ability of a covered person to achieve or maintain reasonable functional ability in performing daily activities or cause physical or mental harm to a covered person. (2) The prescription drug required under the step therapy protocol is expected to be ineffective based on (a) the known clinical characteristics of the covered person, and the known characteristics of the prescription drug regimen as described in peerreviewed literature or in the manufacturer's prescribing information for the drug, (b) the health care professional's medical judgment based on clinical practice guidelines or peer-reviewed journals, or (c) the covered person's documented experience with the prescription drug regimen. (3) The covered person has had a trial of a therapeutically equivalent dose of the prescription drug under the step therapy protocol while under the covered person's current or previous health benefit plan for a period of time to allow for a positive treatment outcome, and such prescription drug was discontinued by the covered person's health care professional due to lack of effectiveness. (4) The covered person is currently receiving a positive therapeutic outcome on a prescription drug selected by the covered person's health care professional. Determination must be made within seventy-two (72) hours for urgent claims and five (5) calendar days for non-urgent claims
4. Resources and Next Steps
● State government or regulatory agency websites.
● Legislative tracking tools or compliance resources.