Binding law — in force
From 2026-07-01, a utilization review organization may use an artificial intelligence-based algorithm or system to provide an initial review of a request for prior authorization, but for a prior-authorization request for a health care service based on medical necessity it shall not use such an algorithm or system as the sole basis for its decision to deny, delay or downgrade the request (Iowa Code 514F.8(2A), added by 2026 Iowa Acts ch. 1087, sec. 2; a downgrade changes an expedited or urgent request to a standard determination or modifies the service to a lower level). Detect automated output that sets a denial, delay or downgrade without a clinical reviewer's decision.
ia-hf2635.ai-not-sole-basis-for-denial · 2026 Iowa Acts ch. 1087, sec. 2 (Iowa Code 514F.8(2A)) · official source · jurisdictions: US-IA
The guard to add, and how far to trust this rule
Binding law — not yet in force or stayed
For prior-authorization requests made on or after 2027-01-01 under plans delivered, issued, continued or renewed in Iowa on or after that date (Iowa Code 514F.8A(5)-(6)), a utilization review organization shall not deny or downgrade a request unless the decision is made by a qualified reviewer (a physician in the same or a similar specialty with the training and expertise to treat the condition) where the requester is a physician, or a clinical peer where not, and it gives the provider a written statement citing the specific reasons and criteria, signed by that reviewer, a written explanation of the appeals process (also to the covered person) and a written attestation of the reviewer's specialty, training, board certifications and education (514F.8A(2)). Detect automated denials without a reviewer decision and denial statements generated without the reviewer's signature or attestation.
ia-hf2635.qualified-reviewer-signed-denial · 2026 Iowa Acts ch. 1087, sec. 6 (Iowa Code 514F.8A(2)) · official source · applies from 2027-01-01 · jurisdictions: US-IA
The guard to add, and how far to trust this rule
