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Read. Follow. Verify.Iowa Senate File 562 Regulates AI in Medical Utilization Review and Sets Prior Authorization Timelines
Last action · March 11, 2025: Subcommittee: Driscoll, Petersen, and Warme. S.J. 492 .Sponsors: Trone Garriott and 4 others
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What This Bill Would Do
Senate File 562 prohibits s from using artificial intelligence to deny, delay, or modify health care services based on medical necessity, requiring that such decisions be made exclusively by competent health care providers. The bill establishes strict response deadlines for requests, mandates an annual review to eliminate unnecessary prior authorization requirements, and requires health carriers to implement a prior authorization exemption pilot program by January 15, 2026.
Patients and health care providers face mandatory response timeframes for medical treatments, while insurance carriers must publicly disclose statistics and report pilot program results by January 15, 2027.
- Prior authorization is a process used by health insurance companies to determine if a prescribed medical service, treatment, or medication is medically necessary before they will cover its cost. context
- Utilization review organizations evaluate the medical necessity, efficiency, and appropriateness of health care services and treatment plans on behalf of health insurers. context
Who It Would Affect
Groups the bill's text would affect if enacted, as described in the record. Being affected is not a position for or against it.
Covered persons
Patients' health benefit plans are subject to new AI restrictions, mandatory prior authorization response timelines, and transparency measures regarding approval and denial statistics.
Health care providers
Providers experience mandatory response timeframes for prior authorizations, retain exclusive authority over medical necessity decisions, and may qualify for prior authorization exemptions under the 2026 pilot program.
Health carriers
Carriers must comply with new restrictions on AI utilization review, publish prior authorization statistics annually, report independent review records, and implement a prior authorization exemption pilot program.
Utilization review organizations
Organizations must adhere to strict prior authorization response deadlines, conduct annual reviews to eliminate unnecessary review requirements, and comply with state oversight and complaint processes.
Key Facts
- Health carriers using artificial intelligence for utilization review must ensure determinations are based on clinical history, individual circumstances, and relevant medical records.
- Artificial intelligence tools used by health carriers are strictly prohibited from directly or indirectly denying, delaying, or modifying health care services based on medical necessity.
- A determination of medical necessity can only be made by a health care provider competent to evaluate the specific clinical issues.
- Utilization review organizations must respond to prior authorization requests within 48 hours for urgent requests, 10 calendar days for nonurgent requests, or 15 calendar days if there are complex circumstances or high volume.
Show all 11 facts
- Utilization review organizations must acknowledge receipt of a prior authorization request within 24 hours.
- Utilization review organizations must annually review all services requiring prior authorization and eliminate requirements for services routinely approved.
- Health carriers utilizing prior authorization must publish approval and denial statistics on their internet sites, updated annually by March 31.
- Health carriers, hospital and medical service corporations, health maintenance organizations, and health care providers must comply with Title I of the federal No Surprises Act.
- Independent review organizations and health carriers must submit annual reports to the commissioner of insurance, which will be made publicly accessible on the division's internet site.
- All health carriers delivering or renewing health benefit plans in the state on or after January 1, 2026, must implement a prior authorization exemption pilot program for a subset of participating providers by January 15, 2026.
- Each health carrier must submit a report on its prior authorization exemption pilot program to the commissioner of insurance by January 15, 2027.
Frequently Asked Questions
Can an insurance company use artificial intelligence to automatically deny medical procedures?
How quickly must an insurance company respond to a prior authorization request?
Where can consumers see how often an insurance carrier approves or denies prior authorizations?
What else do you want to know?
News Coverage
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Votes, people, money & the original sourceWhere This Stands
Currently in committee. The next step in the legislative lifecycle is Floor Vote.
Procedural history
2 actions- Mar 11, 2025SenateSubcommittee: Driscoll, Petersen, and Warme. S.J. 492 .
- Mar 6, 2025SenateIntroducedIntroduced, referred to Commerce. S.J. 433 .
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Lobbying Activity
No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.
Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Sponsors
Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
Strict Prohibition on AI Medical Denials
The bill explicitly forbids artificial intelligence from making final decisions on medical necessity, ensuring human health care provider oversight.
Phased Implementation and Reporting Schedule
Establishes clear deadlines including annual statistical updates by March 31, pilot program implementation by January 15, 2026, and pilot program evaluation reports by January 15, 2027.
Connected Entities
Sources
www.legis.iowa.gov
Analysis Score
0–100- Significance80How much this matters to a regular citizen
- Controversy65Intensity of disagreement among stakeholders
- Entertainment10Compellingness for a non-policy-wonk reader
- Buzz45Current news / social attention level
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