Prior Authorization Bills Considered in States

This week, the American College of Radiology® (ACR®) is tracking legislation ranging from patients’ bill of rights to prior authorization.

Scope of Practice

New York

Assembly Bill (AB) 6362 would enjoin New York into the interstate medical licensure compact. This allows physicians who meet the compact’s eligibility requirements to practice medicine in other compact states.

Iowa

House Study Bill (HSB) 291 would enjoin the state of Iowa into the interstate podiatric medical licensure compact (IPMLC). This compact allows podiatrists who meet the compact’s eligibility to practice in other compact states.

Rhode Island

Senate Bill 701 allows physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs), who are and are not licensed in Rhode Island to provide telemedicine services under certain conditions to patients who are in the state when those services are rendered.

Texas

HB 3794 would permit APRNs to practice independently, including ordering, performing, and interpreting diagnostic tests.

Patient Bill of Rights

Hawaii

Senate Resolution (SR) 28-2025/ Senate Concurrent Resolution (SCR) 43-2025/ SCR 45-2025 would enact the following provisions regarding the rights of patients in Hawaii:

• Patients must receive clear, written (and, if necessary, translated) explanations from their health insurance plan regarding covered and non-covered services, presented at a reading level understandable to the average enrollee.
• All insurers must maintain and publicly post an up-to-date, accurate, and easily accessible directory of in-network providers.
• All patients must be able to obtain timely specialist referrals without undue administrative barriers or delays.
• No insurer may deny coverage for legitimate emergency services based on retrospective review.
• Every mentally competent patient has the right to accept, receive, reject, or discontinue any legal medical care, treatment, or prescribed medication from any legally licensed medical provider.
• Whenever coverage is denied, insurers must provide a universal external review request form and a step-by-step guide explaining how to appeal.

Prior Authorization

Iowa

Senate File (SF) 562 would make the following changes regarding prior authorization in the state of Iowa:

• Would require any health carrier who uses artificial intelligence (AI), an algorithm, or other software tools, for the purpose of utilization review, to ensure that AI determination is not made solely on a group dataset, AI does not discriminate, and AI does not supplant a healthcare provider’s decision- making.
• Would require utilization review organizations to respond to a request for prior authorization within 48 hours after receiving urgent requests or within 10 calendar days for non-urgent requests.
• This bill would also require all carriers who utilize prior authorization to make statistics available regarding authorization approvals and denials on the carrier’s website.

Maine

Legislative Document (LD) 955 would make the following changes regarding prior authorization in Maine:

• Starting Jan. 1, 2026, health insurance carriers would be prohibited from denying claims that are solely based on the use of AI.
• This bill would also require that before a carrier denies benefits or reduces payment for services using AI, a carrier must conduct a utilization review done by a physician.

Maryland

HB 1314 would prohibit certain insurers, nonprofit health service plans, and health maintenance organizations (HMOs) from using AI to automatically deny prior authorizations. The bill would also prohibit health care providers from charging a fee to obtain prior authorization from a carrier or managed care organization (MCO).

Texas

HB 4018 would prohibit a utilization review agent from using AI as the sole basis of a decision to wholly or partly deny, delay, or modify healthcare services based on medical necessity or appropriateness.

For more information about these bills, contact Dillon Harp, ACR Senior State Government Relations Specialist.

ACR is committed to supporting its chapters in their state-level advocacy efforts. The College also offers resources for members through the State Issues page and can assist with delivering legislative calls to action and grassroots mobilization.

ACR partners with Fiscal Note, a legislation and regulation tracking service, to provide continuous, comprehensive updates on radiology- and healthcare-related legislation. To stay current on state legislative developments relevant to radiology, view the ACR policy map or receive state-specific reports from Fiscal Note. The ACR Bulletin is also a good source for information related to what is happening at the state level.

For state-level calls to action or to sign up to receive Fiscal Note reports, chapter leaders should contact Eugenia Brandt, ACR Senior Government Relations Director, or Melody Ballesteros, ACR Assistant Director Government Relations.