H06552026 Regular Session

Adds to existing law to establish provisions regarding Medicaid prior authorization exemptions for certain preceptorships.

MEDICAID -- Adds to existing law to establish provisions regarding Medicaid prior authorization exemptions for certain preceptorships.

MEDICAID

IntroducedIn CommitteeFloor VoteEnacted

Via committee: Health and Welfare

STATEMENT OF PURPOSE

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This legislation establishes a prior authorization exemption for certain physicians who provide substantial preceptorship training to graduate medical students in Idaho, particularly in rural and underserved communities. Physicians practicing in primary care, psychiatry, or obstetrics and gynecology who provide at least 360 hours of qualifying preceptorship in a calendar year, with at least 60 percent of those hours occurring in qualified rural areas, are eligible for a twelve-month exemption from prior authorization requirements for medically necessary services billed to Idaho Medicaid managed care plans and state-contracted insurers. The bill directs the Department of Health and Welfare to verify reported preceptorship hours and administer the exemption and allows insurers to rescind exemptions if claims fail to meet medical necessity standards. Annual participation is limited to one hundred physicians per eligible specialty. The legislation is intended to encourage physician participation in training programs, strengthen Idaho's healthcare workforce pipeline, and improve access to care in rural and underserved areas.

FISCAL NOTE

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This legislation is not expected to have a significant impact on the state General Fund. Administrative responsibilities related to verification and exemption administration are expected to be absorbed by the Department of Health and Welfare within existing resources. Any fiscal impact associated with reduced prior authorization activity or potential changes in utilization is expected to be minimal, indeterminate, and managed within existing Medicaid managed care contracts.

BILL TEXT

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LEGISLATURE OF THE STATE OF IDAHO Sixty-eighth Legislature Second Regular Session - 2026 IN THE HOUSE OF REPRESENTATIVES HOUSE BILL NO. 655 BY HEALTH AND WELFARE COMMITTEE AN ACT1 RELATING TO PRECEPTOR PRIOR AUTHORIZATION EXEMPTION; AMENDING CHAPTER 2,2 TITLE 56, IDAHO CODE, BY THE ADDITION OF A NEW SECTION 56-276, IDAHO3 CODE, TO ESTABLISH PROVISIONS REGARDING PRECEPTORS AND PRIOR AU-4 THORIZATION EXEMPTIONS; AND DECLARING AN EMERGENCY AND PROVIDING AN5 EFFECTIVE DATE.6

Be It Enacted by the Legislature of the State of Idaho:7

SECTION 1. That Chapter 2, Title 56, Idaho Code, be, and the same is8 hereby amended by the addition thereto of a NEW SECTION, to be known and des-9 ignated as Section 56-276, Idaho Code, and to read as follows:10 56-276. PRECEPTORS -- PRIOR AUTHORIZATION EXEMPTION. (1) A physician11 practicing an eligible specialty who provides three hundred sixty (360)12 hours or more of preceptorship in a calendar year, with at least sixty per-13 cent (60%) of those hours occurring in a qualified rural area, shall qualify14 for a twelve (12) month exemption from prior authorization requirements for15 medically necessary services billed to Idaho medicaid plans.16 (2)(a) A physician shall be responsible for tracking the physician's17 preceptorship hours and may report such hours to the department of18 health and welfare upon reaching the minimum amount of hours needed to19 qualify for the exemption described in subsection (1) of this section.20 (b) The department of health and welfare shall verify the hours sub-21 mitted by a physician, and upon verification shall exempt the physician22 from prior authorization requirements as described in subsection (1) of23 this section at the start of the next calendar year.24 (3) The department of health and welfare may rescind an exemption from25 prior authorization requirements if:26 (a) On the basis of a review of a random sample of a statistically sig-27 nificant number of claims submitted by a physician during an exempted28 period, the department determines that the physician has fallen below29 the acceptable risk-weighted claim sampling score. Such a review may30 not be conducted more than once per year; and31 (b) The department notifies the physician at least twenty-five (25)32 days before the proposed rescinding from exemption is to take effect.33 (4) No more than one hundred (100) physicians from each eligible spe-34 cialty shall receive an exemption from prior authorization requirements35 pursuant to this section per year.36 (5) The department shall promulgate rules, subject to legislative ap-37 proval, to carry out the provisions of this section, including the develop-38 ment of a risk-weighted sampling methodology and scoring system that incor-39 porates both the number and dollar amount of claims.40 (6) For the purpose of this section, the following definitions apply:41

2 (a) "Eligible specialty" means primary care, psychiatry, or obstetrics1 and gynecology.2 (b) "Graduate student" means an individual matriculating at the gradu-3 ate level at any accredited Idaho institution of higher education seek-4 ing a degree in any of the areas of doctor of osteopathy or physician as-5 sistant.6 (c) "Preceptorship" means an uncompensated mentoring experience in7 which a preceptor provides a program of personalized instruction,8 training, and supervision that is offered to eligible graduate students9 to enable the students to obtain professional degrees in primary care10 fields.11 (d) "Qualified rural area" means a primary care health professional12 shortage area or a medically underserved area, as those terms are de-13 fined in section 39-5903, Idaho Code.14

SECTION 2. An emergency existing therefor, which emergency is hereby15 declared to exist, this act shall be in full force and effect on and after16 July 1, 2026.17