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

LEGISLATURE OF THE STATE OF IDAHO Sixty-eighth Legislature Second Regular Session - 2026 IN THE HOUSE OF REPRESENTATIVES HOUSE BILL NO. 788 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) An eligible11 practitioner who provides three hundred sixty (360) hours or more of pre-12 ceptorship in a calendar year, with at least sixty percent (60%) of those13 hours occurring in a qualified rural or underserved area, shall qualify for a14 twelve (12) month exemption from prior authorization requirements for medi-15 cally necessary services billed to Idaho medicaid plans.16 (2)(a) An eligible practitioner shall be responsible for tracking the17 eligible practitioner's preceptorship hours and may report such hours18 to the department of health and welfare upon reaching the minimum amount19 of hours needed to qualify for the exemption described in subsection (1)20 of this section.21 (b) The department of health and welfare shall verify the hours sub-22 mitted by an eligible practitioner, and upon verification shall exempt23 the eligible practitioner from prior authorization requirements as de-24 scribed in subsection (1) of this section at the start of the next calen-25 dar year.26 (3) The department of health and welfare may rescind an exemption from27 prior authorization requirements if:28 (a) On the basis of a review of a random sample of a statistically sig-29 nificant number of claims submitted by an eligible practitioner during30 an exempted period, the department determines that the eligible prac-31 titioner has fallen below the acceptable risk-weighted claim sampling32 score. Such a review may not be conducted more than once per year; and33 (b) The department notifies the eligible practitioner at least twenty-34 five (25) days before the proposed rescinding from exemption is to take35 effect.36 (4) No more than one hundred (100) eligible practitioners from each37 eligible specialty shall receive an exemption from prior authorization re-38 quirements pursuant to this section per year.39 (5) The department shall promulgate rules, subject to legislative ap-40 proval, to carry out the provisions of this section, including the develop-41

2 ment of a risk-weighted sampling methodology and scoring system that incor-1 porates both the number and dollar amount of claims.2 (6) For the purpose of this section, the following definitions apply:3 (a) "Eligible practitioner" means a physician, physician's assis-4 tant, or advanced practice registered nurse practicing an eligible5 specialty.6 (b) "Eligible specialty" means family medicine, psychiatry, or obstet-7 rics and gynecology.8 (c) "Graduate student" means a medical, physician assistant, or ad-9 vanced practice registered nurse student, resident, or fellow seeking10 a degree at the graduate level at any accredited Idaho institution of11 higher education, including Idaho-funded medical education programs,12 or completing training in an Idaho-based residency or fellowship pro-13 gram.14 (d) "Preceptorship" means a mentoring experience in which a preceptor15 provides a program of personalized instruction, training, and supervi-16 sion that is offered to eligible graduate students to enable the stu-17 dents to obtain professional degrees.18 (e) "Qualified rural or underserved area" means a primary care health19 professional shortage area or a medically underserved area, as those20 terms are defined in section 39-5903, Idaho Code.21

SECTION 2. An emergency existing therefor, which emergency is hereby22 declared to exist, this act shall be in full force and effect on and after23 July 1, 2026.24