Anyone in Idaho who has waited on an insurance company to sign off on a scan, a surgery or a prescription may want to watch the Statehouse this winter.
On Wednesday, members of the Legislature's Idaho Health Insurers Working Group agreed to start developing a prior authorization reform bill for the session that opens in January. Prior authorization is the approval many health plans require before they agree to pay for certain treatments. The panel's Republican co-chairs are Sen. Mark Harris of Soda Springs and Rep. Dustin Manwaring of Pocatello, and members also voted to pursue possible bills on late payments to medical providers and on the way insurers credential health care providers.
What the panel wants to change
The prior authorization bill is the headliner, but it has company. One possible measure would aim to cut down on late payments to providers through standards that apply to both insurers and the providers billing them. Another would set uniform credentialing standards across insurers. A third would have the Idaho Department of Insurance, the state agency that oversees insurers, gather numbers on how fast claims get paid and how often care gets denied, then report them to the Legislature.
That reporting might also cover a federal arbitration process created by Congress. Blue Cross of Idaho, the largest insurer in the state, contends that a microhospital in North Idaho relies on the tool heavily and says the practice could raise health care costs. Congress is considering an overhaul.
Idaho providers say prior authorization requests have been eating up more of their administrative time in recent years, according to data Manwaring summarized. The working group also collected survey responses from insurers, providers and members of the public. Nationally, 92% of physicians who answered a 2025 American Medical Association survey said prior authorization had a negative impact on their patients.
What the 2026 bill would have required
This is not the Legislature's first run at the issue. House Bill 611, the Idaho Prior Authorization Reform Act, was introduced in February by the House Health and Welfare Committee and sent to the House Business Committee, where it never received a hearing. Its statement of purpose listed Rep. Josh Wheeler of Ammon, who now sits on the working group, as a contact alongside Reps. Ben Fuhriman and Rod Furniss.
The bill would have put insurers on the clock. Once they had the information they needed, they would have had five calendar days to decide a standard request, two business days for prescription drugs and 24 hours for urgent care. Approvals generally would have stayed valid for 12 months. For chemotherapy and other ongoing treatment of chronic conditions, an approval would have lasted for the course of treatment, up to a year. Those longer approvals would not have applied to benzodiazepines or to opioids and other Schedule II narcotics.
Patients switching plans would have gotten some protection, too. A new insurer would have had to honor an approval from the patient's previous insurer for at least the first 90 days of coverage, subject to the plan's terms. The bill also included a backstop: if an insurer missed a deadline, the care would have been considered approved automatically.
The deadlines came with accountability measures. The Department of Insurance would have enforced the rules with cease-and-desist orders, correction plans and fines of up to $10,000 per violation for repeated violations or for failing to submit or follow a correction plan. Fine money would have gone to the state General Fund. The bill did not create a private right to sue. Starting in 2027, insurers also would have filed annual public reports listing how many requests they received, the share they denied, how often denials were reversed on appeal, the 10 services denied most often and the five most common reasons for denial.
The bill's stated purpose was to protect the relationship between patients and their doctors from unreasonable third-party interference and to keep prior authorization from getting in the way of a physician's independent medical judgment. For taxpayers, its fiscal note projected no significant impact on the state General Fund. It said the Department of Insurance would handle oversight within existing resources and that implementation costs would fall on insurers, not the state. Self-insured employer plans governed by federal law and workers' compensation care were exempt.
Bill language for the new proposals has not been released, so it is not yet clear how much of that framework will return.
A hospital standoff started the inquiry
Senate President Pro Tem Kelly Anthon and House Speaker Mike Moyle formed the eight-member group this summer, after Portneuf Medical Center in Pocatello fell out of Regence BlueShield of Idaho's provider network in a contract dispute. A Regence government relations director told lawmakers the insurer had been negotiating with an out-of-state entity and that the rate increase being sought was severe. Portneuf, whose parent company is Ardent Health, said the insurer was turning down most of the claims it submitted. The two sides have since resolved the dispute.
The standoff hit state workers directly. Regence runs the health plan for Idaho state employees, which covers more than 20,000 workers and family members. At an August meeting, members discussed roughly 3,000 state plan members in southeastern Idaho who were out of network. Faith Knowlton, a state administrator who answered lawmakers' questions about the employee plan, said out-of-network costs fell on those members, that other in-network providers were available in the area and that emergency treatment would still count as in network.
Moyle said at the outset that lawmakers should do their homework before jumping to conclusions. Rep. Soñia Galaviz is the panel's only Democrat. The other members are Sens. Kevin Cook of Idaho Falls, Carl Bjerke of Coeur d'Alene and Josh Keyser of Meridian, along with Wheeler and Rep. Cornel Rasor of Sagle.
In September, Cook asked why lawmakers needed an interim panel when state agencies already have authority to review these issues. Department of Insurance Director Dean Cameron answered that the Legislature sets state policy and agencies enforce it. Cameron also said the department needs to improve how it collects data on complaints from providers.
Portneuf CEO Nathan Carter told the panel that patients and providers often do not know who can help them, and said he was grateful for the department's assistance. Asked why an approved procedure might later be denied, Carter pointed to "down coding," which he said tends to affect advanced treatments with complex billing codes. He also said he would prefer that providers and insurers agree on what information belongs on approval forms rather than have lawmakers mandate it.
At the same meeting, Sean Weatherston, a physical therapist, described what the approval process looks like inside his private practice. Asked by Galaviz how delays affect his business and his patients, he said therapists spend time on approval paperwork that could go to treating patients, and that waiting can interrupt a patient's progress, which stretches out therapy and adds to its cost.
What happens in January
Wednesday's agenda included a presentation from Idaho Hospital Association President and CEO Brian Whitlock on community hospital data and reforms in other states, followed by in-person public testimony. Any bills that come out of the working group could be considered when the Legislature returns in January.
Insurer performance could matter even more in the years ahead. Idaho plans to move Medicaid, which covers low-income residents and people with disabilities, from a state-run program to management by private insurance companies.
For Idaho families, the question is practical: how long should it take to get an answer after a doctor orders care? When lawmakers return in January, they could be asked to write that answer into state law.