# Iowa HF 2635: A bill for an act relating to health carriers standards of conduct; utilization review organizations, artificial intelligence, audits, and prior authorizations; certificate of need processes; and including applicability provisions. (Formerly HF 2438.) Effective date: 07/01/2026. Iowa HF 2635, A bill for an act relating to health carriers standards of conduct; utilization review organizations, artificial intelligence, audits, and prior authorizations; certificate of need processes; and including applicability provisions. (Formerly HF 2438.) Effective date: 07/01/2026., is a 91st General Assembly (2025–2026) House bill sponsored by COMMITTEE ON HEALTH AND HUMAN SERVICES; status signed, last action 2026-05-13 (Signed by Governor.); PRIA reads it as touching household money (as of 2026-10-18). - Canonical: https://policyrisk.com/state-bill/IA-HF2635-2025-2026 - As of: 2026-10-18 - Plain-text twin of the page above; the HTML and this file carry the same facts. ## Facts - Bill: Iowa HF 2635 - State: Iowa - Session: 91st General Assembly (2025–2026) - Title: A bill for an act relating to health carriers standards of conduct; utilization review organizations, artificial intelligence, audits, and prior authorizations; certificate of need processes; and including applicability provisions. (Formerly HF 2438.) Effective date: 07/01/2026. - Status: signed - Chamber: House - Introduced: 2026-02-19 - Last action: 2026-05-13, Signed by Governor. - Sponsor: COMMITTEE ON HEALTH AND HUMAN SERVICES - Cosponsors: 0 - Touches household money: yes - Roll calls: 3 (225 yes, 1 no in all) - Economic provisions PRIA read: 11 ## Summary No summary available. ## Bill overview: provisions PRIA read - Fewer approval barriers for urgent care: benefit, medium. Beginning January 1, 2027, covered plans cannot require prior approval or extra utilization review for two types of care. Cancer screenings must be provider-recommended under the latest National Comprehensive Cancer Network oncology guidelines designated category 2A or lower. The second exception c… - Stronger safeguards against automated care denials: benefit, medium. Beginning July 1, 2026, review organizations cannot use artificial intelligence alone to deny, delay, or downgrade care based on medical necessity. The insurance commissioner can use enforcement remedies and suspend review authority for a pattern of noncompliance. For covered plans and requests sta… - Providers gain referral and contract protections: benefit, low. Beginning July 1, 2026, health carriers cannot punish providers for out-of-network referrals or affiliations. Banned actions include financial penalties, lower payments, administrative fees, and ending network participation for those reasons. Carriers cannot interfere with provider staffing or refe… - Faster application checks for health projects: benefit, low. Beginning July 1, 2026, Iowa ends the preliminary letter-of-intent process for certificate-of-need applicants. The Department of Health and Human Services must check applications for form and completeness within 15 business days. It may reject an application only for information missing under depar… - Higher review thresholds for health projects: benefit, low. Beginning January 1, 2027, certain facility projects and equipment acquisitions for new services face higher certificate-of-need thresholds. These review triggers apply above $4 million from January 1, 2027, through December 30, 2031. The threshold is above $4.5 million from January 1, 2032, throug… - More health services avoid state approval: benefit, low. Beginning July 1, 2026, more services are exempt from certificate-of-need approval, Iowa’s review of certain health service projects. Exempt services include open-heart surgery, organ transplants, radiation therapy, and cardiac catheterization. Qualifying outpatient behavioral health facilities are… - Providers gain audit deadlines and remedies: benefit, low. For covered audits started January 1, 2027, review organizations must notify providers within 15 calendar days after selecting a claim. They must decide within 45 calendar days after receiving all requested records. Providers have 30 calendar days after an adverse decision to appeal; appeal decisio… - Health project comments replace public hearings: cost, low. Beginning July 1, 2026, Iowa replaces certificate-of-need application hearings with written comments before the department finishes its evaluation. After accepting an application, the department must notify affected people electronically; consumer and payer notices may also be electronic. The depar… - Providers must send approval requests electronically: cost, low. For requests made on or after July 1, 2027, providers must submit prior authorization requests electronically. This applies to health carriers and Medicaid managed care organizations, which must accept electronic submissions by that date. Providers must use a standards-based application programming… - Health project refunds favor early withdrawals: mixed, low. Beginning July 1, 2026, certificate-of-need applicants who voluntarily withdraw within 30 calendar days receive a 75% fee refund. The law removes previous refund provisions for withdrawals after 30 days. Application fees are 0.3% of expected project cost, with a $600 minimum and $21,000 maximum, cr… - More facilities covered by health rules: mixed, low. Beginning July 1, 2026, Iowa clarifies and broadens the health facilities covered by chapter 135P. The definition expressly includes birth centers, hospices, home health agencies, assisted living programs, clinics, and community health centers. It also includes University of Iowa Hospitals and Clin… ## Sponsors and cosponsors - Sponsor: COMMITTEE ON HEALTH AND HUMAN SERVICES ## Roll call votes | Date | Chamber | Motion | Result | Yes | No | Other | | --- | --- | --- | --- | --- | --- | --- | | 2026-03-05 | House | Passed House | pass | 87 | 0 | | | 2026-03-04 | Senate | Passed Senate | pass | 44 | 0 | | | 2026-03-03 | House | Passed House | pass | 94 | 1 | | ## Actions (22) - 2026-05-13: Signed by Governor. (House) - 2026-05-06: Reported correctly enrolled, signed by Speaker and President, and sent to Governor. (House) - 2026-03-31: Fiscal note. (legislature) - 2026-03-09: Message from House. (Senate) - 2026-03-05: Immediate message. (House) - 2026-03-05: Passed House, yeas 87, nays 0. (House) - 2026-03-05: House concurred in Senate amendment H-8154. (House) - 2026-03-04: Senate amendment H-8154 filed. (House) - 2026-03-04: Message from Senate. (House) - 2026-03-04: Immediate message. (Senate) - 2026-03-04: Passed Senate, yeas 44, nays 0. (Senate) - 2026-03-04: Amendment S-5067 filed, adopted. (Senate) - 2026-03-04: Substituted for SF 2421. (Senate) - 2026-03-04: Read first time, attached to SF 2421. (Senate) - 2026-03-04: Message from House. (Senate) - 2026-03-03: Immediate message. (House) - 2026-03-03: Passed House, yeas 94, nays 1. (House) - 2026-03-03: Amendment H-8080 adopted, as amended. (House) - 2026-03-03: Amendment H-8104 to amendment H-8080 filed, adopted. (House) - 2026-03-03: Fiscal note. (legislature) - 2026-03-02: Amendment H-8080 filed. (House) - 2026-02-19: Introduced, placed on calendar. (House) ## Bill text - As Introduced: [PDF](https://www.legis.iowa.gov/docs/publications/LGI/91/HF2635.pdf) - Enrolled: [PDF](https://www.legis.iowa.gov/docs/publications/LGE/91/HF2635.pdf) ## Related bills - HF 2801: A bill for an act modifying the major economic growth attraction program, and including effective date provisions. (Formerly HSB 785.) Effective date: 10/02/20… (signed) - SF 2472: A bill for an act relating to state and local government taxes, fees, financial authority, and budgets, by modifying property assessment provisions, divisions… (signed) - HF 2601: A bill for an act relating to campaign finance, including participation in ballot issue campaigns by foreign nationals and investigations of election misconduc… (signed) - SF 2399: A bill for an act relating to bail and bond amounts and conditions. (Formerly SSB 3162.) Effective date: 07/01/2026. (signed) - SF 2471: A bill for an act relating to fees for lifetime fur harvester licenses. (Formerly SF 2317, SSB 3121.) Effective date: 07/01/2026. (signed) - SF 2299: A bill for an act relating to the district-to-community college sharing or concurrent enrollment program. (Formerly SF 2176.) Vetoed 6-2-26. (vetoed) ## Sources - [As Introduced (PDF)](https://www.legis.iowa.gov/docs/publications/LGI/91/HF2635.pdf) - [Enrolled (PDF)](https://www.legis.iowa.gov/docs/publications/LGE/91/HF2635.pdf) ## Related - [HF 2801: A bill for an act modifying the major economic growth attraction program, and i…](https://policyrisk.com/state-bill/IA-HF2801-2025-2026) - [SF 2472: A bill for an act relating to state and local government taxes, fees, financial…](https://policyrisk.com/state-bill/IA-SF2472-2025-2026) - [HF 2601: A bill for an act relating to campaign finance, including participation in ball…](https://policyrisk.com/state-bill/IA-HF2601-2025-2026) - [SF 2399: A bill for an act relating to bail and bond amounts and conditions. (Formerly S…](https://policyrisk.com/state-bill/IA-SF2399-2025-2026) - [SF 2471: A bill for an act relating to fees for lifetime fur harvester licenses. (Former…](https://policyrisk.com/state-bill/IA-SF2471-2025-2026) - [SF 2299: A bill for an act relating to the district-to-community college sharing or conc…](https://policyrisk.com/state-bill/IA-SF2299-2025-2026) - [Iowa bills](https://policyrisk.com/states/iowa/bills) - [Iowa state hub](https://policyrisk.com/states/iowa) - [All state legislation](https://policyrisk.com/state-bills) Source: PRIA, https://policyrisk.com/state-bill/IA-HF2635-2025-2026 (as of 2026-10-18).