IdahoIdaho law will offer some Medicaid practitioners prior approval exemptions
Starting July 1, 2026, Idaho practitioners who meet mentoring requirements may qualify for a year without prior approval for medically necessary Medicaid services; the provisions expire in 2030.
What it does
Eligible practitioners who meet the mentoring-hour rules can receive a year without prior approval for medically necessary services billed to Idaho Medicaid plans.
The department may cancel an exemption if a claims review finds the practitioner below the required score, but it must give at least 25 days' notice.
No more than 100 practitioners in each eligible specialty may receive an exemption in a year.
Argument forPractitioners who mentor students in rural or underserved areas may spend less time seeking approval for medically needed care.
Argument againstThe yearly cap could leave some qualified practitioners without an exemption, even if they meet the mentoring requirements.
More detail
The law provides a 12-month exemption from prior authorization for eligible practitioners who meet the mentoring-hour requirements. It covers physicians, physician assistants, and advanced practice registered nurses in family medicine, psychiatry, or obstetrics and gynecology who mentor eligible graduate students in Idaho. The practitioner must provide at least 360 mentoring hours in a calendar year, with at least 60% of those hours in a qualified rural or underserved area. The practitioner must track and report the hours. The Idaho Department of Health and Welfare must verify them before granting the exemption. The law takes effect July 1, 2026. After the department verifies reported hours, the exemption starts at the beginning of the next calendar year. These provisions expire July 1, 2030.
The department may cancel an exemption after a qualifying claims review and must give advance notice before cancellation takes effect. This applies to practitioners using the exemption. The department may review a random, statistically significant sample of claims no more than once per year. It may cancel the exemption if the practitioner falls below the acceptable risk-weighted claims score. Rules for the scoring system require legislative approval; the system must consider both the number and dollar amount of claims. Notice must come at least 25 days before the cancellation takes effect.
The law limits how many practitioners in each eligible specialty may receive an exemption each year. The limit applies separately to family medicine, psychiatry, and obstetrics and gynecology. The limit applies each year while these provisions are in effect, through June 30, 2030.
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Where it stands
- Introduced
- Passed 1st Chamber
- Passed 2nd Chamber
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Apr 1Reported Signed by Governor Brad Little on March 31, 2026 Session Law Chapter 226 Effective: 07/01/2026; 07/01/2030 Sunset Clause - SECTION 2Became Law
- Mar 30Delivered to Governor at 1:45 p.m. on March 27, 2026To Governor
- Mar 27Returned Signed by the President; Ordered Transmitted to GovernorMinor
- Mar 27Signed by President; returned to HouseMajor
- Mar 27Received from the House enrolled/signed by SpeakerMajor
- Mar 26Reported Enrolled; Signed by Speaker; Transmitted to SenateMajor
- Vote recorded Rules Suspended: Ayes 68 Nays 1 Abs/Excd 1, read in full as required –. Result: pass.Lower
- Mar 26Rules Suspended: Ayes 68 Nays 1 Abs/Excd 1, read in full as required – PASSED - 39-30-1AYES – Beiswenger, Berch, Bingham, Cannon, Cheatum, Church, Cornilles, Dygert, Egbert, Erickson, Fuhriman, Furniss, Galaviz, Gannon, Garner, Green, Hall(Stone), Handy, Haws, Healey, Manwaring, Mathias, McCann, Mickelsen, Miller, Nelsen, Petzke, Pickett, Pohanka, Raybould, Raymond, Redman, Rubel, Sauter, Shirts, Vander Woude, Veile, Weber, WheelerNAYS – Alfieri, Barbieri, Boyle, Bruce, Burgoyne, Cayler, Crane(12), Crane(13), Ehardt, Ehlers, Harris, Hawkins, Hill, Holtzclaw, Hostetler, Leavitt, Marmon, Mendive, Mitchell, Monks, Price, Rasor, Scott, Shepherd, Skaug, Tanner(13), Tanner(14), Thompson, Wisniewski, Mr. SpeakerAbsent – PalmerFloor Sponsor - WheelerTitle apvd - to enrolMajor
- Mar 26Read second time as amended in Senate; Filed for Third ReadingMinor
- Mar 25Read first time as amended in Senate; Filed for Second Reading
- Mar 25Reported Engrossed; Filed for First Reading of Engrossed Bills
- Mar 24Bills as Amended Referred to JRA for Engrossing
- Vote recorded Read third time as amended in the Senate –. Result: pass.Upper
- Mar 24Returned from the Senate Amended; Held at Desk
- Mar 24House Concurred in Senate Amendments
- Mar 24Returned from the Senate Amended; Held at Desk
- Mar 24Read third time as amended in the Senate – PASSED - 19-15-1AYES – Adams, Anthon, Bernt, Blaylock, Burtenshaw, Cook, Den Hartog, Guthrie, Harris, Lent, Rabe, Ricks, Ruchti, Semmelroth, Taylor, VanOrden, Ward-Engelking, Wintrow, WoodwardNAYS – Carlson, Foreman, Galloway, Grow, Hart, Keyser, Kohl, Lakey, Lenney, Nichols, Okuniewicz, Shippy, Toews, Zito, ZuiderveldAbsent and excused – Bjerke(Bjerke)Floor Sponsor - BlaylockTitle apvd - to HousePassed 2nd Chamber
- Mar 19Read second time as amended in the Senate, filed for Third ReadingMinor
- Mar 18Read first time as amended in the Senate; Filed for Second Reading
- Mar 18Amendments reported printed
- Mar 17Reported out as amended; filed for first reading
- Mar 17Amendments ordered printed
- Mar 17Placed in the Committee of the Whole
- Mar 13Reported out of committee; to 14th Order for amendment
- Mar 6Introduced, read first time; referred to: Health & WelfareMinor
- Mar 6Received from the House passed; filed for first reading
- Mar 5Read Third Time in Full – PASSED - 44-25-1AYES – Beiswenger, Berch, Bingham, Cannon, Cayler, Cheatum, Church, Cornilles, Crane(12), Dygert, Egbert, Erickson, Fuhriman, Furniss, Galaviz, Gannon, Garner, Hall(Stone), Handy, Haws, Healey, Holtzclaw, Manwaring, Mathias, McCann, Mickelsen(Athay), Miller, Monks, Nelsen, Palmer, Petzke, Pickett, Pohanka, Raybould, Raymond, Redman, Rubel, Sauter, Shirts, Vander Woude, Veile, Weber, Wheeler, Mr. SpeakerNAYS – Alfieri, Barbieri, Boyle, Bruce, Burgoyne, Crane(13), Ehardt, Ehlers, Harris, Hawkins, Hill, Hostetler, Leavitt, Marmon, Mendive, Mitchell, Price, Rasor, Scott, Shepherd, Skaug, Tanner(13), Tanner(14), Thompson, WisniewskiAbsent – GreenFloor Sponsor - WheelerTitle apvd - to SenatePassed 1st Chamber
- Vote recorded Read Third Time in Full –. Result: pass.Lower
- Mar 4U.C. to hold place on third reading calendar one legislative day
- Mar 3Read second time; Filed for Third ReadingMinor
- Mar 2Reported Printed; Filed for Second Reading
- Feb 27Introduced, read first time, referred to JRA for PrintingIntroduced
Healthcare