Bill Text: IL SB3732 | 2023-2024 | 103rd General Assembly | Introduced
Bill Title: Amends the Prior Authorization Reform Act. Provides that the Act applies to the program of group health benefits under the State Employees Group Insurance Act of 1971. Provides that a health insurance issuer shall not require prior authorization: where a medication is prescribed for a chronic condition, long-term condition, or mental health condition, has been prescribed for 6 months or more, or is a treatment for the clinical indication as supported by peer-reviewed medical publications; or for patients currently managed with an established treatment regimen. Removes language requiring a health insurance issuer to periodically review its prior authorization requirements and consider removal of prior authorization requirements under certain circumstances. Makes a conforming change. Effective July 1, 2024.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced) 2024-05-17 - Rule 2-10 Third Reading Deadline Established As May 24, 2024 [SB3732 Detail]
Download: Illinois-2023-SB3732-Introduced.html
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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois, | |||||||||||||||||||||||
3 | represented in the General Assembly:
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4 | Section 5. The Prior Authorization Reform Act is amended | |||||||||||||||||||||||
5 | by changing Sections 10, 50, and 65 as follows:
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6 | (215 ILCS 200/10) | |||||||||||||||||||||||
7 | Sec. 10. Applicability; scope. This Act applies to health | |||||||||||||||||||||||
8 | insurance coverage as defined in the Illinois Health Insurance | |||||||||||||||||||||||
9 | Portability and Accountability Act, the program of group | |||||||||||||||||||||||
10 | health benefits under the State Employees Group Insurance Act | |||||||||||||||||||||||
11 | of 1971, and policies issued or delivered in this State to the | |||||||||||||||||||||||
12 | Department of Healthcare and Family Services and providing | |||||||||||||||||||||||
13 | coverage to persons who are enrolled under Article V of the | |||||||||||||||||||||||
14 | Illinois Public Aid Code or under the Children's Health | |||||||||||||||||||||||
15 | Insurance Program Act, amended, delivered, issued, or renewed | |||||||||||||||||||||||
16 | on or after the effective date of this Act, with the exception | |||||||||||||||||||||||
17 | of employee or employer self-insured health benefit plans | |||||||||||||||||||||||
18 | under the federal Employee Retirement Income Security Act of | |||||||||||||||||||||||
19 | 1974, health care provided pursuant to the Workers' | |||||||||||||||||||||||
20 | Compensation Act or the Workers' Occupational Diseases Act, | |||||||||||||||||||||||
21 | and State, employee, unit of local government, or school | |||||||||||||||||||||||
22 | district health plans. This Act does not diminish a health | |||||||||||||||||||||||
23 | care plan's duties and responsibilities under other federal or |
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1 | State law or rules promulgated thereunder. This Act is not | ||||||
2 | intended to alter or impede the provisions of any consent | ||||||
3 | decree or judicial order to which the State or any of its | ||||||
4 | agencies is a party. | ||||||
5 | (Source: P.A. 102-409, eff. 1-1-22 .)
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6 | (215 ILCS 200/50) | ||||||
7 | Sec. 50. Limitations on Review of prior authorization | ||||||
8 | requirements. A health insurance issuer shall not require | ||||||
9 | periodically review its prior authorization requirements and | ||||||
10 | consider removal of prior authorization requirements : | ||||||
11 | (1) where a medication is or procedure prescribed for | ||||||
12 | a chronic condition, long-term condition, or mental health | ||||||
13 | condition; has been prescribed for 6 months or more; is | ||||||
14 | customary and properly indicated or is a treatment for the | ||||||
15 | clinical indication as supported by peer-reviewed medical | ||||||
16 | publications; or | ||||||
17 | (2) for patients currently managed with an established | ||||||
18 | treatment regimen. | ||||||
19 | (Source: P.A. 102-409, eff. 1-1-22 .)
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20 | (215 ILCS 200/65) | ||||||
21 | Sec. 65. Length of prior authorization approval for | ||||||
22 | treatment for chronic or long-term conditions. If a health | ||||||
23 | insurance issuer requires a prior authorization for a | ||||||
24 | recurring health care service or maintenance medication for |
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1 | the treatment of a chronic or long-term condition, the | ||||||
2 | approval shall remain valid for the lesser of 12 months from | ||||||
3 | the date the health care professional or health care provider | ||||||
4 | receives the prior authorization approval or the length of the | ||||||
5 | treatment as determined by the patient's health care | ||||||
6 | professional. This Section shall not apply to the prescription | ||||||
7 | of benzodiazepines or Schedule II narcotic drugs, such as | ||||||
8 | opioids. Except to the extent required by medical exceptions | ||||||
9 | processes for prescription drugs set forth in Section 45.1 of | ||||||
10 | the Managed Care Reform and Patient Rights Act, nothing in | ||||||
11 | this Section shall require a policy to cover any care, | ||||||
12 | treatment, or services for any health condition that the terms | ||||||
13 | of coverage otherwise completely exclude from the policy's | ||||||
14 | covered benefits without regard for whether the care, | ||||||
15 | treatment, or services are medically necessary. | ||||||
16 | (Source: P.A. 102-409, eff. 1-1-22 .)
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