Illinois General Assembly

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 Bill Status of HB3638  98th General Assembly


Short Description:  DHFS-INS-RX DRUGS-FORMS

House Sponsors
Rep. Laura Fine - Jack D. Franks - Patricia R. Bellock - Sara Feigenholtz - Robyn Gabel, Keith Farnham, Robert Rita, Deborah Conroy, Luis Arroyo, Robert F. Martwick, Mike Smiddy, Carol A. Sente, Elgie R. Sims, Jr., Kelly M. Cassidy, Kathleen Willis, Rita Mayfield, Cynthia Soto, Maria Antonia Berrios, Linda Chapa LaVia, John M. Cabello, Kelly Burke, Jehan A. Gordon-Booth, Camille Y. Lilly, Mary E. Flowers, Kenneth Dunkin, John D'Amico, Ann Williams, Michelle Mussman, Monique D. Davis, Esther Golar, Michael W. Tryon, Martin J. Moylan, Marcus C. Evans, Jr., Sam Yingling, Natalie A. Manley, Lawrence M. Walsh, Jr., Stephanie A. Kifowit, Sue Scherer, Dennis M. Reboletti, Elaine Nekritz, Elizabeth Hernandez and Greg Harris

Senate Sponsors
(Sen. Dan Kotowski - Melinda Bush - Linda Holmes - Jacqueline Y. Collins - David Koehler, Napoleon Harris, III and William R. Haine)

Last Action
DateChamber Action
  8/25/2014HousePublic Act . . . . . . . . . 98-1035

Statutes Amended In Order of Appearance
215 ILCS 5/364.3 new
305 ILCS 5/5-5.12b new


Synopsis As Introduced
Amends the Illinois Public Aid Code and the Illinois Insurance Code. Requires the Department of Healthcare and Family Services and the Department of Insurance to jointly develop a uniform prior authorization form for prescription drug benefits on or before July 1, 2014. Provides that on and after January 1, 2015, or 6 months after the form is developed, whichever is later, every prescribing provider may use that uniform prior authorization form to request prior authorization for coverage of prescription drug benefits and every health care service plan shall accept that form as sufficient to request prior authorization for prescription drug benefits. Provides that on and after January 1, 2015, a health insurer that provides prescription drug benefits shall utilize and accept the prior authorization form when requiring prior authorization for prescription drug benefits; and that if a health care service plan fails to utilize or accept the prior authorization form, or fails to respond within 2 business days upon receipt of a completed prior authorization request from a prescribing provider, the prior authorization request shall be deemed to have been granted. Exempts certain providers. Sets forth certain criteria for the prior authorization form. Provides that "prescribing provider" includes a provider authorized to write a prescription as described in the Pharmacy Practice Act. Effective January 1, 2014.

House Floor Amendment No. 3
Deletes reference to:
305 ILCS 5/5-5.12b new

Replaces everything after the enacting clause. Amends the Illinois Insurance Code. Provides that on and after January 1, 2015, a health insurer that provides prescription drug benefits must, within 72 hours after receipt of a prior authorization form from a prescribing provider or pharmacist, either approve or deny the prior authorization; and in the case of an expedited coverage determination, the health insurer must either approve or deny the prior authorization within 24 hours after receipt of the prior authorization form. In the case of a denial, requires the health insurer to provide the prescriber with the reason for the denial, an alternative covered medication, if applicable, and information regarding the procedure for submitting an appeal to the denial. Requires health insurers to provide confirmation of receipt of a prior authorization form within one hour after receipt of the prior authorization form. Provides that the provision concerning prior authorization forms and prescription benefits do not apply to plans for beneficiaries of Medicare or Medicaid. Effective immediately.

Senate Committee Amendment No. 2
Deletes reference to:
215 ILCS 5/364.3 new
Adds reference to:
215 ILCS 5/355afrom Ch. 73, par. 967a
215 ILCS 134/15
215 ILCS 134/45.1 new
215 ILCS 134/45.2 new

Replaces everything after the enacting clause. Provides that the Act may be referred to as the Health Insurance Consumer Protection Act of 2014 and sets forth findings and a purpose. Amends the Illinois Insurance Code. Provides that no policy shall be offered for sale directly to consumers in the State as a qualified health plan, as defined in the federal Patient Protection and Affordable Care Act, unless certain information is made available to the consumer at the time he or she is comparing policies and their premiums. Sets forth provisions concerning providing information and applicability. Amends the Managed Care Reform and Patient Rights Act. Provides that no health care plan shall be offered for sale directly to consumers in the State as a qualified health plan, as defined in the federal Patient Protection and Affordable Care Act, unless certain information is made available to the consumer at the time he or she is comparing policies and their premiums. Sets forth provisions concerning providing information and applicability. Provides that every health carrier that offers a qualified health plan, as defined in the federal Patient Protection and Affordable Care Act, directly to consumers in the State shall establish and maintain a medical exceptions process that allows covered persons or their authorized representatives to request any clinically appropriate prescription drug when certain conditions exist. Inserts provisions similar to the provisions of the engrossed bill (that amended the Illinois Insurance Code) with the following changes. Replaces references to "prior authorization form" with "paper or electronic prior authorization form". Provides that in the case of a denial, the health insurer shall provide the prescriber with information regarding the denial (rather than information regarding the procedure for submitting an appeal to the denial). Deletes a requirement that health insurers must provide confirmation of receipt of a prior authorization form within one hour after receipt of the prior authorization form. Effective immediately.

Senate Floor Amendment No. 3
Adds reference to:
215 ILCS 5/155.36

Further amends the Illinois Insurance Code to provide that certain insurers must comply with the medical exceptions procedures and prior authorization form requirements established under the Managed Care Reform and Patient Rights Act. Provides that no qualified health plans shall be offered for sale directly to consumers through the health insurance marketplace operating in the State (rather than no policy shall be offered for sale directly to consumers in this State as a qualified health plan), unless specified information is made available to the consumer a the time he or she is comparing policies and premiums, and makes conforming changes throughout the language. Changes references from "up-to-date formulary" to "most recently published formulary". Makes other changes.

Actions 
DateChamber Action
  5/31/2013HouseFiled with the Clerk by Rep. Laura Fine
  6/19/2013HouseFirst Reading
  6/19/2013HouseReferred to Rules Committee
  10/24/2013HouseAdded Chief Co-Sponsor Rep. Jack D. Franks
  11/5/2013HouseAdded Chief Co-Sponsor Rep. Patricia R. Bellock
  11/5/2013HouseAdded Chief Co-Sponsor Rep. Sara Feigenholtz
  11/5/2013HouseAdded Chief Co-Sponsor Rep. Robyn Gabel
  11/5/2013HouseAdded Co-Sponsor Rep. Keith Farnham
  11/5/2013HouseAdded Co-Sponsor Rep. Robert Rita
  11/5/2013HouseAdded Co-Sponsor Rep. Deborah Conroy
  11/7/2013HouseAdded Co-Sponsor Rep. Luis Arroyo
  11/7/2013HouseAdded Co-Sponsor Rep. Robert F. Martwick
  11/7/2013HouseAdded Co-Sponsor Rep. Mike Smiddy
  11/7/2013HouseAdded Co-Sponsor Rep. Carol A. Sente
  11/7/2013HouseAdded Co-Sponsor Rep. Elgie R. Sims, Jr.
  11/7/2013HouseAdded Co-Sponsor Rep. Kelly M. Cassidy
  12/12/2013HouseAdded Co-Sponsor Rep. Kathleen Willis
  1/28/2014HouseAssigned to Human Services Committee
  1/29/2014HouseAdded Co-Sponsor Rep. Rita Mayfield
  2/4/2014HouseHouse Committee Amendment No. 1 Filed with Clerk by Rep. Laura Fine
  2/4/2014HouseHouse Committee Amendment No. 1 Referred to Rules Committee
  2/5/2014HouseDo Pass / Short Debate Human Services Committee; 008-005-000
  2/5/2014HouseHouse Committee Amendment No. 1 Tabled Pursuant to Rule 40
  2/5/2014HousePlaced on Calendar 2nd Reading - Short Debate
  2/19/2014HouseAdded Co-Sponsor Rep. Cynthia Soto
  2/19/2014HouseAdded Co-Sponsor Rep. Maria Antonia Berrios
  2/19/2014HouseAdded Co-Sponsor Rep. Linda Chapa LaVia
  2/19/2014HouseAdded Co-Sponsor Rep. John M. Cabello
  2/19/2014HouseAdded Co-Sponsor Rep. Kelly Burke
  2/19/2014HouseAdded Co-Sponsor Rep. Jehan A. Gordon-Booth
  2/19/2014HouseAdded Co-Sponsor Rep. Camille Y. Lilly
  2/20/2014HouseAdded Co-Sponsor Rep. Mary E. Flowers
  2/20/2014HouseAdded Co-Sponsor Rep. Kenneth Dunkin
  2/20/2014HouseAdded Co-Sponsor Rep. John D'Amico
  2/20/2014HouseAdded Co-Sponsor Rep. Ann Williams
  2/20/2014HouseAdded Co-Sponsor Rep. Michelle Mussman
  2/26/2014HouseAdded Co-Sponsor Rep. Monique D. Davis
  2/26/2014HouseAdded Co-Sponsor Rep. Esther Golar
  2/26/2014HouseAdded Co-Sponsor Rep. Michael W. Tryon
  2/26/2014HouseAdded Co-Sponsor Rep. Martin J. Moylan
  2/26/2014HouseAdded Co-Sponsor Rep. Marcus C. Evans, Jr.
  2/26/2014HouseAdded Co-Sponsor Rep. Sam Yingling
  2/26/2014HouseAdded Co-Sponsor Rep. Natalie A. Manley
  2/26/2014HouseAdded Co-Sponsor Rep. Lawrence M. Walsh, Jr.
  2/26/2014HouseAdded Co-Sponsor Rep. Stephanie A. Kifowit
  2/26/2014HouseAdded Co-Sponsor Rep. Sue Scherer
  2/26/2014HouseAdded Co-Sponsor Rep. Dennis M. Reboletti
  2/26/2014HouseAdded Co-Sponsor Rep. Elaine Nekritz
  3/5/2014HouseHouse Floor Amendment No. 2 Filed with Clerk by Rep. Laura Fine
  3/5/2014HouseHouse Floor Amendment No. 2 Referred to Rules Committee
  3/13/2014HouseHouse Floor Amendment No. 2 Rules Refers to Human Services Committee
  3/25/2014HouseHouse Floor Amendment No. 3 Filed with Clerk by Rep. Laura Fine
  3/25/2014HouseHouse Floor Amendment No. 3 Referred to Rules Committee
  3/26/2014HouseHouse Floor Amendment No. 3 Rules Refers to Human Services Committee
  3/27/2014HouseHouse Floor Amendment No. 3 Recommends Be Adopted Human Services Committee; 009-006-000
  4/1/2014HouseSecond Reading - Short Debate
  4/1/2014HouseHouse Floor Amendment No. 3 Adopted
  4/1/2014HousePlaced on Calendar Order of 3rd Reading - Short Debate
  4/9/2014HouseAdded Co-Sponsor Rep. Elizabeth Hernandez
  4/9/2014HouseAdded Co-Sponsor Rep. Greg Harris
  4/9/2014HouseThird Reading - Short Debate - Passed 093-019-000
  4/9/2014HouseHouse Floor Amendment No. 2 Tabled Pursuant to Rule 40
  4/9/2014SenateArrive in Senate
  4/9/2014SenatePlaced on Calendar Order of First Reading April 10, 2014
  4/9/2014SenateChief Senate Sponsor Sen. Dan Kotowski
  4/10/2014SenateFirst Reading
  4/10/2014SenateReferred to Assignments
  4/23/2014SenateAdded as Alternate Chief Co-Sponsor Sen. Melinda Bush
  4/29/2014SenateAdded as Alternate Chief Co-Sponsor Sen. Linda Holmes
  4/30/2014SenateAdded as Alternate Chief Co-Sponsor Sen. Jacqueline Y. Collins
  4/30/2014SenateAdded as Alternate Chief Co-Sponsor Sen. David Koehler
  4/30/2014SenateAdded as Alternate Co-Sponsor Sen. Napoleon Harris, III
  5/7/2014SenateAssigned to Insurance
  5/8/2014SenateSenate Committee Amendment No. 1 Filed with Secretary by Sen. Dan Kotowski
  5/8/2014SenateSenate Committee Amendment No. 1 Referred to Assignments
  5/12/2014SenateSenate Committee Amendment No. 1 Assignments Refers to Insurance
  5/12/2014SenateSenate Committee Amendment No. 2 Filed with Secretary by Sen. Dan Kotowski
  5/12/2014SenateSenate Committee Amendment No. 2 Referred to Assignments
  5/13/2014SenateSenate Committee Amendment No. 2 Assignments Refers to Insurance
  5/14/2014SenateSenate Committee Amendment No. 2 Adopted
  5/14/2014SenateAdded as Alternate Co-Sponsor Sen. William R. Haine
  5/15/2014SenateSenate Committee Amendment No. 1 Postponed - Insurance
  5/15/2014SenateDo Pass as Amended Insurance; 008-001-000
  5/15/2014SenatePlaced on Calendar Order of 2nd Reading May 19, 2014
  5/16/2014SenateSenate Committee Amendment No. 1 Rule 3-9(a) / Re-referred to Assignments
  5/16/2014SenateSenate Floor Amendment No. 3 Filed with Secretary by Sen. Dan Kotowski
  5/16/2014SenateSenate Floor Amendment No. 3 Referred to Assignments
  5/19/2014SenateSecond Reading
  5/19/2014SenatePlaced on Calendar Order of 3rd Reading May 20, 2014
  5/19/2014SenateSenate Floor Amendment No. 3 Assignments Refers to Insurance
  5/21/2014SenateSenate Floor Amendment No. 3 Recommend Do Adopt Insurance; 010-000-000
  5/22/2014SenateRecalled to Second Reading
  5/22/2014SenateSenate Floor Amendment No. 3 Adopted; Kotowski
  5/22/2014SenatePlaced on Calendar Order of 3rd Reading
  5/22/2014SenateThird Reading - Passed; 045-003-003
  5/22/2014SenateSenate Committee Amendment No. 1 Tabled Pursuant to Rule 5-4(a)
  5/22/2014HouseArrived in House
  5/22/2014HousePlaced on Calendar Order of Concurrence Senate Amendment(s) 2, 3
  5/23/2014HouseSenate Committee Amendment No. 2 Motion Filed Concur Rep. Laura Fine
  5/23/2014HouseSenate Floor Amendment No. 3 Motion Filed Concur Rep. Laura Fine
  5/23/2014HouseSenate Committee Amendment No. 2 Motion to Concur Referred to Rules Committee
  5/23/2014HouseSenate Floor Amendment No. 3 Motion to Concur Referred to Rules Committee
  5/26/2014HouseSenate Committee Amendment No. 2 Motion to Concur Rules Referred to Human Services Committee
  5/26/2014HouseSenate Floor Amendment No. 3 Motion to Concur Rules Referred to Human Services Committee
  5/27/2014HouseSenate Committee Amendment No. 2 Motion to Concur Recommends Be Adopted Human Services Committee; 013-000-000
  5/27/2014HouseSenate Floor Amendment No. 3 Motion to Concur Recommends Be Adopted Human Services Committee; 013-000-000
  5/28/2014HouseSenate Committee Amendment No. 2 House Concurs 114-000-000
  5/28/2014HouseSenate Floor Amendment No. 3 House Concurs 114-000-000
  5/28/2014HouseHouse Concurs
  5/28/2014HousePassed Both Houses
  6/26/2014HouseSent to the Governor
  8/25/2014HouseGovernor Approved
  8/25/2014HouseEffective Date August 25, 2014
  8/25/2014HousePublic Act . . . . . . . . . 98-1035

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