HB3638ham001 98TH GENERAL ASSEMBLY

Rep. Laura Fine

Filed: 2/4/2014

09800HB3638ham001 LRB098 12067 RPM 55224 a

AMENDMENT TO HOUSE BILL 3638

AMENDMENT NO. ______. Amend House Bill 3638 by replacing everything after the enacting clause with the following:

"Section 5. The Illinois Insurance Code is amended by adding Section 364.3 as follows:

(215 ILCS 5/364.3 new)

Sec. 364.3. Uniform prior authorization form; prescription benefits.

(a) Notwithstanding any other provision of law, on and after January 1, 2016, a health insurer that provides prescription drug benefits shall utilize and accept the prior authorization form developed pursuant to subsection (c) when requiring prior authorization for prescription drug benefits. This subsection (a) does not apply to plans for beneficiaries of Medicare or Medicaid.

(b) If a health insurer 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, pursuant to the submission of the prior authorization form developed as described in subsection (c), the prior authorization request shall be deemed to have been granted.

(c) On or before July 1, 2015, the Department shall develop a uniform prior authorization form. Notwithstanding any other provision of law, on and after January 1, 2016, 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 insurer shall accept that form as sufficient to request prior authorization for prescription drug benefits.

(d) The prior authorization form developed pursuant to subsection (c) shall meet the following criteria:

(1) The form shall not exceed 2 pages.

(2) The form shall be made electronically available by the Department and the health insurer.

(3) The completed form may also be electronically submitted from the prescribing provider to the health insurer.

(4) The Department shall develop the form with input from interested parties from at least one public meeting.

(5) The Department, in development of the standardized form, shall take into consideration the following:

(A) Existing prior authorization forms established by the federal Centers for Medicare and Medicaid Services and the Department of Healthcare and Family Services.

(B) National standards pertaining to electronic prior authorization.

(e) For purposes of this Section, "prescribing provider" includes a provider authorized to write a prescription, as described in subsection (e) of Section 3 of the Pharmacy Practice Act, to treat a medical condition of an insured.

Section 99. Effective date. This Act takes effect January 1, 2015.".