SB3732 103RD GENERAL ASSEMBLY

LRB103 37491 RPS 67614 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB3732

Introduced 2/9/2024, by Sen. Cristina Castro

SYNOPSIS AS INTRODUCED:

215 ILCS 200/10
215 ILCS 200/50
215 ILCS 200/65

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.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Prior Authorization Reform Act is amended by changing Sections 10, 50, and 65 as follows:

(215 ILCS 200/10)

Sec. 10. Applicability; scope. This Act applies to health insurance coverage as defined in the Illinois Health Insurance Portability and Accountability Act, the program of group health benefits under the State Employees Group Insurance Act of 1971, and policies issued or delivered in this State to the Department of Healthcare and Family Services and providing coverage to persons who are enrolled under Article V of the Illinois Public Aid Code or under the Children's Health Insurance Program Act, amended, delivered, issued, or renewed on or after the effective date of this Act, with the exception of employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974, health care provided pursuant to the Workers' Compensation Act or the Workers' Occupational Diseases Act, and State, employee, unit of local government, or school district health plans. This Act does not diminish a health care plan's duties and responsibilities under other federal or State law or rules promulgated thereunder. This Act is not intended to alter or impede the provisions of any consent decree or judicial order to which the State or any of its agencies is a party.

(Source: P.A. 102-409, eff. 1-1-22.)

(215 ILCS 200/50)

Sec. 50. Limitations on Review of prior authorization requirements. A health insurance issuer shall not require periodically review its prior authorization requirements and consider removal of prior authorization requirements:

(1) where a medication is or procedure prescribed for a chronic condition, long-term condition, or mental health condition; has been prescribed for 6 months or more; is customary and properly indicated or is a treatment for the clinical indication as supported by peer-reviewed medical publications; or

(2) for patients currently managed with an established treatment regimen.

(Source: P.A. 102-409, eff. 1-1-22.)

(215 ILCS 200/65)

Sec. 65. Length of prior authorization approval for treatment for chronic or long-term conditions. If a health insurance issuer requires a prior authorization for a recurring health care service or maintenance medication for the treatment of a chronic or long-term condition, the approval shall remain valid for the lesser of 12 months from the date the health care professional or health care provider receives the prior authorization approval or the length of the treatment as determined by the patient's health care professional. This Section shall not apply to the prescription of benzodiazepines or Schedule II narcotic drugs, such as opioids. Except to the extent required by medical exceptions processes for prescription drugs set forth in Section 45.1 of the Managed Care Reform and Patient Rights Act, nothing in this Section shall require a policy to cover any care, treatment, or services for any health condition that the terms of coverage otherwise completely exclude from the policy's covered benefits without regard for whether the care, treatment, or services are medically necessary.

(Source: P.A. 102-409, eff. 1-1-22.)

Section 99. Effective date. This Act takes effect July 1, 2024.