HB3782 104TH GENERAL ASSEMBLY

LRB104 09217 BAB 19274 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB3782

Introduced 2/18/2025, by Rep. Sonya M. Harper

SYNOPSIS AS INTRODUCED:

215 ILCS 200/65

Amends the Prior Authorization Reform Act. Provides that a chronic health condition is a condition that is expected to last on year or more and requires ongoing medical attention to effectively manage the condition or prevent an adverse health event limits one or more activities of daily living. Replaces "chronic or long-term condition" with "chronic health condition". Provides that, if a health insurance issuer requires a prior authorization for a recurring health care service or maintenance medication for the treatment of a chronic health condition, the approval shall remain valid from the date the health care professional or health care provider receives the prior authorization approval for the duration of the chronic health condition or the length of the treatment, as determined by the patient's health care professional, unless the standard of treatment for that health condition changes.

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 Section 65 as follows:

(215 ILCS 200/65)

Sec. 65. Length of prior authorization approval for treatment for chronic health or long-term conditions. A chronic health condition is a condition that is expected to last one year or more and: (1) requires ongoing medical attention to effectively manage the condition or prevent an adverse health event; or (2) limits one or more activities of daily living. If a health insurance issuer requires a prior authorization for a recurring health care service or maintenance medication for the treatment of a health 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 for the duration of the chronic health condition or the length of the treatment, as determined by the patient's health care professional, unless the standard of treatment for that health condition changes. 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.)