97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB3482

 

Introduced 2/7/2012, by Sen. William Delgado

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.12b new

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that no later than November 1, 2012, the Department of Healthcare and Family Services shall promulgate and file a regulation defining criteria utilized for granting prior authorization for non-preferred medications; criteria utilized for denying a request for prior authorization; criteria utilized for approval or denial of a request for prior authorization made to any managed care entity under contract with the State to administer pharmaceutical drug benefits to any recipient of medical assistance benefits; and other matters. Provides that prior to promulgating this regulation, the Department shall consult with recipients of aid, health care advocates, including mental health care advocates, and providers. Grants the Department the authority to use preemptory rulemaking, in accordance with the Illinois Administrative Procedure Act, to place into the Illinois Administrative Code the criteria, appeal process, and policies set forth. Effective immediately.


LRB097 19951 KTG 65245 b

 

 

A BILL FOR

 

SB3482LRB097 19951 KTG 65245 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5adding Section 5-5.12b as follows:
 
6    (305 ILCS 5/5-5.12b new)
7    Sec. 5-5.12b. Medicaid Prior Authorization Program.
8    (a) No later than November 1, 2012, the Department shall
9promulgate and file a regulation defining:
10        (1) Criteria utilized for granting prior authorization
11    for non-preferred medications.
12        (2) Criteria utilized for denying a request for prior
13    authorization.
14        (3) Criteria utilized for approval or denial of a
15    request for prior authorization made to any managed care
16    entity under contract with the State to administer
17    pharmaceutical drug benefits to any recipient of aid under
18    this Article.
19        (4) A non-exclusive list of circumstances under which
20    prior authorization will be waived, specifying particular
21    medical conditions and classes of drugs.
22        (5) An expedited appeal procedure for immediate
23    authorization in "emergency situations" as defined by the

 

 

SB3482- 2 -LRB097 19951 KTG 65245 b

1    Department by rule.
2        (6) Safeguard provisions to ensure continued benefits
3    when a prescriber fails to request prior authorization,
4    including written notice and appeal procedures.
5    (b) Prior to promulgating this regulation, the Department
6shall consult with recipients of aid, health care advocates,
7including mental health care advocates, and providers.
8    (c) The Department is authorized to use preemptory
9rulemaking, in accordance with Section 5-50 of the Illinois
10Administrative Procedure Act, to place into the Illinois
11Administrative Code the criteria, appeal process, and policies
12set forth in this Section.
 
13    Section 99. Effective date. This Act takes effect upon
14becoming law.