Full Text of SB1454 98th General Assembly
SB1454sam006 98TH GENERAL ASSEMBLY | Sen. William Delgado Filed: 5/17/2013
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| 1 | | AMENDMENT TO SENATE BILL 1454
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 1454, AS AMENDED, | 3 | | with reference to page and line numbers of Senate Amendment No. | 4 | | 5, as follows:
| 5 | | on page 1, line 5, before "Section 5.", by inserting the | 6 | | following: | 7 | | "Section 3. The Illinois Insurance Code is amended by | 8 | | adding Section 364.3 as follows: | 9 | | (215 ILCS 5/364.3 new) | 10 | | Sec. 364.3. Uniform prior authorization
form; prescription | 11 | | benefits. | 12 | | (a) Notwithstanding any other provision of law, on and
| 13 | | after January 1, 2015, a health insurer that provides | 14 | | prescription
drug benefits shall utilize and accept the prior | 15 | | authorization
form developed pursuant to subsection (c) when |
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| 1 | | requiring prior
authorization for prescription drug benefits. | 2 | | (b) If a health insurer fails to utilize or accept the | 3 | | prior
authorization form, or fails to respond within 2 business | 4 | | days upon
receipt of a completed prior authorization request | 5 | | from a
prescribing provider, pursuant to the submission of the | 6 | | prior
authorization form developed as described in subsection | 7 | | (c), the
prior authorization request shall be deemed to have | 8 | | been granted. | 9 | | (c) On or before July 1, 2014, the Department and the | 10 | | Department
of Healthcare and Family Services shall jointly | 11 | | develop a uniform prior
authorization form. Notwithstanding | 12 | | any other provision of law, on
and after January 1, 2015, or 6 | 13 | | months after the form is developed,
whichever is later, every | 14 | | prescribing provider may use that
uniform prior authorization | 15 | | form to request prior authorization for
coverage of | 16 | | prescription drug benefits and every health insurer
shall | 17 | | accept that form as sufficient to request prior authorization
| 18 | | for prescription drug benefits. | 19 | | (d) The prior authorization form developed pursuant to | 20 | | subsection
(c) shall meet the following criteria: | 21 | | (1) The form shall not exceed 2 pages. | 22 | | (2) The form shall be made electronically available by | 23 | | the
Department and the health insurer. | 24 | | (3) The completed form may also be electronically | 25 | | submitted from
the prescribing provider to the health | 26 | | insurer. |
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| 1 | | (4) The Department and the Department of Healthcare and | 2 | | Family Services shall develop the form with input from | 3 | | interested parties from at least
one public meeting. | 4 | | (5) The Department and the Department of Healthcare and | 5 | | Family Services, in development of the standardized form, | 6 | | shall take into consideration
the following: | 7 | | (A) Existing prior authorization forms established | 8 | | by the federal
Centers for Medicare and Medicaid | 9 | | Services and the Department
of Healthcare and Family | 10 | | Services. | 11 | | (B) National standards pertaining to electronic | 12 | | prior
authorization. | 13 | | (e) For purposes of this Section, "prescribing provider" | 14 | | includes a provider authorized to write a prescription, as | 15 | | described in subsection (e) of Section 3 of the Pharmacy | 16 | | Practice Act,
to treat a medical condition of an insured. "; and | 17 | | on page 2, immediately below line 16, by inserting the | 18 | | following: | 19 | | "Section 9. The Illinois Public Aid Code is amended by | 20 | | adding Section 5-5.12b as follows: | 21 | | (305 ILCS 5/5-5.12b new) | 22 | | Sec. 5-5.12b. Uniform prior authorization
form; | 23 | | prescription benefits. |
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| 1 | | (a) Notwithstanding any other provision of law, on and
| 2 | | after January 1, 2015, a health care service plan that provides
| 3 | | prescription drug benefits shall utilize and accept the prior | 4 | | authorization
form developed pursuant to subsection (c) when | 5 | | requiring prior
authorization for prescription drug benefits. | 6 | | This Section does not
apply in the event that a physician or | 7 | | physician group has been
delegated the financial risk for | 8 | | prescription drugs by a health care
service plan and does not | 9 | | use a prior authorization process. This
Section does not apply | 10 | | to a health care service plan, or to its
affiliated providers, | 11 | | if the health care service plan owns and
operates its | 12 | | pharmacies and does not use a prior authorization
process for | 13 | | prescription drugs. | 14 | | (b) If a health care service plan fails to utilize or | 15 | | accept the
prior authorization form, or fails to respond within | 16 | | 2 business
days upon receipt of a completed prior authorization | 17 | | request from a
prescribing provider, pursuant to the submission | 18 | | of the prior
authorization form developed as described in | 19 | | subsection (c), the
prior authorization request shall be deemed | 20 | | to have been granted. | 21 | | (c) On or before July 1, 2014, the Department and the | 22 | | Department of Insurance shall jointly develop a uniform prior | 23 | | authorization
form. Notwithstanding any other provision of | 24 | | law, on and after
January 1, 2015, or 6 months after the form | 25 | | is developed, whichever
is later, every prescribing provider | 26 | | may use that uniform prior
authorization form to request prior |
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| 1 | | authorization for coverage of
prescription drug benefits and | 2 | | every health care service plan shall
accept that form as | 3 | | sufficient to request prior authorization for
prescription | 4 | | drug benefits. | 5 | | (d) The prior authorization form developed pursuant to | 6 | | subsection
(c) shall meet the following criteria: | 7 | | (1) The form shall not exceed 2 pages. | 8 | | (2) The form shall be made electronically available by | 9 | | the
Department and the health care service plan. | 10 | | (3) The completed form may also be electronically | 11 | | submitted from
the prescribing provider to the health care | 12 | | service plan. | 13 | | (4) The Department and the Department of Insurance | 14 | | shall develop the form with input from interested parties | 15 | | from at least one public meeting. | 16 | | (5) The Department and the Department of Insurance, in | 17 | | development of the standardized form, shall take into | 18 | | consideration the
following: | 19 | | (A) Existing prior authorization forms established | 20 | | by the federal
Centers for Medicare and Medicaid | 21 | | Services and the Department. | 22 | | (B) National standards pertaining to electronic | 23 | | prior
authorization. | 24 | | (e) For purposes of this Section, "prescribing provider" | 25 | | includes a provider authorized to write a prescription, as | 26 | | described in subsection (e) of Section 3 of the Pharmacy |
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| 1 | | Practice Act,
to treat a medical condition of an enrollee. ".
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