Full Text of SB2585 98th General Assembly
SB2585 98TH GENERAL ASSEMBLY |
| | 98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014 SB2585 Introduced 5/29/2013, by Sen. Dan Kotowski - Mattie Hunter SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Public Aid Code and the Illinois Insurance Code. Requires the Department of Healthcare and Family Services and the Department of Insurance to jointly develop a uniform prior authorization
form for prescription drug benefits on or before July 1, 2014. Provides that on and after
January 1, 2015, 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 care service plan shall
accept that form as sufficient to request prior authorization for
prescription drug benefits. Provides that on and
after January 1, 2015, a health insurer that provides prescription
drug benefits shall utilize and accept the prior authorization
form when requiring prior
authorization for prescription drug benefits; and that if a health care service plan 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, the
prior authorization request shall be deemed to have been granted. Exempts certain providers. Sets forth certain criteria for the prior authorization form. Provides that "prescribing provider" includes a provider authorized to write a prescription as described in
the Pharmacy Practice Act. Effective January 1, 2014.
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| | | FISCAL NOTE ACT MAY APPLY | |
| | A BILL FOR |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by adding | 5 | | Section 364.3 as follows: | 6 | | (215 ILCS 5/364.3 new) | 7 | | Sec. 364.3. Uniform prior authorization
form; prescription | 8 | | benefits. | 9 | | (a) Notwithstanding any other provision of law, on and
| 10 | | after January 1, 2015, a health insurer that provides | 11 | | prescription
drug benefits shall utilize and accept the prior | 12 | | authorization
form developed pursuant to subsection (c) when | 13 | | requiring prior
authorization for prescription drug benefits. | 14 | | (b) If a health insurer fails to utilize or accept the | 15 | | prior
authorization form, or fails to respond within 2 business | 16 | | days upon
receipt of a completed prior authorization request | 17 | | from a
prescribing provider, pursuant to the submission of the | 18 | | prior
authorization form developed as described in subsection | 19 | | (c), the
prior authorization request shall be deemed to have | 20 | | been granted. | 21 | | (c) On or before July 1, 2014, the Department and the | 22 | | Department
of Healthcare and Family Services shall jointly | 23 | | develop a uniform prior
authorization form. Notwithstanding |
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| 1 | | any other provision of law, on
and after January 1, 2015, or 6 | 2 | | months after the form is developed,
whichever is later, every | 3 | | prescribing provider may use that
uniform prior authorization | 4 | | form to request prior authorization for
coverage of | 5 | | prescription drug benefits and every health insurer
shall | 6 | | accept that form as sufficient to request prior authorization
| 7 | | for prescription drug benefits. | 8 | | (d) The prior authorization form developed pursuant to | 9 | | subsection
(c) shall meet the following criteria: | 10 | | (1) The form shall not exceed 2 pages. | 11 | | (2) The form shall be made electronically available by | 12 | | the
Department and the health insurer. | 13 | | (3) The completed form may also be electronically | 14 | | submitted from
the prescribing provider to the health | 15 | | insurer. | 16 | | (4) The Department and the Department of Healthcare and | 17 | | Family Services shall develop the form with input from | 18 | | interested parties from at least
one public meeting. | 19 | | (5) The Department and the Department of Healthcare and | 20 | | Family Services, in development of the standardized form, | 21 | | shall take into consideration
the following: | 22 | | (A) Existing prior authorization forms established | 23 | | by the federal
Centers for Medicare and Medicaid | 24 | | Services and the Department
of Healthcare and Family | 25 | | Services. | 26 | | (B) National standards pertaining to electronic |
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| 1 | | prior
authorization. | 2 | | (e) For purposes of this Section, "prescribing provider" | 3 | | includes a provider authorized to write a prescription, as | 4 | | described in subsection (e) of Section 3 of the Pharmacy | 5 | | Practice Act,
to treat a medical condition of an insured. | 6 | | Section 10. The Illinois Public Aid Code is amended by | 7 | | adding Section 5-5.12b as follows: | 8 | | (305 ILCS 5/5-5.12b new) | 9 | | Sec. 5-5.12b. Uniform prior authorization
form; | 10 | | prescription benefits. | 11 | | (a) Notwithstanding any other provision of law, on and
| 12 | | after January 1, 2015, a health care service plan that provides
| 13 | | prescription drug benefits shall utilize and accept the prior | 14 | | authorization
form developed pursuant to subsection (c) when | 15 | | requiring prior
authorization for prescription drug benefits. | 16 | | This Section does not
apply in the event that a physician or | 17 | | physician group has been
delegated the financial risk for | 18 | | prescription drugs by a health care
service plan and does not | 19 | | use a prior authorization process. This
Section does not apply | 20 | | to a health care service plan, or to its
affiliated providers, | 21 | | if the health care service plan owns and
operates its | 22 | | pharmacies and does not use a prior authorization
process for | 23 | | prescription drugs. | 24 | | (b) If a health care service plan fails to utilize or |
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| 1 | | accept the
prior authorization form, or fails to respond within | 2 | | 2 business
days upon receipt of a completed prior authorization | 3 | | request from a
prescribing provider, pursuant to the submission | 4 | | of the prior
authorization form developed as described in | 5 | | subsection (c), the
prior authorization request shall be deemed | 6 | | to have been granted. | 7 | | (c) On or before July 1, 2014, the Department and the | 8 | | Department of Insurance shall jointly develop a uniform prior | 9 | | authorization
form. Notwithstanding any other provision of | 10 | | law, on and after
January 1, 2015, or 6 months after the form | 11 | | is developed, whichever
is later, every prescribing provider | 12 | | may use that uniform prior
authorization form to request prior | 13 | | authorization for coverage of
prescription drug benefits and | 14 | | every health care service plan shall
accept that form as | 15 | | sufficient to request prior authorization for
prescription | 16 | | drug benefits. | 17 | | (d) The prior authorization form developed pursuant to | 18 | | subsection
(c) shall meet the following criteria: | 19 | | (1) The form shall not exceed 2 pages. | 20 | | (2) The form shall be made electronically available by | 21 | | the
Department and the health care service plan. | 22 | | (3) The completed form may also be electronically | 23 | | submitted from
the prescribing provider to the health care | 24 | | service plan. | 25 | | (4) The Department and the Department of Insurance | 26 | | shall develop the form with input from interested parties |
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| 1 | | from at least one public meeting. | 2 | | (5) The Department and the Department of Insurance, in | 3 | | development of the standardized form, shall take into | 4 | | consideration the
following: | 5 | | (A) Existing prior authorization forms established | 6 | | by the federal
Centers for Medicare and Medicaid | 7 | | Services and the Department. | 8 | | (B) National standards pertaining to electronic | 9 | | prior
authorization. | 10 | | (e) For purposes of this Section, "prescribing provider" | 11 | | includes a provider authorized to write a prescription, as | 12 | | described in subsection (e) of Section 3 of the Pharmacy | 13 | | Practice Act,
to treat a medical condition of an enrollee.
| 14 | | Section 99. Effective date. This Act takes effect January | 15 | | 1, 2014.
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INDEX
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Statutes amended in order of appearance
| | 3 | | 215 ILCS 5/364.3 new | | | 4 | | 305 ILCS 5/5-5.12b new | |
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