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.


LRB103 37491 RPS 67614 b

 

 

A BILL FOR

 

SB3732LRB103 37491 RPS 67614 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Prior Authorization Reform Act is amended
5by changing Sections 10, 50, and 65 as follows:
 
6    (215 ILCS 200/10)
7    Sec. 10. Applicability; scope. This Act applies to health
8insurance coverage as defined in the Illinois Health Insurance
9Portability and Accountability Act, the program of group
10health benefits under the State Employees Group Insurance Act
11of 1971, and policies issued or delivered in this State to the
12Department of Healthcare and Family Services and providing
13coverage to persons who are enrolled under Article V of the
14Illinois Public Aid Code or under the Children's Health
15Insurance Program Act, amended, delivered, issued, or renewed
16on or after the effective date of this Act, with the exception
17of employee or employer self-insured health benefit plans
18under the federal Employee Retirement Income Security Act of
191974, health care provided pursuant to the Workers'
20Compensation Act or the Workers' Occupational Diseases Act,
21and State, employee, unit of local government, or school
22district health plans. This Act does not diminish a health
23care plan's duties and responsibilities under other federal or

 

 

SB3732- 2 -LRB103 37491 RPS 67614 b

1State law or rules promulgated thereunder. This Act is not
2intended to alter or impede the provisions of any consent
3decree or judicial order to which the State or any of its
4agencies is a party.
5(Source: P.A. 102-409, eff. 1-1-22.)
 
6    (215 ILCS 200/50)
7    Sec. 50. Limitations on Review of prior authorization
8requirements. A health insurance issuer shall not require
9periodically review its prior authorization requirements and
10consider removal of prior authorization requirements:
11        (1) where a medication is or procedure prescribed for
12    a chronic condition, long-term condition, or mental health
13    condition; has been prescribed for 6 months or more; is
14    customary and properly indicated or is a treatment for the
15    clinical indication as supported by peer-reviewed medical
16    publications; or
17        (2) for patients currently managed with an established
18    treatment regimen.
19(Source: P.A. 102-409, eff. 1-1-22.)
 
20    (215 ILCS 200/65)
21    Sec. 65. Length of prior authorization approval for
22treatment for chronic or long-term conditions. If a health
23insurance issuer requires a prior authorization for a
24recurring health care service or maintenance medication for

 

 

SB3732- 3 -LRB103 37491 RPS 67614 b

1the treatment of a chronic or long-term condition, the
2approval shall remain valid for the lesser of 12 months from
3the date the health care professional or health care provider
4receives the prior authorization approval or the length of the
5treatment as determined by the patient's health care
6professional. This Section shall not apply to the prescription
7of benzodiazepines or Schedule II narcotic drugs, such as
8opioids. Except to the extent required by medical exceptions
9processes for prescription drugs set forth in Section 45.1 of
10the Managed Care Reform and Patient Rights Act, nothing in
11this Section shall require a policy to cover any care,
12treatment, or services for any health condition that the terms
13of coverage otherwise completely exclude from the policy's
14covered benefits without regard for whether the care,
15treatment, or services are medically necessary.
16(Source: P.A. 102-409, eff. 1-1-22.)
 
17    Section 99. Effective date. This Act takes effect July 1,
182024.