Illinois General Assembly - Bill Status for HB2472
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 Bill Status of HB2472  103rd General Assembly


Short Description:  INS-ADVERSE DETERMINATION

House Sponsors
Rep. Bob Morgan

Last Action
DateChamber Action
  3/10/2023HouseRule 19(a) / Re-referred to Rules Committee

Statutes Amended In Order of Appearance
215 ILCS 5/155.36
215 ILCS 5/370s
215 ILCS 124/10
215 ILCS 134/10
215 ILCS 134/45
215 ILCS 134/70
215 ILCS 134/85
215 ILCS 180/10
215 ILCS 200/55


Synopsis As Introduced
Amends the Managed Care Reform and Patient Rights Act. Provides that if a health care plan uses an automated process to make an initial adverse determination or relies on a utilization review organization's automated process for an initial adverse determination, the health care plan shall ensure that any appeal is processed as required by the provisions, including the restriction that only a clinical peer may review an appeal. Provides that an automated process of a health care plan or registered utilization review program may make an initial adverse determination for services not included under specified provisions. Provides that utilization review programs that use automated processes to render an adverse determination shall base all adverse determinations on objective, evidence-based criteria that have been accredited by the American Accreditation Healthcare Commission or by the National Committee for Quality Assurance and shall provide proof of such accreditation to the Department of Insurance with any required registration. Provides that the utilization review program shall include with its registration materials attachments that contain specified policies and procedures. Amends the Health Carrier External Review Act. Changes the definition of "adverse determination". Amends the Prior Authorization Reform Act. Provides that if a health insurance issuer imposes a penalty for the failure to obtain any form of prior authorization for any health care service, the penalty may not exceed the lesser of the actual cost of the health care service or $1,000 per occurrence in addition to the plan cost-sharing provisions. Provides that a health insurance issuer may not require both the enrollee and the health care professional or health care provider to obtain any form of prior authorization for the same instance of a health care service, nor otherwise require more than one prior authorization for the same instance of a health care service. Makes conforming changes in the Illinois Insurance Code and the Network Adequacy and Transparency Act. Effective January 1, 2024.

Actions 
DateChamber Action
  2/15/2023HouseFiled with the Clerk by Rep. Bob Morgan
  2/15/2023HouseFirst Reading
  2/15/2023HouseReferred to Rules Committee
  2/21/2023HouseAssigned to Insurance Committee
  3/10/2023HouseRule 19(a) / Re-referred to Rules Committee
  3/10/2023HouseRule 19(a) / Re-referred to Rules Committee

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