Illinois General Assembly - Bill Status for SB1465

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that prior approval by the Department of Healthcare and Family Services to administer to a recipient of medical assistance any interferon-free therapy for the treatment of the hepatitis C virus shall be limited to certain criteria, including that: (i) the recipient must be 18 years of age; (ii) the recipient must have a diagnosis of chronic hepatitis C infection, genotype 1, 2, 3, or 4, confirmed by stage 2 fibrosis; (iii) the recipient must not have end stage renal disease requiring dialysis; and (iv) the recipient may not have abused a controlled substance within the past 6 months. Provides that the Department may not use certain criteria as a basis for requiring prior approval to administer to a recipient of medical assistance any interferon-free therapy for the treatment of the hepatitis C virus, including: (a) any evidence or known diagnosis of malignancy of any body organ; (b) the recipient's mental capacity or any determination related to the recipient's ability to make appropriate decisions about the interferon-free therapy treatment or to comply with related instructions; and (c) the fact that the recipient was previously administered an interferon-free therapy for the treatment of the hepatitis C virus. Contains provisions concerning persons authorized to prescribe an interferon-free therapy for the treatment of the hepatitis C virus to a recipient of medical assistance; the submission of lab results; an appeals process; and payments to managed care entities for any interferon-free therapy for the treatment of the hepatitis C virus that is prescribed to a recipient of medical assistance. Effective immediately.

In the list of persons authorized to prescribe any interferon-free therapy for the treatment of the hepatitis C virus to a recipient of medical assistance, changes the list of authorized persons to include "any physician licensed to practice medicine in all its branches with a current license who has received a written consultation report" from a board-certified gastroenterologist or specialist in a relevant sub-specialty or from an infectious disease specialist (rather than any physician holding a current unrestricted license to practice medicine who, within 6 months prior to submitting a prior approval request as prescribed by the Department, has (i) completed a course in Illinois with a 3-year certification period that is provided by a program which aims to build the healthcare system's capacity to diagnose and cure persons with the hepatitis C virus or (ii) received a written consultation report from a board-certified gastroenterologist or specialist in a relevant sub-specialty or from an infectious disease specialist). Provides that a formal request for prior approval to administer to a medical assistance recipient any interferon-free therapy for the treatment of the hepatitis "C virus shall not be submitted to the Department without a written" consultation report (rather than a formal request for prior approval to administer to a medical assistance recipient any interferon-free therapy for the treatment of the hepatitis C virus shall not be submitted before the Department receives either documentation that the physician has satisfied the 3-year certification period of an eligible program or a written consultation report).

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