Full Text of HB5769 100th General Assembly
HB5769enr 100TH GENERAL ASSEMBLY |
| | HB5769 Enrolled | | LRB100 18687 SMS 33918 b |
|
| 1 | | AN ACT concerning regulation.
| 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. Insurer uniform electronic prior authorization | 8 | | form; prescription benefits. | 9 | | (a) As used in this Section, "prescribing provider" | 10 | | includes a provider authorized to write a prescription, as | 11 | | described in subsection (e) of Section 3 of the Pharmacy | 12 | | Practice Act, to treat a medical condition of an insured. | 13 | | (b) Notwithstanding any other provision of law to the | 14 | | contrary, on and after July 1, 2020, an insurer that provides | 15 | | prescription drug benefits shall utilize and accept the uniform | 16 | | electronic prior authorization form developed pursuant to | 17 | | subsection (c) when requiring prior authorization for | 18 | | prescription drug benefits. | 19 | | (c) On or before July 1, 2019, the Department shall develop | 20 | | a uniform electronic prior authorization form that shall be | 21 | | used by commercial insurers. Notwithstanding any other | 22 | | provision of law to the contrary, on and after July 1, 2020, | 23 | | every prescribing provider must use the uniform electronic |
| | | HB5769 Enrolled | - 2 - | LRB100 18687 SMS 33918 b |
|
| 1 | | prior authorization form to request prior authorization for | 2 | | coverage of prescription drug benefits and every insurer shall | 3 | | accept the uniform electronic prior authorization form as | 4 | | sufficient to request prior authorization for prescription | 5 | | drug benefits. | 6 | | (d) The Department shall develop the uniform electronic | 7 | | prior authorization form with input from interested parties, | 8 | | including, but not limited to, the following individuals | 9 | | appointed by the Director: 2 psychiatrists recommended by a | 10 | | State organization that represents psychiatrists, 2 | 11 | | pharmacists recommended by a State organization that | 12 | | represents pharmacists, 2 physicians recommended by a State | 13 | | organization that represents physicians, 2 family physicians | 14 | | recommended by a State organization that represents family | 15 | | physicians, 2 pediatricians recommended by a State | 16 | | organization that represents pediatricians, and 2 | 17 | | representatives of the association that represents commercial | 18 | | insurers, from at least one public meeting. | 19 | | (e) The Department, in development of the uniform | 20 | | electronic prior authorization form, shall take into | 21 | | consideration the following: | 22 | | (1) existing prior authorization forms established by | 23 | | the federal Centers for Medicare and Medicaid Services and | 24 | | the Department; and | 25 | | (2) national standards pertaining to electronic prior | 26 | | authorization. |
| | | HB5769 Enrolled | - 3 - | LRB100 18687 SMS 33918 b |
|
| 1 | | (f) If, upon receipt of a completed and accurate electronic | 2 | | prior authorization request from a prescribing provider | 3 | | pursuant to the submission of a uniform electronic prior | 4 | | authorization form, an insurer fails to use or accept the | 5 | | uniform electronic prior authorization form or fails to respond | 6 | | within 24 hours (if the patient has urgent medication needs) or | 7 | | within 72 hours (if the patient has regular medication needs), | 8 | | then the prior authorization request shall be deemed to have | 9 | | been granted. | 10 | | Section 10. The Illinois Public Aid Code is amended by | 11 | | adding Section 5-5.12b as follows: | 12 | | (305 ILCS 5/5-5.12b new) | 13 | | Sec. 5-5.12b. Managed care organization uniform electronic | 14 | | prior authorization form; prescription benefits. | 15 | | (a) As used in this Section, "prescribing provider" | 16 | | includes a provider authorized to write a prescription, as | 17 | | described in subsection (e) of Section 3 of the Pharmacy | 18 | | Practice Act, to treat a medical condition of an insured. | 19 | | (b) Notwithstanding any other provision of law to the | 20 | | contrary, on and after July 1, 2020, a managed care | 21 | | organization that provides prescription drug benefits shall | 22 | | utilize and accept the uniform electronic prior authorization | 23 | | form developed pursuant to subsection (c) when requiring prior | 24 | | authorization for prescription drug benefits. |
| | | HB5769 Enrolled | - 4 - | LRB100 18687 SMS 33918 b |
|
| 1 | | (c) On or before July 1, 2019, the Department of Healthcare | 2 | | and Family Services shall develop a uniform electronic prior | 3 | | authorization form that shall be used by managed care | 4 | | organizations. Notwithstanding any other provision of law to | 5 | | the contrary, on and after July 1, 2020, every prescribing | 6 | | provider must use the uniform electronic prior authorization | 7 | | form to request prior authorization for coverage of | 8 | | prescription drug benefits, and every managed care | 9 | | organization shall accept the uniform electronic prior | 10 | | authorization form as sufficient to request prior | 11 | | authorization for prescription drug benefits. | 12 | | (d) The Department of Healthcare and Family Services shall | 13 | | develop the uniform electronic prior authorization form with | 14 | | input from interested parties, including, but not limited to, | 15 | | the following individuals appointed by the Director of | 16 | | Healthcare and Family Services: 2 psychiatrists recommended by | 17 | | a State organization that represents psychiatrists, 2 | 18 | | pharmacists recommended by a State organization that | 19 | | represents pharmacists, 2 physicians recommended by a State | 20 | | organization that represents physicians, 2 family physicians | 21 | | recommended by a State organization that represents family | 22 | | physicians, 2 pediatricians recommended by a State | 23 | | organization that represents pediatricians, and 2 | 24 | | representatives of the association that represents managed | 25 | | care organizations, from at least one public meeting. | 26 | | (e) The Department of Healthcare and Family Services, in |
| | | HB5769 Enrolled | - 5 - | LRB100 18687 SMS 33918 b |
|
| 1 | | development of the uniform electronic prior authorization | 2 | | form, shall take into consideration the following: | 3 | | (1) existing prior authorization forms established by | 4 | | the federal Centers for Medicare and Medicaid Services and | 5 | | the Department of Healthcare and Family Services; and | 6 | | (2) national standards pertaining to electronic prior | 7 | | authorization. | 8 | | (f) If, upon receipt of a completed and accurate electronic | 9 | | prior authorization request from a prescribing provider | 10 | | pursuant to the submission of a uniform electronic prior | 11 | | authorization form, a managed care organization fails to use or | 12 | | accept the uniform electronic prior authorization form or fails | 13 | | to respond within 24 hours, then the prior authorization | 14 | | request shall be deemed to have been granted.
|
|