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| Public Act 101-0463 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Insurance Code is amended by adding | ||||
Section 364.3 as follows: | ||||
(215 ILCS 5/364.3 new) | ||||
Sec. 364.3. Insurer uniform electronic prior authorization | ||||
form; prescription benefits. | ||||
(a) As used in this Section, "prescribing provider" | ||||
includes a provider authorized to write a prescription, as | ||||
described in subsection (e) of Section 3 of the Pharmacy | ||||
Practice Act, to treat a medical condition of an insured. | ||||
(b) Notwithstanding any other provision of law to the | ||||
contrary, on and after July 1, 2021, an insurer that provides | ||||
prescription drug benefits shall utilize and accept the uniform | ||||
electronic prior authorization form developed pursuant to | ||||
subsection (c) when requiring prior authorization for | ||||
prescription drug benefits. | ||||
(c) On or before July 1, 2020, the Department shall develop | ||||
a uniform electronic prior authorization form that shall be | ||||
used by commercial insurers. Notwithstanding any other | ||||
provision of law to the contrary, on and after July 1, 2021, | ||||
every prescribing provider must use the uniform electronic | ||||
prior authorization form to request prior authorization for | ||
coverage of prescription drug benefits and every insurer shall | ||
accept the uniform electronic prior authorization form as | ||
sufficient to request prior authorization for prescription | ||
drug benefits. | ||
(d) The Department shall develop the uniform electronic | ||
prior authorization form with input from interested parties, | ||
including, but not limited to, the following individuals | ||
appointed by the Director: 2 psychiatrists recommended by a | ||
State organization that represents psychiatrists, 2 | ||
pharmacists recommended by a State organization that | ||
represents pharmacists, 2 physicians recommended by a State | ||
organization that represents physicians, 2 family physicians | ||
recommended by a State organization that represents family | ||
physicians, 2 pediatricians recommended by a State | ||
organization that represents pediatricians, and 2 | ||
representatives of the association that represents commercial | ||
insurers, from at least one public meeting. | ||
(e) The Department, in development of the uniform | ||
electronic prior authorization form, shall take into | ||
consideration the following: | ||
(1) existing prior authorization forms established by | ||
the federal Centers for Medicare and Medicaid Services and | ||
the Department; and | ||
(2) national standards pertaining to electronic prior | ||
authorization. | ||
(f) If, upon receipt of a completed and accurate electronic | ||
prior authorization request from a prescribing provider | ||
pursuant to the submission of a uniform electronic prior | ||
authorization form, an insurer fails to use or accept the | ||
uniform electronic prior authorization form or fails to respond | ||
within 24 hours (if the patient has urgent medication needs) or | ||
within 72 hours (if the patient has regular medication needs), | ||
then the prior authorization request shall be deemed to have | ||
been granted. | ||
Section 10. The Illinois Public Aid Code is amended by | ||
adding Section 5-5.12c as follows: | ||
(305 ILCS 5/5-5.12c new) | ||
Sec. 5-5.12c. Managed care organization uniform electronic | ||
prior authorization form; prescription benefits. | ||
(a) As used in this Section, "prescribing provider" | ||
includes a provider authorized to write a prescription, as | ||
described in subsection (e) of Section 3 of the Pharmacy | ||
Practice Act, to treat a medical condition of an insured. | ||
(b) Notwithstanding any other provision of law to the | ||
contrary, on and after July 1, 2021, a managed care | ||
organization that provides prescription drug benefits shall | ||
utilize and accept the uniform electronic prior authorization | ||
form developed pursuant to subsection (c) when requiring prior | ||
authorization for prescription drug benefits. | ||
(c) On or before July 1, 2020, the Department of Healthcare | ||
and Family Services shall develop a uniform electronic prior | ||
authorization form that shall be used by managed care | ||
organizations. Notwithstanding any other provision of law to | ||
the contrary, on and after July 1, 2021, every prescribing | ||
provider must use the uniform electronic prior authorization | ||
form to request prior authorization for coverage of | ||
prescription drug benefits, and every managed care | ||
organization shall accept the uniform electronic prior | ||
authorization form as sufficient to request prior | ||
authorization for prescription drug benefits. | ||
(d) The Department of Healthcare and Family Services shall | ||
develop the uniform electronic prior authorization form with | ||
input from interested parties, including, but not limited to, | ||
the following individuals appointed by the Director of | ||
Healthcare and Family Services: 2 psychiatrists recommended by | ||
a State organization that represents psychiatrists, 2 | ||
pharmacists recommended by a State organization that | ||
represents pharmacists, 2 physicians recommended by a State | ||
organization that represents physicians, 2 family physicians | ||
recommended by a State organization that represents family | ||
physicians, 2 pediatricians recommended by a State | ||
organization that represents pediatricians, and 2 | ||
representatives of the association that represents managed | ||
care organizations, from at least one public meeting. | ||
(e) The Department of Healthcare and Family Services, in | ||
development of the uniform electronic prior authorization | ||
form, shall take into consideration the following: | ||
(1) existing prior authorization forms established by | ||
the federal Centers for Medicare and Medicaid Services and | ||
the Department of Healthcare and Family Services; and | ||
(2) national standards pertaining to electronic prior | ||
authorization. | ||
(f) If, upon receipt of a completed and accurate electronic | ||
prior authorization request from a prescribing provider | ||
pursuant to the submission of a uniform electronic prior | ||
authorization form, a managed care organization fails to use or | ||
accept the uniform electronic prior authorization form or fails | ||
to respond within 24 hours, then the prior authorization | ||
request shall be deemed to have been granted.
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