Creates the Prior Authorization Reform Act. Provides requirements concerning disclosure and review of prior authorization requirements, denial of claims or coverage by a utilization review organization, and the implementation of prior authorization requirements or restrictions. Provides requirements concerning a utilization review organization's obligations with respect to prior authorizations in nonurgent circumstances, urgent health care services, and emergency health care services. Provides that a utilization review organization shall not require prior authorization under specified circumstances. Provides requirements concerning the length of prior authorizations. Provides that health care services are automatically deemed authorized if a utilization review organization fails to comply with the requirements of the Act. Provides that the Director of Insurance may impose an administrative fine not to exceed $250,000 for violations of the Act. Defines terms. Amends the Illinois Insurance Code to change the definition of "emergency medical condition". Amends the Managed Care Reform and Patient Rights Act to provide that companies that transact accident and health insurance shall comply with specified requirements of the Managed Care Reform and Patient Rights Act. Amends the Illinois Public Aid Code to provide that all managed care organizations shall comply with the requirements of the Prior Authorization Reform Act. Makes other changes. Effective January 1, 2022. House Floor Amendment No. 1 Replaces everything after the enacting clause with the provisions of the introduced bill with the following changes. Changes references from "utilization review organization" to "health insurance issuer" or "health insurance issuer or its contracted utilization review organization". Provides that a health insurance issuer or its contracted utilization review organization must ensure that all adverse determinations are made by a physician when the request is by a physician or a representative of a physician. Provides that a health insurance issuer shall periodically review its prior authorization requirements and consider removal of prior authorization requirements in specified circumstances (rather than a utilization review organization shall not require prior authorization in specified circumstances). In provisions concerning length of prior authorization approval, provides that a prior authorization approval shall be valid for the lesser of 12 months after the date the health care professional or health care provider receives the prior authorization approval or the length of treatment as determined by the patient's health care professional. In provisions concerning clinical review criteria of prior authorization requirements, removes language that provides that a utilization review organization shall seek input from actively practicing physicians representing major areas of the specialty who are not employees of the utilization review organization or consultants to the utilization review organization before establishing or substantially or materially altering written clinical review criteria. Removes language that provides that a utilization review organization shall not deny prior authorization of a health care service solely based on the grounds that a health care professional or health care provider judges a service, product, or procedure is medically appropriate for his or her patient even if it has not been formally approved for the specific condition being treated. In provisions concerning statistics that shall be made available regarding prior authorization approvals and denials, removes specified categories of information. In provisions concerning requirements applicable to the physician who can review consultations and appeals, removes language that provides that the physician must not be employed by a utilization review organization, be under contract with the utilization review organization other than to participate in one or more of the utilization review organization's health care professional networks or to perform reviews of appeals, or otherwise have any financial interest in the outcome of the appeal. Makes other changes. Effective January 1, 2022. House Floor Amendment No. 2 Deletes reference to: 215 ILCS 134/65 Adds reference to: 215 ILCS 5/155.36 Replaces everything after the enacting clause with the provisions of the introduced bill, and makes the following changes: In the Prior Authorization Reform Act, deletes a Section concerning obligations with respect to prior authorization concerning emergency health care services, and makes changes in provisions governing applicability; definitions; disclosure and review of prior authorization requirements; obligations with respect to prior authorizations; personnel qualified to make adverse determinations of a prior authorization request; adverse determinations; review of appeals; denials; length of prior authorization approval; continuity of care; effect of failure to comply with the Act; and administration and enforcement. Makes further changes in the Illinois Insurance Code in a Section concerning obligations under the Managed Care Reform and Patient Rights Act. Deletes changes made to the Managed Care Reform and Patient Rights Act in a Section concerning emergency services prior to stabilization. Effective January 1, 2022.
Sponsored bills
Amends the School Code. In the provisions relating to holidays, adds January 17 (the birthday of Muhammad Ali) to the list of commemorative holidays. In the provisions relating to courses of study, provides that the teaching of history of the United States shall include the study of the contributions made by Muslims and Muslim Americans to society. House Committee Amendment No. 1 In the provisions relating to courses of study, provides that the teaching of history of the United States shall include the contributions made to society by Americans of different faith practices, including, but not limited to, Muslim Americans, Jewish Americans, Christian Americans, Hindu Americans, Sikh Americans, Buddhist Americans, and any other collective community of faith that has shaped America (rather than the study of the contributions made by Muslims and Muslim Americans to society).
Amends the State Designations Act. Provides that Penicillium chrysogenum NRRL 1951 is designated the official State microbe of the State of Illinois. Senate Committee Amendment No. 1 Replaces everything after the enacting clause. Reinserts the provisions of the engrossed bill with changes. Provides that Penicillium rubens (rather than chrysogenum) NRRL 1951 is designated the official State microbe of the State of Illinois.
Amends the Department of Veterans' Affairs Act. Provides that a person or company advertising veterans' benefits appeal services must conspicuously disclose in the advertisement that such services are also offered at no cost by county veterans service officers. Provides that a person who provides veterans' benefits services in exchange for compensation shall (i) provide a written disclosure statement to each client or prospective client and (ii) obtain the client's signature on a written disclosure statement containing an attestation by the client that the client has read and understands the written disclosure statement. Directs the Department of Veterans' Affairs to investigate alleged violations and to submit the results of any investigation to the Office of the Attorney General if the Department concludes that a violation has occurred. Provides that if, upon review, the Attorney General decides to file a complaint, the Attorney General must do so within 90 days of receiving the results of the Department's investigation. Imposes a civil penalty not to exceed $1,000 for each violation of the amendatory Act. House Floor Amendment No. 1 Deletes reference to: 20 ILCS 2805/2 20 ILCS 2805/39 new Adds reference to: 815 ILCS 505/2WWW new Replaces everything after the enacting clause. Amends the Consumer Fraud and Deceptive Business Practices Act. Requires persons providing veteran or military benefit services to make disclosures that the benefits are available without charge. Provides that it is an unlawful practice under that Act to fail to make the required disclosure, fail to comply with fiduciary responsibilities under federal law, and to charge fees in violation of federal law.
Amends the Pharmacy Practice Act. Removes a provision limiting consumers to 10 requests for disclosure of the current usual and customary retail price of prescription drugs or medical devices for which the person making the request has a prescription. Provides that a pharmacy must post a notice informing customers that they may request, in person or by telephone, the current usual and customary retail price of any brand or generic prescription drug or medical device that the pharmacy offers for sale to the public. Provides that a pharmacist or his or her authorized employee must disclose to the consumer at the point of sale the current pharmacy retail price for each prescription medication the consumer intends to purchase. If the consumer's cost-sharing amount for a prescription exceeds the current pharmacy retail price, the pharmacist or his or her authorized employee must disclose to the consumer that the pharmacy retail price is less than the patient's cost-sharing amount.
Amends the State Treasurer Act. Provides that for purposes of the ABLE account program, a designated beneficiary means the ABLE account owner. Provides that upon the death of a designated beneficiary, proceeds from an account may be transferred pursuant to a payable on death account agreement. Provides that upon the death of a designated beneficiary, the State Treasurer may require verification that the funeral and burial expenses of the designated beneficiary have been paid. Makes conforming changes. Effective immediately.
Amends the Managed Care Reform and Patient Rights Act. Requires health insurance carriers that provide coverage for prescription drugs to ensure that, within service areas and levels of coverage specified by federal law, at least half of individual and group plans meet one or more of the following criteria: apply a pre-deductible and flat-dollar copayment structure to the entire drug benefit, limit a beneficiary's monthly out-of-pocket financial responsibility for prescription drugs to a specified amount, or limit a beneficiary's annual out-of-pocket financial responsibility for prescription drugs to a specified amount. Provides that all plans for prescription drugs offered under the amendatory Act must be clearly and appropriately named, marketed in the same manner as other plans offered by the health insurance carrier, and offered for purchase to any individual and group plan sponsor. Effective January 1, 2022. House Committee Amendment No. 1 Replaces everything after the enacting clause. Amends the Managed Care Reform and Patient Rights Act. In provisions concerning individual health plans that provide coverage for prescription drugs, provides that beginning January 1, 2023, health insurance carriers shall ensure that at least 10% of individual health care plans offered in each applicable service area apply a flat-dollar copayment structure to the entire drug benefit; and beginning January 1, 2024, health insurance carriers shall ensure that at least 25% of individual health care plans offered in each applicable service area apply a flat-dollar copayment structure to the entire drug benefit. In provisions concerning group health plans that provide coverage for prescription drugs, provides that beginning January 1, 2023, health insurance carriers shall offer at least one group health plan in each applicable service area that applies a flat-dollar copayment structure to the entire drug benefit; and beginning January 1, 2024, health insurance carriers shall offer at least 2 group health plans in each applicable service area that apply a flat-dollar copayment structure to the entire drug benefit. Provides that the flat-dollar copayment structure for prescription drugs must be applied pre-deductible and be reasonably graduated and proportionately related in all tier levels such that the copayment structure as a whole does not discriminate against or discourage the enrollment of individuals with significant health care needs. Requires the health insurance carriers to clearly and appropriately name the plans to aid in individual or group plan selection. Requires the health insurance carriers to market the plans in the same manner as their other plans. Requires the Department of Insurance to adopt rules necessary to implement and enforce the provisions. Effective January 1, 2023.
Amends the Medical Practice Act of 1987. Provides that not later than 12 months after the effective date of the amendatory Act, the Department of Financial and Professional Regulation shall adopt rules that require a person seeking licensure to practice medicine in all of its branches to have completed 3 hours of education on the diagnosis, treatment, and care of individuals with cognitive impairments, including, but not limited to, Alzheimer's disease and other dementias. Specifies that the education requirement shall only apply to applicants who serve or will serve adult populations and have or will have direct patient interactions in their capacity as physicians. Provides that not later than 12 months after the effective date of the amendatory Act, the Department shall adopt rules that require any continuing education for persons licensed to practice medicine under all of its branches to include an average of one hour of continuing education per license year on the diagnosis, treatment, and care of individuals with cognitive impairments, including, but not limited to, Alzheimer's disease and other dementias. Specifies that the continuing education requirement shall only apply to persons who serve adult populations and have direct patient interactions in their capacity as physicians. Provides that the curriculum used for the education and continuing education requirements shall cover the diagnosis of Alzheimer's disease and other dementias, including recognizing the signs and symptoms of dementia; person-centered care; assessment and care planning; and culturally competent health care. Senate Committee Amendment No. 2 Deletes reference to: 225 ILCS 60/11 225 ILCS 60/20.1 new Adds reference to: 20 ILCS 2105/2105-365 new Replaces everything after the enacting clause. Amends the Department of Professional Regulation Law of the Civil Administrative Code of Illinois. Provides that for license or registration renewals occurring on or after January 1, 2023, a health care professional who has continuing education requirements must complete at least a one-hour course in training on the diagnosis, treatment, and care of individuals with Alzheimer's disease and other dementias per renewal period. Provides that the training shall include, but not be limited to, assessment and diagnosis, effective communication strategies, and management and care planning. Provides that the requirement shall only apply to health care professionals who provide health care services to adult populations age 26 or older in the practice of their profession. Provides that a health care professional may count that one hour for completion of the course toward meeting the minimum credit hours required for continuing education. Provides that any training on Alzheimer's disease and other dementias applied to meet any other State licensure requirement, professional accreditation or certification requirement, or health care institutional practice agreement may count toward the continuing education requirement. Provides that the Department of Financial and Professional Regulation may adopt rules for the implementation of the continuing education requirement. Effective immediately. Senate Floor Amendment No. 4 Provides that the continuing education requirements shall only apply to health care professionals who provide health care services to, and have direct patient interactions with (rather than who provide health care services to), adult populations age 26 or older in the practice of their profession.
Amends the Statute on Statutes. Makes a technical change in a Section regarding the application of the Act. House Floor Amendment No. 1 Deletes reference to: 5 ILCS 70/1.43 new Adds reference to: 5 ILCS 70/1.44 new Replaces everything after the enacting clause. Amends the Statute on Statutes. Provides that in determining the meaning of any statute or rule or interpretation by the various administrative agencies of this State, for purposes of determining eligibility for any veterans benefit available from the State, the words "honorable discharge" and "honorably discharged" include a discharge under other than honorable conditions or general discharge under honorable conditions due to a person's sexual orientation or gender identity but does not include a bad conduct discharge or a dishonorable discharge. Senate Committee Amendment No. 1 Provides that the words "honorable discharge" and "honorably discharged" include a discharge other than honorable conditions or general discharge under honorable conditions if only due to a person's sexual orientation or gender identity (rather than "honorable discharge" and "honorably discharged" include a discharge other than honorable conditions or general discharge under honorable conditions due to a person's sexual orientation or gender identity).
Amends the Military Code of Illinois. Provides that members of the Illinois National Guard serving on State Active Duty, in addition to those serving in a federal duty or training status, shall have a State flag presented to their next of kin upon their death.