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 various Acts relating to the governance of public universities in Illinois. With respect to the high school coursework that a person must satisfactorily complete for university admission, adds agricultural sciences as a course option for the science category and agricultural education as a course option for the electives category. Senate Floor Amendment No. 1 Replaces everything after the enacting clause. Reinserts the contents of the bill, but changes references from vocational education to career and technical education.
Amends the Department of Natural Resources Act. Provides that the Department of Natural Resources shall fly a United States Flag, an Illinois flag, and a POW/MIA flag at all State parks. Senate Committee Amendment No. 1 Replaces everything after the enacting clause. Reinserts the provisions of the bill as introduced, with the following changes: (1) provides that the Department of Natural Resources shall have flags at State parks within 5 years after the effective date of the amendatory Act; and (2) provides that donations related to costs of flags and flagpoles may be made by individuals and groups to the Department's Special Projects Fund.
Amends the Illinois Vehicle Code. Allows the issuance of Fold of Honor special license plate decals by the Department of Veterans' Affairs. Provides that $10 of each original issuance and $23 of each renewal shall be deposited into the Folds of Honor Foundation Fund, and that $15 of each original issuance and $2 of each renewal shall be deposited into the Secretary of State Special License Plate Fund. Provides that money in the Folds of Honor Foundation Fund shall be paid as grants to the Folds of Honor Foundation to aid in providing educational scholarships to military families. Makes a corresponding change in the State Finance Act.
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 Civil Administrative Code of Illinois. Provides that service members and their spouses may engage in the practice of their occupation or profession without being licensed in the State of Illinois, subject to outlined circumstances and limitations. Provides that each director of a department that issues an occupational or professional license shall verify that the existing license for a service member or military spouse is in good standing from any state, commonwealth, or territory of the United States or the District of Columbia. Provides that if an existing license for a service member or military spouse is in good standing, the Department of Financial and Professional Regulation shall waive any examination, educational, or experience requirements enabling exception to state licensure requirements. Provides that a department may adopt any rules necessary for the implementation and administration of provisions regarding military license exceptions and by rule shall provide for fees for administration. Senate Committee Amendment No. 1 Deletes reference to: 20 ILCS 5/5-518 new Adds reference to: 20 ILCS 5/5-715 Replaces everything after the enacting clause. Amends the Civil Administrative Code of Illinois. Provides that review and determination of an application for a professional license to a service member or his or her spouse shall be expedited by the department processing the application within 30 days (instead of 60) after the date on which the department receives all necessary documentation. Includes any required information from State and federal agencies as necessary documentation. Removes language requiring that the requirements for licensure in another state in which the service member or his or her spouse is licensed be substantially equivalent to the standards for licensure of this State. Provides instead that an application for licensure by a service member or his or her spouse must include proof that the applicant meets the requirements and standards for licensure through endorsement or reciprocity for the occupation or profession for which the applicant is applying.
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 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.
Amends the Dual Credit Quality Act. Makes a technical change in a Section concerning the short title. Senate Floor Amendment No. 1 Deletes reference to: 110 ILCS 27/1 Adds reference to: 105 ILCS 5/2-3.182 new Replaces everything after the enacting clause. Amends the School Code. Requires the State Board of Education to develop and implement a School Unused Food Program that allows public schools in this State to provide food that is unused by the school to needy children who are students of that school. Provides that unused food under the Program shall be provided at no cost to the student. Provides that a school participating in the Program may contract with third parties to provide services under the Program. Provides for the adoption of rules. Defines "needy children". Effective immediately. House Committee Amendment No. 1 Adds reference to: 110 ILCS 805/3-8 from Ch. 122, par. 103-8 110 ILCS 805/3-10 from Ch. 122, par. 103-10 110 ILCS 805/3-33.6 from Ch. 122, par. 103-33.6 Replaces everything after the enacting clause. Reinserts the contents of the engrossed bill with the following addition. Amends the Public Community College Act. Provides that the position of secretary of a board of trustees of a community college district may be held by a member of the board. Provides that if the secretary is not a member of the board, the secretary may receive compensation as fixed by the board prior to the election of the secretary. Provides that if a district abolishes its working cash fund, the transfer of any balance must take place at the close of the then current fiscal year. Allows a community college district to abate its working cash fund upon the adoption of a resolution and transfer part of the balance at any time. Provides that if a community college district elects to abolish or abate its working cash fund, it shall have the authority to again create a working cash fund at any time (rather than if a district elects to abolish its working cash fund, it shall not establish another working cash fund unless approved by the voters). Effective immediately. House Committee Amendment No. 2 Deletes reference to: 110 ILCS 805/3-8 110 ILCS 805/3-10 110 ILCS 805/3-33.6 Replaces everything after the enacting clause. Amends the School Code. Requires school districts to establish a food sharing plan for unused food with a focus on needy students. Provides that each school district shall incorporate the plan into its local wellness policy. Requires the plan to be developed and supported jointly by the district's local health department. Provides that participants in the child nutrition programs, the National School Lunch Program and National School Breakfast Program, the Child and Adult Care Food Program (CACFP), and the Summer Food Service Program (SFSP) shall adhere to the provisions of the Richard B. Russell National School Lunch Act, as well as accompanying guidance from the U.S. Department of Agriculture on the Food Donation Program, to ensure that any leftover food items are properly donated in order to combat potential food insecurity in their communities. Effective immediately.
Amends the Illinois Municipal Code and the Fire Protection District Act. Provides that a person 35 years of age or older who has served a municipality as a regularly enrolled volunteer, paid-on-call, or part-time firefighter is eligible to take an examination for a position as a firefighter (removing a requirement the volunteer, paid-on-call, or part-time work was 5 years immediately preceding the time that the municipality begins to use full-time firefighters to provide all or part of its fire protection service). Effective immediately.