Rep. Deb Conroy

Filed: 5/25/2018

 

 


 

 


 
10000HB5769ham002LRB100 18687 SMS 40913 a

1
AMENDMENT TO HOUSE BILL 5769

2    AMENDMENT NO. ______. Amend House Bill 5769 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5adding Section 364.3 as follows:
 
6    (215 ILCS 5/364.3 new)
7    Sec. 364.3. Insurer uniform electronic prior authorization
8form; prescription benefits.
9    (a) As used in this Section, "prescribing provider"
10includes a provider authorized to write a prescription, as
11described in subsection (e) of Section 3 of the Pharmacy
12Practice Act, to treat a medical condition of an insured.
13    (b) Notwithstanding any other provision of law to the
14contrary, on and after July 1, 2020, an insurer that provides
15prescription drug benefits shall utilize and accept the uniform
16electronic prior authorization form developed pursuant to

 

 

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1subsection (c) when requiring prior authorization for
2prescription drug benefits.
3    (c) On or before July 1, 2019, the Department shall develop
4a uniform electronic prior authorization form that shall be
5used by commercial insurers. Notwithstanding any other
6provision of law to the contrary, on and after July 1, 2020,
7every prescribing provider must use the uniform electronic
8prior authorization form to request prior authorization for
9coverage of prescription drug benefits and every insurer shall
10accept the uniform electronic prior authorization form as
11sufficient to request prior authorization for prescription
12drug benefits.
13    (d) The Department shall develop the uniform electronic
14prior authorization form with input from interested parties,
15including, but not limited to, the following individuals
16appointed by the Director: 2 psychiatrists recommended by a
17State organization that represents psychiatrists, 2 physicians
18recommended by a State organization that represents
19physicians, 2 family physicians recommended by a State
20organization that represents family physicians, 2
21pediatricians recommended by a State organization that
22represents pediatricians, and 2 representatives of the
23association that represents commercial insurers, from at least
24one public meeting.
25    (e) The Department, in development of the uniform
26electronic prior authorization form, shall take into

 

 

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1consideration the following:
2        (1) existing prior authorization forms established by
3    the federal Centers for Medicare and Medicaid Services and
4    the Department; and
5        (2) national standards pertaining to electronic prior
6    authorization.
7    (f) If, upon receipt of a completed and accurate electronic
8prior authorization request from a prescribing provider
9pursuant to the submission of a uniform electronic prior
10authorization form, an insurer fails to use or accept the
11uniform electronic prior authorization form or fails to respond
12within 24 hours (if the patient has urgent medication needs) or
13within 72 hours (if the patient has regular medication needs),
14then the prior authorization request shall be deemed to have
15been granted.
 
16    Section 10. The Illinois Public Aid Code is amended by
17adding Section 5-5.12b as follows:
 
18    (305 ILCS 5/5-5.12b new)
19    Sec. 5-5.12b. Managed care organization uniform electronic
20prior authorization form; prescription benefits.
21    (a) As used in this Section, "prescribing provider"
22includes a provider authorized to write a prescription, as
23described in subsection (e) of Section 3 of the Pharmacy
24Practice Act, to treat a medical condition of an insured.

 

 

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1    (b) Notwithstanding any other provision of law to the
2contrary, on and after July 1, 2020, a managed care
3organization that provides prescription drug benefits shall
4utilize and accept the uniform electronic prior authorization
5form developed pursuant to subsection (c) when requiring prior
6authorization for prescription drug benefits.
7    (c) On or before July 1, 2019, the Department of Healthcare
8and Family Services shall develop a uniform electronic prior
9authorization form that shall be used by managed care
10organizations. Notwithstanding any other provision of law to
11the contrary, on and after July 1, 2020, every prescribing
12provider must use the uniform electronic prior authorization
13form to request prior authorization for coverage of
14prescription drug benefits, and every managed care
15organization shall accept the uniform electronic prior
16authorization form as sufficient to request prior
17authorization for prescription drug benefits.
18    (d) The Department of Healthcare and Family Services shall
19develop the uniform electronic prior authorization form with
20input from interested parties, including, but not limited to,
21the following individuals appointed by the Director of
22Healthcare and Family Services: 2 psychiatrists recommended by
23a State organization that represents psychiatrists, 2
24physicians recommended by a State organization that represents
25physicians, 2 family physicians recommended by a State
26organization that represents family physicians, 2

 

 

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1pediatricians recommended by a State organization that
2represents pediatricians, and 2 representatives of the
3association that represents managed care organizations, from
4at least one public meeting.
5    (e) The Department of Healthcare and Family Services, in
6development of the uniform electronic prior authorization
7form, shall take into consideration the following:
8        (1) existing prior authorization forms established by
9    the federal Centers for Medicare and Medicaid Services and
10    the Department of Healthcare and Family Services; and
11        (2) national standards pertaining to electronic prior
12    authorization.
13    (f) If, upon receipt of a completed and accurate electronic
14prior authorization request from a prescribing provider
15pursuant to the submission of a uniform electronic prior
16authorization form, a managed care organization fails to use or
17accept the uniform electronic prior authorization form or fails
18to respond within 24 hours, then the prior authorization
19request shall be deemed to have been granted.".