Rep. Deb Conroy

Filed: 5/24/2018

 

 


 

 


 
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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, 2 psychiatrists recommended by a
16State organization that represents psychiatrists appointed by
17the President of the Senate, 2 physicians recommended by a
18State organization that represents physicians appointed by the
19Speaker of the House of Representatives, 2 family physicians
20recommended by a State organization that represents family
21physicians appointed by the President of the Senate, 2
22pediatricians recommended by a State organization that
23represents pediatricians appointed by the Speaker of the House
24of Representatives, and 2 representatives of the association
25that represents commercial insurers appointed by the President
26of the Senate, from at least one public meeting.

 

 

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

 

 

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

 

 

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1Representatives, 2 family physicians recommended by a State
2organization that represents family physicians appointed by
3the President of the Senate, 2 pediatricians recommended by a
4State organization that represents pediatricians appointed by
5the Speaker of the House of Representatives, and 2
6representatives of the association that represents managed
7care organizations appointed by the President of the Senate,
8from at least one public meeting.
9    (e) The Department of Healthcare and Family Services, in
10development of the uniform electronic prior authorization
11form, shall take into consideration the following:
12        (1) existing prior authorization forms established by
13    the federal Centers for Medicare and Medicaid Services and
14    the Department of Healthcare and Family Services; and
15        (2) national standards pertaining to electronic prior
16    authorization.
17    (f) If, upon receipt of a completed and accurate electronic
18prior authorization request from a prescribing provider
19pursuant to the submission of a uniform electronic prior
20authorization form, a managed care organization fails to use or
21accept the uniform electronic prior authorization form or fails
22to respond within 24 hours, then the prior authorization
23request shall be deemed to have been granted.".