Rep. Laura Fine

Filed: 2/4/2014

 

 


 

 


 
09800HB3638ham001LRB098 12067 RPM 55224 a

1
AMENDMENT TO HOUSE BILL 3638

2    AMENDMENT NO. ______. Amend House Bill 3638 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. Uniform prior authorization form; prescription
8benefits.
9    (a) Notwithstanding any other provision of law, on and
10after January 1, 2016, a health insurer that provides
11prescription drug benefits shall utilize and accept the prior
12authorization form developed pursuant to subsection (c) when
13requiring prior authorization for prescription drug benefits.
14This subsection (a) does not apply to plans for beneficiaries
15of Medicare or Medicaid.
16    (b) If a health insurer fails to utilize or accept the

 

 

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1prior authorization form, or fails to respond within 2 business
2days upon receipt of a completed prior authorization request
3from a prescribing provider, pursuant to the submission of the
4prior authorization form developed as described in subsection
5(c), the prior authorization request shall be deemed to have
6been granted.
7    (c) On or before July 1, 2015, the Department shall develop
8a uniform prior authorization form. Notwithstanding any other
9provision of law, on and after January 1, 2016, or 6 months
10after the form is developed, whichever is later, every
11prescribing provider may use that uniform prior authorization
12form to request prior authorization for coverage of
13prescription drug benefits and every health insurer shall
14accept that form as sufficient to request prior authorization
15for prescription drug benefits.
16    (d) The prior authorization form developed pursuant to
17subsection (c) shall meet the following criteria:
18        (1) The form shall not exceed 2 pages.
19        (2) The form shall be made electronically available by
20    the Department and the health insurer.
21        (3) The completed form may also be electronically
22    submitted from the prescribing provider to the health
23    insurer.
24        (4) The Department shall develop the form with input
25    from interested parties from at least one public meeting.
26        (5) The Department, in development of the standardized

 

 

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1    form, shall take into consideration the following:
2            (A) Existing prior authorization forms established
3        by the federal Centers for Medicare and Medicaid
4        Services and the Department of Healthcare and Family
5        Services.
6            (B) National standards pertaining to electronic
7        prior authorization.
8    (e) For purposes of this Section, "prescribing provider"
9includes a provider authorized to write a prescription, as
10described in subsection (e) of Section 3 of the Pharmacy
11Practice Act, to treat a medical condition of an insured.
 
12    Section 99. Effective date. This Act takes effect January
131, 2015.".