Bill Amendment: IL HB5769 | 2017-2018 | 100th General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: DRUGS-PRIOR AUTHORIZATION FORM
Status: 2019-01-15 - Bill Dead - No Positive Action Taken - Amendatory Veto [HB5769 Detail]
Download: Illinois-2017-HB5769-House_Amendment_001.html
Bill Title: DRUGS-PRIOR AUTHORIZATION FORM
Status: 2019-01-15 - Bill Dead - No Positive Action Taken - Amendatory Veto [HB5769 Detail]
Download: Illinois-2017-HB5769-House_Amendment_001.html
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1 | AMENDMENT TO HOUSE BILL 5769
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2 | AMENDMENT NO. ______. Amend House Bill 5769 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Insurance Code is amended by | ||||||
5 | adding Section 364.3 as follows:
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6 | (215 ILCS 5/364.3 new) | ||||||
7 | Sec. 364.3. Insurer uniform electronic prior authorization | ||||||
8 | form; prescription benefits. | ||||||
9 | (a) As used in this Section, "prescribing provider" | ||||||
10 | includes a provider authorized to write a prescription, as | ||||||
11 | described in subsection (e) of Section 3 of the Pharmacy | ||||||
12 | Practice Act, to treat a medical condition of an insured. | ||||||
13 | (b) Notwithstanding any other provision of law to the | ||||||
14 | contrary, on and after July 1, 2020, an insurer that provides | ||||||
15 | prescription drug benefits shall utilize and accept the uniform | ||||||
16 | electronic prior authorization form developed pursuant to |
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1 | subsection (c) when requiring prior authorization for | ||||||
2 | prescription drug benefits. | ||||||
3 | (c) On or before July 1, 2019, the Department shall develop | ||||||
4 | a uniform electronic prior authorization form that shall be | ||||||
5 | used by commercial insurers. Notwithstanding any other | ||||||
6 | provision of law to the contrary, on and after July 1, 2020, | ||||||
7 | every prescribing provider must use the uniform electronic | ||||||
8 | prior authorization form to request prior authorization for | ||||||
9 | coverage of prescription drug benefits and every insurer shall | ||||||
10 | accept the uniform electronic prior authorization form as | ||||||
11 | sufficient to request prior authorization for prescription | ||||||
12 | drug benefits. | ||||||
13 | (d) The Department shall develop the uniform electronic | ||||||
14 | prior authorization form with input from interested parties, | ||||||
15 | including, but not limited to, 2 psychiatrists recommended by a | ||||||
16 | State organization that represents psychiatrists appointed by | ||||||
17 | the President of the Senate, 2 physicians recommended by a | ||||||
18 | State organization that represents physicians appointed by the | ||||||
19 | Speaker of the House of Representatives, 2 family physicians | ||||||
20 | recommended by a State organization that represents family | ||||||
21 | physicians appointed by the President of the Senate, 2 | ||||||
22 | pediatricians recommended by a State organization that | ||||||
23 | represents pediatricians appointed by the Speaker of the House | ||||||
24 | of Representatives, and 2 representatives of the association | ||||||
25 | that represents commercial insurers appointed by the President | ||||||
26 | of the Senate, from at least one public meeting. |
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1 | (e) The Department, in development of the uniform | ||||||
2 | electronic prior authorization form, shall take into | ||||||
3 | consideration 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 | ||||||
10 | prior authorization request from a prescribing provider | ||||||
11 | pursuant to the submission of a uniform electronic prior | ||||||
12 | authorization form, an insurer fails to use or accept the | ||||||
13 | uniform electronic prior authorization form or fails to respond | ||||||
14 | within 24 hours (if the patient has urgent medication needs) or | ||||||
15 | within 72 hours (if the patient has regular medication needs), | ||||||
16 | then the prior authorization request shall be deemed to have | ||||||
17 | been granted.
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18 | Section 10. The Illinois Public Aid Code is amended by | ||||||
19 | adding Section 5-5.12b as follows:
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20 | (305 ILCS 5/5-5.12b new) | ||||||
21 | Sec. 5-5.12b. Managed care organization uniform electronic | ||||||
22 | prior authorization form; prescription benefits. | ||||||
23 | (a) As used in this Section, "prescribing provider" | ||||||
24 | includes a provider authorized to write a prescription, as |
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1 | described in subsection (e) of Section 3 of the Pharmacy | ||||||
2 | Practice Act, to treat a medical condition of an insured. | ||||||
3 | (b) Notwithstanding any other provision of law to the | ||||||
4 | contrary, on and after July 1, 2020, a managed care | ||||||
5 | organization that provides prescription drug benefits shall | ||||||
6 | utilize and accept the uniform electronic prior authorization | ||||||
7 | form developed pursuant to subsection (c) when requiring prior | ||||||
8 | authorization for prescription drug benefits. | ||||||
9 | (c) On or before July 1, 2019, the Department of Healthcare | ||||||
10 | and Family Services shall develop a uniform electronic prior | ||||||
11 | authorization form that shall be used by managed care | ||||||
12 | organizations. Notwithstanding any other provision of law to | ||||||
13 | the contrary, on and after July 1, 2020, every prescribing | ||||||
14 | provider must use the uniform electronic prior authorization | ||||||
15 | form to request prior authorization for coverage of | ||||||
16 | prescription drug benefits, and every managed care | ||||||
17 | organization shall accept the uniform electronic prior | ||||||
18 | authorization form as sufficient to request prior | ||||||
19 | authorization for prescription drug benefits. | ||||||
20 | (d) The Department of Healthcare and Family Services shall | ||||||
21 | develop the uniform electronic prior authorization form with | ||||||
22 | input from interested parties, including, but not limited to, 2 | ||||||
23 | psychiatrists recommended by a State organization that | ||||||
24 | represents psychiatrists appointed by the President of the | ||||||
25 | Senate, 2 physicians recommended by a State organization that | ||||||
26 | represents physicians appointed by the Speaker of the House of |
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1 | Representatives, 2 family physicians recommended by a State | ||||||
2 | organization that represents family physicians appointed by | ||||||
3 | the President of the Senate, 2 pediatricians recommended by a | ||||||
4 | State organization that represents pediatricians appointed by | ||||||
5 | the Speaker of the House of Representatives, and 2 | ||||||
6 | representatives of the association that represents managed | ||||||
7 | care organizations appointed by the President of the Senate, | ||||||
8 | from at least one public meeting. | ||||||
9 | (e) The Department of Healthcare and Family Services, in | ||||||
10 | development of the uniform electronic prior authorization | ||||||
11 | form, 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 | ||||||
18 | prior authorization request from a prescribing provider | ||||||
19 | pursuant to the submission of a uniform electronic prior | ||||||
20 | authorization form, a managed care organization fails to use or | ||||||
21 | accept the uniform electronic prior authorization form or fails | ||||||
22 | to respond within 24 hours, then the prior authorization | ||||||
23 | request shall be deemed to have been granted. ".
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