Bill Amendment: IL HB5769 | 2017-2018 | 100th General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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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_002.html

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Rep. Deb Conroy

Filed: 5/25/2018

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

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subsection (c) when requiring prior authorization for
prescription drug benefits.
(c) On or before July 1, 2019, the Department shall develop
a uniform electronic prior authorization form that shall be
used by commercial insurers. Notwithstanding any other
provision of law to the contrary, on and after July 1, 2020,
every prescribing provider must use the uniform electronic
prior authorization form to request prior authorization for
coverage of prescription drug benefits and every insurer shall
accept the uniform electronic prior authorization form as
sufficient to request prior authorization for prescription
drug benefits.
(d) The Department shall develop the uniform electronic
prior authorization form with input from interested parties,
including, but not limited to, the following individuals
appointed by the Director: 2 psychiatrists recommended by a
State organization that represents psychiatrists, 2 physicians
recommended by a State organization that represents
physicians, 2 family physicians recommended by a State
organization that represents family physicians, 2
pediatricians recommended by a State organization that
represents pediatricians, and 2 representatives of the
association that represents commercial insurers, from at least
one public meeting.
(e) The Department, in development of the uniform
electronic prior authorization form, shall take into

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

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(b) Notwithstanding any other provision of law to the
contrary, on and after July 1, 2020, a managed care
organization that provides prescription drug benefits shall
utilize and accept the uniform electronic prior authorization
form developed pursuant to subsection (c) when requiring prior
authorization for prescription drug benefits.
(c) On or before July 1, 2019, the Department of Healthcare
and Family Services shall develop a uniform electronic prior
authorization form that shall be used by managed care
organizations. Notwithstanding any other provision of law to
the contrary, on and after July 1, 2020, every prescribing
provider must use the uniform electronic prior authorization
form to request prior authorization for coverage of
prescription drug benefits, and every managed care
organization shall accept the uniform electronic prior
authorization form as sufficient to request prior
authorization for prescription drug benefits.
(d) The Department of Healthcare and Family Services shall
develop the uniform electronic prior authorization form with
input from interested parties, including, but not limited to,
the following individuals appointed by the Director of
Healthcare and Family Services: 2 psychiatrists recommended by
a State organization that represents psychiatrists, 2
physicians recommended by a State organization that represents
physicians, 2 family physicians recommended by a State
organization that represents family physicians, 2

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