HB 711

  • Illinois House Bill
  • 102nd Regular Session
  • Introduced in House Apr 21, 2021
  • Passed House Apr 21, 2021
  • Passed Senate May 27, 2021
  • Signed by Governor Aug 19, 2021

Prior Authorization Reform Act

Abstract

Creates the Prior Authorization Reform Act. Provides requirements concerning disclosure and review of prior authorization requirements, denial of claims or coverage by a utilization review organization, and the implementation of prior authorization requirements or restrictions. Provides requirements concerning a utilization review organization's obligations with respect to prior authorizations in nonurgent circumstances, urgent health care services, and emergency health care services. Provides that a utilization review organization shall not require prior authorization under specified circumstances. Provides requirements concerning the length of prior authorizations. Provides that health care services are automatically deemed authorized if a utilization review organization fails to comply with the requirements of the Act. Provides that the Director of Insurance may impose an administrative fine not to exceed $250,000 for violations of the Act. Defines terms. Amends the Illinois Insurance Code to change the definition of "emergency medical condition". Amends the Managed Care Reform and Patient Rights Act to provide that companies that transact accident and health insurance shall comply with specified requirements of the Managed Care Reform and Patient Rights Act. Amends the Illinois Public Aid Code to provide that all managed care organizations shall comply with the requirements of the Prior Authorization Reform Act. Makes other changes. Effective January 1, 2022. House Floor Amendment No. 1 Replaces everything after the enacting clause with the provisions of the introduced bill with the following changes. Changes references from "utilization review organization" to "health insurance issuer" or "health insurance issuer or its contracted utilization review organization". Provides that a health insurance issuer or its contracted utilization review organization must ensure that all adverse determinations are made by a physician when the request is by a physician or a representative of a physician. Provides that a health insurance issuer shall periodically review its prior authorization requirements and consider removal of prior authorization requirements in specified circumstances (rather than a utilization review organization shall not require prior authorization in specified circumstances). In provisions concerning length of prior authorization approval, provides that a prior authorization approval shall be valid for the lesser of 12 months after the date the health care professional or health care provider receives the prior authorization approval or the length of treatment as determined by the patient's health care professional. In provisions concerning clinical review criteria of prior authorization requirements, removes language that provides that a utilization review organization shall seek input from actively practicing physicians representing major areas of the specialty who are not employees of the utilization review organization or consultants to the utilization review organization before establishing or substantially or materially altering written clinical review criteria. Removes language that provides that a utilization review organization shall not deny prior authorization of a health care service solely based on the grounds that a health care professional or health care provider judges a service, product, or procedure is medically appropriate for his or her patient even if it has not been formally approved for the specific condition being treated. In provisions concerning statistics that shall be made available regarding prior authorization approvals and denials, removes specified categories of information. In provisions concerning requirements applicable to the physician who can review consultations and appeals, removes language that provides that the physician must not be employed by a utilization review organization, be under contract with the utilization review organization other than to participate in one or more of the utilization review organization's health care professional networks or to perform reviews of appeals, or otherwise have any financial interest in the outcome of the appeal. Makes other changes. Effective January 1, 2022. House Floor Amendment No. 2 Deletes reference to: 215 ILCS 134/65 Adds reference to: 215 ILCS 5/155.36 Replaces everything after the enacting clause with the provisions of the introduced bill, and makes the following changes: In the Prior Authorization Reform Act, deletes a Section concerning obligations with respect to prior authorization concerning emergency health care services, and makes changes in provisions governing applicability; definitions; disclosure and review of prior authorization requirements; obligations with respect to prior authorizations; personnel qualified to make adverse determinations of a prior authorization request; adverse determinations; review of appeals; denials; length of prior authorization approval; continuity of care; effect of failure to comply with the Act; and administration and enforcement. Makes further changes in the Illinois Insurance Code in a Section concerning obligations under the Managed Care Reform and Patient Rights Act. Deletes changes made to the Managed Care Reform and Patient Rights Act in a Section concerning emergency services prior to stabilization. Effective January 1, 2022.

Bill Sponsors (92)

Greg Harris

     
Primary

Deb Conroy

     
Cosponsor

Lawrence Walsh, Jr.

     
Cosponsor

Charles Meier

     
Cosponsor

Jehan Gordon-Booth

     
Cosponsor

Bill Cunningham

     
Cosponsor

Votes


Actions


Aug 19, 2021

House

Governor Approved

House

Effective Date January 1, 2022

House

Public Act . . . . . . . . . 102-0409

Jun 23, 2021

House

Sent to the Governor

May 27, 2021

Senate

Third Reading - Passed; 057-000-000

House

Passed Both Houses

May 24, 2021

Senate

Placed on Calendar Order of 3rd Reading ** May 25, 2021

Senate

Added as Alternate Co-Sponsor Sen. Ann Gillespie

May 20, 2021

Senate

Added as Alternate Co-Sponsor Sen. Steve Stadelman

May 13, 2021

Senate

Placed on Calendar Order of 3rd Reading May 14, 2021

Senate

Second Reading

Senate

Added as Alternate Co-Sponsor Sen. Julie A. Morrison

May 11, 2021

Senate

Added as Alternate Co-Sponsor Sen. Win Stoller

May 06, 2021

Senate

Added as Alternate Co-Sponsor Sen. Bill Cunningham

Senate

Placed on Calendar Order of 2nd Reading May 10, 2021

Senate

Do Pass Insurance; 011-000-000

May 04, 2021

Senate

Added as Alternate Co-Sponsor Sen. Christopher Belt

Senate

Added as Alternate Co-Sponsor Sen. Mattie Hunter

Senate

Added as Alternate Co-Sponsor Sen. Emil Jones, III

Senate

Added as Alternate Co-Sponsor Sen. Scott M. Bennett

May 03, 2021

Senate

Added as Alternate Co-Sponsor Sen. Laura M. Murphy

Senate

Added as Alternate Co-Sponsor Sen. Napoleon Harris, III

Senate

Added as Alternate Co-Sponsor Sen. Melinda Bush

Apr 30, 2021

Senate

Added as Alternate Co-Sponsor Sen. Doris Turner

Apr 29, 2021

Senate

Added as Alternate Co-Sponsor Sen. Adriane Johnson

Senate

Added as Alternate Co-Sponsor Sen. Laura Fine

Apr 28, 2021

Senate

Added as Alternate Co-Sponsor Sen. Sue Rezin

Senate

Assigned to Insurance

Senate

Added as Alternate Co-Sponsor Sen. Kimberly A. Lightford

Senate

Added as Alternate Co-Sponsor Sen. Patricia Van Pelt

Senate

Added as Alternate Co-Sponsor Sen. Donald P. DeWitte

Apr 27, 2021

Senate

Added as Alternate Co-Sponsor Sen. Suzy Glowiak Hilton

Senate

Added as Alternate Co-Sponsor Sen. Rachelle Crowe

Senate

Added as Alternate Co-Sponsor Sen. Jacqueline Y. Collins

Senate

Added as Alternate Chief Co-Sponsor Sen. Antonio Muñoz

Senate

Added as Alternate Chief Co-Sponsor Sen. David Koehler

Senate

Added as Alternate Chief Co-Sponsor Sen. Cristina Castro

Apr 22, 2021

Senate

Chief Senate Sponsor Sen. Linda Holmes

Senate

First Reading

Senate

Referred to Assignments

Senate

Added as Alternate Chief Co-Sponsor Sen. Dale Fowler

Apr 21, 2021

House

House Floor Amendment No. 2 Adopted

House

Placed on Calendar Order of 3rd Reading - Short Debate

House

Third Reading - Short Debate - Passed 117-000-000

House

Added Co-Sponsor Rep. Camille Y. Lilly

Senate

Placed on Calendar Order of First Reading April 22, 2021

Senate

Arrive in Senate

House

Recalled to Second Reading - Short Debate

House

Added Co-Sponsor Rep. Seth Lewis

House

House Floor Amendment No. 2 Recommends Be Adopted Rules Committee; 005-000-000

Apr 20, 2021

House

House Floor Amendment No. 2 Referred to Rules Committee

House

Second Reading - Short Debate

House

House Floor Amendment No. 1 Adopted

House

Placed on Calendar Order of 3rd Reading - Short Debate

House

Added Co-Sponsor Rep. Joyce Mason

House

Added Co-Sponsor Rep. Emanuel Chris Welch

House

Added Co-Sponsor Rep. Carol Ammons

House

House Floor Amendment No. 2 Filed with Clerk by Rep. Greg Harris

Apr 14, 2021

House

House Floor Amendment No. 1 Recommends Be Adopted Human Services Committee; 012-000-000

Apr 13, 2021

House

House Floor Amendment No. 1 Rules Refers to Human Services Committee

Apr 07, 2021

House

Added Co-Sponsor Rep. Maurice A. West, II

House

House Floor Amendment No. 1 Filed with Clerk by Rep. Greg Harris

House

House Floor Amendment No. 1 Referred to Rules Committee

Apr 01, 2021

House

Added Co-Sponsor Rep. Chris Bos

Mar 18, 2021

House

Added Co-Sponsor Rep. Jehan Gordon-Booth

Mar 17, 2021

House

Added Co-Sponsor Rep. Sam Yingling

House

Placed on Calendar 2nd Reading - Short Debate

Mar 16, 2021

House

Added Co-Sponsor Rep. Charles Meier

Mar 12, 2021

House

Added Co-Sponsor Rep. Keith P. Sommer

House

Added Co-Sponsor Rep. Adam Niemerg

Mar 09, 2021

House

Do Pass / Short Debate Human Services Committee; 015-000-000

Mar 04, 2021

House

Added Co-Sponsor Rep. Dan Caulkins

Mar 03, 2021

House

Added Co-Sponsor Rep. Dave Severin

Mar 02, 2021

House

Assigned to Human Services Committee

Feb 28, 2021

House

Added Co-Sponsor Rep. Jaime M. Andrade, Jr.

Feb 26, 2021

House

Added Co-Sponsor Rep. Terra Costa Howard

Feb 25, 2021

House

Added Co-Sponsor Rep. Michael Halpin

Feb 24, 2021

House

Added Co-Sponsor Rep. Dave Vella

Feb 19, 2021

House

Added Co-Sponsor Rep. Amy Elik

House

Added Co-Sponsor Rep. Amy Grant

Feb 18, 2021

House

Added Co-Sponsor Rep. Daniel Didech

House

Added Co-Sponsor Rep. Tony McCombie

House

Added Co-Sponsor Rep. Thomas M. Bennett

Feb 16, 2021

House

Added Co-Sponsor Rep. Stephanie A. Kifowit

House

Added Co-Sponsor Rep. Barbara Hernandez

House

Added Co-Sponsor Rep. Tom Weber

House

Added Co-Sponsor Rep. Dagmara Avelar

Feb 11, 2021

House

Added Co-Sponsor Rep. Debbie Meyers-Martin

House

Added Co-Sponsor Rep. Lakesia Collins

Feb 10, 2021

House

Added Co-Sponsor Rep. Sue Scherer

House

Added Co-Sponsor Rep. Maura Hirschauer

Feb 08, 2021

House

Co-Sponsor Rep. Mark Batinick

House

Chief Co-Sponsor Rep. Tom Demmer

House

Co-Sponsor Rep. Kelly M. Cassidy

House

Co-Sponsor Rep. Deb Conroy

House

Co-Sponsor Rep. Robyn Gabel

House

Co-Sponsor Rep. Ann M. Williams

House

Co-Sponsor Rep. Keith R. Wheeler

House

Chief Co-Sponsor Rep. Ryan Spain

House

Co-Sponsor Rep. Jeff Keicher

House

Chief Co-Sponsor Rep. Anna Moeller

House

Chief Co-Sponsor Rep. William Davis

House

Filed with the Clerk by Rep. Greg Harris

House

Referred to Rules Committee

House

First Reading

House

Co-Sponsor Rep. Lawrence Walsh, Jr.

House

Co-Sponsor Rep. Lindsey LaPointe

House

Co-Sponsor Rep. Bob Morgan

House

Co-Sponsor Rep. Katie Stuart

House

Co-Sponsor Rep. Margaret Croke

House

Co-Sponsor Rep. Jennifer Gong-Gershowitz

House

Co-Sponsor Rep. Will Guzzardi

House

Co-Sponsor Rep. Natalie A. Manley

House

Co-Sponsor Rep. Michael J. Madigan

House

Co-Sponsor Rep. Nicholas K. Smith

House

Co-Sponsor Rep. Norine K. Hammond

House

Co-Sponsor Rep. Andrew S. Chesney

House

Co-Sponsor Rep. Mike Murphy

House

Co-Sponsor Rep. Deanne M. Mazzochi

House

Co-Sponsor Rep. Justin Slaughter

House

Co-Sponsor Rep. Michelle Mussman

House

Co-Sponsor Rep. Martin J. Moylan

House

Co-Sponsor Rep. Frances Ann Hurley

House

Co-Sponsor Rep. Tim Butler

House

Co-Sponsor Rep. Elizabeth Hernandez

House

Co-Sponsor Rep. Jonathan Carroll

House

Co-Sponsor Rep. Michael T. Marron

Bill Text

Bill Text Versions Format
Introduced HTML
Engrossed HTML
Enrolled HTML
House Amendment 001 HTML
House Amendment 002 HTML

Related Documents

Document Format
Public Act

Sources

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