Gov. Pritzker Signs Legislation Reforming the Use of Prior Authorization to Protect Patients
SPRINGFIELD - Building on efforts to protect the wellbeing of Illinois residents and medical patients, Governor JB Pritzker signed legislation that reforms the use of prior authorization. The legislation ensures faster access to medically necessary treatments for patients and holds health insurance companies accountable through timelines for approvals, transparency measures, and discipline for infractions.
"This legislation advances a key belief of mine that I know is shared by millions of residents across Illinois: health care is a right, not a privilege," said Governor JB Pritzker. "For too long, the misuse of prior authorization led to delays and additional worry for Illinois families in need of care. Through this legislation, we are taking bold action to overhaul this process and ensure Illinoisans have faster access to the quality care they deserve ."
"Abuse of prior authorization by insurance companies has lead to many denials of care, and even worse, delays of critical testing and treatment that have cost people's health dearly," said Majority Leader Greg Harris (D-Chicago). "It's time to make sure prior authorization isn't used to delay care and drive up profits."
"Having a condition that requires medical treatment, supplies and related services is stressful enough; add on top of that the worries about waiting for the treatment to begin because of seemingly arbitrary delays, and this builds a tremendous amount of stress for the patient and their family," said Assistant Senate Majority Leader Linda Holmes (D-Aurora). "These delays must end throughout the whole treatment process."
HB 711 creates the Prior Authorization Reform Act and makes significant reforms to prior authorization's use in Illinois. Previous use of prior authorization resulted in patients waiting too long for medically necessary and appropriate treatments. Patients often faced longer wait times, adverse health outcomes, and rising costs for necessary urgent medical treatments.
• Establishing approval timelines. Prior authorization approvals will remain valid for six months, and 12 months for chronic and long-term diseases to ensure continuity of care for patients.
• Establishes a robust system for prior authorization denials which includes the reasons for the denial and instructions on how to appeal.
• Sets guidelines for individuals designated to review prior authorization applications. Determinations must now be done by physicians with same or similar areas of medicine.
• Establishes discipline measures for infractions.
• Increases transparency by requiring insurers to maintain a list of services for which prior authorization is required.
• Reduces the number of medically necessary services that are subjected to prior authorization requirements.
• Requires that a decision must be made no later than 5 calendar days after obtaining the necessary information.
HB 711 is effective January 1, 2022.