PRIOR AUTHORIZATION REFORM ACT House SponsorsRep. Greg Harris-Tom Demmer-William Davis-Anna Moeller-Ryan Spain, Keith R. Wheeler, Ann M. Williams, Robyn Gabel, Deb Conroy, Kelly M. Cassidy, Jeff Keicher, Mark Batinick, Michael T. Marron, Jonathan Carroll, Elizabeth Hernandez, Tim Butler, Frances Ann Hurley, Martin J. Moylan, Michelle Mussman, Justin Slaughter, Deanne M. Mazzochi, Mike Murphy, Andrew S. Chesney, Norine K. Hammond, Nicholas K. Smith, Michael J. Madigan, Natalie A. Manley, Will Guzzardi, Jennifer Gong-Gershowitz, Margaret Croke, Katie Stuart, Bob Morgan, Lindsey LaPointe, Lawrence Walsh, Jr., Sue Scherer, Maura Hirschauer, Debbie Meyers-Martin, Lakesia Collins, Barbara Hernandez, Tom Weber, Dagmara Avelar, Stephanie A. Kifowit, Daniel Didech, Tony McCombie, Thomas M. Bennett, Amy Elik, Amy Grant, Dave Vella, Michael Halpin, Terra Costa Howard, Jaime M. Andrade, Jr., Dave Severin, Dan Caulkins, Keith P. Sommer, Adam Niemerg, Charles Meier, Sam Yingling, Jehan Gordon-Booth, Chris Bos, Maurice A. West, II, Carol Ammons, Emanuel Chris Welch, Joyce Mason, Seth Lewis and Camille Y. Lilly Senate Sponsors(Sen. Linda Holmes-Dale Fowler-Cristina Castro-David Koehler-Antonio Muņoz, Suzy Glowiak Hilton, Jacqueline Y. Collins, Rachelle Crowe, Patricia Van Pelt, Kimberly A. Lightford, Donald P. DeWitte, Sue Rezin, Laura Fine, Adriane Johnson, Doris Turner, Melinda Bush, Napoleon Harris, III, Laura M. Murphy, Mattie Hunter, Emil Jones, III, Christopher Belt, Scott M. Bennett, Bill Cunningham, Win Stoller, Julie A. Morrison, Steve Stadelman and Ann Gillespie) 8/19/2021HousePublic Act . . . . . . . . . 102-0409 New Act215 ILCS 5/370gfrom Ch. 73, par. 982g215 ILCS 134/10215 ILCS 134/65305 ILCS 5/5-5.12d new 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 134/65Adds reference to:215 ILCS 5/155.36Replaces 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. 2/8/2021HouseFiled with the Clerk by Rep. Greg Harris 2/8/2021HouseChief Co-Sponsor Rep. Tom Demmer 2/8/2021HouseChief Co-Sponsor Rep. William Davis 2/8/2021HouseChief Co-Sponsor Rep. Anna Moeller 2/8/2021HouseChief Co-Sponsor Rep. Ryan Spain 2/8/2021HouseCo-Sponsor Rep. Keith R. Wheeler 2/8/2021HouseCo-Sponsor Rep. Ann M. Williams 2/8/2021HouseCo-Sponsor Rep. Robyn Gabel 2/8/2021HouseCo-Sponsor Rep. Deb Conroy 2/8/2021HouseCo-Sponsor Rep. Kelly M. Cassidy 2/8/2021HouseCo-Sponsor Rep. Jeff Keicher 2/8/2021HouseCo-Sponsor Rep. Mark Batinick 2/8/2021HouseCo-Sponsor Rep. Michael T. Marron 2/8/2021HouseCo-Sponsor Rep. Jonathan Carroll 2/8/2021HouseCo-Sponsor Rep. Elizabeth Hernandez 2/8/2021HouseCo-Sponsor Rep. Tim Butler 2/8/2021HouseCo-Sponsor Rep. Frances Ann Hurley 2/8/2021HouseCo-Sponsor Rep. Martin J. Moylan 2/8/2021HouseCo-Sponsor Rep. Michelle Mussman 2/8/2021HouseCo-Sponsor Rep. Justin Slaughter 2/8/2021HouseCo-Sponsor Rep. Deanne M. Mazzochi 2/8/2021HouseCo-Sponsor Rep. Mike Murphy 2/8/2021HouseCo-Sponsor Rep. Andrew S. Chesney 2/8/2021HouseCo-Sponsor Rep. Norine K. Hammond 2/8/2021HouseCo-Sponsor Rep. Nicholas K. Smith 2/8/2021HouseCo-Sponsor Rep. Michael J. Madigan 2/8/2021HouseCo-Sponsor Rep. Natalie A. Manley 2/8/2021HouseCo-Sponsor Rep. Will Guzzardi 2/8/2021HouseCo-Sponsor Rep. Jennifer Gong-Gershowitz 2/8/2021HouseCo-Sponsor Rep. Margaret Croke 2/8/2021HouseCo-Sponsor Rep. Katie Stuart 2/8/2021HouseCo-Sponsor Rep. Bob Morgan 2/8/2021HouseCo-Sponsor Rep. Lindsey LaPointe 2/8/2021HouseCo-Sponsor Rep. Lawrence Walsh, Jr. 2/8/2021HouseFirst Reading 2/8/2021HouseReferred to Rules Committee 2/10/2021HouseAdded Co-Sponsor Rep. Sue Scherer 2/10/2021HouseAdded Co-Sponsor Rep. Maura Hirschauer 2/11/2021HouseAdded Co-Sponsor Rep. Debbie Meyers-Martin 2/11/2021HouseAdded Co-Sponsor Rep. Lakesia Collins 2/16/2021HouseAdded Co-Sponsor Rep. Barbara Hernandez 2/16/2021HouseAdded Co-Sponsor Rep. Tom Weber 2/16/2021HouseAdded Co-Sponsor Rep. Dagmara Avelar 2/16/2021HouseAdded Co-Sponsor Rep. Stephanie A. Kifowit 2/18/2021HouseAdded Co-Sponsor Rep. Daniel Didech 2/18/2021HouseAdded Co-Sponsor Rep. Tony McCombie 2/18/2021HouseAdded Co-Sponsor Rep. Thomas M. Bennett 2/19/2021HouseAdded Co-Sponsor Rep. Amy Elik 2/19/2021HouseAdded Co-Sponsor Rep. Amy Grant 2/24/2021HouseAdded Co-Sponsor Rep. Dave Vella 2/25/2021HouseAdded Co-Sponsor Rep. Michael Halpin 2/26/2021HouseAdded Co-Sponsor Rep. Terra Costa Howard 2/28/2021HouseAdded Co-Sponsor Rep. Jaime M. Andrade, Jr. 3/2/2021HouseAssigned to Human Services Committee 3/3/2021HouseAdded Co-Sponsor Rep. Dave Severin 3/4/2021HouseAdded Co-Sponsor Rep. Dan Caulkins 3/9/2021HouseDo Pass / Short Debate Human Services Committee; 015-000-000 3/12/2021HouseAdded Co-Sponsor Rep. Keith P. Sommer 3/12/2021HouseAdded Co-Sponsor Rep. Adam Niemerg 3/16/2021HouseAdded Co-Sponsor Rep. Charles Meier 3/17/2021HousePlaced on Calendar 2nd Reading - Short Debate 3/17/2021HouseAdded Co-Sponsor Rep. Sam Yingling 3/18/2021HouseAdded Co-Sponsor Rep. Jehan Gordon-Booth 4/1/2021HouseAdded Co-Sponsor Rep. Chris Bos 4/7/2021HouseAdded Co-Sponsor Rep. Maurice A. West, II 4/7/2021HouseHouse Floor Amendment No. 1 Filed with Clerk by Rep. Greg Harris 4/7/2021HouseHouse Floor Amendment No. 1 Referred to Rules Committee 4/13/2021HouseHouse Floor Amendment No. 1 Rules Refers to Human Services Committee 4/14/2021HouseHouse Floor Amendment No. 1 Recommends Be Adopted Human Services Committee; 012-000-000 4/20/2021HouseAdded Co-Sponsor Rep. Carol Ammons 4/20/2021HouseAdded Co-Sponsor Rep. Emanuel Chris Welch 4/20/2021HouseHouse Floor Amendment No. 2 Filed with Clerk by Rep. Greg Harris 4/20/2021HouseHouse Floor Amendment No. 2 Referred to Rules Committee 4/20/2021HouseSecond Reading - Short Debate 4/20/2021HouseHouse Floor Amendment No. 1 Adopted 4/20/2021HousePlaced on Calendar Order of 3rd Reading - Short Debate 4/20/2021HouseAdded Co-Sponsor Rep. Joyce Mason 4/21/2021HouseRecalled to Second Reading - Short Debate 4/21/2021HouseAdded Co-Sponsor Rep. Seth Lewis 4/21/2021HouseHouse Floor Amendment No. 2 Recommends Be Adopted Rules Committee; 005-000-000 4/21/2021HouseHouse Floor Amendment No. 2 Adopted 4/21/2021HousePlaced on Calendar Order of 3rd Reading - Short Debate 4/21/2021HouseThird Reading - Short Debate - Passed 117-000-000 4/21/2021HouseAdded Co-Sponsor Rep. Camille Y. Lilly 4/21/2021SenateArrive in Senate 4/21/2021SenatePlaced on Calendar Order of First Reading April 22, 2021 4/22/2021SenateChief Senate Sponsor Sen. Linda Holmes 4/22/2021SenateFirst Reading 4/22/2021SenateReferred to Assignments 4/22/2021SenateAdded as Alternate Chief Co-Sponsor Sen. Dale Fowler 4/27/2021SenateAdded as Alternate Chief Co-Sponsor Sen. Cristina Castro 4/27/2021SenateAdded as Alternate Chief Co-Sponsor Sen. David Koehler 4/27/2021SenateAdded as Alternate Chief Co-Sponsor Sen. Antonio Muņoz 4/27/2021SenateAdded as Alternate Co-Sponsor Sen. Suzy Glowiak Hilton 4/27/2021SenateAdded as Alternate Co-Sponsor Sen. Jacqueline Y. Collins 4/27/2021SenateAdded as Alternate Co-Sponsor Sen. Rachelle Crowe 4/28/2021SenateAdded as Alternate Co-Sponsor Sen. Patricia Van Pelt 4/28/2021SenateAdded as Alternate Co-Sponsor Sen. Kimberly A. Lightford 4/28/2021SenateAssigned to Insurance 4/28/2021SenateAdded as Alternate Co-Sponsor Sen. Donald P. DeWitte 4/28/2021SenateAdded as Alternate Co-Sponsor Sen. Sue Rezin 4/29/2021SenateAdded as Alternate Co-Sponsor Sen. Laura Fine 4/29/2021SenateAdded as Alternate Co-Sponsor Sen. Adriane Johnson 4/30/2021SenateAdded as Alternate Co-Sponsor Sen. Doris Turner 5/3/2021SenateAdded as Alternate Co-Sponsor Sen. Melinda Bush 5/3/2021SenateAdded as Alternate Co-Sponsor Sen. Napoleon Harris, III 5/3/2021SenateAdded as Alternate Co-Sponsor Sen. Laura M. Murphy 5/4/2021SenateAdded as Alternate Co-Sponsor Sen. Mattie Hunter 5/4/2021SenateAdded as Alternate Co-Sponsor Sen. Emil Jones, III 5/4/2021SenateAdded as Alternate Co-Sponsor Sen. Christopher Belt 5/4/2021SenateAdded as Alternate Co-Sponsor Sen. Scott M. Bennett 5/6/2021SenateDo Pass Insurance; 011-000-000 5/6/2021SenatePlaced on Calendar Order of 2nd Reading May 10, 2021 5/6/2021SenateAdded as Alternate Co-Sponsor Sen. Bill Cunningham 5/11/2021SenateAdded as Alternate Co-Sponsor Sen. Win Stoller 5/13/2021SenateAdded as Alternate Co-Sponsor Sen. Julie A. Morrison 5/13/2021SenateSecond Reading 5/13/2021SenatePlaced on Calendar Order of 3rd Reading May 14, 2021 5/20/2021SenateAdded as Alternate Co-Sponsor Sen. Steve Stadelman 5/24/2021SenateAdded as Alternate Co-Sponsor Sen. Ann Gillespie 5/24/2021SenatePlaced on Calendar Order of 3rd Reading ** May 25, 2021 5/27/2021SenateThird Reading - Passed; 057-000-000 5/27/2021HousePassed Both Houses 6/23/2021HouseSent to the Governor 8/19/2021HouseGovernor Approved 8/19/2021HouseEffective Date January 1, 2022 8/19/2021HousePublic Act . . . . . . . . . 102-0409