Prior Authorization

I've been following this bill for awhile now but never got around to writing about it until after it passed through both chambers of the Illinois legislature. That's a shame, because it's a pretty Big F*cking Deal for Illinois residents.

Via WAND Illinois:

 The Illinois House passed the Healthcare Protection Act Saturday to help curb predatory insurance practices and protect consumers.

Gov. JB Pritzker's monumental plan could make Illinois the first state to ban prior authorization for in-patient adult and children's mental healthcare. The legislation also bans step therapy, or the fail first method, where insurers force people to receive less effective treatment before moving to options initially recommended by doctors.

...The measure requires prior approval from the Department of Insurance before large group insurance plans can increase rates and states premiums must align with the actual cost of providing care as well.

CMS Logo

via the Centers for Medicare & Medicaid Services:

As part of the Biden-Harris Administration’s ongoing commitment to increasing health data exchange and investing in interoperability, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services. CMS proposes to modernize the health care system by requiring certain payers to implement an electronic prior authorization process, shorten the time frames for certain payers to respond to prior authorization requests, and establish policies to make the prior authorization process more efficient and transparent. The rule also proposes to require certain payers to implement standards that would enable data exchange from one payer to another payer when a patient changes payers or has concurrent coverage, which is expected to help ensure that complete patient records would be available throughout patient transitions between payers.