Prairie State Wire

The Illinois State Medical Society (ISMS) has announced its support for House Bill 3019, a legislative initiative backed by Governor Pritzker. The bill, which passed through the General Assembly before the end of the Spring Legislative session, is aimed at expanding the Healthcare Protection Act.

The bill introduces several changes to increase transparency and strengthen coverage requirements in healthcare. One key aspect involves requiring health insurers to submit annual reports to the Department of Insurance. These reports must detail how premium revenues are spent, specifically on clinical services, activities that improve healthcare quality, and other non-claims costs.

For substance use disorder (SUD) treatment, the bill proposes eliminating mandatory notification timeframes for providers when treatment begins. While insurers may still implement notification requirements, retrospective denial will be prohibited except in specified cases.

In terms of mental health coverage, prior authorization for outpatient or partial hospitalization services will no longer be required. Concurrent and retrospective reviews will be allowed within permissible notification guidelines. Additionally, inpatient mental health services will not require prior authorization or concurrent review for 72 hours post-admission if proper notifications are made within 48 hours.

The Network Adequacy and Transparency Act will also see enhancements under this legislation. Health Maintenance Organization (HMO) beneficiaries will now receive network exemptions when preferred provider access is insufficient. Furthermore, plans must reimburse patients for expenses incurred due to necessary travel for SUD or mental health care if in-network providers are unavailable.

This ISMS-supported bill now awaits the governor's signature to become law. Questions regarding this legislative development can be directed to Erin O'Brien, ISMS Senior Vice President of State Legislative Affairs.