Illinois lawmakers have introduced a bill aimed at simplifying the process of obtaining ongoing medical care for individuals with chronic health conditions. House Bill 3782, introduced by Rep. Sonya M. Harper seeks to amend the Prior Authorization Reform Act by providing more consistent and long-term approval for treatments related to chronic conditions.
Key Provisions of the Bill
- Definition of Chronic Health Conditions: The bill defines a chronic health condition as one expected to last at least one year, requiring ongoing medical attention to manage the condition or prevent adverse health events, or limiting one or more activities of daily living. It replaces the term “chronic or long-term condition” with “chronic health condition” in relevant legislation.
- Prior Authorization Approval Duration: If a health insurance issuer requires prior authorization for recurring healthcare services or maintenance medications for chronic conditions, the approval will remain valid for the duration of the condition or the length of treatment, as determined by the patient’s healthcare professional. However, this approval will not exceed 12 months unless the standard of treatment changes.
- Exclusions: The bill does not apply to prescriptions for benzodiazepines or Schedule II narcotic drugs, such as opioids. Additionally, it does not mandate coverage for treatments excluded by the policy’s terms, even if they are medically necessary.
This legislation could significantly reduce administrative burdens for both patients and healthcare providers by minimizing the need for frequent prior authorization renewals. It aims to ensure that individuals with chronic conditions receive consistent and uninterrupted care, improving their quality of life and potentially reducing healthcare costs associated with delayed or interrupted treatments.
