Illinois Legislature Passes Bill Prohibiting Prior Authorization for Inpatient Mental Health Admissions
As reported in
Becker's this week, the Illinois General Assembly has passed a new
health insurance reform bill, which Governor JB Pritzker is expected to sign.
The enrolled bill, passed on May 25, prohibits state-regulated insurers from requiring prior authorization for inpatient admissions for mental health treatment at participating hospitals. In addition, the coverage would not be subject to concurrent review for the first 72 hours as long as the hospital notifies the insurer of the admission and initial treatment plan within the first two days of admission. Finally, the treatment could not be retroactively denied for the first 72 hours of treatment except in limited circumstances. These provisions would go into effect on Jan. 1, 2026.
The bill contains additional requirements on insurers, including implementing new penalties for failing to keep the network plan directory up to date; and requiring insurers that use a drug formulary to post the formulary on their website in a manner that is searchable and accessible to the general public.