summary
Introduced
01/31/2025
01/31/2025
In Committee
03/21/2025
03/21/2025
Crossed Over
Passed
Dead
Introduced Session
104th General Assembly
Bill Summary
Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision prohibiting prior authorization mandates and utilization management controls under the fee-for-service and managed care medical assistance programs for FDA-approved prescription drugs that treat mental illness, requires the Department of Healthcare and Family Services and managed care organizations to report quarterly on compliance with the specified prohibitions beginning with dates of service on and after July 1, 2025. Requires the Department to post on its website a report on fee-for-service prescriptions and the reports from each managed care organization. Sets forth the information that must be contained in the quarterly reports, including, but not limited to: (i) the number of denied prescriptions and estimated net cost to the State for those covered prescriptions summarized by each of the allowed categories specified in the Code; (ii) the number of denied prescriptions and estimated net cost to the State for those prescriptions summarized by each of the non-allowed categories specified in the Code; and (iii) the number of denied prescriptions and estimated gross cost to the State for those prescriptions summarized by any other reason not specified in the Code. Requires the Department to sanction those managed care organizations that do not file the required reports. Effective immediately.
AI Summary
This bill amends the Illinois Public Aid Code to strengthen protections for patients with serious mental illnesses by requiring detailed quarterly reporting on prescription drug access and denials. Specifically, the bill maintains existing prohibitions against prior authorization mandates and utilization management controls for FDA-approved prescription drugs treating serious mental illnesses, which include conditions like schizophrenia, bipolar disorder, and major depressive disorder. Beginning July 1, 2025, the Department of Healthcare and Family Services and managed care organizations must submit comprehensive quarterly reports detailing prescription denials, including the number of denied prescriptions, estimated costs to the state, prior authorization denials, step therapy exception requests, and other relevant metrics. These reports must also track emergency room visits and hospital admissions related to mental health conditions. The reports will be posted on the department's website, and managed care organizations that fail to submit the required reports will be subject to sanctions. The bill aims to improve transparency and ensure timely access to mental health medications by requiring detailed tracking and reporting of prescription drug management practices.
Committee Categories
Health and Social Services
Sponsors (2)
Last Action
Added Co-Sponsor Rep. Edgar González, Jr. (on 03/28/2025)
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.ilga.gov/legislation/BillStatus.asp?DocNum=2398&GAID=18&DocTypeID=HB&SessionID=114&GA=104 |
| BillText | https://www.ilga.gov/legislation/104/HB/10400HB2398.htm |
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