summary
Introduced
02/06/2025
02/06/2025
In Committee
06/02/2025
06/02/2025
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 enhance reporting requirements for prescription drugs used to treat serious mental illnesses under Medicaid. Specifically, the bill requires the Department of Healthcare and Family Services and managed care organizations to submit quarterly reports starting July 1, 2025, detailing prescription drug access and denials. These reports must include comprehensive information such as the number of denied prescriptions, estimated costs, prior authorization denials, step therapy exception requests, and the number of complaints related to prescription denials. The reports will cover prescription drugs used to treat serious mental illnesses, which are defined by a specific list of diagnoses including conditions like schizophrenia, bipolar disorder, major depressive disorder, and posttraumatic stress disorder. The bill maintains existing provisions that prohibit prior authorization mandates and utilization management controls for FDA-approved mental health prescription drugs under certain circumstances, such as when a patient has changed providers or insurance coverage while stable on a medication. Additionally, the Department is authorized to sanction managed care organizations that fail to submit the required reports, ensuring compliance with the new reporting requirements.
Committee Categories
Health and Social Services
Sponsors (5)
Last Action
Rule 3-9(a) / Re-referred to Assignments (on 06/02/2025)
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=1844&GAID=18&DocTypeID=SB&SessionID=114&GA=104 |
| BillText | https://www.ilga.gov/legislation/104/SB/10400SB1844.htm |
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