summary
Introduced
01/29/2026
01/29/2026
In Committee
02/06/2026
02/06/2026
Crossed Over
Passed
Dead
Introduced Session
104th General Assembly
Bill Summary
Creates the Standardized Prior Authorization Act. Requires a health insurance issuer to maintain a complete list of services for which prior authorization is required and to make any current prior authorization requirements and restrictions readily accessible and conspicuously posted on its website or online portals to enrollees, health care professionals, and health care providers. Sets forth further provisions concerning disclosure and review of prior authorization requirements; standard prior authorizations; expedited prior authorizations; notifications of adverse determinations; appeals of adverse determinations; prohibitions on revocation of prior authorization and nonpayment by a health insurance issuer; the length of approvals; approvals for chronic conditions; continuity of prior approvals; and enforcement and administration of the Act. Requires a health insurance issuer to periodically review its prior authorization requirements and consider removal of prior authorization requirements. Provides that a failure by a health insurance issuer to comply with the deadlines and other requirements specified in the Act shall result in any health care services subject to review to be automatically deemed authorized by the health insurance issuer or its contracted private review agent. Establishes reporting and notification requirements for health insurance issuers. Grants rulemaking authority to the Department of Insurance. Repeals the Prior Authorization Reform Act. Amends the Illinois Insurance Code and the Illinois Public Aid Code to make conforming changes. Effective January 1, 2027.
AI Summary
This bill, the Standardized Prior Authorization Act, aims to regulate prior authorization processes by health insurance issuers to protect the patient-provider relationship and ensure transparency. Key provisions include requiring issuers to publicly list all services requiring prior authorization and make their requirements easily accessible online, standardizing electronic prior authorization requests, and setting deadlines for approvals and adverse determinations (denials). It also mandates that adverse determinations include clear reasons and appeal instructions, and that appeals be reviewed by qualified professionals. The bill prohibits revoking prior authorizations without specific justification and establishes rules for the duration of approvals, especially for chronic conditions, and for maintaining continuity of prior approvals when a patient switches insurance. Furthermore, it states that if an issuer fails to meet deadlines, services will be automatically deemed authorized, and it grants the Department of Insurance authority to enforce these provisions with potential fines. The Act also repeals the Prior Authorization Reform Act and makes conforming changes to other Illinois laws, becoming effective on January 1, 2027.
Sponsors (1)
Last Action
Referred to Rules Committee (on 02/06/2026)
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