On July 10, 2024, Illinois took significant strides toward improving healthcare access and patient rights with the passage the Healthcare Protection Act. Enacted to bolster consumer protections and streamline healthcare processes, this comprehensive legislation introduces multiple reforms aimed at safeguarding patient rights and enhancing transparency in health care. Key provisions include:
- Step Therapy Ban: Starting January 1, 2026, insurers cannot impose step therapy requirements, ensuring timely access to medications.
- Prior Authorization for Mental Health: Bans prior authorization for inpatient mental health emergency admissions, with initial treatment covered for the first 72 hours in most cases.
- Junk Insurance Prohibition: Ensures all plans meet ACA standards, prohibiting policies with limited coverage or lacking consumer protections.
- Transparency and Accessibility: Requires clear prior authorization disclosures and online drug formulary accessibility by October 1, 2025.
- Network Adequacy: Sets stringent standards for provider-to-patient ratios and travel/wait times.
- Utilization Review Programs: Requires use of updated treatment criteria for medical necessity determinations.
- Provider Directory Information: Mandates a uniform electronic form by January 1, 2026.
- Insurance Rate Regulation: Establishes oversight to ensure reasonable premium rates and classifications for large group policies.
Illinois’ Healthcare Protection Act sets a new standard in healthcare oversight, prioritizing patient rights and equitable access to quality care.
Read the Healthcare Protection Act.
Last Updated on October 14, 2024 by Aimed Alliance
