* WTVO…

Illinois Gov. JB Pritzker signed a package of healthcare reforms into law on Wednesday, with the signing of the Healthcare Protection Act.

With the law’s signage, Illinois becomes the first state in the U.S. to ban prior authorization for in-patient adult and children’s mental health care.

The law bans “step therapy” for private insurance and Medicaid, which is the practice of requiring patients to try cheaper forms of treatments prior to trying more expensive options.

Additionally, the law adds Illinois to a list of 12 states banning “junk” insurance plans, which offer temporary and often incomplete coverage. Junk insurance plans are otherwise known as short-term limited duration plans, like health insurance plans people can buy when covered through an employer.

It also requires insurers to offer enough in-network doctors to meet patients’ needs, requiring insurance companies to keep up-to-date directories of which doctors are available. Health insurance companies would be required to conduct audits on themselves every 90 days and report their findings to the Department of Insurance.

* Press release…

Today Governor JB Pritzker signed the package of bills comprising the Healthcare Protection Act (HPA) into law, a series of reforms initially proposed by the Governor in his 2024 State of the State address. The HPA works to improve healthcare consumer experiences by banning step therapy and prior authorization for crisis mental healthcare, banning junk insurance plans, and ending unchecked rate increases for large group insurance companies.

“With the signing of these bills, we’re putting power back into the hands of patients and their doctors and out of the grasps of predatory insurance companies who prioritize profits over patient outcomes,” said Governor JB Pritzker. “Accessing care shouldn’t require endless bureaucracy and navigation, especially when someone is at their most vulnerable, and this legislation will make care more affordable and accessible for millions of Illinoisans.” […]

A main target of the HPA is step therapy, the practice of insurance providers requiring patients to try and fail on often less effective treatment options and medications first before getting the care recommended by their doctor. The legislation also eliminates prior authorization requirements for in-patient mental health care, recognizing that patients in need of urgent mental health care are often not able to navigate and wait out a prior authorization process.

The HPA also requires insurance companies be transparent about prior authorization requirements when advertising coverage. Since in-network availability is often the only way patients can access care, the HPA also sets standards for appointment time availability and number of in-network doctors, ensuring that patients can actually locate care in their area and have a transparent view of their in-network providers.

In addition to utilization management regulation, the HPA also pans the sale of junk insurance plans that fail to meet Affordable Care Act standards. In 2023, the General Assembly and Governor Pritzker ended unfair rate increases for individual policy holders and the small group insurance market. The HPA extends that regulation to large group insurance carriers as well.

* This is a big package…

“The Healthcare Protection Act reflects some of the strongest behavioral and physical health protections ever enacted in the United States. Banning junk insurance, ending step therapy and prior authorization for mental health, taking on ghost networks, and lowering health insurance rates to make healthcare more affordable will immeasurably improve healthcare in Illinois,” said Rep. Bob Morgan (D-Deerfield). “Today marks a major step towards healthcare equity, and we will use this legislation as a benchmark for future efforts toward a healthier Illinois.”

* More…

State Rep. Bill Hauter, who doubles as an emergency room physician, co-sponsored House Bill 4055. The bill bans prior authorization and Hauter sponsored the legislation with Democrats. Hauter explained a provision of the bill that specifically benefits those with bleeding disorders.

“This amendment addresses pre authorization abuse … specifically this amendment focuses on hemophiliacs or those with bleeding disorders and the pre authorization required if they have an emergency condition and require medications. They will now be allowed to skip the emergency department and go directly to their specialist and avoid an emergency department visit,” said Hauter.

* WCIA…

Finally, the bill also addresses network adequacy and ghost networks. In 2022, WCIA published a series investigating Blue Cross Blue Shield’s ghost networks in Central Illinois. The Illinois Department of Insurance has fined Blue Cross Blue Shield of Illinois twice in 2023 for not following the Network Adequacy and Transparency Act.