A Successful Year Already and More to Come for ISMS
J. Regan Thomas, MD
September 2, 2021
I’m only a third of the way through my term as ISMS president, but so far I can say that one of the best parts of the job is being the bearer of good news. Lucky for me, our strong and effective advocacy has yielded a steady stream of good news this year.
Let’s start with our latest victory: Last week, Governor Pritzker signed into law Public Act 102-0409 , the Prior Authorization Reform Act. This bill was initiated by ISMS, and we led a coalition of other physician and patient advocacy groups to secure its final passage. Reforming burdensome and overused prior authorization processes has been ISMS’ top legislative priority since before the pandemic began, and the signing of this new law – which passed the General Assembly without a single dissenting vote in either chamber – marks a key milestone in our ongoing efforts to improve care for our patients and reduce frustrations for our members.
For those who aren’t yet familiar, the Prior Authorization Reform Act puts a series of new requirements in place for state-regulated health insurance plans. Among other important provisions, it:
- Increases transparency by requiring payers to make information about prior authorization policies readily available at the point of care.
- Standardizes response times by requiring utilization review organizations to respond to prior authorization requests within specific timeframes.
- Establishes minimum qualifications for individuals who can deny a prior authorization request and specifies the information that a utilization review organization must provide at the time of denial.
- Sets specific time frames for how long a prior authorization approval is valid for acute and chronic conditions, including required time frames if a patient changes health insurance plans in the middle of treatment.
(For more information about this law, check out our fact sheet – and don’t forget to share it with your colleagues when discussing the importance of ISMS membership.)
But wait, there’s more! In July, Governor Pritzker signed into law an ISMS-supported bill that will increase patient access to telemedicine by reducing barriers and aligning telehealth coverage and payment with in-person care.
Public Act 102-0104 contains provisions that echo the governor’s executive orders on telehealth, which were drafted with significant ISMS input and issued in the early days of the COVID-19 pandemic. Among other changes, this law:
- Requires all health state-regulated insurance plans to cover all clinically appropriate, medically necessary services delivered via telemedicine by in-network health professionals – including both video and audio-only encounters, e-visits and virtual check-ins.
- Requires plans to reimburse in-network healthcare professionals or facilities for telemedicine encounters on the same basis, in the same manner and at the same reimbursement rate that would apply to the services if the services had been delivered via an in-person encounter by the in-network professional or facility. (This provision sunsets for nonbehavioral health services only in December 2027.)
- Prohibits health insurers from charging higher deductibles, copayments or coinsurance for services provided through telemedicine than would be charged for the same services delivered in person.
ISMS has developed an Issue Brief that details the new law and provides some guidance for physicians who deliver telemedicine service – another reminder that ISMS’ work goes beyond the statehouse, offering helpful practical resources for individual members.
Of course, much more came out of this year’s legislative session, and I barely have the space here to scratch the surface of ISMS’ advocacy. That’s why our end-of-session legislative report is a must-read for any physician who cares about the future of our profession. It’s also why I’m so eager to get in front of as many audiences as possible this year to share the latest updates from ISMS. Whether you belong to a hospital medical staff; a county, specialty, or ethnic medical society; or another civic organization, I would be pleased to attend your next meeting, either virtually or in person.
If you bring people who care about the health of our patients, our communities, and our state, I’ll bring the latest from ISMS – and if our recent history is any guide, that means I’ll get to bring more good news.
Throughout my term as president, I can be reached at DrThomas@isms.org . Please don't hesitate to reach out any time!