Illinois Doctors Thank Governor for Signing Prior Authorization Reform Bill

New legislation will ease the burden of bureaucracy for patients and doctors

CHICAGO – Today’s action by Governor Pritzker to sign into law the Prior Authorization Reform Act (Public Act 102-409) is a major victory for reducing the bureaucratic barriers for Illinois patients to receive the medical treatment they need in a timely manner.

“The misuse of prior authorization has caused delays and denials to patients who may need potentially life-saving care. Our hope is that by enacting this law, patients will get the medical care they deserve and need without unnecessary delays,” said Regan Thomas, MD, President, Illinois State Medical Society (ISMS).

With bipartisan support in both chambers, the Illinois General Assembly unanimously approved ISMS’ top initiative during the Spring legislative session.

The law requires important, substantive changes to health insurer prior authorization practices. These require that:

• Health insurance companies respond to prior authorization requests within well-defined shortened and more immediate timelines for urgent and non-urgent care; no one will have to wait longer than one week for an answer from their health insurance company
• Insurers use medical professionals with relevant experience in the appropriate specialty to make prior authorization decisions
• Clear and definite time frames be in place for how long a prior authorization approval is valid for acute and chronic conditions to avoid disruptions in medical care for patients who are stable on a prescribed treatment
• Prior authorization requirements are transparent and follow evidence-based guidelines

ISMS has been leading this fight for reform along with many other healthcare and patient advocacy organizations as part of the Your Care Can’t Wait Coalition.

“The issues with prior authorization became so cumbersome that when we conducted a survey of Illinois physicians, more than 95% reported that this process had caused harm to their patients,” Dr. Thomas noted. “The physicians of Illinois appreciate that the Governor and the General Assembly have supported this legislation to make sure patients receive the medical care and treatment they deserve without delays.”

The new law takes effect Jan. 1, 2022. It applies to state-regulated insurance plans, including Medicaid. It does not apply to federally regulated ERISA plans or Medicare.

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Founded in 1840, ISMS is a professional membership association representing Illinois physicians in all medical specialties, and their patients, statewide. Dr. Thomas is a practicing reconstructive facial plastic surgeon in Chicago.