Illinois HB 4709: STANDARDIZED PRIOR AUTH ACT

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 Full Text of HB4709

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104TH GENERAL ASSEMBLY 
State of Illinois 
2025 and 2026
HB4709

Introduced , by Rep. Rita Mayfield 

SYNOPSIS AS INTRODUCED:

New Act

215 ILCS 5/356z.66

215 ILCS 5/370c from Ch. 73, par. 982c

215 ILCS 124/10

305 ILCS 5/5-5.12e

215 ILCS 200/Act rep.

 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 Illi