Legislative Updates


September 17. 2018

House Bill 5769 Creates Consistency and Efficiency for Illinois’ Existing Prior Authorization Protocol
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The problem
Currently in Illinois, Medicaid managed care organizations (MCOs) and commercial insurers have multiple, varying prior authorization forms, resulting in additional paperwork and time for the prescribing clinician. This flawed system of varying prior authorization forms has a direct, negative impact on the patient-doctor relationship. Here are some of the challenges facing Illinois doctors:
 

  • Contacting the insurer to determine which form is the appropriate document to submit takes approximately 15-20 minutes. Completion of the form requires an additional 40 minutes. This is time taken away from other patients, who relies on the ability to have necessary, sometimes time-sensitive consultations with their health care team. 
     
  • For a child and adolescent psychiatrist who accepts Medicaid insurance, he or she must complete roughly 20 prior authorization forms each day. Many psychiatrists are unable to carry out this over-burdening administrative responsibility and hire an additional staff person, resulting in additional operational expenses.
     
  • A psychiatrist who specializes in addiction disorders spends on average 2 hours each day on prior authorizations for medication assisted treatments.

Risks
When patients are denied coverage of their medications, many can experience medication non-compliance because they cannot afford to pay for the therapy out-of-pocket. These treatment interruptions can result in relapse, disease progression, hospitalizations or worsening health outcomes such as death.

Solution
Developing a stream-lined, consistent prior authorization form and protocol will limit negative health outcomes to Illinois patients. The bill would create 2 committees.  One committee will work on drafting a uniform prior authorization form for MCOs and another committee will draft a uniform prior authorization form for commercial insurers.  Requiring electronic prior authorization will ensure that prior authorizations will be properly transitioned to the MCO or insurance company and allows the physician to track the prior authorization. According to Joel White, the Director of the Opioid Safety Alliance, electronic prior authorization decreases “the potential for medication mismanagement, including in cases of powerful opioids.”  Having a single, uniform electronic prior authorization form will eliminate at least 15-20 minutes from the physician’s prior authorization work which is not reimbursed. In addition, it will also eliminate some time from doing the prior authorization form because physicians will become knowledgeable about each of the 2 forms. 

The undersigned advocacy and provider groups collectively ask for your support of HB 5769 as it will promote patient safety and protect the patient-doctor relationship. For any questions, please contact Meryl Sosa at msosa@ilpsych.org.

Respectfully,

Illinois Psychiatric Society

Illinois State Medical Society

Illinois Academy of Family Physicians

Illinois Chapter of the American Academy of Pediatrics

Gateway Foundation

Regroup Therapy

Community Behavioral Health Association

Illinois Association for Behavioral Health

American Psychiatric Association

Thresholds

Heartland Alliance

Illinois Primary Care Health Association

Rosecrance

Otsuka US

Niles Family Services, Village of Niles

HRDI (Human Resources Development Institute, Inc.)

Health & Medicine Policy Research Group

The Josselyn Center

NAMI Illinois

Illinois Collaboration on Youth

Transitions Mental Health Services

Depression Bipolar Support Alliance (DBSA)

National Psoriasis Foundation

Mental Health America of Illinois

Chicagoland Leadership Council

IARF

American College of Physicians Illinois Council

University of Chicago

NAMI Chicago

Mental Health Summit

Coalition of State Rheumatology Associations

Northwestern Medicine

Illinois Academy of Physician Assistants

Illinois Society of Eye Physicians & Surgeons

Illinois Chapter of Child & Adolescent Psychiatry

EverThrive Illinois

Loyola University Health System

Riveredge Hospital

Sunovion

Community Counseling Centers of Chicago

AIDS Foundation of Chicago

US Pain Foundation

Addiction Wellness Services