Legislative Update - September 19, 2018
September 17. 2018 - House Bill 5769 Creates Consistency and Efficiency for Illinois’ Existing Prior Authorization Protocol
House Bill 5769 Creates Consistency and Efficiency for Illinois’ Existing Prior Authorization Protocol
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:
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.
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 firstname.lastname@example.org.
Illinois Psychiatric Society
Illinois State Medical Society
Illinois Academy of Family Physicians
Illinois Chapter of the American Academy of Pediatrics
Community Behavioral Health Association
Illinois Association for Behavioral Health
American Psychiatric Association
Illinois Primary Care Health Association
Niles Family Services, Village of Niles
HRDI (Human Resources Development Institute, Inc.)
Health & Medicine Policy Research Group
The Josselyn Center
Illinois Collaboration on Youth
Transitions Mental Health Services
Depression Bipolar Support Alliance (DBSA)
National Psoriasis Foundation
Mental Health America of Illinois
Chicagoland Leadership Council
American College of Physicians Illinois Council
University of Chicago
Mental Health Summit
Coalition of State Rheumatology Associations
Illinois Academy of Physician Assistants
Illinois Society of Eye Physicians & Surgeons
Illinois Chapter of Child & Adolescent Psychiatry
Loyola University Health System
Community Counseling Centers of Chicago
AIDS Foundation of Chicago
US Pain Foundation
Addiction Wellness Services
- 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.