Prior Authorization 2021The Illinois State Medical Society (ISMS) and a coalition of other healthcare organizations, including our DuPage County Medical Society, are supporting a campaign to pass the Prior Authorization Reform Act (HB 711/SB 177) in Springfield.
The prior authorization cost management tool used by third-party payers regularly requires physicians to submit additional forms and documentation before their recommended patient care is approved for payment. The requirements delay needed care, sometimes preventing patients from accessing care at all. Physicians stress that increasing overuse and misuse of prior authorization by insurers is harming Illinois patients and placing heavy burdens on their care teams.
To assess the impact, ISMS surveyed Illinois physicians and healthcare institutions about their prior authorization experiences. The more than 1,000 responses received detailed a wide range of concerns and highlighted the urgent need for reform.
House Bill 711 and Senate Bill 177, the Prior Authorization Reform Act, will create a system to reduce long term health care costs by eliminating or reducing inefficiencies and by keeping people healthy on the front end. Among other provisions, the Act would establish deadlines for prior authorization decisions – 24 hours for urgent care services and 72 hours for nonurgent care.