SPRINGFIELD - Today, Governor JB Pritzker joined legislators, doctors, patients, and stakeholders in Springfield to celebrate the passage of HB5395, also known as the Healthcare Protection Act (HPA), in Illinois’ House of Representatives. The bill, first proposed by Governor Pritzker in his FY25 Budget Address, aims to put power back into the hands of patients by banning step therapy, banning prior authorization for crisis mental health care, improving network adequacy, banning junk insurance plans, and ending unchecked rate increases for large group insurance companies.

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“I’m pleased that dedicated advocates and legislators have made further progress in passing the Healthcare Protection Act, a bill that will curb predatory insurance practices and empower both doctors and patients,” said Governor JB Pritzker. “I want to especially thank the HPA’S lead sponsors, Senator Robert Peters and Representative Anna Moeller, two outstanding partners in the longtime fight for health insurance reform. Both you and your cosponsors are doing important work to advocate for Illinois families, and I’m proud to have you fighting alongside me.”

The Governor was also joined by the bill’s chief sponsors, Representative Anna Moeller and Senator Robert Peters, alongside various cosponsors working to promote the sweeping health insurance reforms. Acting Director Ann Gillespie also attended on behalf of the Department of Insurance.

“The Department will hold insurers accountable for unfair business practices that undermine Illinoisans, requiring them to jump through hoops just to access the health care services that they pay for each month,” said IDOI Acting Director Ann Gillespie. “Protecting Illinois insurance consumers is our priority, and we stand ready to enforce the Healthcare Protection Act.”

The Healthcare Protection Act targets three primary issues with the healthcare insurance industry: utilization management, network adequacy, and rate review.

Utilization Management

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The first goal of HPA is to eliminate harmful utilization management practices, which force consumers to wait for permission (also known as prior authorization) from their insurance providers before receiving doctor-recommended treatments. Often, utilization management causes patients to be denied care deemed medically necessary or delay the process and create barriers to care. Another example of utilization management is “step therapy”, which requires patients to try other less effective treatment options before their insurance company will approve access to the original prescribed treatment from healthcare providers.

To address unfair utilization management practices, HPA will:

  • require insurance companies to adopt the same definitions of medical necessity as doctors,
  • require insurance companies to post all treatments that require prior authorization to help consumers make informed decisions while shopping for plans,
  • ban “step therapy” processes in Illinois, and
  • ban prior authorization for in-patient adult and children’s mental health care (becoming the first state in the nation to do so).

Additionally, with the passage of HPA, Illinois will join twelve other states in banning “junk insurance” plans, or Short Term Limited Duration plans, which are dangerous and misleading to consumers: junk insurance plans do not have to comply with the basic standards of the Affordable Care Act, such as coverage for preexisting conditions.

Network Adequacy

The second goal of HPA is to improve network adequacy and standards for transparency across Illinois. The bill implements stricter standards for insurance companies as they update their in-network care directories, which must now reflect actual availability. To ensure consumers can find care where and when they need it, companies will be required to indicate whether or not doctors and specialists are currently accepting new patients. Companies will also be required to remove healthcare professionals who are not in-network anymore or no longer practicing in a timely fashion. If these standards are unmet, companies will face potential penalties.

Rate Review

The final initiative of the Healthcare Protection Act eliminates unchecked rate increases in fully-insured large group insurance carriers. This follows similar action in June 2023, when Governor Pritzker signed HB 579, ending unfair rate hikes in the fully-insured individual and small group insurance market. Now, large-group providers will be required to do the same, protecting Illinois consumers further.

More like this:

Mar 13, 2024 - Gov. Pritzker Highlights Health Insurance Reform Initiatives

Apr 22, 2024 - Pritzker Launches Healthcare Protection Act Tour With Visits To Belleville, Peoria and Rockford

Apr 23, 2024 - Pritzker, Mendoza Statements On House Passage Of Birth Equality and Black Maternal Health Legislation

May 1, 2024 - OSF Saint Anthony’s Earns An “A” Hospital Safety Grade From The Leapfrog Group  

Apr 9, 2024 - Gov. Pritzker Announces Upcoming Personnel Transitions At Illinois Department Of Insurance

 

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