Illinois Passes Monumental Patient Protection Act

July 11, 2024

On July 10, 2024, Illinois took significant strides toward improving healthcare access and patient rights
with the passage of the Healthcare Protection Act. Enacted to bolster consumer protections and
streamline healthcare processes, this comprehensive legislation introduces multiple reforms aimed at
safeguarding patient rights and enhancing transparency in health care. Key provisions include:

• Step Therapy Ban: Starting January 1, 2026, insurers cannot impose step therapy requirements,
  ensuring timely access to medications.
• Prior Authorization for Mental Health: Bans prior authorization for inpatient mental health
  emergency admissions, with initial treatment covered for the first 72 hours in most cases.
• Junk Insurance Prohibition: Ensures all plans meet ACA standards, prohibiting policies with
  limited coverage or lacking consumer protections.
• Transparency and Accessibility: Requires clear prior authorization disclosures and online drug
  formulary accessibility by October 1, 2025.
• Network Adequacy: Sets stringent standards for provider-to-patient ratios, travel, and wait
  times.
• Utilization Review Programs: Requires use of legitimate, updated treatment criteria for medical
  necessity determinations.
• Provider Directory Information: Mandates a uniform electronic form by January 1, 2026.
  Insurance Rate Regulation: Establishes oversight to ensure reasonable premium rates and
  classifications for large group policies.

Illinois’ Healthcare Protection Act sets a new standard in healthcare oversight, prioritizing patient rights
and access to quality care.

Read the Healthcare Protection Act.