Illinois vows to ban prior authorization for behavioral health

Illinois Gov. JB Pritzker is proposing the state ban prior authorization for inpatient mental healthcare for children and adults. 

The move is part of broader legislation proposed by the governor aimed at regulating prior authorization and the health insurance industry. 

"Illinois will become the first state in the nation to ban prior authorization for inpatient adult and children's mental healthcare," Mr. Pritzker said in a Feb. 21 address. "That means patients suffering a mental health crisis can get the care they need without jumping through hoops designed to deny coverage." 

A 2023 survey from KFF found adults who sought treatment or took prescription medication for a mental health condition were more likely to report having issues with prior authorization than adults who did not seek mental healthcare. 

CMS has proposed tougher rules on mental health parity that would prevent insurers from imposing more stringent prior authorizations on mental healthcare than other forms of care. 

Other proposed changes in the Illinois legislation include: 

  • barring insurers from using step therapy as a form of utilization management
  • banning the sale of short-term or "junk insurance" plans
  • requiring insurers to maintain accurate network directories 
  • preventing unfair rate hikes 

"I know how hard the insurance industry will fight me on this," Mr. Pritzker said. "But let me be perfectly clear: I am willing to spend serious political capital and put my shoulder to the wheel to get this done." 

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