ISMS 2020 LEGISLATIVE UPDATE Erin OBrien SVP State

ISMS 2020 LEGISLATIVE UPDATE Erin O’Brien SVP, State Legislative Affairs

2020 Spring Legislative Session The Good…. . ISMS Priority – Taking on Prior Authorization Overview v Reforming the prior authorization processes utilized by state regulated plans. v. Need for change based on 2019 ISMS Survey. v. Created the Your Care Can’t Wait Campaign at www. yourcarecantwait. com info@isms. org 800 -782 -4767 www. isms. org 2 © 2020 Illinois State Medical Society

Reforming Prior Authorization ISMS Bills seek the following changes: • Increase transparency. Overview • Establish timelines for urgent and non-urgent prior authorization requests. • Define qualifications of individuals qualified to review and make prior authorization determinations. • Ensure that appropriate medically accepted, clinically valid, evidence based criteria are being used. info@isms. org 800 -782 -4767 www. isms. org 3 © 2020 Illinois State Medical Society

Reforming Prior Authorization • Ensure that if a prior authorization is approved for a given procedure, reasonably related supplies or services are considered to have been approved. Overview • Provide for continuity of care for patients by requiring that prior authorization. • Ensure that prior authorization determinations confirms requirements for payment for the delivery of the health care service. info@isms. org 800 -782 -4767 www. isms. org 4 © 2020 Illinois State Medical Society

2020 Legislative Session The Bad… • Mandates, mandates. • Inappropriate Overview changes to scope of practice. • Bills introduced by the plaintiff’s bar. info@isms. org 800 -782 -4767 www. isms. org 5 © 2020 Illinois State Medical Society

COVID-19 & the Public Health Emergency v What happened to the state’s legislative session? v Working with Pritzker’s Administration Overview – Executive Order on Telehealth. – Executive Orders on Immunity from Civil Lawsuits. – Illinois Department of Public Health’s guidance on elective surgeries and procedures. – Communicating with the Illinois Department of Financial and Professional Regulation on scope of practice and other licensure issues. info@isms. org 800 -782 -4767 www. isms. org 6 © 2020 Illinois State Medical Society

Illinois Legislature Returns… Why Return? The state needs a budget Overview Physicians vs. Insurance Companies on Telehealth 7 info@isms. org 800 -782 -4767 www. isms. org © 2020 Illinois State Medical Society

What Happens Next? Watch Governor Pritzker v Are we staying in phase four? Overview v. The Governor’s Regional Approach v When do we move to stage five? What will the Illinois Legislature do? v Fall Veto Session v 2021 Spring Legislative Session v. What to expect. 8 info@isms. org 800 -782 -4767 www. isms. org © 2020 Illinois State Medical Society