Fabio
107 lines
9.1 KiB
Markdown
107 lines
9.1 KiB
Markdown
---
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type: "Bill"
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title: "INS-ADVERSE DETERMINATION"
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description: "Amends the Managed Care Reform and Patient Rights Act. Provides that if a health care plan uses an automated process to make an initial adverse determination or relies on a utilization review organization's automated process for an initial adverse determination, the health care plan shall ensure that any appeal is processed as required by the provisions, including the restriction that only a clinical peer may review an appeal. Provides that an automated process of a health care plan or registered utilization review program may make an initial adverse determination for services not included under specified provisions. Provides that utilization review programs that use automated processes to render an adverse determination shall base all adverse determinations on objective, evidence-based criteria that have been accredited by the American Accreditation Healthcare Commission or by the National Committee for Quality Assurance and shall provide proof of such accreditation to the Department of Insurance with any required registration. Provides that the utilization review program shall include with its registration materials attachments that contain specified policies and procedures. Amends the Health Carrier External Review Act. Changes the definition of \"adverse determination\". Amends the Prior Authorization Reform Act. Provides that if a health insurance issuer imposes a penalty for the failure to obtain any form of prior authorization for any health care service, the penalty may not exceed the lesser of the actual cost of the health care service or $1,000 per occurrence in addition to the plan cost-sharing provisions. Provides that a health insurance issuer may not require both the enrollee and the health care professional or health care provider to obtain any form of prior authorization for the same instance of a health care service, nor otherwise require more than one prior authorization for the same instance of a health care service. Makes conforming changes in the Illinois Insurance Code and the Network Adequacy and Transparency Act. Effective January 1, 2024."
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jurisdiction: "us/states/il"
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legislature: "Illinois General Assembly"
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session: "103rd"
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identifier: "HB 2472"
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citation: "Illinois HB 2472 (103rd)"
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classification: ["bill"]
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subjects: []
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status: "enacted"
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primary_sponsors: ["Bob Morgan", "Laura Fine"]
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version_count: 5
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action_count: 40
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vote_count: 5
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first_action: "2023-02-15"
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last_action: "2024-07-19"
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source: "openstates"
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source_identifier: "ocd-bill/8dc02985-9a02-4f27-97f0-99d5f8e7c843"
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source_url: "https://beta.ilga.gov/Legislation/BillStatus?DocNum=2472&GAID=17&DocTypeID=HB&LegId=147556&SessionID=112"
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source_hash: "2002c126de7ea60c696f45481bca38402b5333cf64c08ccd782133289b46bd65"
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vintage: "2026-07-01"
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source_snapshot: "https://data.openstates.org/daily/2026-07-01/public.pgdump"
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retrieved_at: "2026-07-06"
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confidence: "reported"
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tags: ["legislation", "bill", "us-il"]
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---
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# Illinois HB 2472 (103rd) — INS-ADVERSE DETERMINATION
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Amends the Managed Care Reform and Patient Rights Act. Provides that if a health care plan uses an automated process to make an initial adverse determination or relies on a utilization review organization's automated process for an initial adverse determination, the health care plan shall ensure that any appeal is processed as required by the provisions, including the restriction that only a clinical peer may review an appeal. Provides that an automated process of a health care plan or registered utilization review program may make an initial adverse determination for services not included under specified provisions. Provides that utilization review programs that use automated processes to render an adverse determination shall base all adverse determinations on objective, evidence-based criteria that have been accredited by the American Accreditation Healthcare Commission or by the National Committee for Quality Assurance and shall provide proof of such accreditation to the Department of Insurance with any required registration. Provides that the utilization review program shall include with its registration materials attachments that contain specified policies and procedures. Amends the Health Carrier External Review Act. Changes the definition of "adverse determination". Amends the Prior Authorization Reform Act. Provides that if a health insurance issuer imposes a penalty for the failure to obtain any form of prior authorization for any health care service, the penalty may not exceed the lesser of the actual cost of the health care service or $1,000 per occurrence in addition to the plan cost-sharing provisions. Provides that a health insurance issuer may not require both the enrollee and the health care professional or health care provider to obtain any form of prior authorization for the same instance of a health care service, nor otherwise require more than one prior authorization for the same instance of a health care service. Makes conforming changes in the Illinois Insurance Code and the Network Adequacy and Transparency Act. Effective January 1, 2024.
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## Version chain
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The bill's text revisions, in order — the diff chain from filing to enrollment.
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1. **Introduced** (filed) — [source](https://beta.ilga.gov/documents/legislation/103/HB/PDF/10300HB2472.pdf)
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2. **Engrossed** (committee substitute) — [source](https://beta.ilga.gov/documents/legislation/103/HB/PDF/10300HB2472eng.pdf)
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3. **House Amendment 001** (committee substitute) — [source](https://beta.ilga.gov/documents/legislation/103/HB/PDF/10300HB2472ham001.pdf)
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4. **House Amendment 002** (committee substitute) — [source](https://beta.ilga.gov/documents/legislation/103/HB/PDF/10300HB2472ham002.pdf)
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5. **Enrolled** (enrolled) — [source](https://beta.ilga.gov/documents/legislation/103/HB/PDF/10300HB2472enr.pdf)
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## Votes
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- Insurance, Amendment 2 — **15–0** (pass) · lower
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- Third Reading — **106–0** (pass) · lower
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- Insurance — **13–0** (pass) · lower
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- Insurance — **10–0** (pass) · lower
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- Third Reading — **57–0** (pass) · lower
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## Sponsors
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- Bob Morgan — primary (person)
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- Laura Fine — primary (person)
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- Lilian Jiménez — cosponsor (person)
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## Timeline
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The legislative action history — every referral, reading, and vote.
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- **2023-02-15** Filed with the Clerk by Rep. Bob Morgan `filing`
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- **2023-02-15** First Reading `reading-1`
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- **2023-02-15** Referred to Rules Committee
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- **2023-02-21** Assigned to Insurance Committee `referral-committee`
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- **2023-03-10** Rule 19(a) / Re-referred to Rules Committee
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- **2023-03-10** Rule 19(a) / Re-referred to Rules Committee
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- **2024-02-29** Assigned to Insurance Committee `referral-committee`
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- **2024-03-14** House Committee Amendment No. 1 Filed with Clerk by Rep. Bob Morgan `amendment-introduction`
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- **2024-03-14** House Committee Amendment No. 1 Referred to Rules Committee
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- **2024-03-20** House Committee Amendment No. 1 Rules Refers to Insurance Committee
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- **2024-03-20** House Committee Amendment No. 1 Adopted in Insurance Committee; by Voice Vote `amendment-passage`
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- **2024-03-20** Do Pass as Amended / Short Debate Insurance Committee; 013-000-000
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- **2024-03-21** Placed on Calendar 2nd Reading - Short Debate `reading-2`
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- **2024-03-22** Added Co-Sponsor Rep. Lilian Jiménez
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- **2024-04-16** House Floor Amendment No. 2 Filed with Clerk by Rep. Bob Morgan `amendment-introduction`
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- **2024-04-16** House Floor Amendment No. 2 Referred to Rules Committee
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- **2024-04-17** House Floor Amendment No. 2 Rules Refers to Insurance Committee
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- **2024-04-17** Second Reading - Short Debate `reading-2`
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- **2024-04-17** Held on Calendar Order of Second Reading - Short Debate `reading-2`
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- **2024-04-18** House Floor Amendment No. 2 Recommends Be Adopted Insurance Committee; 015-000-000 `committee-passage-favorable`
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- **2024-04-19** House Floor Amendment No. 2 Adopted `amendment-passage`
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- **2024-04-19** Placed on Calendar Order of 3rd Reading - Short Debate
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- **2024-04-19** Third Reading - Short Debate - Passed 106-000-000 `passage, reading-3`
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- **2024-04-24** Arrive in Senate `introduction`
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- **2024-04-24** Placed on Calendar Order of First Reading `reading-1`
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- **2024-04-24** Chief Senate Sponsor Sen. Laura Fine
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- **2024-04-24** First Reading `reading-1`
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- **2024-04-24** Referred to Assignments
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- **2024-04-30** Assigned to Insurance `referral-committee`
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- **2024-04-30** Rule 2-10 Committee Deadline Established As May 10, 2024
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- **2024-05-08** Do Pass Insurance; 010-000-000
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- **2024-05-08** Placed on Calendar Order of 2nd Reading May 9, 2024 `reading-2`
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- **2024-05-09** Second Reading `reading-2`
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- **2024-05-09** Placed on Calendar Order of 3rd Reading
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- **2024-05-15** Third Reading - Passed; 057-000-000 `passage, reading-3`
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- **2024-05-15** Passed Both Houses
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- **2024-06-13** Sent to the Governor `executive-receipt`
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- **2024-07-19** Governor Approved `executive-signature`
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- **2024-07-19** Effective Date January 1, 2025
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- **2024-07-19** Public Act . . . . . . . . . 103-0656 `became-law`
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## Source
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OpenStates / OpenCivicData bulk snapshot [2026-07-01](https://data.openstates.org/daily/2026-07-01/public.pgdump); origin `ocd-bill/8dc02985-9a02-4f27-97f0-99d5f8e7c843`. Confidence: reported (aggregated from official Illinois legislature records).
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