Illinois 2023-2024 Regular Session

Illinois Senate Bill SB2328 Compare Versions

Only one version of the bill is available at this time.

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1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2328 Introduced 2/10/2023, by Sen. Laura M. Murphy SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.12f new Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after July 1, 2023, all non-controlled FDA-approved prescription medications for the treatment of a serious mental illness shall be covered under the medical assistance program for persons otherwise eligible for medical assistance who are diagnosed with a mental disorder that meets criteria established in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and which is the focus of the treatment provided, including, but not limited to, schizophrenia, schizo-affective disorders, bipolar disorders, or major depression. Exempts medications covered under the amendatory Act from any prior authorization or lifetime restriction limit mandate. Provides that, for any covered medication that contains an opioid antagonist, the prescriber shall check the Illinois Prescription Monitoring Program to determine if the patient is being actively prescribed an opioid. Requires a prescriber of any medication covered under the amendatory Act to be a board-certified psychiatrist or a medical professional with prescribing authority that routinely treats patients with a serious mental illness. Effective July 1, 2023. LRB103 30756 KTG 57238 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2328 Introduced 2/10/2023, by Sen. Laura M. Murphy SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.12f new 305 ILCS 5/5-5.12f new Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after July 1, 2023, all non-controlled FDA-approved prescription medications for the treatment of a serious mental illness shall be covered under the medical assistance program for persons otherwise eligible for medical assistance who are diagnosed with a mental disorder that meets criteria established in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and which is the focus of the treatment provided, including, but not limited to, schizophrenia, schizo-affective disorders, bipolar disorders, or major depression. Exempts medications covered under the amendatory Act from any prior authorization or lifetime restriction limit mandate. Provides that, for any covered medication that contains an opioid antagonist, the prescriber shall check the Illinois Prescription Monitoring Program to determine if the patient is being actively prescribed an opioid. Requires a prescriber of any medication covered under the amendatory Act to be a board-certified psychiatrist or a medical professional with prescribing authority that routinely treats patients with a serious mental illness. Effective July 1, 2023. LRB103 30756 KTG 57238 b LRB103 30756 KTG 57238 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2328 Introduced 2/10/2023, by Sen. Laura M. Murphy SYNOPSIS AS INTRODUCED:
3	3	305 ILCS 5/5-5.12f new 305 ILCS 5/5-5.12f new
4	4	305 ILCS 5/5-5.12f new
5	5	Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after July 1, 2023, all non-controlled FDA-approved prescription medications for the treatment of a serious mental illness shall be covered under the medical assistance program for persons otherwise eligible for medical assistance who are diagnosed with a mental disorder that meets criteria established in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and which is the focus of the treatment provided, including, but not limited to, schizophrenia, schizo-affective disorders, bipolar disorders, or major depression. Exempts medications covered under the amendatory Act from any prior authorization or lifetime restriction limit mandate. Provides that, for any covered medication that contains an opioid antagonist, the prescriber shall check the Illinois Prescription Monitoring Program to determine if the patient is being actively prescribed an opioid. Requires a prescriber of any medication covered under the amendatory Act to be a board-certified psychiatrist or a medical professional with prescribing authority that routinely treats patients with a serious mental illness. Effective July 1, 2023.
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8	8	A BILL FOR
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11	11	1 AN ACT concerning public aid.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 1. Findings. The General Assembly finds that:
15	15	5 (1) The Department of Human Services identifies
16	16	6 persons with a serious mental illness as those individuals
17	17	7 who have a diagnosis that meets the diagnostic criteria
18	18	8 established in the Diagnostic and Statistical Manual of
19	19	9 Mental Disorders, Fifth Edition (DSM-5) and which is the
20	20	10 focus of the treatment being provided, such as
21	21	11 schizophrenia, schizophreniform disorder,
22	22	12 schizo-affective disorder, delusional disorder, shared
23	23	13 psychotic disorder, brief psychotic disorder, psychotic
24	24	14 disorder, bipolar disorder NOS, cyclothymic disorder,
25	25	15 major depression, obsessive-compulsive disorder, anorexia
26	26	16 nervosa, and bulimia nervosa.
27	27	17 (2) Annually, more than 380,000 emergency department
28	28	18 visits in the U.S. involve adults with schizophrenia.
29	29	19 According to the National Center for Health Statistics,
30	30	20 32.7% of these emergency department visits result in a
31	31	21 hospital admission while 16.7% of these visits result in a
32	32	22 transfer to a psychiatric hospital.
33	33	23 (3) In its July 2021 Statistical Brief #278, the
34	34	24 Agency for Healthcare Research and Quality identified
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38	38	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2328 Introduced 2/10/2023, by Sen. Laura M. Murphy SYNOPSIS AS INTRODUCED:
39	39	305 ILCS 5/5-5.12f new 305 ILCS 5/5-5.12f new
40	40	305 ILCS 5/5-5.12f new
41	41	Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after July 1, 2023, all non-controlled FDA-approved prescription medications for the treatment of a serious mental illness shall be covered under the medical assistance program for persons otherwise eligible for medical assistance who are diagnosed with a mental disorder that meets criteria established in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and which is the focus of the treatment provided, including, but not limited to, schizophrenia, schizo-affective disorders, bipolar disorders, or major depression. Exempts medications covered under the amendatory Act from any prior authorization or lifetime restriction limit mandate. Provides that, for any covered medication that contains an opioid antagonist, the prescriber shall check the Illinois Prescription Monitoring Program to determine if the patient is being actively prescribed an opioid. Requires a prescriber of any medication covered under the amendatory Act to be a board-certified psychiatrist or a medical professional with prescribing authority that routinely treats patients with a serious mental illness. Effective July 1, 2023.
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43	43	LRB103 30756 KTG 57238 b
44	44	A BILL FOR
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50	50	305 ILCS 5/5-5.12f new
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69	69	1 schizophrenia as the 7th most common diagnosis among
70	70	2 adults for hospital readmissions across all insurers in
71	71	3 2018.
72	72	4 (4) Serious mental illnesses can be effectively
73	73	5 treated with medications approved by the federal Food and
74	74	6 Drug Administration (FDA).
75	75	7 (5) Other states, including Michigan, Indiana, Ohio,
76	76	8 Missouri, Texas, Florida, Georgia, Connecticut, Hawaii,
77	77	9 Oregon, Arizona, and Maine, have recognized the importance
78	78	10 of patient access to FDA-approved medications for the
79	79	11 treatment of a serious mental illness and have removed
80	80	12 prior authorization barriers to those FDA-approved
81	81	13 medications.
82	82	14 (6) Illinois has a shortage of mental health
83	83	15 providers. FDA-approved medications for the treatment of a
84	84	16 serious mental illness should be available to all
85	85	17 providers with prescriptive authority in the State,
86	86	18 including medical doctors, osteopathic doctors, physicians
87	87	19 assistants, and nurse practitioners.
88	88	20 (7) The Illinois Medicaid Preferred Drug List already
89	89	21 includes FDA-approved medications that do not require
90	90	22 prior authorization and that have a safety and
91	91	23 tolerability profile equivalent to FDA-approved
92	92	24 medications for the treatment of a serious mental illness
93	93	25 that do require prior authorization.
94	94	26 (8) Annually, this State issues an estimated 60,000
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105	105	1 prescription medications that do not require prior
106	106	2 authorization and that have a safety and tolerability
107	107	3 profile that is equivalent to FDA-approved medications for
108	108	4 the treatment of a serious mental illness that do require
109	109	5 prior authorization.
110	110	6 (9) As a matter of professional practice, Illinois
111	111	7 health care providers who prescribe FDA-approved
112	112	8 medications that contain an opioid antagonist first
113	113	9 consult the Illinois Prescription Monitoring Program to
114	114	10 determine if the patient is being actively prescribed an
115	115	11 opioid.
116	116	12 (10) The removal of prior authorization requirements
117	117	13 for FDA-approved medications for the treatment of a
118	118	14 serious mental illness would have no impact on any
119	119	15 federally-mandated drug rebates Illinois receives from
120	120	16 drug manufactures under the Medicaid Drug Rebate Program.
121	121	17 Section 5. The Illinois Public Aid Code is amended by
122	122	18 adding Section 5-5.12f as follows:
123	123	19 (305 ILCS 5/5-5.12f new)
124	124	20 Sec. 5-5.12f. Non-controlled prescription medications to
125	125	21 treat mental illness.
126	126	22 (a) As used in this Section:
127	127	23 "DSM-5 criteria" means the diagnostic criteria established
128	128	24 in the Diagnostic and Statistical Manual of Mental Disorders,
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139	139	1 Fifth Edition (DSM-5).
140	140	2 "FDA" means the United States Food and Drug
141	141	3 Administration.
142	142	4 (b) Notwithstanding any other provision of this Code to
143	143	5 the contrary, on and after July 1, 2023, all non-controlled
144	144	6 FDA-approved prescription medications for the treatment of a
145	145	7 serious mental illness, as defined by the Department of Human
146	146	8 Services, shall be covered under the medical assistance
147	147	9 program for persons otherwise eligible for medical assistance
148	148	10 who are diagnosed with a mental disorder that meets DSM-5
149	149	11 criteria and which is the focus of the treatment provided,
150	150	12 including, but not limited to, schizophrenia, schizo-affective
151	151	13 disorders, bipolar disorders, or major depression.
152	152	14 Prescription medications covered under this Section shall not
153	153	15 be subject to any prior authorization mandate or lifetime
154	154	16 restriction limit mandate. For any medication covered under
155	155	17 this Section that contains an opioid antagonist, the
156	156	18 prescriber shall check the Illinois Prescription Monitoring
157	157	19 Program to determine if the patient is being actively
158	158	20 prescribed an opioid. The prescriber of a non-controlled
159	159	21 FDA-approved prescription medication must be a board-certified
160	160	22 psychiatrist or a medical professional with prescribing
161	161	23 authority that routinely treats patients with a serious mental
162	162	24 illness.
163	163	25 Section 99. Effective date. This Act takes effect July 1,
164	164	26 2023.
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