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First Episode Psychosis Rule Ready for First Notice
After weeks of negotiations, the Department of Insurance is ready to post its rule for medical necessity determinations for first episode psychosis,
assertive community treatment and community support team treatment models for commercial insurance plans. The rule is required under Public Act 101-0461. You can read the draft first notice here.
The Chamber worked collaboratively with health plans and providers to develop the criteria for the insurance requirement.
Pharmaceutical Prior Authorization Form Working Group to Reconvene Next Week
In April participants of the working group required under Public Act 101-0463
met for the first time to begin the process of developing a universal electronic form for prior authorization requests for pharmaceuticals. The next meeting is scheduled for May 15, although the Department has not yet posted the call-in information. All of their working group public notices are found on their website, wwww.insurance.illinois.gov.
JCAR Update
Last week DOI adopted a new Part by emergency rulemaking titled Temporary Health Coverage Requirements During an Epidemic or Public Health Emergency (50 IAC 2040; 44 Ill Reg 7766) effective 4/20/20 for a maximum of 150 days. An identical proposed amendment appears in last week's Illinois Register at 44 Ill Reg 6693. The new Part prevents issuers of group health insurance policies and standalone dental plans from canceling coverage for non-payment of premiums during epidemics or public health emergencies when the Governor has issued a stay-athome order or generally closed non-essential businesses. (These rules do not apply to short-term, limited duration or excepted benefit policies.) When such an emergency is in effect, issuers must allow employers to continue covering employees that would normally lose coverage due to layoffs or reduction in their working hours. For employers with 20 or more workers, the insurance issuer cannot prevent eligible employees from electing continuation coverage under COBRA or the State's HMO Act as along as at least one worker remains actively employed. For health insurance coverage that is not issued through the Exchange established under the federal Affordable Care Act, special enrollment procedures shall be waived for persons who have lost workplace insurance coverage so that the enrollee's new policy becomes effective the day after the prior coverage terminated. Issuers must also allow insured persons, upon request, to defer premium payments without interest for at least 60 calendar days from each original premium due date. For insured persons who missed premium payments prior to 4/20/20 but whose coverage has not yet been terminated, the issuer shall not cancel or refuse to renew coverage for nonpayment for at least 60 days after this Part takes effect. Deadlines for binder payments must be extended at least 30 days beyond the normal applicable deadline. Communications from an issuer to an insured person must clearly state that the insured still has an obligation to pay back deferred premiums or potentially be subject to billing for unpaid claims. Policies that cover prescription drugs must cover off-formulary drugs if no formulary drug is available to the insured, without prior authorization, step-therapy requirements, higher cost sharing or other additional conditions. Insured persons must also be allowed to obtain at least 90-day supplies of maintenance medications upon refill of a prescription, except for categories of drugs prone to abuse such as opioids and stimulants. Those affected by this emergency rule include small businesses and other employers that provide health insurance coverage to their employees.
Last week DPH adopted emergency amendments to Hospital Licensing Requirements (77 IAC 250; 44 Ill Reg 7788) and Hospital Report Card Code (77 IAC 255; 44 Ill Reg 7806), effective 4/17/20 for a maximum of 150 days. This emergency rule establishes procedures for licensed hospitals to set up alternate care facilities for overflow patients during the COVID-19 emergency at remote or temporary locations and also establishes health, safety and other requirements for the operation of alternate care facilities. Licenses granted to alternate care facilities will automatically expire 150 days after the effective date of the emergency rule, and DPH must be notified within 24 hours after an alternate care facility ceases operations. For existing hospitals, the emergency rule also suspends requirements elsewhere in the Part concerning the size, dimension and furnishings of patient rooms; adherence to formal nurse staffing plans; use of verbal or telephone medication orders; notification to patients regarding impending discharge or observation status; and reporting of opioid overdoses. HEALTH DATA REPORTING DPH also adopted emergency amendments to Adverse Health Care Events Reporting Code (77 IAC 235; 44 Ill Reg 7785) and Hospital Report Card Code (77 IAC 255; 44 Ill Reg 7806) both effective 4/17/20 for a maximum of 150 days. These emergency rules suspend all requirements of each Part for the duration of the COVID19 emergency. (Part 235 requires hospitals and ambulatory care facilities to report adverse events such as surgical mistakes, malfunctions of medical products or devices, or lapses in patient supervision or care management. Part 255 requires hospitals to report, on a quarterly basis, staffing levels, patient care hours, and other data used by DPH to compile hospital report cards.) Hospitals and outpatient facilities are affected by these emergency rules.
This week
DPH proposed amendments to Ambulatory Surgical Treatment Center Licensing Requirements (77 IAC 205; 44 Ill Reg 7833) implementing two Public Acts. The rulemaking implements PA 101-13 by repealing special licensing provisions for pregnancy termination specialty centers (abortion facilities) and excluding from the definition of an ambulatory surgical treatment center (ASTC) any facility that performs only abortion procedures without general, spinal or epidural anesthesia and that is not otherwise required to hold an ASTC license. The rulemaking also implements PA 101-323 by allowing dentists to have privileges at ASTCs when their patients require sedation beyond what the dentist is trained to administer. The dentist must have admitting privileges at a nearby hospital that would handle that dentist's patient emergencies or else have a memorandum of understanding with a physician who has privileges at that hospital. Other provisions clarify the conditions under which an ASTC is not required to have a physician on site (e.g., when all current patients have completed surgery, are awake and stable with no complications, and a qualified physician is on call and can arrive within 15 minutes), the staffing requirements when a physician is not on site, and the types of clinical records that must be kept. Outpatient surgery/procedure centers are affected by this rulemaking.
DPH also adopted an emergency amendment to Long-Term Care Assistants and Aide Training Programs Code (77 IAC 395; 44 Ill Reg 7936) effective 4/21/20 for a maximum of 150 days. The emergency rule establishes a short-term certification program for Temporary Nursing Assistants (TNAs) to perform certain nonmedical patient/resident care tasks that would otherwise have to be performed by Certified Nursing Assistants or licensed nurses. TNAs must complete at least 8 hours of classroom education plus at least 8 hours of on-the-job training in care procedures such as bathing, dressing and feeding patients; assisting them with oral hygiene and shaving; transferring patients to/from wheelchairs or lifts; taking vital signs (temperature, pulse, respirations, blood pressure); hand washing; putting on and taking off non-sterile gloves; and performing the Heimlich maneuver in case of choking. Both phases of training must be supervised by a Registered Professional Nurse (RN). A TNA must report to the employing facility's charge nurse or nursing supervisor and may only be assigned duties authorized by the supervising nurses. All TNA candidates and employees are subject to background checks and will be included in DPH's Health Care Worker Registry. Facilities may employ TNAs only for the duration of the Gubernatorial Disaster Proclamations related to COVID-19, and TNAs are not eligible to take the CNA competency exam without also completing CNA training. The emergency rule also suspends the requirement that students in the Basic Nursing Assistant Training Program (BNATP) pass the written competency examination within 12 months after completing the BNATP. Health care and longterm care facilities that employ nursing assistants are affected by this emergency rule.
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