The bill mandates that only clinical peers can make adverse determinations in health care plans using algorithmic processes, effective January 1, 2025.
If you operate a health care plan using AI for utilization review in Illinois, you must ensure clinical peer review of adverse determinations by January 1, 2025.
What do these statuses mean? ▼
Affected Industries
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What This Means
Illinois HB2472 focuses on the intersection of health care and algorithmic decision-making. It requires that adverse determinations based on medical necessity be made solely by clinical peers, even when automated processes are used. This bill impacts health care plans and utilization review programs, emphasizing compliance with evidence-based criteria.
Key Provisions
- Only clinical peers can make adverse determinations based on medical necessity.
- Utilization review programs must certify compliance with the National Committee for Quality Assurance.
- Objective, evidence-based criteria must be used in algorithmic processes for adverse determinations.
- Changes made to the definition of 'adverse determination'.
Latest Legislative Action
Public Act . . . . . . . . . 103-0656
Bill Sponsors
| Name | Role | District |
|---|---|---|
| Bob Morgan D | Sponsor | HD-058 |
| Lilian Jimenez D | Sponsor | HD-004 |
| Laura Fine D | Sponsor | SD-009 |
Roll Call Votes
Amendments (2)
Compliance Checklist
Who: Health care plans and utilization review programs.
Deadline: By January 1, 2025.
Penalty: Potential penalties for non-compliance are unspecified.
Who: Utilization review programs.
Deadline: By January 1, 2025.
Penalty: Potential penalties for non-compliance are unspecified.
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