Disclaimer: This page provides general informational summaries only and does not constitute legal advice. AI-generated content may contain errors. Always consult a qualified attorney for guidance specific to your situation.
Read full disclaimer →
AI Summary
The bill mandates that only clinical peers make adverse determinations in health care plans using automated processes, effective January 1, 2025.
Business Impact
If you operate a health care plan using automated decision-making in Illinois, you must ensure clinical peer review of adverse determinations by January 1, 2025.
What do these statuses mean? ▼
Introduced
— Filed in the legislature; not yet heard in committee
In Committee
— Assigned to and being reviewed by a legislative committee
Passed
— Approved by one or both chambers; awaiting further action
Signed / Enacted
— Signed into law by the governor; may or may not be in effect yet
Dead / Vetoed
— Vetoed, failed to pass, or session expired without action
Unknown
— Status data not yet available or awaiting classification
Affected Industries
Topics How we classify →
What This Means
Illinois HB2472 addresses the use of algorithmic processes in health care utilization reviews. It ensures that only clinical peers can make adverse determinations, impacting health care plans and utilization review programs. The bill aims to enhance accountability and compliance with accreditation standards.
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.
- Programs using automated processes must apply objective, evidence-based criteria.
- Definition of 'adverse determination' modified to include decisions made using automated processes.
Latest Legislative Action
Public Act . . . . . . . . . 103-0656
Bill Sponsors (showing 5 of 30)
| Name | Role |
|---|---|
| Barbara Wheeler | Primary |
| Bob Morgan D | Primary |
| Deanne M. Mazzochi | Primary |
| Frank J. Mautino | Primary |
| Fred Crespo D | Primary |
Roll Call Votes (showing 3 of 5)
Third Reading ·
May 15, 2024
57 Yea
0 Nay
2 Other
Passed ✓
Insurance ·
May 7, 2024
10 Yea
0 Nay
1 Other
Passed ✓
Third Reading ·
Apr 19, 2024
106 Yea
0 Nay
12 Other
Passed ✓
Amendments (2)
House Amendment 001
Pending
2024-03-14
House Amendment 002
Pending
2024-04-16
Compliance Checklist
Ensure clinical peer review of adverse determinations
Who: Health care plans and utilization review programs
Deadline: By January 1, 2025
Penalty: Potential penalties for non-compliance not specified
Who: Health care plans and utilization review programs
Deadline: By January 1, 2025
Penalty: Potential penalties for non-compliance not specified
Certify compliance with accreditation standards
Who: Utilization review programs
Deadline: By January 1, 2025
Penalty: Potential penalties for non-compliance not specified
Who: Utilization review programs
Deadline: By January 1, 2025
Penalty: Potential penalties for non-compliance not specified
Full Legal Analysis
HB2472 establishes that health care plans and utilization review programs utilizing algorithmic automated processes for determining medical necessity must ensure that only clinical peers make any adverse determinations. This requirement aims to enhance the quality and accountability of health care decisions made through automated systems. The bill also mandates that these programs use objective, evidence-based criteria that comply with accreditation requirements, thus ensuring a standard of care in automated decision-making. Compliance is required by January 1, 2025. The bill modifies the definition of 'adverse determination' to specify that it includes decisions made using automated processes, emphasizing the importance of human oversight in automated health care decisions.
Official Source
Official Bill Text
View HB2472 on official legislature website →
Related Topics
Affected Industries
More Illinois AI Legislation
View All IL Laws →More Illinois AI Laws
Browse all published AI bills and regulations for Illinois.