IL HB4979

Requires the Department of Healthcare and Family Services to adopt rules by January 1, 2025 establishing a service authorization exemption process for providers meeting performance standards.

Providers qualify for exemptions if they submitted at least 25 service authorization requests in the preceding calendar year with at least 80% approval rate; no formal request required.

Service authorization programs must notify qualifying providers by December 1 each year of their exemption status for the following calendar year, and cannot deny claims from exempt providers except for fraud.

Department must establish standardized methods for evaluating provider eligibility, processing appeals of denied or rescinded exemptions, and requiring MCOs to process claims from exempt providers without additional authorization.

Department shall conduct annual reviews of service authorization denials beginning January 1, 2026 and publish quarterly performance reports by MCO; MCOs face sanctions for noncompliance including financial penalties, enrollment suspension, or contract termination.