IL SB3373

Requires the Department of Healthcare and Family Services to adopt rules by January 1, 2025 establishing a process for providers meeting performance standards to receive service authorization exemptions from all service authorization programs for at least one year.

Providers qualify for exemptions if they submitted at least 25 service authorization requests in the preceding calendar year with at least 80% approval rate; providers do not need to formally request exemptions.

Service authorization programs must notify qualifying providers by December 1 each year of their exemption status for the subsequent calendar year and cannot deny claims from exempted providers except in cases of fraud.

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must establish standard methods for evaluating provider eligibility, processing provider appeals of denied or rescinded exemptions, and requiring MCOs to process claims from exempted providers without additional authorization.

Requires annual reviews of service authorization denials beginning January 1, 2026 and quarterly performance reports stratified by MCO; imposes sanctions on MCOs for noncompliance including financial penalties, enrollment suspensions, and contract termination.