April 1, 2025
Illinois SB 3268 (Public Act 103-0593) amends various statutory provisions and establishes new requirements, including service authorization program requirements (any utilization review, including but not limited to prior authorization, concurrent review, and retrospective review), which will require changes to utilization management programs, including inpatient notification requirements, concurrent review, standardization and transparency. This provision is effective July 1, 2025, and applies to services provided to our members with Blue Cross Community Health PlansSM. In response to SB 3268, Blue Cross and Blue Shield of Illinois has made several process changes to ensure compliance with the required changes.
Notification requirements: Beginning July 1, for members with BCCHP, providers should notify BCBSIL of emergent hospital inpatient admissions within the notification period, 48 hours of the date and time of the inpatient admission order.
If notification requirements are met, utilization review (including concurrent and post-service review) will not be initiated before the end of the 72-hour inpatient stabilization period.
If notification requirements aren’t met, utilization review (including concurrent and post-service review) may be initiated at the end of the 48-hour notification period.
How to notify us: Continue to submit notification of inpatient admissions using your current method. To submit notification of inpatient admission for members with BCCHP, you can use the Availity® Authorizations tool. If you don’t have electronic access, call the number on the member’s ID card or fax your request to 312-233-4060.
Background on the bill: Illinois SB 3268 amends several provisions within the Illinois Public Aid Code. It includes a range of measures aimed at increasing access to quality health care services, preserving existing health care coverage and continuing to create a more equitable health care system in Illinois. It applies to Medicaid, with additional applicability to some non-Medicaid statutes. Different provisions go into effect at different times.
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