Regulating Automation of Utilization Review in Managed Care: Illinois’ Approach
This Briefing is brought to you by AHLA’s Payers, Plans, and Managed Care Practice Group.
- April 30, 2025
- Kathy Roe , Health Law Consultancy
Illinois has taken substantial legislative action in recent years to address perceived deficiencies in how managed care plans conduct utilization review, including prior authorization. These legislative enactments seek to more closely regulate utilization review conducted for and by commercial and Medicaid managed care plans. In 2024, the Illinois General Assembly put automation of utilization review in its sights, making Illinois one of the first states seeking to control application of automation to utilization review. This article provides an overview of these Illinois legislative enactments.
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