Healthcare

Amends the Assisted Living and Shared Housing Act. In provisions concerning assessment and service plan requirements, provides that a comprehensive assessment shall be completed by a physician, a physician assistant, or an advanced practice registered nurse (instead of only a physician). In provisions concerning Alzheimer and dementia programs, provides that an assessment must be approved by a resident's physician, physician assistant, or advanced practice registered nurse (instead of only a physician) and shall occur prior to acceptance for residency, annually, and at such time that a change in the resident's condition is identified by a family member, staff of the establishment, or the resident's physician, physician assistant, or advanced practice registered nurse (instead of only a physician).

Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage for eye medication under the provisions of those Acts pursuant to the Topical Eye Medication Prescription Act.

Amends the School Code. Allows a school district, public school, charter school, or nonpublic school to authorize a school nurse or trained personnel to: (1) provide undesignated ready-to-use glucagon to authorized personnel to administer ready-to-use glucagon to a student that meets the student's prescription on file; (2) administer undesignated ready-to-use glucagon that meets the prescription on file to any student who has a plan that authorizes the use of ready-to-use glucagon; and (3) administer undesignated ready-to-use glucagon to any person that the school nurse or trained personnel believes in good faith is having a severe hypoglycemia emergency. Makes conforming changes regarding liability, where and when the undesignated ready-to-use glucagon may be administered, supply maintenance, notification of administration to the student's parent or guardian or emergency contact, training, and reports of administration to the State Board of Education, General Assembly, and Department of Public Health.

Amends the Illinois Occupational Therapy Practice Act. Requires a licensed occupational therapist or licensed occupational therapy assistant who intends to provide services for individuals, groups, and populations concerning occupational therapy needs without a referral to do so within the licensee's scope of practice. Provides that a referral is not required for the purpose of providing consultations, habilitation services, screenings, education, wellness services, preventions services, environmental assessments, and work-related ergonomic services. Provides that, except for occupational therapy services within the licensee's scope of practice at the time of evaluation and services provided pursuant to provisions concerning when referrals are not required, an occupational therapist shall refer a patient to the patient's treating health care professional of record, or to a health care professional of the patient's choosing if there is no health care professional of record, if the patient meets certain criteria. Provides that an occupational therapist shall refer a patient to the patient's treating health care professional of record, or to a health care professional of the patient's choosing if there is no health care professional of record if the patient does not demonstrate measurable or function improvement after 10 visits (rather than after 10 visits or 15 business days, whichever occurs first).

Amends the Illinois Insurance Code. Provides that every insurer that amends, delivers, issues, or renews a group or individual policy or certificate of disability insurance or disability income insurance shall ensure parity for the payment of mental, emotional, nervous, or substance use disorders or conditions. Changes the definition of "treatment limitation" to include benefit payments under disability insurance or disability income insurance.

Amends the Department of Human Services Act. Requires the Department of Human Services to revise all Department forms and billing codes to remove the term "mental retardation" and replace it with "intellectual disability".

Amends the Department of Public Health Act. Provides that the Breakthrough Therapies for Veteran Suicide Prevention Program Advisory Council created by Public Act 103-8 is continued within the Department of Public Health, with modifications to its duties and composition. Amends the Department of Healthcare and Family Services Law of the Civil Administrative Code of Illinois by repealing provisions regarding the Council.

Amends the Limited Health Service Organization Act. Makes changes to defined terms. In provisions concerning the offering of a point-of-sale contract by a limited health service organization (LHSO), removes a provision requiring the LHSO to include an annual maximum benefit allowance not to exceed $2,500 per year that is separate from any limits or allowances applied to in-plan services. Provides that, if an LHSO expends in any calendar quarter more than 20% of its total limited health services expenditures for all its members for out-of-plan covered services, then specified limitations shall not apply subject to the LHSO minimum capital and surplus requirements applicable to a life, accident, and health insurance company. Makes other changes.

Amends the Nursing Home Care Act. Replaces reporting requirement provisions for the Department of Public Health concerning nurse surveyors. Provides that, in addition to the listed information, the Department's annual report on all survey activity from the preceding fiscal year shall include: (i) the total number of authorized nursing home surveyor positions within the Department, (ii) the total number of filled and vacant nursing home surveyor positions, (iii) the average length of tenure for nursing home surveyors employed by the Department at the time the report is created, and (iv) any additional information the Department deems relevant regarding nursing home surveyor recruitment, retention, or workload.

Creates the Transparency in Downcoding Act. Provides that the Act applies to certain policies of health insurance amended, delivered, issued, or renewed on or after the effective date of the Act, except for employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974 and health care provided pursuant to the Workers' Compensation Act or the Workers' Occupational Diseases Act. Prohibits a health insurance issuer from using an automated process, system, or tool to downcode a claim; from downcoding a claim based solely on the reported diagnosis codes; and from using downcoding practices in a targeted or discriminatory manner against physicians who routinely treat patients with complex or chronic conditions. Requires downcoding decisions to be made by a physician licensed to practice medicine in all its branches in any United States jurisdiction and of the same or similar specialty as a physician who typically manages the medical condition or disease. Sets forth provisions concerning notification requirements for downcoded claims; the appeal process for downcoded claims; enforcement by the Department of Insurance; and penalties. Provides that any pattern or practice of discriminatory downcoding identified by the Director of Insurance or another regulatory authority shall be subject to enforcement actions, including fines, restitution, or suspension of the health insurance issuer's license in this State. Effective immediately.