Healthcare

Amends the Illinois Administrative Procedure Act. Provides that, for any law implementing the federal Patient Protection and Affordable Care Act, the Department of Insurance may adopt rules that include incorporations by reference of federal rules and regulations without identifying the incorporated matter by date and without including a statement that the incorporation does not include later amendments. Amends the Illinois Insurance Code. Makes changes concerning the assignment or transfer of property and casualty policies; formatting requirements for the insurance company supplier diversity report; and insurance coverage for dependent parents. Provides that the Director of Insurance shall maintain as confidential any records or information received from the National Association of Insurance Commissioners or other state, federal, and international regulatory agencies (instead of insurance regulatory officials of other states) that are confidential in that other jurisdiction. Provides that the Department may waive registration and course certification fees if the pre-licensing or continuing education course is provided by a government entity free of charge. Amends the Network Adequacy and Transparency Act. In applicability provisions, removes language concerning exemptions for short-term, limited-duration health insurance coverage with a network plan. Repeals the Health Care Purchasing Group Act. Effective immediately.

Amends the Illinois Health Insurance Portability and Accountability Act. Defines "grandfathered health plan". Provides that, except for grandfathered health plans, a health insurance issuer in the individual, small group, or large group market shall not deny coverage to an individual or employer due to the individual's or employer's failure to pay premiums owed under a prior policy, certificate, or contract of insurance. Specifies that nothing in the provisions concerning past-due premiums prohibits a health insurance issuer from pursuing the collection of past-due premiums from an individual or employer by any other means permitted by law. Effective immediately.

Amends the Substance Use Disorder Treatment for Criminal Justice Clients Article of the Substance Use Disorder Act. Changes references from "treatment" to "case management" and changes the name of the Article. Provides that nothing in provisions concerning case management shall preclude any individual with a substance use disorder who is charged with or convicted of a crime from receiving case management services with a designated program if such services are ordered by the court. Provides that the court, with the consent of the defendant and the State's Attorney, may, without entering a judgment, sentence the defendant to probation under a provision concerning case management as a condition of probation. Provides that the sentence to probation under the provisions shall not be considered a conviction under Illinois law unless and until judgment is entered upon violation of a term or condition of probation. Provides that, upon fulfillment of the terms and conditions of probation, the court shall discharge the person and dismiss the proceedings against the person. Provides that case management services by a designated program may be made a condition of pretrial release, and failure to comply with such services may be treated as a violation of a condition of pretrial release. Requires the designated program to make periodic progress reports regarding each such defendant to the appropriate pretrial services agency or Office of Statewide Pretrial Services and to report failures to comply with the requirements of the designated program. Makes conforming and other changes.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Removes provisions requiring the Department of Healthcare and Family Services to: (i) establish benchmarks for hospitals to measure and align payments to reduce potentially preventable hospital readmissions, inpatient complications, and unnecessary emergency room visits; (ii) publish provider-specific historical readmission data and anticipated potentially preventable targets 60 days prior to the start of the program; and (iii) adopt policies and rates of reimbursement for readmission services and other payments.

Amends the Illinois Insurance Code. Provides that coverage for treatment in a residential treatment center shall include residential coverage for the diagnosis and treatment of substance use disorders. Provides that this coverage shall include unlimited medically necessary treatment for substance use disorder treatment services provided in residential settings. Prohibits the coverage from applying financial requirements or treatment limitations to residential substance use disorder benefits that are more restrictive than the predominant financial requirements and treatment limitations applied to other medical and surgical benefits covered by the policy. Sets forth provisions concerning cost sharing; application of coverage requirements; prior authorization; clinical review; discharge plans; other forms of utilization review; and the criteria for medical necessity determinations.

Amends the Illinois Insurance Code. Provides that any individual or group policy of accident or health insurance that is delivered, extended, renewed, or modified after January 1, 2026 must provide coverage for at least one 6-month supply of each of the following for each infant covered by the policy: an early egg allergen introduction dietary supplement prescribed by a health care practitioner; and an early peanut allergen introduction dietary supplement prescribed by a health care practitioner. Provides that the coverage shall be provided without cost-sharing, except to the extent the cost-sharing limitation would cause a catastrophic plan to fail to be treated as a catastrophic plan under the Patient Protection and Affordable Care Act or would keep a high-deductible health plan from being treated as a high-deductible health plan or to the extent the cost-sharing limitation would disqualify the plan from a health savings account. Amends the State Employees Group Insurance Act of 1971 and the Medical Assistance Article of the Illinois Public Aid Code to require that coverage. Effective immediately.

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident or health insurance that is issued, amended, delivered, or renewed on or after January 1, 2027 shall not charge insured persons a copayment as a method of cost-sharing or include a deductible greater than $1,000. Provides that yearly out-of-pocket expenses for insured persons must be less than or equal to $1,500. 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 under those provisions.

Amends the School Code. Requires each school district that offers one or more courses in health education to pupils in middle school or high school to include in those courses instruction in mental health. Sets forth the required instruction topics and materials. Provides that a pupil receiving instruction under in mental health shall not be required to disclose the pupil's confidential health or mental health information at any time in the course of receiving the instruction.

Amends the Illinois Insurance Code. Provides that any plan of health or accident insurance that provides coverage for prescription drugs and that is issued amended, renewed, or delivered on or after January 1, 2027 must include any amount paid by the insured or paid on behalf of the insured by another person when calculating the insured's overall contribution to any out-of-pocket maximum or other cost-sharing requirement. Provides an exception for a high-deductible health plan to the extent that providing coverage would disqualify that plan from eligibility for a health savings account.

Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Requires the Department of Public Health to establish the Abortion Access Fund Grant Program to award grants from the Abortion Access Fund to support access to abortion care services throughout the State. Provides that grants awarded under the Program shall only be used to fund abortion services for which the use of federal funds is prohibited for patients who are uninsured or underinsured with respect to those services. Allows the Department to establish rules necessary to implement the Abortion Access Fund Grant Program, including eligibility criteria, grant limits, application standards, requirements for the distribution and obligation of grant funds, accounting for the use of the funds, and standards for monitoring compliance with the requirements of the Program. Amends the State Finance Act to create the Abortion Access Fund as a special fund in the State treasury. Amends the Illinois Health Benefits Exchange Law. Requires specified health insurance issuers that have offered one or more qualified health plans through the Illinois Health Benefits Exchange to report to the Department of Insurance an accounting of receipts, disbursements, transfers of funds between accounts, total dollar claims paid, accrued interest, and the year-end balance for each reporting year for the separate allocation accounts that the issuer has established under specified provisions of federal law for abortion services for which federal funding is prohibited. Establishes further reporting requirements for health insurance issuers. Provides that, if the amount of premiums collected during the plan year for abortion services for which federal funding is prohibited exceeds total claims paid for such services rendered during the plan year, the Director of Insurance shall order the health insurance issuer to transfer funds, and the issuer shall complete the transfer, to the Abortion Access Fund. Makes other changes. Effective immediately.