Creates the Preventing Crisis Cost Shifting to Medicaid Act. Provides that the General Assembly finds that (i) behavioral health crisis services, including crisis call centers, mobile crisis response, and crisis stabilization and receiving services, function as essential public health infrastructure and must be available statewide without regard to insurance status; and (ii) commercial health insurance policies issued or administered in the State generally do not provide comprehensive coverage for the full continuum of behavioral health crisis services, resulting in the cost of such services being disproportionately borne by Medicaid, local governments, and taxpayers. Requires specified entities (surcharge payors) that are authorized to issue or administer a policy or contract of accident and health insurance or a health maintenance organization contract in the State to pay a behavioral health crisis assessment to the Department of Human Services for deposit into the Statewide 9-8-8 Trust Fund. Exempts Medicaid managed care organizations from paying the behavioral health crisis assessment. Permits the Department to update the total behavioral health crisis assessment amount as necessary to ensure the continued availability, quality, or geographic equity of the statewide behavioral health crisis system. Requires the Department to establish an appropriate mechanism for enforcing a surcharge payor's liability, which may include accrued interest on unpaid liabilities at a rate not to exceed 18% per annum and late fees or penalties at a rate not to exceed 5% per month. Provides that the enforcement mechanism may also include notification to the Department of Healthcare and Family Services to offset payments on the surcharge payor's claims. Provides that the Department of Human Services shall not direct the Department of Healthcare and Family Services to offset claims payments unless the surcharge payor has maintained an outstanding liability to the Statewide 9-8-8 Trust Fund for a period longer than 45 days and has received proper notice of pending enforcement.
Amends the Hospital Services Trust Fund Article in the Illinois Public Aid Code. In provisions concerning annual funding for the health care transformation program, provides that funds that had been budgeted but unexpended in State fiscal years 2021 through 2027 may be allocated in State fiscal year 2028 in an amount not to exceed $150,000,000.
Amends the Medicaid Technical Assistance Act. Requires the Medicaid Technical Assistance Center to collaborate with public and private partners throughout the State to identify, establish, and maintain best practices necessary for health providers to ensure their capacity to participate in the Illinois Medical Assistance Program (rather than ensure their capacity to participate in HealthChoice Illinois or YouthCare). Requires the Medicaid Technical Assistance Center to promote equitable delivery systems, remaining committed to the principle that all Medicaid recipients have accessible and equitable physical and mental health care services. Removes provisions concerning the Medicaid Technical Assistance Center's administration of network adequacy reports, and instead requires the Medicaid Technical Assistance Center to administer a network recruitment plan. Provides that by using reports and data provided by the Department of Healthcare and Family Services’ External Quality Review Organization on network adequacy, provider service deserts, and health care disparities by race and ethnicity, the Medicaid Technical Assistance Center shall propose for Department review and approval an annual plan for recruiting providers to participate in the Illinois Medical Assistance Program and report on outcomes of its recruitment efforts to the Department for continuous improvement. Repeals a provision requiring the Department to maximize federal financial participation for any moneys appropriated to the Department for the Medicaid Technical Assistance Center and to deposit all federal financial participation funds into the Medicaid Technical Assistance Center Fund. Repeals a provision creating the Medicaid Technical Assistance Center Fund. Amends the State Finance Act. Provides for the dissolution of the Medicaid Technical Assistance Center Fund on July 1, 2026, or as soon thereafter as practical, after the transfer of all remaining funds into the Healthcare Provider Relief Fund. Effective July 1, 2026.
Amends the Illinois Controlled Substances Act. Provides that, if a pharmacy is unable to fill an initial prescription received electronically because the prescribed drug is not in stock, the dispenser must immediately contact the patient to notify the patient of the situation and ask if the patient would like the prescription transferred electronically to a pharmacy of the patient's choosing, consistent with federal regulations concerning the prescribing of controlled substances. Provides that the prescriber shall not be required to issue prescriptions electronically if the prescriptions need to be filled outside of typical retail pharmacy operating hours or may be difficult to obtain because of drug shortages or pharmacy inventory limitations. Amends the Pharmacy Practice Act to make conforming changes. Effective immediately.
Amends the Mental Health and Developmental Disabilities Administrative Act. Provides that notwithstanding any other law or rule to the contrary, a State-operated developmental center funded, certified, or licensed by the Department of Human Services shall readmit, upon request, any former resident who transferred to and currently receives services at a licensed community-integrated living arrangement, if the former resident consents or if the former resident has a guardian with placement authority and that guardian consents based on a determination that the former resident's medical needs cannot be met by the program of services administered by the community-integrated living arrangement. Effective immediately.
Amends the Illinois Dental Practice Act. Provides that "community health center" means a migrant health center, community health center, health care program for the homeless or for residents of public housing supported under the federal Public Health Service Act, or FQHC, including an FQHC Look-Alike, as designated by the U.S. Department of Health and Human Services, that operates at least one federally designated primary health care delivery site in Illinois. Provides that "physician" means a person licensed under the Medical Practice Act of 1987 to practice medicine in all of its branches and does not include a chiropractic physician. In provisions concerning acts constituting the practice of dental hygiene, provides that a public health dental hygienist may not administer local anesthesia except as provided in the amendatory provisions. Provides that a dental hygienist practicing in a community health center may administer local anesthetics upon the successful completion of a training program approved by the Department and under the general supervision of a dentist as long as the community health center: (i) has adopted written policies and procedures establishing supervision by a dentist or physician at the time the local anesthetics are administered, and (ii) ensures that a dentist or physician is physically present in the clinic at the time the local anesthetics are administered.
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 Hospital Licensing Act. Removes provisions requiring the Department on Aging to adopt rules to address instances when a case coordination unit is unable to complete an assessment in a hospital prior to the discharge of a patient 60 years or older to a nursing home to ensure that the patient is able to access nursing home care, the nursing home is not penalized for accepting the admission, and the patient's timely discharge from the hospital is not delayed, to the extent permitted under federal law or regulation.
Amends the Illinois Controlled Substances Act. Provides that interstate data sharing agreements shall be mutual. Provides that the Department of Human Services shall only share data if the reciprocal state provides the opportunity to access data from the reciprocating state to licensed healthcare entities and application vendors regardless of their method of connection to the Prescription Monitoring Program for interstate data sharing as defined in administrative rule. Effective immediately.
Amends the Illinois Controlled Substances Act concerning the Prescription Monitoring Program. Provides that interstate data sharing agreements shall be mutual. Provides that the Department of Human Services shall only share data if the reciprocal state provides equal access to data of the reciprocating state to all authorized users, licensed health care entities, and application vendors regardless of their method of connection to the Prescription Monitoring Program for interstate data sharing. Effective immediately.
