Healthcare

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires hospitals and birthing centers to adopt and maintain written policies and procedures authorizing a patient enrolled in the medical assistance program to select an Illinois Medicaid certified and enrolled doula of the patient's choice to accompany the patient within the facility's premises for the purposes of providing support before, during, and after labor and childbirth, and during the patient's entire postpartum stay. Provides that the doula shall be considered part of the patient's care team and shall not be counted as a support person or against any guest quota. Requires hospitals and birthing centers to provide a written copy of their policies and procedures to maternity patients, the facilities' maternity health care providers, and any other person at the patient's request. Requires publication of the written policies on each facility's website. Contains provisions concerning hospital and birthing center liaisons and doulas certification acknowledgment requirements. Permits the Department of Healthcare and Family Services and the Department of Public Health to establish standing recommendations to meet Centers for Medicare and Medicaid Services requirements and ensure access to preventive services, including Medicaid-covered maternal and reproductive health supports and services.

Creates the Artificial Intelligence Systems Use in Health Insurance Act. Provides that the Department of Insurance's regulatory oversight of insurers includes oversight of an insurer's use of AI systems to make or support adverse determinations that affect consumers. Provides that any insurer authorized to operate in the State is subject to review by the Department in an investigation or market conduct action regarding the development, implementation, and use of AI systems or predictive models and the outcomes from the use of those AI systems or predictive models. Provides that an insurer authorized to do business in Illinois shall not issue an adverse consumer outcome with regard to the denial, reduction, or termination of insurance plans or benefits that result solely from the use or application of any AI system or predictive model. Provides that any decision-making process for the denial, reduction, or termination of insurance plans or benefits that results from the use of AI systems or predictive models shall be meaningfully reviewed, in accordance with review procedures determined by Department rules, by an individual with authority to override the AI systems and determinations. Authorizes the Department to adopt emergency rules to implement the Act and to adopt rules concerning standards for full and fair disclosure of an insurer's use of AI systems. Makes a conforming change in the Illinois Administrative Procedure Act.

Expresses opposition to the Trump healthcare cuts, which fundamentally undermine the basic dignity and financial security of working families across the country. Calls upon the United States Senate to immediately table the Trump healthcare cuts bill and instead pursue reforms such as the Illinois' Healthcare Protection Act to make healthcare more accessible and more affordable.

Amends the Managed Care Reform and Patient Rights Act. Provides that any intergovernmental joint self-insurance pool providing health benefits under a specified provision of the Intergovernmental Cooperation Act shall not be included under the definition of "health care plan". Effective immediately.

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed after January 1, 2027 shall provide coverage for disposable incontinence supplies for any person with a disability. 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, and the Voluntary Health Services Plans Act to require coverage under those provisions.

Amends the Illinois Insurance Code. Provides that any group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after January 1, 2027 shall provide coverage for emergency medical services delivered by an out-of-network provider on the same terms as coverage that would be provided for an in-network provider. Provides that this requirement does not apply if the services rendered are not covered for in-network providers. 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 Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2027 that provides coverage for: habilitative services shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental; rehabilitative services shall provide coverage for rehabilitative speech therapy as a treatment for stuttering; or habilitative services and rehabilitative services shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental, and shall provide coverage for rehabilitative speech therapy as a treatment for stuttering. Sets forth requirements and limitations for the coverage. 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 State Mandates Act to require implementation without reimbursement. Effective January 1, 2027.

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed after January 1, 2026 shall provide coverage for one pair of custom-made retainers and one night guard every 2 years for each family covered by the policy. 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 Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2027 shall be prohibited from limiting or excluding coverage of any prescription drug that an enrollee has been continuously using for a period of 6 months or more, so long as the prescription drug was selected by the enrollee's prescribing provider while the enrollee was covered by the enrollee's current or previous health plan. 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 Prior Authorization Reform Act. Provides that a chronic health condition is a condition that is expected to last on year or more and requires ongoing medical attention to effectively manage the condition or prevent an adverse health event limits one or more activities of daily living. Replaces "chronic or long-term condition" with "chronic health condition". Provides that, if a health insurance issuer requires a prior authorization for a recurring health care service or maintenance medication for the treatment of a chronic health condition, the approval shall remain valid from the date the health care professional or health care provider receives the prior authorization approval for the duration of the chronic health condition or the length of the treatment, as determined by the patient's health care professional, unless the standard of treatment for that health condition changes.