Healthcare

Amends the Illinois Insurance Code. Provides that no provision of the Illinois Insurance Code, or any other law, prohibits assignability rights to an insured under any policy of dental insurance (in addition to accident and health insurance). Provides that if an enrollee or insured of an insurer, health maintenance organization, managed care plan, health care plan, preferred provider organization, dental service plan corporation, dental insurer, or third party administrator assigns a claim to a health care professional, or health care facility, a dental care provider, or a dental care facility, then payment shall be made directly to the health care professional, or health care facility, dental care provider, or dental care facility, including any required interest. Effective immediately.

Amends the Pharmacy Practice Act. Provides that every licensed pharmacy directly serving patients at a physical location shall conspicuously post a sign provided by the Department of Human Services that contains the following: (i) a statement that the Department of Human Services runs a Suicide and Crisis Lifeline; (ii) the Lifeline number; and (iii) any other information the Department of Human Services deems appropriate. Provides that the sign shall be printed in color ink or displayed electronically in color, measure at least 8.5 x 11 inches in size, and be posted at either a cashier counter or a waiting area that is clearly visible to patients. Requires licensed pharmacies that do not maintain a physical location that directly serves patients to include a copy of the sign with any dispensed prescriptions. Provides that the sign shall also be available to download on the Department of Human Services's website.

Amends the Illinois Vehicle Code. Allows a decal to be issued for sickle cell anemia awareness. Provides that a $25 fee for original issuance shall be paid with $10 to the Sickle Cell Anemia License Fund and $15 to the Secretary of State Special License Plate Fund. Provides that a $25 fee for renewal shall be paid with $23 to the Sickle Cell Anemia License Fund and $2 to the Secretary of State Special License Plate Fund. Creates the Sickle Cell Anemia License Fund, from which all money shall be paid as grants to the Sickle Cell Disease Association of Illinois. Makes a conforming change in the State Finance Act.

Amends the Emergency Medical Services (EMS) Systems Act. Provides that the Department of Public Health shall allow for an alternative rural staffing model for vehicle service providers that serve a rural or semi-rural population of 10,000 or fewer inhabitants and exclusively use volunteers, paid-on-call, or part-time employees, or a combination thereof (now, the use of part-time employees is not an option). Effective immediately.

Amends the Emergency Medical Services (EMS) Systems Act. Makes changes to defined terms. Replaces references to Primary Stroke Centers with Stroke Centers. Provides that a hospital that no longer meets nationally recognized, evidence-based standards for Stroke Centers, loses its Stroke Center certification, or has any change to its designation level shall notify the Department of Public Health and the Regional EMS Advisory Committee within 5 business days. Requires the Department to consult with the State Stroke Advisory Subcommittee for the adoption or deletion of approved stroke designation levels. Provides that the approved stroke designation levels shall coincide with the stroke designation levels recognized by Department-approved certifying bodies. Requires the Department to establish reporting requirements for designated Stroke Centers to capture information using new or existing electronic reporting tools for statewide data collection and certification purposes. Removes provisions concerning previous Stroke Center designations. Makes other changes.

Amends the Illinois Insurance Code. In provisions concerning biomarker testing: makes changes to defined terms; requires applicable health insurers, nonprofit health service plans, and health maintenance organizations to update and make publicly available medical policies and coverage guidelines within 90 days after the effective date of the amendatory Act; provides that, if a health insurer or nonprofit health service plan denies a claim for coverage of testing that is supported by any specified evidence, the insurer or nonprofit health service plan shall provide to the requesting entity specific written justification explaining in detail why the claim for coverage was denied as it pertains to the individual for whom the test was ordered; sets forth provisions concerning utilization review and prior authorization; provides that the Department of Insurance may conduct periodic audits and reviews to ensure entity compliance; and makes other changes.

Amends the Community Services Act. Adds community day services to the list of service categories covered under the Act. Defines "community day services" to mean a Home and Community-Based Waiver day program that is certified by the Department of Human Services and provides assistance with gaining, maintaining, or improving skills and functioning to individuals with developmental disabilities. Makes conforming changes to the Mental Health and Developmental Disabilities Administrative Act.

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 Insurance Code. In provisions concerning the payment of nonparticipating ground ambulance service providers, makes changes to defined term, removes jurisdictional provisions, and provides that, for nonparticipating ground ambulance service providers owned and operated by (instead of subject to) a unit of local government, a rate shall be paid that is equal to the rate established or approved by the governing body of the unit of local government providing the ground ambulance service. Establishes a rate of pay for nonparticipating ground ambulance service providers that are not owned and operated by (instead of subject to the jurisdiction of) a unit of local government. Amends the Health Maintenance Organization Act. Replaces provisions concerning coverage for emergency transportation by ambulance with provisions concerning coverage for ground ambulance service.

Amends the Pharmacy Practice Act. Provides that a pharmacist who is exercising his or her professional judgment may add missing non-pharmaceutical devices or durable medical equipment that aid in the appropriate clinical usage of a medication or in achieving a positive therapeutic outcome to a prescription. Provides that a pharmacist may complete missing information on a prescription if there is evidence to support the change. Requires any adaptations to a prescription to be documented in the patient's record. In provisions concerning the distribution of a prescription drug for less than its fair market value, provides that it shall be unlawful to require a pharmacist or pharmacy to dispense a prescription drug for less than its fair market value, including the cost of dispensing. Provides that a payor that reimburses a pharmacy for less than fair market value, including the cost of dispensing, shall not be able to include the pharmacy toward any network adequacy requirements and shall not be deemed in compliance with any willing provider provisions.