Healthcare

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. Provides that, upon request by a patient, a hospital must transfer the patient to the requested health care facility, regardless of whether the facility is part of the hospital's health care network. Effective immediately.

Amends the Hospital Licensing Act. Provides that a hospital that operates an emergency department shall not use health care kiosks in the hospital's emergency department to assess or determine a patient's medical state, to determine the priority level of a patient's injuries or illness, or to otherwise triage patients. Provides that health care kiosks may be used for data entry of a patient's personal identifying information and billing information in place of paper forms. Amends the University of Illinois Hospital Act to set forth conforming requirements for a University of Illinois Hospital emergency department. Effective January 1, 2027.

Amends the Pharmacy Practice Act. Defines "retail pharmacy". Provides that a retail pharmacy that, on average, receives 150 or more prescription drug orders during its operating hours must satisfy one of the following requirements during all times that the pharmacy remains open for the transaction of business: (1) a pharmacist is present at the location and working in his or her capacity as a pharmacist, or (2) a registered pharmacy technician, registered certified pharmacy technician, student pharmacist, or other supportive staff that is authorized to sell prescriptions is present at the location and working in that capacity pursuant to provisions concerning pharmacy working conditions.

Creates the Health Care Availability and Access Board Act. Establishes the Health Care Availability and Access Board to protect State residents, State and local governments, commercial health plans, health care providers, pharmacies licensed in the State, and other stakeholders within the health care system from the high costs of prescription drug products. Contains provisions concerning Board membership and terms; staff for the Board; Board meetings; circumstances under which Board members must recuse themselves; and other matters. Provides that the Board shall perform the following actions in open session: (i) deliberations on whether to subject a prescription drug product to a cost review; and (ii) any vote on whether to impose an upper payment limit on purchases, payments, and payor reimbursements of prescription drug products in the State. Permits the Board to adopt rules to implement the Act and to enter into a contract with a qualified, independent third party for any service necessary to carry out the powers and duties of the Board. Creates the Health Care Availability and Access Stakeholder Council to provide stakeholder input to assist the Board in making decisions as required by the Act. Contains provisions concerning Council membership, member terms, and other matters. Provides that the Board shall adopt the federal Medicare Maximum Fair Price as the upper payment limit for a prescription drug product intended for use by individuals in the State. Prohibits the Board from creating an upper payment limit that is different from the Medicare Maximum Fair Price for the prescription drug product that has a Medicare Maximum Fair Price. Requires the Board to implement an upper payment limit that is the same as the Medicare Maximum Fair Price no sooner than the Medicare implementation date. Provides that Medicare Part C and D plans are not required to reimburse at the upper payment limit. Provides that the Attorney General may enforce the Act and may pursue any available remedy under State law when enforcing the Act. Effective 180 days after becoming law.

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.

Amends the Illinois Insurance Code. In a provision requiring policies of group accident and health insurance to provide coverage for certain examination and testing services provided to a victim of specified criminal offenses, prohibits the policy from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided, except to the extent that the coverage would disqualify a high-deductible health plan from eligibility for a health savings account under the Internal Revenue Code. Effective January 1, 2026.

Opposes Illinois Senate Bill 3572 (SB3572). Opposes any effort to punish women for accessing reproductive healthcare, efforts to subject survivors of rape and incest to more severe punishments than a rapist, and efforts to restrict access to in vitro fertilization (IVF) and other forms of assisted reproductive technology.

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 provide coverage for medically necessary prescribed vitamins. Amends the State Employee Group Insurance Act of 1971, 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 Nursing Home Care Act and the Assisted Living and Shared Housing Act. Requires the Department of Public Health to hold semiannual joint training sessions for surveyors, nursing home providers, and assisted living establishment providers. Provides that the Department shall include the State long-term care ombudsman, or the State long-term care ombudsman's designee, and representatives of each nursing home provider association and assisted living provider association in the State in the planning process to create the topics and content of the joint training sessions as well as the coordination and presentations for the joint training sessions. Provides that, at least annually, a joint training session shall include, but not be limited to, regional citation patterns relating to complaints, standards, and outcomes in the nursing home and assisted living survey process. Requires the Department to develop standardized training for establishments to prevent common citations in the assisted living survey process.