Healthcare

Creates the Limitations on Facility Fees Act. Provides that no health care provider shall charge, bill, or collect a facility fee, except for: (i) services provided on a hospital's campus; (ii) services provided at a facility that includes a licensed hospital emergency department; or (iii) emergency services provided at a freestanding emergency center. Provides that, except as specified, no health care provider shall charge, bill, or collect a facility fee for: (i) outpatient evaluation and management services; or (ii) any other outpatient, diagnostic, or imaging services identified by the Department of Public Health. Requires the Department to annually identify services subject to the limitations on specified facility fees that may reliably be provided safely and effectively in settings other than hospitals. Sets forth provisions concerning reporting, rulemaking, and enforcement of the Act. Amends the Fair Patient Billing Act to make a conforming change. Amends the Consumer Fraud and Deceptive Business Practices Act. Provides that any person who violates the Limitations on Facility Fees Act commits an unlawful practice.

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 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.

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 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.

Creates the Ban on Harmful Supplements for Minors Act. Prohibits the sale of diet pills or dietary supplements for weight loss or muscle building to any person under 18 years of age, unless that individual has a prescription. Provides for responsibilities of retail establishments. Provides for responsibilities of delivery sellers. Provides that the Attorney General may apply for a special proceeding to issue an injunction upon notice to the defendant of not less than 5 days, with certain requirements. Provides that any person who violates any provision of this Act is liable for a civil penalty of up to $1,000 per violation. Provides for an affirmative defense based upon compliance with the Act, with certain requirements. Provides for rulemaking by the Attorney General or the Department of Public Health to determine additional dietary supplements or drugs that are subject to the Act. Provides that the Department of Public Health may adopt other rules as necessary to implement this Act. Defines terms.

Creates the Holistic Overdose Prevention and Equity Act. Creates the Harm Reduction Program Board, with certain requirements. Provides that the Department of Public Health shall issue grants to harm reduction providers, with certain requirements. Establishes a Chief Harm Reduction Officer within the Department. Provides for a place-based approach to harm reduction pilot program. Provides for local government training and continuing education. Provides that naloxone shall be made readily available to all staff and individuals in prisons and jails, with certain requirements. Provides for medication for opioid use disorder and fentanyl testing. Restricts the use of abstinence-only or sobriety requirements to housing, with certain requirements. Limits home rule powers. Makes findings. Defines terms. Amends the Department of Professional Regulation Law of the Civil Administrative Code of Illinois, the Counties Code, the County Jail Act, the Unified Code of Corrections, the Hospital Licensing Act, and the Overdose Prevention and Harm Reduction Act to make conforming changes.

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.