Healthcare

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 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.

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 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.