Healthcare

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.

Amends the Illinois Insurance Code. Provides that a group or individual plan of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after January 1, 2027 shall provide coverage for medically prescribed seizure detection devices. Requires all covered seizure detection devices to be approved for use by individuals, and for the choice of device to be made based upon the individual's circumstances and medical needs in consultation with the individual's medical provider. Sets forth provisions prohibiting prior authorization and cost-sharing, as specified. 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 the provisions of those Acts. Effective immediately.

Amends the Assisted Living and Shared Housing Act. Provides that an assisted living establishment or a shared housing establishment shall only make referrals to its residents for home services providers that are licensed under the Home Health, Home Services, and Home Nursing Agency Licensing Act. Establishes penalties for violating the referral requirement. Amends the Assisted Living and Shared Housing Act, the Community Living Facilities Licensing Act, and the Life Care Facilities Act to require that the Department of Public Health to distribute to each establishment or facility a one-page, 8.5 by 11 inch public safety announcement flyer in at least 12-point type and that the each establishment or facility post the flyer in a prominent location for all visitors to see. Effective January 1, 2027.

Amends the Nursing Home Care Act. Replaces provisions concerning serious mental illness rescreening. Provides that all persons admitted to a nursing home facility with a diagnosis of serious mental illness shall receive a follow-up visit within 60 days after admission and shall receive a resident review by the Department of Human Services or its designee promptly after a significant change in the resident's physical or mental condition. Provides that the Department of Human Services shall ensure there are no conflicts of interest for pre-admission screeners.

Amends the Rehabilitation of Persons with Disabilities Act. Requires direct service workers employed by the Department of Human Services, or an agency contracted with the Department, to provide services under the Home Services Program to complete at least 2 hours of dementia training at the start of their employment and annually thereafter. Requires the training to cover subjects concerning Alzheimer's disease and dementia, safety risks, and communication and behavior. Requires the Department to provide contractors with dementia training curriculum on the required subjects. Provides that any other laws or rules that impose more rigorous dementia training for direct service workers under the Home Services Program shall apply. Exempts from the training requirements direct service workers who provide proof that they obtained equivalent dementia training in compliance with another law or rule. For personal assistants covered by a collective bargaining agreement, requires the Department to establish, in consultation with the joint training committee created under the collective bargaining agreement, different parameters and specific topics for curriculum covering dementia training.

Amends the Illinois Occupational Therapy Practice Act. Requires a licensed occupational therapist or licensed occupational therapy assistant who intends to provide services for individuals, groups, and populations concerning occupational therapy needs without a referral to do so within the licensee's scope of practice. Provides that a referral is not required for the purpose of providing consultations, habilitation services, screenings, education, wellness services, preventions services, environmental assessments, and work-related ergonomic services. Provides that, except for occupational therapy services within the licensee's scope of practice at the time of evaluation and services provided pursuant to provisions concerning when referrals are not required, an occupational therapist shall refer a patient to the patient's treating health care professional of record, or to a health care professional of the patient's choosing if there is no health care professional of record, if the patient meets certain criteria. Provides that an occupational therapist shall refer a patient to the patient's treating health care professional of record, or to a health care professional of the patient's choosing if there is no health care professional of record if the patient does not demonstrate measurable or function improvement after 10 visits (rather than after 10 visits or 15 business days, whichever occurs first).

Amends the Illinois Insurance Code. Provides that every insurer that amends, delivers, issues, or renews a group or individual policy or certificate of disability insurance or disability income insurance shall ensure parity for the payment of mental, emotional, nervous, or substance use disorders or conditions. Changes the definition of "treatment limitation" to include benefit payments under disability insurance or disability income insurance.

Amends the Department of Human Services Act. Requires the Department of Human Services to revise all Department forms and billing codes to remove the term "mental retardation" and replace it with "intellectual disability".

Amends the Limited Health Service Organization Act. Makes changes to defined terms. In provisions concerning the offering of a point-of-sale contract by a limited health service organization (LHSO), removes a provision requiring the LHSO to include an annual maximum benefit allowance not to exceed $2,500 per year that is separate from any limits or allowances applied to in-plan services. Provides that, if an LHSO expends in any calendar quarter more than 20% of its total limited health services expenditures for all its members for out-of-plan covered services, then specified limitations shall not apply subject to the LHSO minimum capital and surplus requirements applicable to a life, accident, and health insurance company. Makes other changes.

Amends the Illinois Speech-Language Pathology and Audiology Practice Act. Allows a speech-language pathologist to diagnose autism spectrum disorders if: (1) the child is under 3 years of age; and (2) the speech-language pathologist is trained in autism diagnostic evaluation methods as part of the curriculum of an approved program, through worksite training, or through continuing education. Provides that if a diagnosis requires a plan of care that includes elements that are outside the scope of practice of a speech-language pathologist, the speech-language pathologist must refer the patient to the appropriate medical personnel for further evaluation or management. Makes conforming changes in the Medical Assistance Article of the Illinois Public Aid Code, and provisions of the Illinois Insurance Code concerning autism spectrum disorders. Effective July 1, 2027.