Healthcare

Amends the Managed Care Reform and Patient Rights Act. Sets forth requirements for carriers that offer a provider panel. Requires notice of the development of a provider panel to be filed with Department of Public Health prior to establishment. Provides that a carrier that uses a provider panel shall establish procedure for notifying an enrollee of the termination of a health care provider. Sets forth provisions permitting, under certain circumstances, a health care provider to continue to render health care services following termination from the carrier's provider panel. Requires a carrier to provide a list of members in the carrier's provider panel. Establishes notice requirements for benefit reductions and termination of health care providers from the carrier's provider panel. Requires any carrier requiring preauthorization for medical treatment to have personnel available to provide preauthorization at all times when the preauthorization is required. Provides that no contract between a health care provider and a carrier shall include provisions that require a health care provider to deny covered services that the provider knows to be medically necessary and appropriate that are provided with respect to a specific enrollee or group of enrollees with similar medical conditions. Sets forth prohibited provisions in a contract between a carrier and a health care provider. Defines terms. Makes other and conforming changes.

Amends the Department of Early Childhood Act. Expands the definition of "eligible infants and toddlers" to list infants having a birth weight less than 1,000 grams. Requires the Department of Early Childhood, as the designated lead agency to administer the system of early intervention services on and after July 1, 2026, to develop informational materials and handouts for hospitals to distribute to the parents or legal guardians of severely premature infants, explaining that infants having a birth weight of less than 1,000 grams automatically qualify for early intervention services up until their 3rd birthday. Provides that the informational materials and handouts shall also contain information on the benefits of early intervention services for severely premature infants, the website addresses and phone numbers that parents and legal guardians can access to obtain more information on early intervention services, and the contact information of the early intervention regional intake entity designated to coordinate services for eligible infants. Requires the statewide system of coordinated, comprehensive, interagency and interdisciplinary early intervention programs to include in its public awareness program, a special focus on the early identification of infants who automatically qualify for early intervention services on account of having a birth weight less than 1,000 grams. Amends the Hospital Licensing Act. Requires hospitals to distribute, free of charge, to the parents or legal guardians of each severely premature infant having a birth weight of less than 1,000 grams informational materials and handouts developed by the Department of Early Childhood on the availability of early intervention services for severely premature infants. Requires a nurse or physical therapist to review the proffered materials with the infant's parents or legal guardians prior to discharge and explain that premature infants having a birth weight of less than 1,000 grams automatically qualify for early intervention services up until their 3rd birthday, including speech, physical, occupational, and other therapies.

Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Allows the Department of Public Health to develop and publish on its website a nonopioid alternatives pamphlet, with certain requirements. Amends the Illinois Insurance Code. Prohibits a health insurance issuer to deny coverage of a nonopioid prescription drug in favor of an opioid prescription drug. Amends the Illinois Public Aid Code. Provides that coverage shall not be denied for a nonopioid prescription drug in favor of an opioid prescription drug. Requires that nonopioid drugs preferred on a specific list for the treatment or management of pain shall not be disadvantaged or discouraged with respect to coverage relative to any opioid or narcotic drug for the treatment or management of pain. Effective July 1, 2027.

Creates the Health Care Facility Fee Transparency Act. Sets forth provisions concerning notice requirements for a hospital or health system that charges a facility fee using a current procedural terminology evaluation code or assessment and management code for outpatient services provided at a hospital-based facility where a professional fee is also expected to be charged. Provides notice requirements for hospital-based facilities created or acquired through a business transaction. Establishes limitations on facility fees. Sets forth provisions concerning facility fee billing statements, reporting of facility fees charged by each hospital and health system, and enforcement of the Act by the Department of Public Health. Amends the Consumer Fraud and Deceptive Business Practices Act. Provides that it is an unlawful practice if, from the date of the transaction, a hospital, health system, or hospital-based facility does not wait at least 30 days after the written notice has been mailed to the patient or a copy of the notice has been filed with the Department of Public Health to collect a facility fee for services provided at a hospital-based facility.

Amends the Pharmacy Practice Act. Provides that "practice of pharmacy" includes the assessment and consultation of patients and dispensing of contraceptives, including emergency contraception (rather than the dispensation of hormonal contraceptives). In provisions concerning the dispensation of contraceptives, changes the contraceptives dispensed to contraceptives, including emergency contraception (rather than hormonal contraceptives). Makes conforming changes. Amends the Illinois Public Aid Code. Provides that the medical assistance program shall cover patient care services provided by a pharmacist for contraceptives, including emergency contraception (rather than hormonal contraceptives). Makes conforming changes.

Amends the Emergency Medical Services (EMS) Systems Act. In provisions concerning opioid overdose reporting, provides that overdose information reported by a covered vehicle service provider shall not be used in an opioid use-related criminal investigation, prosecution, welfare checks, or warrant checks of the individual who was treated by the covered vehicle service provider personnel for experiencing the suspected or actual overdose. Provides that any misuse of the information reported by a covered vehicle service provider shall result in, but is not limited to, the Department of Transportation reporting misuse to the Washington/Baltimore High Intensity Drug Trafficking Area Overdose Detection Mapping Application or similar technology platform. Permits the Department of Health to adopt rules to set forth standards under which misuse of access may be reported to the Washington/Baltimore High Intensity Drug Trafficking Area Overdose Detection Map or similar platform based on misuse or misconduct by a covered vehicle service provider or other individual or entity at the discretion of the Department. Provides that no data that allows for or creates a risk of identification of an individual or individuals experiencing a suspected or actual overdose treated by the covered vehicle service provider personnel shall be submitted to the Washington/Baltimore High Intensity Drug Trafficking Area Overdose Detection Mapping Application or Similar technology platform. Provides that covered vehicle service provider personnel may report overdose surveillance through an identified technology platform for the use of overdose surveillance under exceptions to HIPAA and the reported data shall only be used to support public safety and public health efforts. Sets forth additional provisions concerning requirements for the Department concerning opioid overdose reporting.

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 after January 1, 2026 must provide coverage, no less than once every 12 months, for a peripheral artery disease screening test for any at-risk individual. 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.

Amends the Network Adequacy and Transparency Act. Provides that the Department of Insurance shall consider establishing ratios for providers of genetic medicine and genetic counseling.

Creates the Complex Wheelchair Right to Repair Act. Provides that, for complex wheelchairs and parts for complex wheelchairs sold or used in the State, an original equipment manufacturer shall make available to an independent repair provider, solely for the purpose of repairing complex wheelchairs, on fair and reasonable terms, any documentation, parts, service access methods, and tools, including, but not limited to, any updates to information, firmware, or embedded software that is needed for purposes of repair of complex wheelchairs and training courses and materials on the operation, inspection, diagnosis, maintenance, and repair of complex wheelchairs. Provides that a violation of any of the provisions of the Act is an unlawful practice under the Consumer Fraud and Deceptive Business Practices Act. Provides for penalties. Provides that nothing in the Act shall require an original equipment manufacturer to divulge a trade secret to an independent repair provider. Amends the Illinois Insurance Code. Prohibits 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, 2026 from requiring a qualified complex rehabilitation technology supplier to obtain any form of prior authorization or any medical documentation to complete repairs for consumer-owned complex rehab technology. Requires coverage for time and labor expenses; travel allowance; and maintenance and repair of a consumer's backup power wheelchair or a rental wheelchair. Provides coverage for preventive maintenance. Amends various Acts to require coverage under those provisions. Amends the Consumer Fraud and Deceptive Business Practices Act to make a conforming change. Effective January 1, 2026.

Amends the Mental Health and Developmental Disabilities Confidentiality Act. Provides those entitled to inspect and copy a recipient's record include the parent or guardian of a minor, regardless of the minor's age, who is involved in special education services under the School Code or the "designated representative" of a student over the age of 18 involved in special education services under the School Code.