Healthcare

Amends the Medicare-Medicaid Alignment Initiative (MMAI) Nursing Home Residents' Managed Care Rights Law of the Illinois Public Aid Code. Provides that the Article applies to a fully integrated dual eligible special needs plan and any managed care plan for persons who are dually eligible for Medicare and Medicaid. Adds to the definition of "Demonstration Project", a fully integrated dual eligible special needs plan and any managed care plan for persons who are dually eligible for Medicare and Medicaid. Provides that the Department of Healthcare and Family Services shall provide each managed care organization with the quarterly facility-specific nursing component (instead of RUG-IV nursing component) per diem along with any add-ons for enhanced care services, support component per diem, and capital component per diem effective for each nursing home under contract with the managed care organization. Effective immediately.

Amends the Mental Health and Developmental Disabilities Administrative Act and the Rehabilitation of Persons with Disabilities Act. Required the Department of Human Services to provide informational materials about the Senator Scott Bennett ABLE Program to: persons who are placed in a facility licensed under the ID/DD Community Care Act, the MC/DD Act, or the Specialized Mental Health Rehabilitation Act of 2013; persons with disabilities who receive services funded by or administered in conjunction with the Department, including, but not limited to, home and community based services, home-based support services, PUNS services, home care services, and services at a Center for Independent Living. Provides that the informational materials shall be provided when a person first enrolls for such services and as part of any annual process required for the person to maintain eligibility for such services. Requires the Office of the State Treasurer to prepare and deliver the informational materials in an electronic format to the Department and distribute the materials to eligible persons.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides medical assistance coverage for sickle cell disease (rather than sickle cell anemia).

Amends the Emergency Medical Services (EMS) Systems Act. Makes changes to defined terms. Replaces references to Primary Stroke Centers with Stroke Centers. Provides that a hospital that no longer meets nationally recognized, evidence-based standards for Stroke Centers, loses its Stroke Center certification, or has any change to its designation level shall notify the Department of Public Health and the Regional EMS Advisory Committee within 5 business days. Requires the Department to consult with the State Stroke Advisory Subcommittee for the adoption or deletion of approved stroke designation levels. Provides that the approved stroke designation levels shall coincide with the stroke designation levels recognized by Department-approved certifying bodies. Requires the Department to establish reporting requirements for designated Stroke Centers to capture information using new or existing electronic reporting tools for statewide data collection and certification purposes. Removes provisions concerning previous Stroke Center designations. Makes other changes.

Amends the Abused and Neglected Long Term Care Facility Residents Reporting Act. Includes any facility licensed under the Assisted Living and Shared Housing Act in the definition of "long term care facility". Amends the Adult Protective Services Act. Removes a supportive living facility from the definition of "domestic living situation".

Amends the Genetic Information Privacy Act. Removes language exempting insurers that are issuing a long-term care policy from specified provisions. Provides that, with regard to any policy, contract, or plan offered, entered into, issued, amended, or renewed on or after January 1, 2027 by a health insurer, life insurer, disability insurer, or long-term care insurer authorized to transact insurance in this State, a health insurer, life insurer, disability insurer, or long-term care insurer may not: (1) cancel, limit, or deny coverage or establish differentials in premium rates based on a person's genetic information; or (2) require or solicit an individual's genetic information, use an individual's genetic test results, or consider an individual's decisions or actions relating to genetic information or a genetic test in any manner for any insurance purpose. Provides that the provisions may not be construed as: (1) preventing a life insurer, disability insurer, or long-term care insurer from accessing an individual's medical record as part of an application; or (2) prohibiting a life insurer, disability insurer, or long-term care insurer from considering a clinical diagnosis, such as a manifest disease or disorder, included in an individual's medical record for insurance purposes to the extent otherwise allowable by law. Effective July 1, 2026.

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 Illinois Insurance Code. Prohibits an insurer, dental service plan corporation, professional service corporation, insurance network leasing company, or any other company or its contracted vendor that amends, delivers, issues, or renews an individual or group policy of accident and health insurance on or after the effective date of the amendatory Act from requiring a dental care provider to only accept payment from a credit card or electronic funds transfer, in addition to the existing prohibition on incurred fees to access and obtain payment or reimbursement for services provided. Provides that any insurer, dental service plan corporation, professional service corporation, insurance network leasing company, or any other company or its contracted vendor that amends, delivers, issues, or renews an individual or group policy of accident and health insurance may initiate or change payment methodology to a dental care provider using electronic funds transfer payments, including virtual credit card payments, if the specified conditions are met. Sets forth provisions concerning claim payment methodologies and fees for transmitting payments. Provides that the specified dental coverage reimbursement provisions shall not be waived by contract. Effective January 1, 2027.

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.

This bill nominates Anusha Thotakura to serve as a member of the Illinois Health Benefits Exchange Advisory Committee. If approved, Ms. Thotakura would join the committee responsible for advising on health benefits exchange matters in Illinois.