Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning the Medicaid Access Adjustment payments to nursing facilities, provides that for dates of service beginning January 1, 2027, the Medicaid Access Adjustment shall be increased by $5.75 to $10.50 per diem. Provides that beginning January 1, 2027, facilities located outside of Rate Areas 6, 7, and 8 shall have the Medicaid percent of occupied bed days to be at least 60% of all occupied bed days adjusted quarterly to qualify for the Medicaid Access Adjustment. Provides that the remaining facilities shall have their threshold remain at 70%.
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.
Provides that the Act may be referred to as the Illinois Newborn Equity Support Transfer (NEST) Program Act. Amends the Department of Human Services Act. Requires the Department of Human Services to establish and administer, subject to appropriations, the Illinois Newborn Equity Support Transfer (NEST) Program to provide direct cash assistance to eligible participants by July 1, 2026. Defines "participant" to mean any individual who gives birth in Illinois while enrolled in or eligible for Medicaid through Moms and Babies. Permits the Department to adopt any rules necessary to implement the NEST Program. Provides that program participants shall receive a $1,500 lump sum payment in or around the third trimester of pregnancy, prior to delivery; and a $500 monthly cash payment for the first 6 months following delivery. Requires the Department to submit reports to the General Assembly on a biennial basis that summarizes (1) the number of program participants and distribution across the State, (2) outcomes related to maternal and child health, housing stability, and economic security, or other outcomes identified by the Department in collaboration with stakeholders, and (3) recommendations for program improvements or additional populations beyond Medicaid enrollment to include as participants. Provides that cash disbursements made to participants under the NEST Program shall be considered "guaranteed income" as described in the Hospital Uninsured Patient Discount Act for purposes of determining eligibility for assistance under the Illinois Public Aid Code. Effective immediately.
Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning the supportive living facilities program, prohibits a supportive living dementia care setting from limiting a resident's access to the sink, microwave, or refrigerator located within the respective resident's room, provided a comprehensive safety assessment deems the resident's use of the appliances safe. Requires the comprehensive safety assessment to be conducted prior to any resident moving in and at least once per quarter thereafter. Requires social and recreational programming to be provided no less than 3 times daily, including at least one time and location separate from a meal service. Requires newly constructed supportive living dementia care settings to provide no less than 300 square feet for a single occupancy apartment or no less than 450 square feet for a double occupancy apartment, which may include the closets and bathroom. Requires each apartment to include a sink, microwave, and refrigerator within the unit. Provides that any newly constructed supportive living dementia care setting shall provide a common area completely separate from the dining area.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that beginning October 1, 2026, for rate year 2027 and thereafter, the Medicaid inpatient utilization rate, as defined and used in the determination of eligibility for specified inpatient adjustment payments to hospitals, shall be modified to exclude, from both the numerator and denominator, all days reimbursed by the Department of Human Services for mental health services provided under a specified provision of the Code of Criminal Procedure of 1963 as contracted by the Department of Healthcare and Family Services. Effective immediately.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to adopt rules that require managed care organizations (MCOs) to utilize a universal provider application developed by a council for affordable quality healthcare, as defined, for the purpose of credentialing a health care professional or a health care provider who seeks to participate in an MCO's provider network. Provides that the rules may also require the use of a CAQH application for the renewal of credentials; and that the Department may revise the CAQH universal provider application or the application for renewal of credentials to conform to industry or national standards for credentialing health care professionals or health care providers. Provides that within 180 days after the adoption of rules, health and dental plan carriers must accept the universal provider application and the application for the renewal of credentials approved by the Department. Requires all MCOs to provide a provider network consultant to act as a liaison between a health care provider and the MCO. Require the Department to employ provider enrollment consultants to assist health care providers with enrollment in the Illinois Medicaid Program Advanced Cloud Technology system, help navigate the enrollment and provider credentialing process by serving as the liaison between health care providers and MCOs, and other matters. Amends the Illinois Insurance Code. In provisions concerning recoupments, requires a health care professional or health care provider to be provided a remittance advice that includes an explanation of a recoupment or offset taken by a managed care organization. Removes provisions permitting insurers contracted with the Department of Healthcare and Family Services to recoup or offset payments due to a federal Medicaid requirement. Provides that no contract between an MCO and health care professional or provider may provide for recoupments in violation of the Code. Effective January 1, 2027.
Amends the Mental Health and Developmental Disabilities Administrative Act. Provides that beginning July 1, 2026, the Department of Human Services shall reissue the original cost and wage survey for costs associated with the administration of services to persons with intellectual and developmental disabilities in community day services that was contained in the Department's Guidehouse Rate Study. Provides that the cost and wage survey shall be used to effectuate rate increases in transportation funding for the administration of community day services to persons with intellectual and developmental disabilities and may include provider contact information, total costs of employee salaries and benefits, staff turnover, and other information. Requires the Department to adopt rules. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to file an amendment to the Home and Community-Based Services Waiver Program for Adults with Developmental Disabilities that removes the 5 hour per day billing maximums at community day services. Provides that the amendment shall not modify monthly and yearly billing maximums for community day services. Provides that implementation is contingent on federal approval. Effective July 1, 2026.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for dates of service beginning on and after January 1, 2027, the Department of Healthcare and Family Services shall, for healthcare common procedure coding system codes relating to complex rehabilitation technology wheelchair repair and accessories, apply a reimbursement rate under the Medical Assistance program equivalent to the maximum fee paid in Illinois under the federal Medicare program, including fees under the KU modifier, if applicable. Effective immediately.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after January 1, 2027, certain services shall be eligible for reimbursement at approved programs through the Brain Injury waiver for eligible individuals over the age of 21, including, but not limited to: (1) case management; (2) nursing services; (3) medical oversight by consulting medical director; (4) physical therapy; and (5) occupational therapy. Requires the Department of Human Services to reimburse approved programs at the rates in effect for the Home and Community-Based Services Waiver program most recently approved. Effective January 1, 2027.
Creates the Illinois All-Payer Health Care Payment and Global Budget Act. Creates the Illinois Health Care Cost and Payment Board as an independent body within the Department of Healthcare and Family Services and sets forth its membership and powers. Defines "commercial payer" as any health insurance issuer, health maintenance organization, or third-party administrator subject to regulation by the Illinois Department of Insurance, excluding self-funded plans governed solely by ERISA. Provides that all commercial payers shall reimburse hospitals for covered services at standardized rates established by the Board. Defines "global hospital budget" as a prospective, fixed annual operating revenue amount established for a hospital to cover all inpatient and outpatient hospital services. Provides that the Board shall establish prospective annual global hospital budgets for Illinois hospitals. Provides that the Board shall establish a unified health care data system in coordination with State agencies. Creates the Health Care Payment Reform Advisory Council to advise the Board. Provides that the Governor, in consultation with the Board, shall seek all necessary federal approvals, including Medicare demonstrations and Medicaid waivers, to implement the Act. Amends the Illinois Administrative Procedure Act, Hospital Licensing Act, Illinois Insurance Code, Health Maintenance Organization Act, and Illinois Public Aid Code with regard to the new Act. Contains a severability clause. Effective immediately.
