Healthcare (Substance Abuse)

Amends the Medical Assistance Article of the Illinois Public Aid Code. Repeals provisions that require: (i) the Department of Healthcare and Family Services to consult with stakeholders and General Assembly members for input on a plan to develop enhanced Medicaid rates for substance use disorder treatment and mental health treatment in underserved communities; and (ii) the Department of Healthcare and Family Services and the Department of Human Services to collaborate to review coverage and billing requirements for substance use prevention and recovery and mental health services with the goal of identifying disparities and streamlining coverage and billing requirements to reduce the administrative burden for providers and medical assistance beneficiaries. Effective January 1, 2026.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Repeals provisions that require: (i) the Department of Healthcare and Family Services to consult with stakeholders and General Assembly members for input on a plan to develop enhanced Medicaid rates for substance use disorder treatment and mental health treatment in underserved communities; and (ii) the Department of Healthcare and Family Services and the Department of Human Services to collaborate to review coverage and billing requirements for substance use prevention and recovery and mental health services with the goal of identifying disparities and streamlining coverage and billing requirements to reduce the administrative burden for providers and medical assistance beneficiaries. Effective January 1, 2026.

Amends the Illinois Insurance Code to require an insurance policy to provide coverage for medically necessary treatments for genetic, rare, unknown or unnamed, and unique conditions, including Ehlers-Danlos syndrome and altered drug metabolism. Provides that an insurance policy that provides coverage for prescription drugs shall include coverage for opioid alternatives, coverage for medicines included in the Model List of Essential Medicines published by the World Health Organization, and coverage for custom-made medications and medical food. Provides that an insurance policy that limits the quantity of a medication in accordance with applicable State and federal law shall not require pre-approval for the treatment of patients with rare metabolism conditions that may need a higher dose of medication than what is otherwise allowed within a time frame or prescription schedule. Provides that the burden of proving that treatment is medically necessary shall not lie with the insured in cases of rejections for filing claims, preauthorization requests, and appeals related to coverage required under the Section.

Amends the Hospital Licensing Act. Provides that, if an individual is treated at a hospital and the hospital conducts a urine drug screening to assist in diagnosing the individual's condition, the hospital shall include testing for fentanyl in the individual's urine screening. Provides that if the urine drug screening, conducted in accordance with the provisions, detects fentanyl, the hospital shall report the test results, which shall be deidentified, to the Department of Public Health through the State-designated health information exchange. Provides that a hospital that does not have chemical analyzer equipment is not subject to the provisions. Provides that the provisions do not affect any State law which provides civil or criminal immunity to an individual who is in need of medical assistance after ingesting or using alcohol or drugs or to an individual who, in good faith, assists another who is in need of medical assistance after ingesting or using alcohol or drugs. Effective immediately.