Healthcare

Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions prohibiting prior authorization mandates and utilization management controls under the fee-for-service and managed care medical assistance programs on specified FDA-approved prescription drugs for mental illness, provides that the prohibition shall apply if a preferred or non-preferred drug is prescribed to an adult patient to treat a serious mental illness and during the preceding 60 days, the patient who experienced an inadequate response was prescribed and unsuccessfully treated with a 14-day treatment trial of a drug for the same clinical condition that is included on the preferred drug list. Removes provisions conditioning the receipt of prescription drugs without prior authorization on: (i) the patient changing providers while receiving a previously authorized prescription drug; (ii) the patient changing insurance coverage while receiving a previously authorized prescription drug; and (iii) the patient's prescription for a previously authorized drug modifies the dosage, dosage frequency, or both, of the drug as part of the same treatment for which the drug was previously prescribed.

Amends the Illinois Insurance Code. Provides that 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, shall not impose any prior authorization or utilization management controls on covered behavioral health services. Makes conforming changes to the State Employees Group Insurance Act of 1971, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Insurance and the Department of Healthcare and Family Services to establish a process for receiving complaints from providers and covered individuals for violations of the mandate. Grants the Department of Insurance and the Department of Healthcare and Family Services the authority to issue cease and desist orders and administrative fines. Amends the Prior Authorization Reform Act. Provides that the Department of Healthcare and Family Services shall adopt rules consistent with the Act. Provisions amending the Prior Authorization Reform Act are effective immediately.

Appropriates $9,000,000 from the General Revenue Fund to the Department of Public Health for continued funding to the Illinois Association of Free and Charitable Clinics. Effective July 1, 2025.

Amends the Workers' Compensation Act. Provides that post-traumatic stress disorder is to be rebuttably presumed to arise out of and to be causally connected to the hazards of employment of a person employed as a firefighter, emergency medical technician (EMT), emergency medical technician-intermediate (EMT-I), advanced emergency medical technician (A-EMT), or paramedic.

Amends the Illinois Insurance Code. Provides that, unless certain conditions are met, it is an unfair method of competition and an unfair and deceptive act or practice in the business of insurance to solicit an individual who is over the age of 65, as described in provisions concerning an individual who has executed a health care power of attorney or has a medical condition, such as dementia, that reduces the person's capacity to make informed decisions independently, (instead of to solicit an individual who is over the age of 65) to purchase accident or health insurance. Effective January 1, 2026.

Creates the Accountability in Psychotropic Drug Prescriptions for Children Under Medicaid Act. Requires medical care providers prescribing psychotropic drugs to children under the State's Medicaid program to provide FDA Medication Guides to parents or legal guardians before issuing a prescription. Provides that the Medication Guides must be printed and reviewed with the parent or legal guardian, explaining (1) FDA-identified risks of the medication, including pediatric-specific warnings and (2) signs of potential side effects and adverse drug reactions detailed in the Medication Guide. Provides that written informed consent must be obtained from the parent or legal guardian before prescribing a psychotropic drug. Requires the Department of Healthcare and Family Services to, within 12 months after the effective date of the Act, develop and maintain a secure online reporting system for adverse drug reactions related to psychotropic drugs prescribed to children and adolescents. Contains provisions on adverse drug reaction reporting requirements; legislative oversight and reviews of adverse drug reaction reports related to psychotropic drugs; penalties for medical care providers who fail to comply with medication guide distribution; transparency and accountability reporting requirements for the Department of Healthcare and Family Services; and other matters. Amends the State Finance Act. Creates the Medicaid Oversight and Safety Measures Fund.

Creates the Health Care Transparency Act. Provides that the Department of Public Health shall identify reproductive health care services, LGBTQ health care services, and end-of-life health care services that are or may be subject to denial of care for nonmedical reasons in the State and develop a clear and simple disclosure form for the purpose of conveying to patients and to the public which of the identified health care services are and are not generally available, are subject to restriction for nonmedical reasons, and are subject to restrictions on referral by each covered entity. Requires the Department to publish and maintain on its public-facing website a current list of covered entities and provide for public access to the disclosure form submitted by each covered entity; adopt rules implementing the Department's duties; and develop and administer to the public an education and awareness program regarding how denial of care may negatively impact health care access and quality, may be avoided, and affects vulnerable people and communities. Establishes disclosure requirements for covered entities. Effective immediately.

Amends the Telehealth Act. Provides that no health care provider, health care facility, or associated entity shall impose or collect a facility fee in connection with any telehealth services provided to patients in the State of Illinois. Provides that the prohibition does not apply to any fees that are directly related to in-person services that may be required to supplement telehealth care if such fees are itemized and clearly communicated to the patient before the in-person services are provided.

Creates the Wellness and Oversight for Psychological Resources Act. Defines terms. Provides that an individual, corporation, or entity may not provide, advertise, or otherwise offer therapy or psychotherapy services to the public in the State unless the therapy or psychotherapy services are conducted by an individual who is a licensed professional. Provides that a licensed professional may use an artificial intelligence system only to the extent the use of the artificial intelligence system meets the definition of permitted use of artificial intelligence systems. Provides that a licensed professional may not use an artificial intelligence system in therapy or psychotherapy services to make independent therapeutic decisions, directly interact with clients in any form of therapeutic communication, or generate therapeutic recommendations or treatment plans without the review and approval by a licensed professional. Provides that any individual, corporation, or entity found in violation of the Act shall pay a civil penalty to the Department of Financial and Professional Regulation in an amount not to exceed $10,000 per violation, as determined by the Department, with penalties assessed based on the degree of harm and the circumstances of the violation. Provides that the civil penalty shall be assessed by the Department after a hearing is held in accordance with the Department of Professional Regulation Law. Requires that an individual, corporation, or entity found in violation of the Act shall pay the civil penalty within 60 days after the date of an order by the Department imposing the civil penalty. Provides that the Department shall have authority to investigate any actual, alleged, or suspected violations of the Act. Effective immediately.

Amends the Terrorism Article of the Criminal Code of 2012. Provides that "terrorist act" includes any act that is intended to cause or create and does cause or create substantial damage to or destruction of any building or facility containing an entity providing reproductive health care as the term is defined in the Reproductive Health Act. Provides in the offense of causing a catastrophe that "vital public facility" includes an entity providing reproductive health care as the term is defined in the Reproductive Health Act. Effective immediately.