Healthcare

Creates the Artificial Intelligence Systems Use in Health Insurance Act. Provides that the Department of Insurance's regulatory oversight of insurers includes oversight of an insurer's use of AI systems to make or support adverse determinations that affect consumers. Provides that any insurer authorized to operate in the State is subject to review by the Department in an investigation or market conduct action regarding the development, implementation, and use of AI systems or predictive models and the outcomes from the use of those AI systems or predictive models. Provides that an insurer authorized to do business in Illinois shall not issue an adverse consumer outcome with regard to the denial, reduction, or termination of insurance plans or benefits that result solely from the use or application of any AI system or predictive model. Provides that any decision-making process for the denial, reduction, or termination of insurance plans or benefits that results from the use of AI systems or predictive models shall be meaningfully reviewed, in accordance with review procedures determined by Department rules, by an individual with authority to override the AI systems and determinations. Authorizes the Department to adopt emergency rules to implement the Act and to adopt rules concerning standards for full and fair disclosure of an insurer's use of AI systems. Makes a conforming change in the Illinois Administrative Procedure Act.

Urges the State to increase reimbursement rates, state grants and contracts, and the minimum overhead allowance to meet the rising costs of providing essential human services in Illinois and support the workers who deliver those services.

Creates the 340B Grantee Contract Pharmacy Access Act. Provides that no person, including a pharmaceutical manufacturer, may deny, restrict, or otherwise limit the acquisition of a 340B drug by a 340B grantee or a 340B contract pharmacy authorized to receive 340B drugs on behalf of the 340B grantee unless the acquisition is prohibited by federal law. Provides that the Department of Financial and Professional Regulation is authorized to enforce the Act and investigate possible violations of the Act by any person, including a pharmaceutical manufacturer. Sets forth provisions concerning preemption. Effective immediately.

Declares May 2025 as Prader-Willi Syndrome Awareness Month. Express support for raising awareness and educating the public about Prader-Willi Syndrome and increasing research and funding into the causes and treatments of the disease.

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 Medical Patient Rights Act. Provides that a patient who is covered under a policy of accident and health insurance, dental plan, or vision care plan is entitled to receive medical, dental, or eye care services without being required to pay an amount in excess of the estimated cost share, copayment, or deductible before those services are provided if such services are typically covered under the policy of accident and health insurance, dental plan, or vision care plan.

Amends the School Code. In provisions concerning the health examinations and immunizations that school children are required to receive, provides that a child may not be required to submit proof of having received an immunization against COVID-19 upon enrolling in school nor may a child already enrolled in school be required to receive an immunization against COVID-19. Amends the Communicable Disease Prevention Act. Pursuant to the School Code provisions, prohibits the Department of Public Health from adopting any rules that require children to receive an immunization against COVID-19. Effective immediately.

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 provide coverage for the cost of a karyotype test or related hormone testing to diagnose Klinefelter syndrome. 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 Medical Assistance Article of the Illinois Public Aid Code. Provides that if the United States Supreme Court holds to be unconstitutional a provision under the Patient Protection and Affordable Care Act (Public Law 111-148) that prohibits a group health plan and health insurance issuer from establishing lifetime or annual limits on the dollar value of benefits, or if the holding makes Medicaid eligibility allowed under that specified provision inoperable, then the Department of Healthcare and Family Services shall fully cover the costs of medical assistance for individuals affected by that holding, subject to appropriation. Provides that the Department shall not require individuals receiving medical assistance to work a minimum amount of hours in order to receive benefits.

Creates the Illinois Medicare for All Health Care Act. Provides that all individuals residing in the State are covered under the Illinois Health Services Program for health insurance. Sets forth the health coverage benefits that participants are entitled to under the Program. Sets forth the qualification requirements for participating health providers. Sets forth standards for provider reimbursement. Provides that it is unlawful for private health insurers to sell health insurance coverage that duplicates the coverage of the Program. Provides that investor-ownership of health delivery facilities is unlawful. Provides that the State shall establish the Illinois Health Services Trust to provide financing for the Program. Sets forth the requirements for claims billing under the Program. Provides that the Program shall include funding for long-term care services and mental health services. Provides that the Program shall establish a single prescription drug formulary and list of approved durable medical goods and supplies. Creates the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open bid competitive basis. Sets forth provisions concerning patients' rights. Provides that the employees of the Program shall be compensated in accordance with the current pay scale for State employees and as deemed professionally appropriate by the General Assembly. Effective January 1, 2026.