Healthcare (Insurance)

Declares April 11 through April 17, 2026 as Black Maternal Health Week in the State of Illinois. Commends the work of organizations, health care providers, managed care entities, and community leaders, including Meridian Health Plan's MomCare initiative, for their dedication to improving maternal health outcomes and advancing equity across Illinois. Reaffirms commitment to supporting policies, programs, and partnerships that eliminate maternal health disparities and ensure that every mother in Illinois has access to high-quality, culturally competent care. Encourages continued public-private partnerships and innovative care delivery models that expand access, improve outcomes, and strengthen accountability across the maternal health ecosystem.

Amends the Illinois Insurance Code. Provides that any individual or group policy of accident or health insurance that is delivered, extended, renewed, or modified after January 1, 2027 must provide coverage for at least one 6-month supply of each of the following for each infant covered by the policy: an early egg allergen introduction dietary supplement prescribed by a health care practitioner; and an early peanut allergen introduction dietary supplement prescribed by a health care practitioner. Provides that the coverage shall be provided without cost-sharing, except to the extent the cost-sharing limitation would cause a catastrophic plan to fail to be treated as a catastrophic plan under the Patient Protection and Affordable Care Act or would keep a high-deductible health plan from being treated as a high-deductible health plan or to the extent the cost-sharing limitation would disqualify the plan from a health savings account. 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 Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code to require that coverage. Effective immediately.

Amends the Illinois Insurance Code. Provides that a health insurance issuer that delivers, issues for delivery, or renews in this State a health insurance policy shall not discriminate with respect to participation under the health insurance policy against a health care professional who is acting within the scope of the health care professional's license or certification under applicable State law. Provides that a health insurance issuer is not required to contract with any health care professional willing to abide by the terms and conditions for participation established by the health insurance issuer. Provides that a health insurance issuer is not prohibited from establishing varying reimbursement rates based on quality or performance measures.

Provides that the Act may be referred to as the Mental Health Parity for All Act. Amends the Department of Human Services Act. Provides that subject to appropriations, the Department of Human Services shall establish and administer a program that provides grants to community-based organizations to develop and establish mental health wellness hubs in communities disproportionately impacted by the closure of mental health clinics, hospitals, and schools. Provides that the goal of the program is to provide immediate and accessible behavioral health services and supports to individuals experiencing a mental health crisis or distress prior to the need for psychiatric hospitalization. Requires program grants to be awarded to community-based organizations with a demonstrable history of providing behavioral health services and supports to persons experiencing mental health-related stress. Requires the mental health wellness hubs to provide an array of services aimed at promoting emotional and psychological well-being, including, but not limited to: (1) crisis prevention and intervention; (2) psychiatric assessments and evaluations; (3) individual and group therapy; (4) medication monitoring; (5) nutrition education; and (6) referrals to community resources. Requires the services to be tailored to the community's needs and to be available year-round on a walk-in basis or by appointment to community members regardless of age or insurance coverage. Permits the Department to adopt any rules necessary to implement the program.

Amends the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2027 that provides coverage for durable medical equipment that is authorized or prescribed by a physician licensed to practice medicine in all its branches shall provide the same level of coverage for durable medical equipment that is authorized or prescribed by a different health care practitioner who lawfully prescribes or orders home medical equipment and services or uses home medical equipment and services to treat the health care practitioner's patients. 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 establish the same requirement under the provisions of those Acts. Effective immediately.

Creates the Preventing Crisis Cost Shifting to Medicaid Act. Provides that the General Assembly finds that (i) behavioral health crisis services, including crisis call centers, mobile crisis response, and crisis stabilization and receiving services, function as essential public health infrastructure and must be available statewide without regard to insurance status; and (ii) commercial health insurance policies issued or administered in the State generally do not provide comprehensive coverage for the full continuum of behavioral health crisis services, resulting in the cost of such services being disproportionately borne by Medicaid, local governments, and taxpayers. Requires specified entities (surcharge payors) that are authorized to issue or administer a policy or contract of accident and health insurance or a health maintenance organization contract in the State to pay a behavioral health crisis assessment to the Department of Human Services for deposit into the Statewide 9-8-8 Trust Fund. Exempts Medicaid managed care organizations from paying the behavioral health crisis assessment. Permits the Department to update the total behavioral health crisis assessment amount as necessary to ensure the continued availability, quality, or geographic equity of the statewide behavioral health crisis system. Requires the Department to establish an appropriate mechanism for enforcing a surcharge payor's liability, which may include accrued interest on unpaid liabilities at a rate not to exceed 18% per annum and late fees or penalties at a rate not to exceed 5% per month. Provides that the enforcement mechanism may also include notification to the Department of Healthcare and Family Services to offset payments on the surcharge payor's claims. Provides that the Department of Human Services shall not direct the Department of Healthcare and Family Services to offset claims payments unless the surcharge payor has maintained an outstanding liability to the Statewide 9-8-8 Trust Fund for a period longer than 45 days and has received proper notice of pending enforcement.

Amends the Illinois Power of Attorney Act. Creates rights for patients with a health power of attorney. Provides that all individuals undergoing surgery, hospitalization, or any medical procedure shall have the right to designate a designated representative in a health care power of attorney on their behalf in the event of incapacitation. Provides that patients and their designated representatives are guaranteed the following rights: (1) the right to receive clear, comprehensive information about proposed treatments, including risks, benefits, and alternatives, in a language and format they understand, before agreeing to any procedure; (2) the right to view, request, and receive copies of all medical records, and the assurance of confidentiality in accordance with Health Insurance Portability and Accountability Act and related privacy laws; (3) the right to appeal medical decisions, including denial of treatment, discharge, or transfer; (4) the right to request and receive a second opinion from another qualified medical professional or specialist, including those outside the treating facility, without fear of delay, retaliation, or obstruction; and (5) the right to medical interpretation services for patients or their designated representative who do not speak or understand English fluently, including access to certified medical translators and translated documents, at no cost to the patient. Creates a State Patient Rights and Advocacy Commission to oversee implementation of the Act, monitor compliance by health care providers, and respond to violations. Provides that any health care provider or institution found to be in violation of the Act is subject to disciplinary sanctions, which may include: civil fines; suspension or revocation of professional licenses; facility accreditation review or suspension; and mandatory corrective action plans and staff retraining.

Amends the Illinois Insurance Code. In provisions concerning biomarker testing: makes changes to defined terms; requires applicable health insurers, nonprofit health service plans, and health maintenance organizations to update and make publicly available medical policies and coverage guidelines within 90 days after the effective date of the amendatory Act; provides that, if a health insurer or nonprofit health service plan denies a claim for coverage of testing that is supported by any specified evidence, the insurer or nonprofit health service plan shall provide to the requesting entity specific written justification explaining in detail why the claim for coverage was denied as it pertains to the individual for whom the test was ordered; sets forth provisions concerning utilization review and prior authorization; provides that the Department of Insurance may conduct periodic audits and reviews to ensure entity compliance; and makes other changes.

Prohibits health insurance issuers from specifying or describing personal sensitive health care information in any explanation of benefits, summary of payments, claims history, or any other communication or record relating to payment or coverage of services or procedures involving sensitive health care information for an insured member other than the insured subscriber, unless the insured member receiving the service or procedure clearly makes a request orally or in writing to not suppress information relating to sensitive health care. Grants the Department of Insurance rulemaking authority. Provides that the Department of Insurance, in collaboration with the Department of Public Health, shall develop and implement a plan to educate health care providers and consumers regarding the rights of insured members and the responsibilities of health insurance issuers to promote compliance with the stated requirements. 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 establish the same requirements in the provisions of those Acts. Effective one year after becoming law.

Creates the Transparency in Downcoding Act. Provides that the Act applies to certain policies of health insurance amended, delivered, issued, or renewed on or after the effective date of the Act, except for employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974 and health care provided pursuant to the Workers' Compensation Act or the Workers' Occupational Diseases Act. Prohibits a health insurance issuer from using an automated process, system, or tool to downcode a claim; from downcoding a claim based solely on the reported diagnosis codes; and from using downcoding practices in a targeted or discriminatory manner against physicians who routinely treat patients with complex or chronic conditions. Requires downcoding decisions to be made by a physician licensed to practice medicine in all its branches in any United States jurisdiction and of the same or similar specialty as a physician who typically manages the medical condition or disease. Sets forth provisions concerning notification requirements for downcoded claims; the appeal process for downcoded claims; enforcement by the Department of Insurance; and penalties. Provides that any pattern or practice of discriminatory downcoding identified by the Director of Insurance or another regulatory authority shall be subject to enforcement actions, including fines, restitution, or suspension of the health insurance issuer's license in this State. Effective immediately.