Healthcare

Amends the Limited Health Service Organization Act. Makes changes to defined terms. In provisions concerning the offering of a point-of-sale contract by a limited health service organization (LHSO), removes a provision requiring the LHSO to include an annual maximum benefit allowance not to exceed $2,500 per year that is separate from any limits or allowances applied to in-plan services. Provides that, if an LHSO expends in any calendar quarter more than 20% of its total limited health services expenditures for all its members for out-of-plan covered services, then specified limitations shall not apply subject to the LHSO minimum capital and surplus requirements applicable to a life, accident, and health insurance company. Makes other changes.

Amends the Nursing Home Care Act. Replaces reporting requirement provisions for the Department of Public Health concerning nurse surveyors. Provides that, in addition to the listed information, the Department's annual report on all survey activity from the preceding fiscal year shall include: (i) the total number of authorized nursing home surveyor positions within the Department, (ii) the total number of filled and vacant nursing home surveyor positions, (iii) the average length of tenure for nursing home surveyors employed by the Department at the time the report is created, and (iv) any additional information the Department deems relevant regarding nursing home surveyor recruitment, retention, or workload.

Amends the Substance Use Disorder Act. In provisions requiring the Department of Human Services to establish a public education program regarding gambling disorders, requires the program to (i) promote public awareness regarding the impact of gambling disorders on individuals, families, and communities and the stigma that surrounds gambling disorders and (ii) use screening, crisis intervention, treatment, public awareness, prevention, in-service training, and other innovative means to decrease the incidence of suicide attempts related to gambling disorders or gambling issues. Requires the Department to select the statement regarding obtaining assistance with a gambling disorder, which each licensed gambling establishment owner shall post, and each master sports wagering licensee shall include, on the master sports wagering licensee's portal, Internet website, or computer or mobile application. Permits the Department to provide advice to State and local officials on gambling disorders; to support gambling disorder prevention, recognition, treatment, and recovery projects; to collaborate with other community-based organizations, substance use disorder treatment centers, or other health care providers engaged in treating individuals who are experiencing gambling disorders; and to perform other actions. Allows the Department to award grants to create or support local gambling prevention, recognition, and response projects. Makes other changes.

Amends the Illinois Insurance Code. In a provision concerning coverage of certain cancer screenings, adds having a high level of CA-125, as indicated by a blood test screening, to the definition of "at risk for ovarian cancer". Provides that "surveillance tests for ovarian cancer" means all medically viable methods for the detection and diagnosis of ovarian cancer, including, but not limited to, ultrasounds, magnetic resonance imagings (MRIs), x-rays, computed tomography (CT) scans, and CA-125 blood test screenings (instead of an annual screening using (i) CA-125 serum tumor marker testing, (ii) transvaginal ultrasound, (iii) pelvic examination). Effective January 1, 2028.

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.

Amends the Pharmacy Practice Act. Provides that "practice of pharmacy" includes the monitoring of medication recalls, including notifying patients of applicable medication recalls at the point of sale.

Amends the Illinois Health Insurance Portability and Accountability Act. Defines "grandfathered health plan". Provides that, except for grandfathered health plans, a health insurance issuer in the individual, small group, or large group market shall not deny coverage to an individual or employer due to the individual's or employer's failure to pay premiums owed under a prior policy, certificate, or contract of insurance. Specifies that nothing in the provisions concerning past-due premiums prohibits a health insurance issuer from pursuing the collection of past-due premiums from an individual or employer by any other means permitted by law. 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, 2028 that provides coverage for: habilitative services shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental; rehabilitative services shall provide coverage for rehabilitative speech therapy as a treatment for stuttering; or both habilitative services and rehabilitative services shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental, and shall provide coverage for rehabilitative speech therapy as a treatment for stuttering. Sets forth requirements and limitations for the coverage. 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 the provisions of those Acts. Amends the State Mandates Act to require implementation without reimbursement. Effective January 1, 2028.

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.

Amends the Unified Code of Corrections. Creates the Tamms Minimum Security Unit Task Force. Provides for membership on the Task Force. Provides that the Task Force shall study the subject of a practical, efficient, and beneficial repurposing of the Tamms Minimum Security Unit and its property for the benefit of the public, including the possibility of providing mental health services, health services, public safety, law enforcement training purposes, fire services, medical training and any other option for repurposing that the Task Force deems appropriate. Provides that each member of the Task Force shall serve without compensation. Provides that the Task Force shall meet 2 times per year or at the call of the Chairperson. Provides that the Department of Corrections shall provide administrative support to the Task Force. Provides that the Task Force shall submit a report to the Governor and the General Assembly on or before December 31, 2025 with its recommendations and is dissolved on January 1, 2026. Repeals these provisions on January 1, 2026. Effective immediately.