Healthcare

Amends the Illinois Insurance Code. Sets forth provisions requiring an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in this State on or after January 1, 2028 to provide coverage for up to a 12-month supply of prescription hormone therapy, and the necessary supplies for self-administration, that is prescribed by a network provider within the provider's scope of practice and dispensed at one time for an enrollee by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies. Amends the Pharmacy Practice Act. Provides that, notwithstanding any other provision of law, a dispensing provider or pharmacist shall dispense, at a patient's request, up to a 12-month supply of a prescription hormone therapy and the necessary supplies for self-administration pursuant to a valid prescription that specifies an initial quantity followed by periodic refills, except as specified. Amends the State Employees Group Insurance Act of 1971 and the Illinois Public Aid Code to require coverage under the provisions of those Acts.

Amends the Illinois Controlled Substances Act. Provides that each prescriber or the prescriber's designee shall document an attempt to access patient information in the Prescription Monitoring Program to assess patient access to controlled substances when providing a (rather than an initial) prescription for Schedule II and IV controlled substances (rather than narcotics such as opioids), except for prescriptions for oncology treatment or palliative care, or a 7-day or less supply provided by a hospital emergency department when treating an acute, traumatic medical condition.

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 Assisted Living and Shared Housing Act, the MC/DD Act, and the ID/DD Community Care Act. Provides that notice of closure of an establishment or facility licensed under those Acts shall be given to the Office of the State Long Term Care Ombudsman.

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 Hospital Licensing Act. Defines "pathogens of epidemiological concern". Provides that each hospital shall develop and implement comprehensive interventions to prevent and control pathogens of epidemiological concern (instead of multidrug-resistant organisms) that take into consideration guidelines of the U.S. Centers for Disease Control and Prevention or recommendations from the Infectious Disease Society of America, the Society for Healthcare Epidemiology of America, the Association for Professionals in Infection Control and Epidemiology, or the Pediatric Infectious Disease Society for the management of multidrug-resistant organisms in health care settings. Within 12 months after the effective date of the amendatory Act, requires each hospital to adopt a policy for preventing and controlling the transmission of pathogens of epidemiological concern. Establishes reporting requirements for hospitals with patients carrying pathogens of epidemiological concern. Repeals the MRSA Screening and Reporting Act.

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. Prohibits an insurer, dental service plan corporation, professional service corporation, insurance network leasing company, or any other company or its contracted vendor that amends, delivers, issues, or renews an individual or group policy of accident and health insurance on or after the effective date of the amendatory Act from requiring a dental care provider to only accept payment from a credit card or electronic funds transfer, in addition to the existing prohibition on incurred fees to access and obtain payment or reimbursement for services provided. Provides that any insurer, dental service plan corporation, professional service corporation, insurance network leasing company, or any other company or its contracted vendor that amends, delivers, issues, or renews an individual or group policy of accident and health insurance may initiate or change payment methodology to a dental care provider using electronic funds transfer payments, including virtual credit card payments, if the specified conditions are met. Sets forth provisions concerning claim payment methodologies and fees for transmitting payments. Provides that the specified dental coverage reimbursement provisions shall not be waived by contract. Effective January 1, 2027.

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 Mental Health and Developmental Disabilities Administrative Act and the Rehabilitation of Persons with Disabilities Act. Required the Department of Human Services to provide informational materials about the Senator Scott Bennett ABLE Program to: persons who are placed in a facility licensed under the ID/DD Community Care Act, the MC/DD Act, or the Specialized Mental Health Rehabilitation Act of 2013; persons with disabilities who receive services funded by or administered in conjunction with the Department, including, but not limited to, home and community based services, home-based support services, PUNS services, home care services, and services at a Center for Independent Living. Provides that the informational materials shall be provided when a person first enrolls for such services and as part of any annual process required for the person to maintain eligibility for such services. Requires the Office of the State Treasurer to prepare and deliver the informational materials in an electronic format to the Department and distribute the materials to eligible persons.