Healthcare

Amends the Hospital Services Trust Fund Article in the Illinois Public Aid Code. In provisions concerning annual funding for the health care transformation program, provides that funds that had been budgeted but unexpended in State fiscal years 2021 through 2027 may be allocated in State fiscal year 2028 in an amount not to exceed $150,000,000.

Amends the Medicaid Technical Assistance Act. Requires the Medicaid Technical Assistance Center to collaborate with public and private partners throughout the State to identify, establish, and maintain best practices necessary for health providers to ensure their capacity to participate in the Illinois Medical Assistance Program (rather than ensure their capacity to participate in HealthChoice Illinois or YouthCare). Requires the Medicaid Technical Assistance Center to promote equitable delivery systems, remaining committed to the principle that all Medicaid recipients have accessible and equitable physical and mental health care services. Removes provisions concerning the Medicaid Technical Assistance Center's administration of network adequacy reports, and instead requires the Medicaid Technical Assistance Center to administer a network recruitment plan. Provides that by using reports and data provided by the Department of Healthcare and Family Services’ External Quality Review Organization on network adequacy, provider service deserts, and health care disparities by race and ethnicity, the Medicaid Technical Assistance Center shall propose for Department review and approval an annual plan for recruiting providers to participate in the Illinois Medical Assistance Program and report on outcomes of its recruitment efforts to the Department for continuous improvement. Repeals a provision requiring the Department to maximize federal financial participation for any moneys appropriated to the Department for the Medicaid Technical Assistance Center and to deposit all federal financial participation funds into the Medicaid Technical Assistance Center Fund. Repeals a provision creating the Medicaid Technical Assistance Center Fund. Amends the State Finance Act. Provides for the dissolution of the Medicaid Technical Assistance Center Fund on July 1, 2026, or as soon thereafter as practical, after the transfer of all remaining funds into the Healthcare Provider Relief Fund. Effective July 1, 2026.

Amends the Code of Civil Procedure. Creates an authorization and form for the release of an incapacitated person's health care records. Provides that an incapacitated person's health care records must be released upon written request of the guardian of the incapacitated person or by an agent appointed by the incapacitated person under a power of attorney for health care. Provides that, if no guardian or agent exists and the incapacitated person did not specifically object to disclosure of the incapacitated person's records in writing, then an incapacitated person's health care records must be released upon the written request of a person in one of these categories: (1) the incapacitated person's spouse; or (2) if there is no spouse, any one or more of the following: (i) an adult child of the incapacitated person, (ii) a parent of the incapacitated person, or (iii) an adult sibling of the incapacitated person. Provides that the named authorized relative upon request for records of a incapacitated person, shall provide the facility or practitioner with a statement of a treating health care provider that the person is incapacitated. Effective immediately.

Amends the Substance Use Disorder Treatment for Criminal Justice Clients Article of the Substance Use Disorder Act. Changes references from "treatment" to "case management" and changes the name of the Article. Provides that nothing in provisions concerning case management shall preclude any individual with a substance use disorder who is charged with or convicted of a crime from receiving case management services with a designated program if such services are ordered by the court. Provides that the court, with the consent of the defendant and the State's Attorney, may, without entering a judgment, sentence the defendant to probation under a provision concerning case management as a condition of probation. Provides that the sentence to probation under the provisions shall not be considered a conviction under Illinois law unless and until judgment is entered upon violation of a term or condition of probation. Provides that, upon fulfillment of the terms and conditions of probation, the court shall discharge the person and dismiss the proceedings against the person. Provides that case management services by a designated program may be made a condition of pretrial release, and failure to comply with such services may be treated as a violation of a condition of pretrial release. Requires the designated program to make periodic progress reports regarding each such defendant to the appropriate pretrial services agency or Office of Statewide Pretrial Services and to report failures to comply with the requirements of the designated program. Makes conforming and other changes.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Removes provisions requiring the Department of Healthcare and Family Services to: (i) establish benchmarks for hospitals to measure and align payments to reduce potentially preventable hospital readmissions, inpatient complications, and unnecessary emergency room visits; (ii) publish provider-specific historical readmission data and anticipated potentially preventable targets 60 days prior to the start of the program; and (iii) adopt policies and rates of reimbursement for readmission services and other payments.

Creates the Sexual Orientation, Gender Identity, and Gender Expression in Long-Term Care Bill of Rights Act. Establishes rights for a client who lives in a long-term care facility, or who receives home care services from a home care provider, from discrimination on the basis of actual or perceived sex, actual or perceived sexual orientation, actual or perceived gender identity, actual or perceived gender expression, or actual or perceived HIV status. Provides that an aggrieved person may enforce violations of the Act against a long-term care facility or a home care provider and the staff of the long-term care facility or home care provider through a civil action. Sets forth provisions concerning gender identity in client records; required training for all long-term care facilities and home care providers; arbitration agreements; interpretation of the Act; and enforcement of rights, including civil penalties and other administrative actions. Amends the Assisted Living and Shared Housing Act, the Nursing Home Care Act, and the Home Health, Home Services, and Home Nursing Agency Licensing Act to require compliance with the Sexual orientation, Gender Identity, and Gender Expression in Long-Term Care Bill of Rights Act. Amends the Adult Protective Services Act to include intentional misgendering and unlawful discrimination in the definition of "abuse".

Amends the Illinois Insurance Code. Provides that coverage for treatment in a residential treatment center shall include residential coverage for the diagnosis and treatment of substance use disorders. Provides that this coverage shall include unlimited medically necessary treatment for substance use disorder treatment services provided in residential settings. Prohibits the coverage from applying financial requirements or treatment limitations to residential substance use disorder benefits that are more restrictive than the predominant financial requirements and treatment limitations applied to other medical and surgical benefits covered by the policy. Sets forth provisions concerning cost sharing; application of coverage requirements; prior authorization; clinical review; discharge plans; other forms of utilization review; and the criteria for medical necessity determinations.

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, 2026 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 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 group or individual policy of accident or health insurance that is issued, amended, delivered, or renewed on or after January 1, 2027 shall not charge insured persons a copayment as a method of cost-sharing or include a deductible greater than $1,000. Provides that yearly out-of-pocket expenses for insured persons must be less than or equal to $1,500. 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 Substance Use Disorder Act. Requires the Department of Human Services to establish a mechanism to collect research and data regarding overdose prevention sites (OPSs) and prepare a report for the General Assembly within 12 months after the effective date of the amendatory Act. Provides that the report shall contain information on (1) current research on the effectiveness of an OPS as an overdose prevention strategy; (2) OPS best practices for staffing, placement, and activities; and (3) the benefits and challenges of different OPS models - structures and settings. Requires the Department, in collaboration with people with lived experience, to develop a pilot service, subject to available funding, aimed at saving the lives of people who use substances that shall include the establishment of at least one OPS. Requires the pilot OPSs to offer people, who are most likely to use drugs in public, unobserved, high-risk, and unsanitary locations, a safe space to use pre-obtained substances and connect to community supports or other existing treatment and recovery programs, harm reduction services, and health care. Contains provisions concerning certain principles pilot OPSs must abide by; OPS staffing and location requirements; pilot OPS services; and other matters. Permits the Department to approve an entity to operate a pilot program in one or more jurisdictions. Grants criminal and civil immunity to persons who use pilot OPSs services; pilot OPS staff; and any real property owner upon which the OPS site is located or operates. Contains provisions on public awareness outreach; OPS reporting requirements; home rule exemption; and other matters. Effective immediately.