Healthcare

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.

Creates the Limitations on Facility Fees Act. Provides that no health care provider shall charge, bill, or collect a facility fee, except for: (i) services provided on a hospital's campus; (ii) services provided at a facility that includes a licensed hospital emergency department; or (iii) emergency services provided at a freestanding emergency center. Provides that, except as specified, no health care provider shall charge, bill, or collect a facility fee for: (i) outpatient evaluation and management services; or (ii) any other outpatient, diagnostic, or imaging services identified by the Department of Public Health. Requires the Department to annually identify services subject to the limitations on specified facility fees that may reliably be provided safely and effectively in settings other than hospitals. Sets forth provisions concerning reporting, rulemaking, and enforcement of the Act. Amends the Fair Patient Billing Act to make a conforming change. Amends the Consumer Fraud and Deceptive Business Practices Act. Provides that any person who violates the Limitations on Facility Fees Act commits an unlawful practice.

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.

Amends the Hospital Licensing Act. Provides that, upon request by a patient, a hospital must transfer the patient to the requested health care facility, regardless of whether the facility is part of the hospital's health care network. Effective immediately.

Amends the Hospital Licensing Act. Provides that a hospital that operates an emergency department shall not use health care kiosks in the hospital's emergency department to assess or determine a patient's medical state, to determine the priority level of a patient's injuries or illness, or to otherwise triage patients. Provides that health care kiosks may be used for data entry of a patient's personal identifying information and billing information in place of paper forms. Amends the University of Illinois Hospital Act to set forth conforming requirements for a University of Illinois Hospital emergency department. Effective January 1, 2027.

Amends the Pharmacy Practice Act. Defines "retail pharmacy". Provides that a retail pharmacy that, on average, receives 150 or more prescription drug orders during its operating hours must satisfy one of the following requirements during all times that the pharmacy remains open for the transaction of business: (1) a pharmacist is present at the location and working in his or her capacity as a pharmacist, or (2) a registered pharmacy technician, registered certified pharmacy technician, student pharmacist, or other supportive staff that is authorized to sell prescriptions is present at the location and working in that capacity pursuant to provisions concerning pharmacy working conditions.

Creates the Health Care Availability and Access Board Act. Establishes the Health Care Availability and Access Board to protect State residents, State and local governments, commercial health plans, health care providers, pharmacies licensed in the State, and other stakeholders within the health care system from the high costs of prescription drug products. Contains provisions concerning Board membership and terms; staff for the Board; Board meetings; circumstances under which Board members must recuse themselves; and other matters. Provides that the Board shall perform the following actions in open session: (i) deliberations on whether to subject a prescription drug product to a cost review; and (ii) any vote on whether to impose an upper payment limit on purchases, payments, and payor reimbursements of prescription drug products in the State. Permits the Board to adopt rules to implement the Act and to enter into a contract with a qualified, independent third party for any service necessary to carry out the powers and duties of the Board. Creates the Health Care Availability and Access Stakeholder Council to provide stakeholder input to assist the Board in making decisions as required by the Act. Contains provisions concerning Council membership, member terms, and other matters. Provides that the Board shall adopt the federal Medicare Maximum Fair Price as the upper payment limit for a prescription drug product intended for use by individuals in the State. Prohibits the Board from creating an upper payment limit that is different from the Medicare Maximum Fair Price for the prescription drug product that has a Medicare Maximum Fair Price. Requires the Board to implement an upper payment limit that is the same as the Medicare Maximum Fair Price no sooner than the Medicare implementation date. Provides that Medicare Part C and D plans are not required to reimburse at the upper payment limit. Provides that the Attorney General may enforce the Act and may pursue any available remedy under State law when enforcing the Act. Effective 180 days after becoming law.

Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Requires the Department of Public Health to establish the Abortion Access Fund Grant Program to award grants from the Abortion Access Fund to support access to abortion care services throughout the State. Provides that grants awarded under the Program shall only be used to fund abortion services for which the use of federal funds is prohibited for patients who are uninsured or underinsured with respect to those services. Allows the Department to establish rules necessary to implement the Abortion Access Fund Grant Program, including eligibility criteria, grant limits, application standards, requirements for the distribution and obligation of grant funds, accounting for the use of the funds, and standards for monitoring compliance with the requirements of the Program. Amends the State Finance Act to create the Abortion Access Fund as a special fund in the State treasury. Amends the Illinois Health Benefits Exchange Law. Requires specified health insurance issuers that have offered one or more qualified health plans through the Illinois Health Benefits Exchange to report to the Department of Insurance an accounting of receipts, disbursements, transfers of funds between accounts, total dollar claims paid, accrued interest, and the year-end balance for each reporting year for the separate allocation accounts that the issuer has established under specified provisions of federal law for abortion services for which federal funding is prohibited. Establishes further reporting requirements for health insurance issuers. Provides that, if the amount of premiums collected during the plan year for abortion services for which federal funding is prohibited exceeds total claims paid for such services rendered during the plan year, the Director of Insurance shall order the health insurance issuer to transfer funds, and the issuer shall complete the transfer, to the Abortion Access Fund. Makes other changes. Effective immediately.

Amends the Illinois Insurance Code. In a provision requiring policies of group accident and health insurance to provide coverage for certain examination and testing services provided to a victim of specified criminal offenses, prohibits the policy from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided, except to the extent that the coverage would disqualify a high-deductible health plan from eligibility for a health savings account under the Internal Revenue Code. Effective January 1, 2026.

Opposes Illinois Senate Bill 3572 (SB3572). Opposes any effort to punish women for accessing reproductive healthcare, efforts to subject survivors of rape and incest to more severe punishments than a rapist, and efforts to restrict access to in vitro fertilization (IVF) and other forms of assisted reproductive technology.