Healthcare

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, 2027 shall provide coverage for all medically necessary diagnostic testing and U.S. Food and Drug Administration-approved treatments or medications prescribed to slow the progression of Alzheimer's disease or another related dementia, in accordance with the U.S. Food and Drug Administration label, as determined by a physician licensed to practice medicine in all its branches. Provides that coverage of U.S. Food and Drug Administration-approved treatments or medications prescribed to slow the progression of Alzheimer's disease or another related dementia shall not be subject to step therapy. Amends the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act to require coverage under those provisions. Effective immediately.

Amends the Illinois Insurance Code. Provides that any group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after January 1, 2027 shall provide coverage for emergency medical services delivered by an out-of-network provider on the same terms as coverage that would be provided for an in-network provider. Provides that this requirement does not apply if the services rendered are not covered for in-network providers. 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 Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services may provide medical assistance coverage to persons who are foreign-born victims of human trafficking, torture, or other serious crimes, and their derivative family members, if such persons meet certain residency and income requirements and meet one of the following conditions: (i) have filed an application for asylum status that is pending with the appropriate federal agency or have a pending appeal of such an application; (ii) are receiving services through a federally funded treatment center; (iii) have filed an application for T nonimmigrant status; (iv) have filed an application for U nonimmigrant status; or (v) have filed as a derivative family member of a T or U nonimmigrant status applicant. Removes language conditioning medical assistance eligibility for such persons on their eligibility for benefits under the Temporary Assistance for Needy Families Program and the Supplemental Nutrition Assistance Program.

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, 2027 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 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 those provisions. Amends the State Mandates Act to require implementation without reimbursement. 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 after January 1, 2026 shall provide coverage for one pair of custom-made retainers and one night guard every 2 years for each family covered by the policy. 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 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, 2027 shall be prohibited from limiting or excluding coverage of any prescription drug that an enrollee has been continuously using for a period of 6 months or more, so long as the prescription drug was selected by the enrollee's prescribing provider while the enrollee was covered by the enrollee's current or previous health plan. 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 Interagency Children's Behavioral Health Services Act. Requires the Department of Human Services, in coordination with a statewide association representing a majority of hospitals, to establish and offer a voluntary training that will be recorded and made available on the Department's website to all hospital social workers, clinicians, and administrative staff to inform them of BEACON, a centralized resource for Illinois youth and families seeking services for behavioral health needs, with the goal of encouraging families to seek assistance through BEACON and the Interagency Children's Behavioral Health Services Team. Provides that the training shall include how families and hospital staff can access BEACON, the process once a case is entered into BEACON, and State and community programs accessible through BEACON. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires a psychiatric hospital to contact a youth or the youth's parents, guardian, or caregiver about the BEACON portal (rather than the Family Support Program and the Specialized Family Support Program) prior to referring the youth to the Department of Children and Family Services because the youth was left at the psychiatric hospital beyond medical necessity. Amends the School Code. Requires the State Board of Education, in consultation with the Children's Behavioral Health Transformation Team in the Office of the Governor and relevant stakeholders, to report its work and make available resource materials, including model policies and guidance informed by a phased approach to implementing universal mental health screening in schools. Requires the State Board of Education to report its work by September 1, 2026. Provides that mental health screenings shall be offered by school districts to students enrolled in kindergarten through grade 12, at least once a year, beginning with the 2027-2028 school year.

Amends the Department of Insurance Law of the Civil Administrative Code of Illinois. Requires the Department of Insurance to conduct a study to better understand the gaps in health insurance coverage for uninsured residents, including the reasons why individuals are uninsured and whether insured individuals are insured through an employer-sponsored plan or through the Illinois health insurance marketplace. Requires the Department to submit a report of its findings and recommendations to the General Assembly 12 months after the effective date of the amendatory Act. Amends the Hospital Licensing Act and the University of Illinois Hospital Act. Provides that hospitals licensed under the Act shall provide health insurance coverage to all of their workforce.

Amends the Prior Authorization Reform Act. Provides that a chronic health condition is a condition that is expected to last on year or more and requires ongoing medical attention to effectively manage the condition or prevent an adverse health event limits one or more activities of daily living. Replaces "chronic or long-term condition" with "chronic health condition". Provides that, if a health insurance issuer requires a prior authorization for a recurring health care service or maintenance medication for the treatment of a chronic health condition, the approval shall remain valid from the date the health care professional or health care provider receives the prior authorization approval for the duration of the chronic health condition or the length of the treatment, as determined by the patient's health care professional, unless the standard of treatment for that health condition changes.

Amends the Public Safety Employee Benefits Act. Provides that, if the injured employee subsequently dies, the employer shall continue to pay the entire health insurance premium for the surviving spouse (rather than the surviving spouse until remarried) and for the dependent children under specified conditions.