Creates the Transparency in Downcoding Act. Provides that the Act applies to certain policies of health insurance amended, delivered, issued, or renewed on or after the effective date of the Act, except for employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974 and health care provided pursuant to the Workers' Compensation Act or the Workers' Occupational Diseases Act. Prohibits a health insurance issuer from using an automated process, system, or tool to downcode a claim; from downcoding a claim based solely on the reported diagnosis codes; and from using downcoding practices in a targeted or discriminatory manner against physicians who routinely treat patients with complex or chronic conditions. Requires downcoding decisions to be made by a physician licensed to practice medicine in all its branches in any United States jurisdiction and of the same or similar specialty as a physician who typically manages the medical condition or disease. Sets forth provisions concerning notification requirements for downcoded claims; the appeal process for downcoded claims; enforcement by the Department of Insurance; and penalties. Provides that any pattern or practice of discriminatory downcoding identified by the Director of Insurance or another regulatory authority shall be subject to enforcement actions, including fines, restitution, or suspension of the health insurance issuer's license in this State. Effective immediately.
Amends the Nurse Practice Act. Makes changes to the requirements for a registered professional nursing education program in provisions concerning the establishment of a new program, program policies, faculty members, training and development, the program's curriculum, the program's use of simulation, the accreditation process, approval by the Board of Nursing, and the program closure process. Makes a conforming change. Provides that the Department of Financial and Professional Regulation may, without hearing, rescind the license of any person who obtain a license after completing a program or obtaining credit from a program that does not meet the requirements of the provisions regarding registered professional nursing education programs. In provisions concerning nursing licensure by examination, removes the provision regarding the good standing period for professional nursing programs on probationary status.
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 Physician Assistant Practice Act of 1987. Provides that a physician assistant may prescribe, dispense, order, administer, and procure drugs and medical devices without delegation of authority by a physician. Provides that a physician assistant may practice without a written collaborative agreement. Provides that a physician assistant who files with the Department of Financial and Professional Regulation a notarized attestation of completion of at least 250 hours of AMA PRA Category 1 or equivalent continuing medical education or training and at least 2,000 hours of clinical experience in the specific field in which the physician assistant intends to practice after first attaining national certification shall not require a written collaborative agreement to practice. Makes changes in provisions concerning definitions; physician assistant title; collaboration requirements; written collaborative agreements, prescriptive authority, and physician assistants in hospitals, hospital affiliates, or ambulatory surgical treatment centers; inactive status; limitations; and grounds for disciplinary action. Amends the Illinois Controlled Substances Act to make corresponding changes.
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 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.
