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 requirement plan. Provides that by using reports and data provided by the Department of Healthcare and Family Service's 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 Illinois Insurance Code. In provisions concerning biomarker testing: makes changes to defined terms; requires applicable health insurers, nonprofit health service plans, and health maintenance organizations to update and make publicly available medical policies and coverage guidelines within 90 days after the effective date of the amendatory Act; provides that, if a health insurer or nonprofit health service plan denies a claim for coverage of testing that is supported by any specified evidence, the insurer or nonprofit health service plan shall provide to the requesting entity specific written justification explaining in detail why the claim for coverage was denied as it pertains to the individual for whom the test was ordered; sets forth provisions concerning utilization review and prior authorization; provides that the Department of Insurance may conduct periodic audits and reviews to ensure entity compliance; and makes other changes.

Amends the Mental Health and Developmental Disabilities Administrative Act. Requires the Department of Human Service to publish annually, beginning January 1, 2027, the assessment instruments used by the Department's Bureau of Accreditation, Licensure, and Certification to survey and license providers of community-integrated living arrangement homes for individuals with intellectual or developmental disabilities. Requires rulemaking. Effective immediately.

Amends the Emergency Medical Services (EMS) Systems Act. Provides that the Department of Public Health shall allow for an alternative rural staffing model for vehicle service providers that serve a rural or semi-rural population of 10,000 or fewer inhabitants and exclusively use volunteers, paid-on-call, or part-time employees, or a combination thereof (now, the use of part-time employees is not an option). Effective immediately.

Amends the Mental Health and Developmental Disabilities Administrative Act. Provides that beginning July 1, 2026, the Department of Human Services shall reissue the original cost and wage survey for costs associated with the administration of services to persons with intellectual and developmental disabilities in community day services that was contained in the Department's Guidehouse Rate Study. Provides that the cost and wage survey shall be used to effectuate rate increases in transportation funding for the administration of community day services to persons with intellectual and developmental disabilities and may include provider contact information, total costs of employee salaries and benefits, staff turnover, and other information. Requires the Department to adopt rules. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to file an amendment to the Home and Community-Based Services Waiver Program for Adults with Developmental Disabilities that removes the 5 hour per day billing maximums at community day services. Provides that the amendment shall not modify monthly and yearly billing maximums for community day services. Provides that implementation is contingent on federal approval. Effective July 1, 2026.

Amends the Mental Health and Developmental Disabilities Administrative Act. Requires the Department of Human Services to file an amendment to the Home and Community-Based Services Waiver Program for Adults with Developmental Disabilities that shall include an increase in the rate methodology sufficient to provide for a wage rate of 150% of the statewide, regional, or local minimum wage for services delivered on or after January 1, 2027, for all direct support personnel and all other frontline personnel who are not subject to the Bureau of Labor Statistics' average wage increases and who work in residential and community day services settings. Provides that for services delivered on or after January 1, 2027, the rates shall include adjustments to employment-related expenses as defined by rule by the Department. Requires the Department to adopt rules, including emergency rules, to implement the rate increases. Contains provisions on benchmark rates for therapy and counseling for adults with intellectual and developmental disabilities; tiered rates for community day services; community integration supports for community day services; and benchmark rates for CILA transportation cost and for the supported employment program for adults with intellectual and developmental disabilities. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to submit a Title XIX State Plan amendment to the federal Centers for Medicare and Medicaid Services that shall include an increase in the rate methodology sufficient to provide for a wage rate of 150% of the statewide, regional, or local minimum wage for services delivered on or after January 1, 2027, for all direct support personnel and all other frontline personnel at ID/DD and MC/DD facilities. Provides that the State Plan amendment shall provide wage increases for all residential non-executive direct care staff. Effective immediately.

Creates the Community Mental Health Workforce Paid Internship Act. Requires the Department of Human Services to establish the Community Mental Health Workforce Paid Internship Program to provide funding to eligible entities to support paid internships for non-clinical staff positions within a community mental health organization. Requires the Department to develop the necessary application procedures and standards for acceptance for eligible entities, including, but not limited to, consideration of (1) workforce shortages; (2) service to underserved or rural communities; (3) commitment to training, supervision, and mentorship of interns; and (4) efforts to promote workforce development. Sets forth internship requirements and the permissible uses for funds awarded under the program. Requires eligible entities to submit yearly reports to the Department outlining (1) number of interns hired; (2) duration of internships; (3) positions of internships; and (4) employment outcomes, such as retention, following internship. Requires the Department to submit a report, every 2 years, to the General Assembly outlining the program's outcomes and impact. Grants the Department rulemaking authority. Provides that the General Assembly may appropriate funds for the purposes of the Act. Effective July 1, 2026.

Prohibits health insurance issuers from specifying or describing personal sensitive health care information in any explanation of benefits, summary of payments, claims history, or any other communication or record relating to payment or coverage of services or procedures involving sensitive health care information for an insured member other than the insured subscriber, unless the insured member receiving the service or procedure clearly makes a request orally or in writing to not suppress information relating to sensitive health care. Grants the Department of Insurance rulemaking authority. Provides that the Department of Insurance, in collaboration with the Department of Public Health, shall develop and implement a plan to educate health care providers and consumers regarding the rights of insured members and the responsibilities of health insurance issuers to promote compliance with the stated requirements. 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 requirements in the provisions of those Acts. Effective one year after becoming law.

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 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.