Healthcare

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.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for dates of service starting January 1, 2027, reimbursement calculations and direct payments for services provided by facilities licensed under the ID/DD Community Care Act are the responsibility of the Department of Healthcare and Family Services. Provides that appropriations for facilities licensed under the ID/DD Community Care Act must be shifted from the Department of Human Services to the Department of Healthcare and Family Services. Provides that nothing in the amendatory Act shall prohibit the Department of Healthcare and Family Services from paying more than the rates specified in the amendatory Act. Provides that nothing in the amendatory Act shall affect certain reporting requirements under the ID/DD Community Care Act.

Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning the supportive living facilities program, provides that sites for the operation of the program shall be selected by the Department of Healthcare and Family Services based upon criteria that may include the need for services in a geographic area, the availability of funding, the site's ability to meet the standards, and a need to increase access for Medicaid enrollees who need an alternative to nursing home care. Requires the Department to determine need utilizing the most recently available statewide report every 3 years, and to also consider the occupancy rates, vacancies, and waiting lists in surrounding operational supportive living program sites, and public comments. Provides that based on need, the Department shall make the final determination to establish geographic areas utilizing county or zip code-based geographic areas within a rate setting region as the basis for opening a competitive application process. Contains provisions on the analysis and other information required in the statewide report; primary market areas for supportive living program sites; and other matters. Effective immediately.

Amends the Illinois Insurance Code. Sets forth provisions concerning minimum reimbursement rates that a health insurance company must provide for a physician providing health care services in the specified counties. Prohibits a physician from waiving minimum reimbursement protections as a condition of participation in a health benefit plan or for any other reason. Grants the Department of Insurance rulemaking authority and establishes penalty provisions for violations of the minimum reimbursement provisions.

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.