Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision prohibiting prior authorization mandates and utilization management controls under the fee-for-service and managed care medical assistance programs for FDA-approved prescription drugs that treat mental illness, requires the Department of Healthcare and Family Services and managed care organizations to report quarterly on compliance with the specified prohibitions beginning with dates of service on and after July 1, 2025. Requires the Department to post on its website a report on fee-for-service prescriptions and the reports from each managed care organization. Sets forth the information that must be contained in the quarterly reports, including, but not limited to: (i) the number of denied prescriptions and estimated net cost to the State for those covered prescriptions summarized by each of the allowed categories specified in the Code; (ii) the number of denied prescriptions and estimated net cost to the State for those prescriptions summarized by each of the non-allowed categories specified in the Code; and (iii) the number of denied prescriptions and estimated gross cost to the State for those prescriptions summarized by any other reason not specified in the Code. Requires the Department to sanction those managed care organizations that do not file the required reports. Effective immediately.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that no later than July 1, 2025, over-the-counter choline dietary supplements for pregnant persons shall be covered under the medical assistance program. Effective immediately.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that upon application to the Department of Healthcare and Family Services, supportive living program settings may convert non-dementia care setting units to dementia care setting units. Provides that all conversions must be operational within one year of approval and meet criteria specific to certification for dementia care setting units outlined in the Illinois Administrative Code.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to develop, in collaboration with the Department of Human Services and the Department of Public Health, recommended screening guidelines for tardive dyskinesia for providers serving patients prescribed antipsychotic medications under the medical assistance program in State-operated residential facilities and community-based settings. Provides that the recommended screening guidelines shall be based on current, nationally accepted, evidence-based recommendations for the assessment and treatment of tardive dyskinesia, and shall include structured assessment tools, which can be both quantitative and qualitative. Requires the Department of Healthcare and Family Services and the Department of Human Services, in collaboration with the Department of Public Health, to develop communication strategies and educational materials to be offered to health care providers regarding tardive dyskinesia, the recommended screening guidelines, and any subsequent revisions. Provides that in developing the information to be disseminated, the Departments of Healthcare and Family Services, Human Services, and Public Health shall consult with a statewide association representing physicians licensed to practice medicine in all its branches and a statewide association representing psychiatrists.
Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning Medicaid Access Adjustment payments to nursing facilities, provides that, for dates of service beginning July 1, 2025, the Medicaid Access Adjustment shall be increased to $5.75. Effective immediately.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that if the United States Supreme Court holds to be unconstitutional a provision under the Patient Protection and Affordable Care Act (Public Law 111-148) that prohibits a group health plan and health insurance issuer from establishing lifetime or annual limits on the dollar value of benefits, or if the holding makes Medicaid eligibility allowed under that specified provision inoperable, then the Department of Healthcare and Family Services shall fully cover the costs of medical assistance for individuals affected by that holding, subject to appropriation. Provides that the Department shall not require individuals receiving medical assistance to work a minimum amount of hours in order to receive benefits.
Creates the Access to Medically Necessary Vaccinations Act. Provides that any health care provider in this State must provide a vaccination to a patient if: the patient has requested the specific vaccination to be administered; the health care provider has determined that the vaccination is medically necessary; and the health care provider has a stock of one or more doses of the vaccination that have not been reserved for another patient. Prohibits a health care provider from preventing a medically necessary vaccination from being administered to a patient by keeping separate stocks of the vaccination for patients with private insurance and stocks of the vaccination for patients with Medicaid.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, beginning January 1, 2026, providers offering pediatric primary care shall be reimbursed at a rate that is no lower than 100% of the Medicare program's rates for preventative and screening services.
Urges the Illinois General Assembly to reconsider the repeal of the 2013 Medicaid funding trigger law and to protect those who may be impacted by federal Affordable Care Act (ACA) Medicaid funding cuts. Urges the Illinois General Assembly to take decisive budget actions in the healthcare arena and to aggressively advocate for Medicaid protection and expansion to ensure no vulnerable resident is left behind and no hospital, clinic, or emergency department is threatened out of existence.
Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions prohibiting prior authorization mandates and utilization management controls under the fee-for-service and managed care medical assistance programs on specified FDA-approved prescription drugs for mental illness, provides that the prohibition shall apply if a preferred or non-preferred drug is prescribed to an adult patient to treat a serious mental illness and (i) during the preceding 60 days, the patient who experienced an inadequate response was prescribed and unsuccessfully treated with a 14-day treatment trial of a drug for the same clinical condition that is included on the preferred drug list and (ii) one of the statutory conditions apply.
