Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning medical assistance for employed persons with disabilities and employed persons with a medically improved disability, provides that, subject to federal approval, the Department of Healthcare and Family Services shall eliminate income eligibility standards for such persons to the extent permitted by federal law and shall eliminate the consideration of assets when determining such persons eligibility for medical assistance to the extent permitted by federal law.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to require Medicaid managed care organizations to reimburse at no less than 100% of the Medical Assistance program's Durable Medical Equipment fee schedule for the same service or item of durable medical equipment, complex rehab technology, prosthetics, orthotics, or supplies. Provides that the reimbursement requirement shall also apply to a Medicaid managed care organization's subcontractors and third-party administrators. Provides that the Department has the authority to implement the reimbursement requirement on and after July 1, 2025 and prior to the completion of any regulatory process undertaken in order to effect such change. Effective July 1, 2025.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that on January 1, 2026 the reimbursement rates for applied behavior analysis services for the treatment of autism spectrum disorder shall be increased by 3.5% above the reimbursement rates in effect on December 31, 2025.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Removes a provision that requires the termination of medical assistance for childless adults who do not otherwise qualify for assistance if Illinois' federal medical assistance percentage for such persons is reduced below 90%. Effective immediately.
Provides that, if and only if House Bill 4907 of the 103rd General Assembly becomes law, then the Medical Assistance Article of the Illinois Public Aid Code is amended by adding new provisions concerning PDPM Strive staffing ratio calculations for nursing facilities. Provides that, beginning January 1, 2026, the staffing percentage used in the calculation of the per diem staffing add-on shall be its PDPM STRIVE Staffing Ratio. Sets forth how to calculate a nursing facility's PDPM STRIVE Staffing Ratio, PDPM STRIVE Staffing Target, Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day, and STRIVE staffing fee schedule. Effective immediately or on the date House Bill 4907 of the 103rd General Assembly takes effect, whichever is later.
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. 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.
