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.
Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning provider reimbursement rates for medically fragile and technology dependent children, provides that subject to federal approval, on and after January 1, 2026, the reimbursement rates for nursing paid through Nursing and Personal Care Services for non-waiver customers and to providers of private duty nursing services for children eligible for medical assistance shall be 3.5% higher than the reimbursement rates in effect for nursing services on December 31, 2025. Effective immediately.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that hypoallergenic formula shall be covered under the medical assistance program for persons otherwise eligible for medical assistance who have been prescribed hypoallergenic formula by a physician. Requires the Department of Healthcare and Family Services to apply for any federal waivers or approvals necessary to implement the amendatory Act. Provides that upon federal approval, the Department shall at a minimum determine by rule the amount of hypoallergenic formula an eligible person shall receive coverage for per day.
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.
