Healthcare

Amends the Sexual Assault Survivors Emergency Treatment Act. Provides that a minor who is present at a child advocacy center in the State following disclosure or suspicion of sexual assault shall be eligible to receive a sexual assault services voucher, regardless of the minor's insurance status. Provides that the sexual assault services voucher for a minor may be used for specified circumstances. Allows for rulemaking by the Department of Children and Family Services and the Department of Human Services. Requires each child advocacy center that issues sexual assault services vouchers to submit an annual report to the Department of Children and Family Services. Effective January 1, 2027.

Amends the Mental Health and Developmental Disabilities Code. Provides that whenever psychotropic medication or electroconvulsive therapy is refused under a specified provision at least once that day, the psychiatrist or advanced practice psychiatric nurse (instead of the physician) shall determine and state in writing the reasons why the recipient did not meet the criteria for the administration of medication or electroconvulsive therapy and whether the recipient meets the standard for administration of psychotropic medication or electroconvulsive therapy under a provision concerning the administration of psychotropic medication and electroconvulsive therapy upon application to a court. Provides that a petition requesting that the court authorize treatment with psychotropic medication shall specify the full names of the medications and anticipated range of dosage that comprise such treatment. Provides that no administration of psychotropic medication or electroconvulsive therapy without the informed consent of the recipient may be authorized unless at least one psychiatrist or advanced practice psychiatric nurse who has examined the recipient testifies in person at the hearing. Makes other changes to definitions and provisions concerning administration of psychotropic medication and electroconvulsive therapy upon application to a court.

Amends the Assisted Living and Shared Housing Act, the MC/DD Act, and the ID/DD Community Care Act. Provides that notice of closure of an establishment or facility licensed under those Acts shall be given to the Office of the State Long Term Care Ombudsman.

Amends the Hospital Provider Funding Article of the Illinois Public Aid Code. Provides that, beginning January 1, 2027, if an Illinois freestanding psychiatric hospital reopens a previously closed hospital facility within 4 calendar years of that hospital facility's closure, and the previously closed hospital facility qualified for fee-for-service supplemental payments, then the Illinois freestanding psychiatric hospital shall receive an annual payment equal to $200 per covered inpatient day contained in paid fee-for-service claims and $200 per paid fee-for-service outpatient claim for dates of service of the closed hospital facility in Calendar Year 2019 in the Department of Healthcare and Family Services' Enterprise Data Warehouse as of May 11, 2020. Provides that "closed hospital facility" includes hospitals that have been terminated from participation in the medical assistance program. Effective immediately.

Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning the supportive living facilities program, prohibits a supportive living dementia care setting from limiting a resident's access to the sink, microwave, or refrigerator located within the respective resident's room, provided a comprehensive safety assessment deems the resident's use of the appliances safe. Requires the comprehensive safety assessment to be conducted prior to any resident moving in and at least once per quarter thereafter. Requires social and recreational programming to be provided no less than 3 times daily, including at least one time and location separate from a meal service. Requires newly constructed supportive living dementia care settings to provide no less than 300 square feet for a single occupancy apartment or no less than 450 square feet for a double occupancy apartment, which may include the closets and bathroom. Requires each apartment to include a sink, microwave, and refrigerator within the unit. Provides that any newly constructed supportive living dementia care setting shall provide a common area completely separate from the dining area.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that beginning October 1, 2026, for rate year 2027 and thereafter, the Medicaid inpatient utilization rate, as defined and used in the determination of eligibility for specified inpatient adjustment payments to hospitals, shall be modified to exclude, from both the numerator and denominator, all days reimbursed by the Department of Human Services for mental health services provided under a specified provision of the Code of Criminal Procedure of 1963 as contracted by the Department of Healthcare and Family Services. Effective immediately.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to adopt rules that require managed care organizations (MCOs) to utilize a universal provider application developed by a council for affordable quality healthcare, as defined, for the purpose of credentialing a health care professional or a health care provider who seeks to participate in an MCO's provider network. Provides that the rules may also require the use of a CAQH application for the renewal of credentials; and that the Department may revise the CAQH universal provider application or the application for renewal of credentials to conform to industry or national standards for credentialing health care professionals or health care providers. Provides that within 180 days after the adoption of rules, health and dental plan carriers must accept the universal provider application and the application for the renewal of credentials approved by the Department. Requires all MCOs to provide a provider network consultant to act as a liaison between a health care provider and the MCO. Require the Department to employ provider enrollment consultants to assist health care providers with enrollment in the Illinois Medicaid Program Advanced Cloud Technology system, help navigate the enrollment and provider credentialing process by serving as the liaison between health care providers and MCOs, and other matters. Amends the Illinois Insurance Code. In provisions concerning recoupments, requires a health care professional or health care provider to be provided a remittance advice that includes an explanation of a recoupment or offset taken by a managed care organization. Removes provisions permitting insurers contracted with the Department of Healthcare and Family Services to recoup or offset payments due to a federal Medicaid requirement. Provides that no contract between an MCO and health care professional or provider may provide for recoupments in violation of the Code. Effective January 1, 2027.

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 Limited Health Service Organization Act. Makes changes to defined terms. In provisions concerning the offering of a point-of-sale contract by a limited health service organization (LHSO), removes a provision requiring the LHSO to include an annual maximum benefit allowance not to exceed $2,500 per year that is separate from any limits or allowances applied to in-plan services. Provides that, if an LHSO expends in any calendar quarter more than 20% of its total limited health services expenditures for all its members for out-of-plan covered services, then specified limitations shall not apply subject to the LHSO minimum capital and surplus requirements applicable to a life, accident, and health insurance company. Makes other changes.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for dates of service beginning on and after January 1, 2027, the Department of Healthcare and Family Services shall, for healthcare common procedure coding system codes relating to complex rehabilitation technology wheelchair repair and accessories, apply a reimbursement rate under the Medical Assistance program equivalent to the maximum fee paid in Illinois under the federal Medicare program, including fees under the KU modifier, if applicable. Effective immediately.