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 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.

Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Requires the Department of Public Health to establish the Abortion Access Fund Grant Program to award grants from the Abortion Access Fund to support access to abortion care services throughout the State. Provides that grants awarded under the Program shall only be used to fund abortion services for which the use of federal funds is prohibited for patients who are uninsured or underinsured with respect to those services. Allows the Department to establish rules necessary to implement the Abortion Access Fund Grant Program, including eligibility criteria, grant limits, application standards, requirements for the distribution and obligation of grant funds, accounting for the use of the funds, and standards for monitoring compliance with the requirements of the Program. Amends the State Finance Act to create the Abortion Access Fund as a special fund in the State treasury. Amends the Illinois Health Benefits Exchange Law. Requires specified health insurance issuers that have offered one or more qualified health plans through the Illinois Health Benefits Exchange to report to the Department of Insurance an accounting of receipts, disbursements, transfers of funds between accounts, total dollar claims paid, accrued interest, and the year-end balance for each reporting year for the separate allocation accounts that the issuer has established under specified provisions of federal law for abortion services for which federal funding is prohibited. Establishes further reporting requirements for health insurance issuers. Provides that, if the amount of premiums collected during the plan year for abortion services for which federal funding is prohibited exceeds total claims paid for such services rendered during the plan year, the Director of Insurance shall order the health insurance issuer to transfer funds, and the issuer shall complete the transfer, to the Abortion Access Fund. Makes other changes. Effective immediately.

Appropriates $10,000,000 from the General Revenue Fund to the Department of Human Services for the Housing is Recovery Program to support rental assistance for individuals with mental health and substance use challenges who are experiencing homelessness. Effective July 1, 2026.

Amends the Accident and Health Article of the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2028 shall cover a medically necessary coronary calcium scan and scoring every 36 months for individuals over the age of 40. Defines "coronary calcium scan and scoring". Makes conforming changes in 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 Medical Assistance Article of the Illinois Public Aid Code. Effective January 1, 2027.

Amends the Hospital Licensing Act. Prior to discharge of a postpartum patient, requires a hospital to ensure that a postpartum follow-up appointment is scheduled with an appropriate obstetric care provider. Provides that the appointment shall be scheduled for a date consistent with clinical guidelines, but no later than 6 weeks following birth, unless an earlier visit is medically indicated. Provides that a registered nurse or other designated clinical staff member may fulfill the scheduling requirement. Provides that a patient may decline to have an appointment scheduled, and such declination shall be documented in the patient's medical record. Establishes specified exemptions from discipline if an attempt to schedule an appointment was made. Grants the Department of Public Health rulemaking authority. Amends the University of Illinois Hospital Act to establish the same requirements for the University of Illinois Hospital. Effective January 1, 2027.

Amends the Mental Health and Developmental Disabilities Code. In provisions concerning petitions for involuntary admissions on an outpatient basis, adds a nurse practitioner to the list of examiners who may certify that an individual is subject to involuntary admission on an outpatient basis. Adds provisions that a certificate must contain the clinical observations of the examining psychiatrist or nurse practitioner when applicable. Reduces the number of certificates (from 2 to one) needed for a court to set a hearing without additional examination of the individual.

Amends the Substance Use Disorder Treatment for Criminal Justice Clients Article of the Substance Use Disorder Act. Changes references from "treatment" to "case management" and changes the name of the Article. Provides that nothing in provisions concerning case management shall preclude any individual with a substance use disorder who is charged with or convicted of a crime from receiving case management services with a designated program if such services are ordered by the court. Provides that the court, with the consent of the defendant and the State's Attorney, may, without entering a judgment, sentence the defendant to probation under a provision concerning case management as a condition of probation. Provides that the sentence to probation under the provisions shall not be considered a conviction under Illinois law unless and until judgment is entered upon violation of a term or condition of probation. Provides that, upon fulfillment of the terms and conditions of probation, the court shall discharge the person and dismiss the proceedings against the person. Provides that case management services by a designated program may be made a condition of pretrial release, and failure to comply with such services may be treated as a violation of a condition of pretrial release. Requires the designated program to make periodic progress reports regarding each such defendant to the appropriate pretrial services agency or Office of Statewide Pretrial Services and to report failures to comply with the requirements of the designated program. Makes conforming and other changes.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after January 1, 2027, certain services shall be eligible for reimbursement at approved programs through the Brain Injury waiver for eligible individuals over the age of 21, including, but not limited to: (1) case management; (2) nursing services; (3) medical oversight by consulting medical director; (4) physical therapy; and (5) occupational therapy. Requires the Department of Human Services to reimburse approved programs at the rates in effect for the Home and Community-Based Services Waiver program most recently approved. Effective January 1, 2027.