Healthcare

Creates the Alpha-Gal Syndrome Reporting Act. Directs the Department of Public Health to adopt rules to track cases of alpha-gal syndrome within counties and statewide. Requires medical reporters to report diagnosed cases of alpha-gal syndrome to the Department. Provides that State reporting and tracking of cases of alpha-gal syndrome shall be independent from or concurrent with federal reporting or tracking, and that the Department has the duty to independently track cases in consultation and coordination with federal agencies. Directs the Department to adopt rules requiring a report of alpha-gal syndrome for an alpha-gal immunoglobulin E level of 0.1 kilounits per liter as a suspected case of alpha-gal syndrome through an electronic laboratory reporting system. Directs the Department to follow up on reported suspected cases. Directs the Department to submit an annual report to the Centers for Disease Control and Prevention and to publish the results of the tracking of cases of alpha-gal syndrome on the Department's website. Makes findings. Defines terms.

Amends the State Employees Group Insurance Act of 1971. Requires the Director of Central Management Services to designate one or more individuals who are employees of the Department of Central Management Services to serve as Health Care Ombudspersons. Requires the employees that are designated as Health Care Ombudspersons to monitor and respond to members' email and telephone questions to the Department of Central Management Services regarding the benefits that are available under the Act and the eligibility of members for those benefits. Requires contact information for the Health Care Ombudspersons to be included in any communications sent by the Department of Central Management Services regarding group health insurance benefits and to be readily available on the Department's website. Specifies that the primary goal of the Health Care Ombudspersons shall be to answer questions and generate information useful to participants in the program of group health benefits provided under the Act and, when possible, to resolve any issues between members and third-party providers of services established under this Act.

Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. In provisions regarding a Safety-Net Hospital Health Equity and Access Leadership (HEAL) Grant Program, changes references to safety-net hospitals to references to community safety-net hospitals. Updates references to dates in those provisions. Defines "community safety-net hospital", "health system", and "medically underserved area". Makes changes to required provisions in the report to the General Assembly regarding criteria for a community safety-net hospital to be eligible for the program, deletes required provisions in the report to the General Assembly regarding potential projects eligible for grant funds, and adds required provisions in the report to the General Assembly regarding an application process and criteria, as well as policies, standards, and procedures to administer the program and ensure accountability.

Amends the Illinois Insurance Code. Provides that any policy of insurance amended, delivered, issued, or renewed on or after January 1, 2027 that provides coverage for emergency services for medical or surgical conditions shall also provide coverage for behavioral health emergency services on coverage terms no more restrictive than those applied to emergency services for medical or surgical conditions. Requires coverage for post-stabilization services. Sets forth provisions concerning behavioral health emergency services parity; coverage of services provided by nonlicensed staff performing under direct supervision; restrictions on prior authorization, utilization review, and cost sharing; reimbursement rates; and rulemaking. Amends the Network Adequacy and Transparency Act. Includes behavioral health emergency services providers in network adequacy determinations under the Act. Establishes provisions concerning rulemaking for the Department of Insurance; behavioral health emergency services requirements for health insurance issuers; and enforcement coordination with specified federal law. Effective January 1, 2027.

Amends the Use Tax Act, the Service Use Tax Act, the Service Occupation Tax Act, and the Retailers' Occupation Tax Act. Provides that prescription medicines and products classified as Class III medical devices by the United States Food and Drug Administration that are used for cancer treatment pursuant to a prescription are exempt from the taxes under the Acts. Effective July 1, 2026.

Amends the Hospital Licensing Act. Provides that a hospital licensed under the Act shall not charge a covered hospital employee more than 10% of the total health insurance premium cost. Provides that any agreement permitting a charge to a covered hospital employee in excess of 10% of the total health insurance premium cost shall be deemed invalid, void, and unenforceable. Provides that a hospital in violation of those provisions shall pay a civil penalty of $500 to the Department of Public Health for each impacted covered hospital employee.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall provide coverage under the medical assistance program for intensive outpatient services delivered via telehealth when the services: (1) are otherwise covered when provided in person; (2) are medically necessary; (3) are delivered by a provider enrolled in the medical assistance program and acting within the scope of the provider's license, certification, or authorization under State law; and (4) comply with all applicable federal and State telehealth requirements. Provides that intensive outpatient services provided via telehealth shall be subject to the same coverage requirements, utilization management, and reimbursement methodologies as intensive outpatient services provided in person. Sets forth standards for telehealth delivery of intensive outpatient services. Provides that implementation of the provisions is subject to any required federal approval. Effective immediately.

Amends the Network Adequacy and Transparency Act. Replaces provisions concerning uniform electronic provider directory information forms. Provides that each provider shall notify all contracted health insurance issuers of any change to the provider's information. Provides that the health insurance issuer shall use the information to update its provider directory within the time frames required under the Act. Provides that nothing in the provisions shall prohibit a health insurance issuer from using its own process, platform, or electronic system to receive provider directory updates, so long as the system allows providers to submit the required information. Effective immediately.

Amends the Genetic Information Privacy Act. Removes language exempting insurers that are issuing a long-term care policy from specified provisions. Provides that, with regard to any policy, contract, or plan offered, entered into, issued, amended, or renewed on or after January 1, 2027 by a health insurer, life insurer, disability insurer, or long-term care insurer authorized to transact insurance in this State, a health insurer, life insurer, disability insurer, or long-term care insurer may not: (1) cancel, limit, or deny coverage or establish differentials in premium rates based on a person's genetic information; or (2) require or solicit an individual's genetic information, use an individual's genetic test results, or consider an individual's decisions or actions relating to genetic information or a genetic test in any manner for any insurance purpose. Provides that the provisions may not be construed as: (1) preventing a life insurer, disability insurer, or long-term care insurer from accessing an individual's medical record as part of an application; or (2) prohibiting a life insurer, disability insurer, or long-term care insurer from considering a clinical diagnosis, such as a manifest disease or disorder, included in an individual's medical record for insurance purposes to the extent otherwise allowable by law. Effective July 1, 2026.

Creates the Illinois All-Payer Health Care Payment and Global Budget Act. Creates the Illinois Health Care Cost and Payment Board as an independent body within the Department of Healthcare and Family Services and sets forth its membership and powers. Defines "commercial payer" as any health insurance issuer, health maintenance organization, or third-party administrator subject to regulation by the Illinois Department of Insurance, excluding self-funded plans governed solely by ERISA. Provides that all commercial payers shall reimburse hospitals for covered services at standardized rates established by the Board. Defines "global hospital budget" as a prospective, fixed annual operating revenue amount established for a hospital to cover all inpatient and outpatient hospital services. Provides that the Board shall establish prospective annual global hospital budgets for Illinois hospitals. Provides that the Board shall establish a unified health care data system in coordination with State agencies. Creates the Health Care Payment Reform Advisory Council to advise the Board. Provides that the Governor, in consultation with the Board, shall seek all necessary federal approvals, including Medicare demonstrations and Medicaid waivers, to implement the Act. Amends the Illinois Administrative Procedure Act, Hospital Licensing Act, Illinois Insurance Code, Health Maintenance Organization Act, and Illinois Public Aid Code with regard to the new Act. Contains a severability clause. Effective immediately.