Amends the Managed Care Organization Provider Assessment Article of the Illinois Public Aid Code. In provisions concerning tiered managed care assessment rates, provides that beginning July 1, 2026, the Department of Healthcare and Family Services may implement a tax that is based on uniform rates, determined at a level not to exceed limitations imposed by the federal Centers for Medicare and Medicaid Services, that may be set at either a percentage of premium revenue or on a per member per month basis. Removes a provision requiring any upward adjustment to the Tier 3 rate to be the minimum necessary to meet federal statistical tests. In the definition of "member months", removes language exempting enrollment in a Limited Health Services Organization, a Medicare Supplement Plan, or a Federal Employee Health Benefits Plan from the calculation of member months. Expands the definition of "managed care organization" to include an entity that operates as a preferred provider organization. Effective July 1, 2026.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services, beginning January 1, 2027, to recompute the STAR rating of nursing facilities who had their antipsychotic medication quality measure score suppressed and their STAR rating set to one due to audit action by the federal Centers for Medicare and Medicaid Services. Requires quality payments to such nursing facilities to be made based on the recomputed score. Provides that in order to facilitate the recomputation, nursing facilities may provide the Department with documentation regarding the status of the suppression of the score and STAR rating as well as the quarterly report issued by the federal Centers for Medicare and Medicaid Services that lists the long-stay rating points for the quarter.
Amends the Illinois Insurance Code. Provides that an issuer of a Medicare supplement policy shall not deny coverage to an applicant who voluntarily switches from a Medicare Advantage plan to a Medicare plan under Parts A, B, or D, or any combination of those plans, so long as the application for a Medicare supplement policy is submitted within 30 calendar days after the first effective day of the new plan. Provides that when such an application for a Medicare supplement policy is submitted, the issuer of the Medicare supplement policy may not charge a higher cost than what is normally offered to applicants who have become newly eligible for Medicare, nor raise costs or deny coverage for a preexisting condition.
Amends the State Employees Group Insurance Act of 1971. Provides that, by no later than January 1, 2028, the Department of Central Management Services shall, by rule, establish a program to allow the active members of TRS and their dependent beneficiaries to participate in the program of group health benefits made available under the Act to TRS benefit recipients and TRS dependent beneficiaries, including the program of group health benefits for Medicare-primary members and their Medicare-primary dependents, in lieu of health benefits otherwise provided by the school district. Provides that the Department of Central Management Services shall adopt any rules necessary to implement and administer the program, including, but not limited to, the manner of electing to participate in the program, eligibility for participation in the program, and contributions for coverage through the program. Effective immediately.
Amends the Illinois Act on the Aging. Provides that by January 1, 2026, the Department on Aging shall seek federal approval from the Centers for Medicare and Medicaid Services for any waiver or State Plan amendment necessary to provide monthly monitoring payments to care coordination units for each active participant enrolled in the Community Care Program who is receiving any allowable service and has not utilized services authorized by the care coordination unit or managed care organization for the month preceding the last month of services. Requires managed care organizations to remediate the full monthly monitoring payment to care coordination units that are providing services in accordance with the Act. Defines "active participant" to mean a person 60 years of age or older who has been found eligible to receive Community Care Program services. Provides that to receive administrative payments, a care coordination unit must provide documentation demonstrating that an effort has been made to contact the individual and confirm that the individual no longer needs services provided by the care coordination unit. Requires the Department to secure federal financial participation for expenditures made by the Department for State Fiscal Year 2026 and every State fiscal year thereafter. Effective immediately.
Amends the State Employees Group Insurance Act of 1971. Provides that, by no later than January 1, 2026, the Department of Central Management Services shall, by rule, establish a program to allow the active members of TRS and their dependent beneficiaries to participate in the program of group health benefits made available under the Act to TRS benefit recipients and TRS dependent beneficiaries, including the program of group health benefits for Medicare-primary members and their Medicare-primary dependents, in lieu of health benefits otherwise provided by the school district. Provides that the Department of Central Management Services shall adopt any rules necessary to implement and administer the program, including, but not limited to, the manner of electing to participate in the program, eligibility for participation in the program, and contributions for coverage through the program. Effective immediately.
Amends the Administration Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services, in consultation with the Department of Human Services, to submit the necessary application to the federal Centers for Medicare and Medicaid Services to amend the State's home and community-based services waiver programs for children and adults with developmental disabilities to provide coverage under the Home-Based Services Program for any therapeutic recreation programs offered by park districts, health clubs, and community colleges.
Amends the Mental Health and Developmental Disabilities Administrative Act. Requires the Department of Healthcare and Family Services, in collaboration with the Department of Human Services, to file an amendment to the Home and Community-Based Services Waiver Program for Adults with Developmental Disabilities that shall include an increase in the rate methodology sufficient to provide for a wage rate of 150% of the statewide, regional, or local minimum wage for services delivered on or after January 1, 2026, for all direct support personnel and all other frontline personnel who are not subject to the Bureau of Labor Statistics' average wage increases and who work in residential and community day services settings. Provides that for services delivered on or after January 1, 2026, the rates shall include adjustments to employment-related expenses as defined by rule by the Department of Human Services. Requires the Department of Human Services to adopt rules, including emergency rules, to implement the rate increases. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to submit a Title XIX State Plan amendment to the federal Centers for Medicare and Medicaid Services that shall include an increase in the rate methodology sufficient to provide for a wage rate of 150% of the statewide, regional, or local minimum wage for services delivered on or after January 1, 2026, for all direct support personnel and all other frontline personnel at ID/DD and MC/DD facilities. Provides that the State Plan amendment shall provide wage increases for all residential non-executive direct care staff. Effective immediately.
Amends the Administration Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services, in consultation with the Department of Human Services, to submit the necessary application to the federal Centers for Medicare and Medicaid Services to amend the State's home and community-based services waiver programs for children and adults with developmental disabilities to provide coverage under the Home-Based Services Program for any therapeutic recreation programs offered by park districts, health clubs, and community colleges.
Amends the Mental Health and Developmental Disabilities Administrative Act. Requires the Department of Healthcare and Family Services, in collaboration with the Department of Human Services, to file an amendment to the Home and Community-Based Services Waiver Program for Adults with Developmental Disabilities that shall include an increase in the rate methodology sufficient to provide for a wage rate of 150% of the statewide, regional, or local minimum wage for services delivered on or after January 1, 2026, for all direct support personnel and all other frontline personnel who are not subject to the Bureau of Labor Statistics' average wage increases and who work in residential and community day services settings. Provides that for services delivered on or after January 1, 2026, the rates shall include adjustments to employment-related expenses as defined by rule by the Department of Human Services. Requires the Department of Human Services to adopt rules, including emergency rules, to implement the rate increases. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to submit a Title XIX State Plan amendment to the federal Centers for Medicare and Medicaid Services that shall include an increase in the rate methodology sufficient to provide for a wage rate of 150% of the statewide, regional, or local minimum wage for services delivered on or after January 1, 2026, for all direct support personnel and all other frontline personnel at ID/DD and MC/DD facilities. Provides that the State Plan amendment shall provide wage increases for all residential non-executive direct care staff. Effective immediately.
