Healthcare

Makes appropriations for the ordinary and contingent expenses of the Department of Healthcare and Family Services for the fiscal year beginning July 1, 2026, as follows: General Funds $8,781,379,200; Other State Funds $37,892,170,000; Federal Funds $775,000,000; Total $47,448,549,200.

Amends the Illinois Controlled Substances Act. Provides that, if a pharmacy is unable to fill an initial prescription received electronically because the prescribed drug is not in stock, the dispenser must immediately contact the patient to notify the patient of the situation and ask if the patient would like the prescription transferred electronically to a pharmacy of the patient's choosing, consistent with federal regulations concerning the prescribing of controlled substances. Provides that the prescriber shall not be required to issue prescriptions electronically if the prescriptions need to be filled outside of typical retail pharmacy operating hours or may be difficult to obtain because of drug shortages or pharmacy inventory limitations. Amends the Pharmacy Practice Act to make conforming changes. Effective immediately.

Provides that the Act may be referred to as the Illinois Newborn Equity Support Transfer (NEST) Program Act. Amends the Department of Human Services Act. Requires the Department of Human Services to establish and administer, subject to appropriations, the Illinois Newborn Equity Support Transfer (NEST) Program to provide direct cash assistance to eligible participants by July 1, 2026. Defines "participant" to mean any individual who gives birth in Illinois while enrolled in or eligible for Medicaid through Moms and Babies. Permits the Department to adopt any rules necessary to implement the NEST Program. Provides that program participants shall receive a $1,500 lump sum payment in or around the third trimester of pregnancy, prior to delivery; and a $500 monthly cash payment for the first 6 months following delivery. Requires the Department to submit reports to the General Assembly on a biennial basis that summarizes (1) the number of program participants and distribution across the State, (2) outcomes related to maternal and child health, housing stability, and economic security, or other outcomes identified by the Department in collaboration with stakeholders, and (3) recommendations for program improvements or additional populations beyond Medicaid enrollment to include as participants. Provides that cash disbursements made to participants under the NEST Program shall be considered "guaranteed income" as described in the Hospital Uninsured Patient Discount Act for purposes of determining eligibility for assistance under the Illinois Public Aid Code. Effective immediately.

Creates the Standardized Prior Authorization Act. Requires a health insurance issuer to maintain a complete list of services for which prior authorization is required and to make any current prior authorization requirements and restrictions readily accessible and conspicuously posted on its website or online portals to enrollees, health care professionals, and health care providers. Sets forth further provisions concerning disclosure and review of prior authorization requirements; standard prior authorizations; expedited prior authorizations; notifications of adverse determinations; appeals of adverse determinations; prohibitions on revocation of prior authorization and nonpayment by a health insurance issuer; the length of approvals; approvals for chronic conditions; continuity of prior approvals; and enforcement and administration of the Act. Requires a health insurance issuer to periodically review its prior authorization requirements and consider removal of prior authorization requirements. Provides that a failure by a health insurance issuer to comply with the deadlines and other requirements specified in the Act shall result in any health care services subject to review to be automatically deemed authorized by the health insurance issuer or its contracted private review agent. Establishes reporting and notification requirements for health insurance issuers. Grants rulemaking authority to the Department of Insurance. Repeals the Prior Authorization Reform Act. Amends the Illinois Insurance Code and the Illinois Public Aid Code to make conforming changes. Effective January 1, 2027.

Amends the Mental Health Early Action on Campus Act. Requires the Board of Higher Education to establish the Mental Health Council. Establishes the student membership of the Council. Provides that the Council shall make recommendations to the Board regarding youth mental health. Requires the Council to meet at least 4 times annually.

Amends the Fair Contracting for Health Care Practitioners Act. Provides that, except as otherwise provided, a covenant not to compete entered into on or after the effective date of the Act is deemed contrary to the public policy and is void and unenforceable by an employer. Provides that an employer may enforce a covenant not to compete if the length of the covenant not to compete is no more than one year, provided that the health care practitioner was not dismissed by the employer. Sets forth provisions concerning the scope of the Act. Effective January 1, 2027.

Amends the Substance Use Disorder Act. Requires the Department of Human Services to collaborate with the State Board of Education to the extent the Board develops instructional resources for substance use or gambling disorder prevention and awareness that may be used by school districts. Permits the Department to provide funding programs for parents on healthy gaming and play habits; appropriate financial planning and investment strategies; how to talk about gambling and related activities; and how to talk about substance use or gambling. In provisions requiring the Department to establish a public education, research, and training program regarding gambling disorders, expands the scope of the program by requiring that the program utilize screening, crisis intervention, treatment, public awareness, prevention, in-service training, and other innovative means, to decrease the incidents of suicide attempts related to a gambling disorder or gambling issues. Permits the Department to establish a program to provide for the production and publication, in electronic and other formats, of gambling prevention, recognition, treatment, and recovery literature and other public education methods. Permits the Department to support gambling disorder prevention, recognition, treatment, and recovery projects by facilitating the acquisition of gambling prevention curriculums, providing trainings in gambling disorder prevention best practices, connecting programs to health care resources, establishing learning collaboratives between localities and programs, and assisting programs in navigating any regulatory requirements for establishing or expanding such programs. Permits the Department to award grants to create or support local gambling prevention, recognition, and response projects. Makes other changes. Effective immediately.

Amends 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 Fair Patient Billing Act. Makes changes to findings and defined terms provisions. Provides that a hospital shall not deny any protection or benefit of the Act on the basis of a patient's citizenship or immigration status or assets or prospective assets. Provides that a patient who inquires about a denial of financial assistance in whole or in part must be permitted to appeal the decision within at least 90 days. Requires a hospital to use only a uniform financial assistance form developed and provided by the Attorney General no later than December 31, 2026. Provides that every hospital bill and every collection notice must notify the patient, in the patient's preferred language, of the availability of hospital financial assistance and charity care. Establishes further provisions concerning hospitals pursuing collection actions; outsourced health care services; patient responsibilities; and applicability of the Act. Amends the Hospital Uninsured Patient Discount Act. Sets forth provisions concerning uninsured patient discounts for specified income levels. Prohibits hospitals from making the availability of a discount under the Act contingent upon the uninsured patient first applying for coverage under public health insurance programs. Provides that patients may not be denied a discount under the Act on the basis of citizenship or immigration status or assets or prospective assets. Makes other changes concerning uninsured patient discounts, outsourcing health care services, and patient responsibilities. Effective immediately.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after January 1, 2027, the reimbursement rates for all orthodontic services for children shall be increased 50% above the rates in effect on December 31, 2026. Requires the Department of Healthcare and Family Services to do an evaluation of the network adequacy of Medicaid providers of orthodontic services statewide, and give priority consideration to rural/Downstate areas of the State. Effective January 1, 2027.