Healthcare

Amends the Hospital Provider Funding Article of the Illinois Public Aid Code. In provisions requiring the Department to establish the fixed pool directed payment amounts for specific classes of hospitals listed in the Code, provides that, beginning January 1, 2027, the Department of Healthcare and Family Services shall remove from the list the following hospital classes: (i) hospital inpatient services for public hospitals and (ii) hospital outpatient services for public hospitals. Requires the Department to instead, subject to any necessary federal approval, enter into intergovernmental agreements with the respective governing bodies to ensure continued access for those services in rural areas of the State. Provides that the Department shall reinstate the described hospital classes if federal approval is not received. Effective January 1, 2027.

HB 5700 is a fiscal year 2026 supplemental appropriations bill that allocates specific funds from state budgets to cover operational costs and support key programs. It provides $2 million to the Department of Commerce for Chicago Metropolitan Agency planning, $2.4 million to the Department of Natural Resources for habitat projects, $12.4 million for urban forestry programs, and $10 million to the Department of Corrections for healthcare records. The bill also allocates $100 million for rural healthcare transformation and over $19.8 billion for medical assistance to healthcare providers, including specific grants to clinics like Cook County Health and VNA Healthcare. These funds directly support state agencies and healthcare organizations for existing services, not new policy initiatives.

Amends the Illinois Act on the Aging. Provides that the Department on Aging shall require all provider agencies to administer annual enhanced training for all covered aides regarding all of the following: (1) ethical boundaries and conflicts of interest; (2) the fiduciary duties of an agent under the Illinois Power of Attorney Act; and (3) recognizing and reporting signs of financial exploitation and self-neglect. Provides that a covered aide shall not serve as the agent for a program participant in the Community Care Program unless all of the following conditions are met: (1) the family caregiver discloses the dual role in writing to the provider agency and the Department; (2) the participant undergoes a cognitive capacity assessment by a qualified physician or clinical psychologist confirming the participant understands the dual role and, if the participant lacks capacity, the dual role is permitted only if the agency designation was executed prior to the loss of capacity; and (3) the family caregiver agrees to comply with an administrative oversight mechanism. Amends the Adult Protective Services Act. Provides that a covered aide operating as an agent carries an enhanced duty to report. Amends the Illinois Power of Attorney Act. Allows a covered aide to serve as a health care agent for a program participant in the Community Care Program if the requirements of the Illinois Act on the Aging are met.

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.

Creates the Transparency in Downcoding Act. Provides that the Act applies to certain policies of health insurance amended, delivered, issued, or renewed on or after the effective date of the Act, except for employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974 and health care provided pursuant to the Workers' Compensation Act or the Workers' Occupational Diseases Act. Prohibits a health insurance issuer from using an automated process, system, or tool to downcode a claim; from downcoding a claim based solely on the reported diagnosis codes; and from using downcoding practices in a targeted or discriminatory manner against physicians who routinely treat patients with complex or chronic conditions. Requires downcoding decisions to be made by a physician licensed to practice medicine in all its branches in any United States jurisdiction and of the same or similar specialty as a physician who typically manages the medical condition or disease. Sets forth provisions concerning notification requirements for downcoded claims; the appeal process for downcoded claims; enforcement by the Department of Insurance; and penalties. Provides that any pattern or practice of discriminatory downcoding identified by the Director of Insurance or another regulatory authority shall be subject to enforcement actions, including fines, restitution, or suspension of the health insurance issuer's license in this State. Effective immediately.

Amends the Illinois Controlled Substances Act. Provides that, in relation to the prescriber and dispenser inquiry system, "one-to-one secure link" includes any communications exchange platform that aligns with widely adopted standards, including, but not limited to, the Prescription Monitoring Information Exchange standard, which facilitates the secure transfer of prescription monitoring program data across state lines.

Amends the Illinois Insurance Code. In provisions concerning pharmacy benefit manager contracts, provides that a pharmacy benefit manager must not reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee of $10.49. Provides that, if the national average drug acquisition cost is not available at the time a drug is administered or dispensed, a pharmacy benefit manager may not reimburse in an amount that is less than the wholesale acquisition cost of the drug, plus a professional dispensing fee of $10.49.

Amends the Children's Mental Health Act. In provisions concerning the Children's Mental Health Partnership, makes changes to the Partnership's list of duties to include (i) reviewing or facilitating needs assessments (rather than conducting research assessments) to better understand the challenges and gaps of programs, services, and policies related to children's mental health; (ii) monitoring policy development related to children's mental health in Illinois at the local, State, and federal level; and (iii) regularly reviewing aggregate and de-identified data on the need for children's behavioral health services in Illinois that is collected by the Behavioral Health Care and Ongoing Navigation (BEACON) portal to ensure that system transformation can continue to be driven by data. Provides that the Partnership's membership shall include public members who reflect a diversity of sexual orientation; and that all Partnership members shall serve without compensation and with no entitlement to reimbursement for expenses incurred in the performance of their duties. Removes a provision permitting the Partnership to convene study groups. Expands the membership of the adjunct council to include up to 10 youth aged 16 to 25 (rather than up to 6 youth aged 14 to 25) and up to 4 (rather than a minimum of 4) representatives of 4 different community-based organizations that focus on youth mental health. Makes other changes.

Amends the Assisted Living and Shared Housing Act. Provides that the comprehensive assessment of a patient prior to the patient's admission to an establishment shall be completed by a physician or a nurse practitioner or physician assistant. In provisions concerning licensure of an establishment, changes education requirements for the full-time director of an establishment. Makes changes to the definition of "medication administration" in provisions concerning service requirements. Provides that a licensed health care professional may be employed (instead of may not be employed) by the owner or operator of the establishment, its parent entity, or any other entity with ownership common to either the owner or operator of the establishment or parent entity, including, but not limited to, an affiliate of the owner or operator of the establishment, if the resident chooses to utilize the services of the licensed health care professional working within the scope of the professional's practice. Sets forth provisions concerning an emergency plan and disaster preparedness. Provides that incidents must be reported to the Department of Public Health within 24 hours after the incident or by the end of the next business day. Provides that staff in an establishment may be trained to assist in a nonemergency lift of a resident. Provides that repeated technical infractions by an establishment within a calendar year may result in a Type 3 violation.

Amends the Wholesale Drug Distribution Licensing Act. In provisions concerning restrictions on transactions, provides that prescription drugs furnished by a manufacturer or wholesale distributor licensed under the Act may be delivered only to the business address of a licensee registered with the Department of Financial and Professional Regulation, to the premises listed on a license, or, if the Department has received notice that the licensee has authorized a health care entity to receive the prescription drugs, to the address of a health care entity (instead of only to the premises listed on the license). Provides that "health care entity" means an entity where medical, dental, or veterinary services are provided by a licensed practitioner and where the licensed practitioner is responsible for the receipt, storage, and use of drugs.