Healthcare

Creates the 340B Integrity Act. Defines terms. Provides that, beginning January 1, 2027, 340B covered entities shall not bill any medical assistance fee-for-service or medical assistance managed care programs under the Illinois Public Aid Code for 340B drugs. Provides that, beginning July 1, 2026 a 340B covered entity shall use 80% of 340B profits from the prior year to decrease at the point of sale, including at the 340B contract pharmacy, the out-of-pocket costs paid for 340B drugs that are dispensed or administered to low-income patients of the 340B covered entity. Provides that, on or before September 1, 2026, and on or before September 1 of each year thereafter, each 340B covered entity shall annually report to the Department of Insurance, with respect to the 340B covered entity and separately for each offsite outpatient facility associated with the 340B covered entity, the specified information about the prior year. Provides that, on or before December 31, 2026, the Department of Central Management Services shall submit a report to the General Assembly on any impact to the State employee health plan arising from 340B covered entity purchases, 340B contract pharmacy arrangements, and general practices related to 340B drugs, regardless of whether the 340B drugs were self-administered or provider-administered. Provides that the report shall include, but not be limited to, an analysis of foregone rebates, the impact on premiums, and the impact to State employee out-of-pocket costs. Provides that, on or before December 31, 2026, the Department of Healthcare and Family Services shall report to the General Assembly on certain items for total aggregated covered outpatient drug units dispensed or administered in the State for the prior calendar year in connection with the medical assistance program under the Illinois Public Aid Code, broken out by fee-for-service and by each managed care plan. Makes other changes. Effective immediately.

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 Illinois Health Insurance Portability and Accountability Act. Defines "grandfathered health plan". Provides that, except for grandfathered health plans, a health insurance issuer in the individual, small group, or large group market shall not deny coverage to an individual or employer due to the individual's or employer's failure to pay premiums owed under a prior policy, certificate, or contract of insurance. Specifies that nothing in the provisions concerning past-due premiums prohibits a health insurance issuer from pursuing the collection of past-due premiums from an individual or employer by any other means permitted by law. Effective immediately.

Amends the Hospital Services Trust Fund Article of the Illinois Public Aid Code. In provisions requiring the Department of Healthcare and Family Services to pay safety-net hospitals a health care equity add-on payment that is based on such hospitals' Medicaid inpatient utilization rate, removes the December 31, 2026 sunset date for the add-on payments. Effective immediately.

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. Prohibits a group or individual policy of accident and health insurance issued or renewed in this State from imposing prior authorization or step therapy requirements on menopause therapy under specified conditions. Amends the Medical Practice Act of 1987, the Nurse Practice Act, and the Physician Assistant Practice Act of 1987 to establish provisions concerning continuing education on perimenopause and menopause recognition and management for physicians, advanced practice registered nurses, and physician assistants. Effective January 1, 2027.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Extends the period of eligibility within which a hospital, that would have qualified for the rate year beginning October 1, 2011 or October 1, 2012, shall be a Safety-Net Hospital. Effective immediately.

Opposes Illinois Senate Bill 3572 (SB3572). Opposes any effort to punish women for accessing reproductive healthcare, efforts to subject survivors of rape and incest to more severe punishments than a rapist, and efforts to restrict access to in vitro fertilization (IVF) and other forms of assisted reproductive technology.

Amends the Sexual Assault Survivors Emergency Treatment Act. Provides that beginning January 1, 2028, a treatment hospital, treatment hospital with approved pediatric transfer, or approved pediatric health care facility may submit a sexual assault treatment plan which includes the use of a TeleSANE interactive telecommunications system which allows a qualified medical provider to precept a medical forensic examination while located at a distant site. Amends the Juvenile Court Act of 1987. Provides that in inspection and copying of law enforcement records maintained by law enforcement agencies that relate to a minor who has been investigated, arrested, or taken into custody before the minor's 18th birthday by victims and their attorneys, the information identifying the nonrequesting victims shall be redacted in cases of multiple minor victims or multiple victims of sex offenses. Amends the Rights of Crime Victims and Witnesses Act. Provides that a victim shall not be excluded from any part of the trial unless a written motion to exclude a victim from trial was filed at least 60 days prior to the date set for trial. Makes other structural and technical changes in the Act. Makes other changes. Amends the Address Confidentiality for Victims of Domestic Violence, Sexual Assault, Human Trafficking, or Stalking Act. Defines "eligible person" as a person 18 years of age or older who is the victim of domestic violence, sexual assault, human trafficking, or stalking; the parent or guardian of a minor or disabled adult who is a victim of domestic violence, sexual assault, human trafficking, or stalking; and a household member of a victim of domestic violence, sexual assault, human trafficking, or stalking. Allows household members who are not victims to participate in the program. Provides that a participant whose certification has not been withdrawn or cancelled may reapply to the Address Confidentiality Program to renew certification for an additional 4 years. Changes notice process for certification cancellation. Allows the Attorney General discretion to continue the participation of participants who have a change of legal name and specifies notice in that process. Makes other changes.

Amends the Administration Article of the Illinois Public Aid Code. Prohibits the Department of Human Services and the Department of Healthcare and Family Services from allowing any recipient of cash assistance or medical assistance provided under the Code or any applicant or recipient of benefits provided under the federal Supplemental Nutrition Assistance Program to submit any income self-attestation form or document as proof of income. Requires the Departments to apply for any federal waivers or approvals necessary to implement the amendatory Act.