Healthcare

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services must incorporate minimum standards governing behavioral health pre-payment and post-payment reviews into MCO contracts effective for all services covered on and after January 1, 2027. Requires the Department to develop or adopt behavioral health-specific pre-payment and post-payment review guidelines and incorporate such guidelines by reference into MCO contracts. Provides that the Department-issued guidelines must: (1) define the documentation and clearly specify the discrete data elements that may be requested prior to and during a pre-payment or post-payment review, and applicable response timeframes, ensuring that all requests are specific, reasonable, and directly tied to the review objectives; (2) identify regulatory, statutory, and contractual standards applicable to behavioral health services; (3) establish uniform evaluation criteria and checklists; and (4) be publicly available and updated as necessary. Contains provisions on MCO contracts and required contract terms; pre-payment and post-payment review processes and notice requirements; timeframes for providers to respond to a documentation request; communication protocols; contract transparency and extrapolation from a statistical sampling of claims; the timeliness and closure of claims reviews; submission methods; reviewer qualifications; and enforcement. Effective immediately.

Amends the Emergency Medical Services (EMS) Systems Act. In provisions concerning when EMS personnel may contact Online Medical Control or an EMS Medical Director or Emergency Communications Registered Nurse to request bypass or diversion of the closest emergency department and request transport to the closest or appropriate EMS System-approved mental health facility, removes the requirement that the patient must not be under the influence of drugs or alcohol.

Creates the Substance Use Disorder and Mental Health Program Transparency Act. Provides that, within 6 months after the effective date of the Act, the Department of Healthcare and Family Services, in coordination with the Department of Human Services, shall compile a report concerning all substance use disorder and mental health programs in the State. Provides that the report shall identify each State-funded substance use disorder and mental health program in the State and provide specified information about each program. Provides that the Department of Healthcare and Family Services, in coordination with the Department of Human Services, shall collaborate with relevant State agencies to ensure the timely and accurate collection of information required for the report. Provides that the Department of Healthcare and Family Services, in coordination with the Department of Human Services, shall submit the report to the General Assembly. Requires both Departments to make the report accessible to the public on their respective websites no later than 6 months after the effective date of the Act. Effective immediately.

Amends the Illinois Controlled Substances Act. Provides that, if any substance, scheduled as a Schedule I controlled substance by the United States Drug Enforcement Administration, is rescheduled for the purpose of treating mental health disorders, including, but not limited to, anxiety, depression, and post traumatic stress disorder, the Department of Human Services shall reschedule the substance accordingly within 30 days from the publication in the Federal Register of the final order rescheduling the substance.

Amends the Nursing Home Care Act and the Specialized Mental Health Rehabilitation Act of 2013. Provides that, to facilitate timely applications for Supplemental Security Income or Social Security Disability Insurance, facilities shall assess residents using the Social Security Administration screener to check eligibility for Social Security benefits within 30 days after admission to a facility. If the resident is likely eligible, requires the facility to assist the resident with completing an application within 60 days after admission to a facility. Provides that, within 6 months after the effective date of the amendatory Act, facilities shall conduct a one-time assessment of all current residents and complete a Social Security Administration screener for all residents without income and without a pending Supplemental Security Income or Social Security Disability Insurance application. Twice per year, requires each facility to publicly post on the facility's website the number of residents screened and the number of applications initiated. Effective immediately.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides medical assistance coverage for sickle cell disease (rather than sickle cell anemia).

Amends the Illinois Insurance Code. In provisions requiring policies of group accident and health insurance to provide coverage for certain examination and testing services provided to a victim of specified criminal offenses, prohibits the policy from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided, except to the extent that the coverage would disqualify a high-deductible health plan from eligibility for a health savings account under the Internal Revenue Code. Effective January 1, 2027.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall not require recipients of medical assistance to work a minimum amount of hours in order to maintain eligibility for medical assistance. Amends the Administration Article of the Illinois Public Aid Code. Provides that the Department of Human Services shall not require recipients of benefits provided under the Supplemental Nutrition Assistance Program (SNAP) to work a minimum amount of hours in order to maintain eligibility for SNAP benefits.

Amends the Illinois Insurance Code. Creates the Vision Benefit Managers Article. Beginning on July 1, 2026, requires a vision benefit manager to be registered with the Department of Insurance, as specified, to conduct business in the State. Requires amounts collected under provisions concerning vision benefit manager registration requirements to be deposited into the Low-Income Student Vision Examination Fund, which is created as a special fund in the State treasury. Grants the Director or the Director's designee the authority to examine a registered vision benefit manager related to all of its lines of business. Amends the Vision Care Plan Regulation Act. Changes the name of the Act to the Vision Benefit Manager Regulation Act. Establishes the legislative intent of the Act. Makes changes to defined terms. Throughout the Act, replaces references to vision care plans with vision benefit plans and vision benefit discount plans and vision care organizations with vision benefit managers. Sets forth provisions concerning required actions for noncovered services; fee schedules for eye care providers; reimbursement paid by a vision benefit manager to an eye care provider; application of the Act to a specified limited health service organization; an eye care provider's choice of vendors and affiliations; the modification of a plan; audits of an eye care provider; prohibited conduct impacting patient access and choice; credentialing; termination of agreements; prohibition on security interests; arbitration costs; nonretaliation; and private rights of action. Amends the Consumer Fraud and Deceptive Business Practices Act and the State Finance Act to make conforming changes. Effective January 1, 2027.

Amends the Pharmacy Practice Act. Defines "large pharmacy chain" and "retail pharmacy". Provides that a large pharmacy chain operating in the State shall ensure that each of the large pharmacy chain's retail pharmacy locations maintains, at minimum, an inventory that is sufficient to cover the needs of existing patients for up to 14 days without needing to restock. Requires each retail pharmacy location to implement a predictive restocking practice to prevent or mitigate future inventory shortages. Provides that, if a patient attempts to fill a prescription that a retail pharmacy location does not have in stock, the retail pharmacy location shall provide timely mail-order fulfillment, up to and including overnight shipping, if necessary to provide a medication approved by the United States Food and Drug Administration in time to ensure no missed doses.