Healthcare (Medicare)

Amends the Department of Central Management Services Law of the Civil Administrative Code of Illinois. Provides that, within 6 months after the effective date of the amendatory Act, the Department of Central Management Services, in conjunction with the 5 State-funded retirement systems, may enter into a contract with an administrator to establish and conduct a State Retiree Medicare Primacy Coordination Audit and Assistance Program to identify relevant individuals eligible for Medicare but not enrolled in Medicare, and to assist those individuals with enrolling in Social Security and Medicare. Provides that the State Retiree Medicare Primacy Coordination Audit and Assistance Program shall conduct an annual audit of the State health benefits program for everyone covered under the State Employees Group Insurance Program, the Teachers' Retirement Insurance Program, and the College Insurance Program for the purpose of identifying participants and their dependents who are eligible for Medicare under federal law and shall also ensure that those annuitants, retirees, benefit recipients, survivors, or dependents who are eligible for Medicare are enrolled in Medicare with Medicare as their primary health care benefits coverage and the State Health Benefits Program being the secondary provider of their health care benefits coverage. Provides that the State Retiree Medicare Primacy Coordination Audit and Assistance Program shall assist any annuitant, retiree, benefit recipient, survivor or their dependents who becomes disabled, and is not enrolled in Social Security Disability Insurance and Medicare, with enrolling in and obtaining Social Security Disability Insurance and Medicare benefits. Provides that the administrator of the State Retiree Medicare Primacy Coordination Audit and Assistance Program shall provide the Department, the 5 State-funded retirement systems, and the General Assembly with an annual report. Effective January 1, 2026.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that subject to federal approval, the Department of Healthcare and Family Services shall increase the base rate of reimbursement for both base charges and mileage charges for medical transportation services provided by means of an air ambulance to a level not lower than 75% of the Medicare ambulance fee schedule rates, by designated Medicare locality.

Amends the Comprehensive Healthcare Workforce Planning Act. Requires the State Healthcare Workforce Council to coordinate the State's health workforce education and training to develop a health workforce that meets the State's health care needs. Requires the Council to work with graduate medical education and training programs, health professions, and consumer representatives to address specified issues. Amends the Board of Higher Education Act. Requires the Board of Higher Education to establish a program to provide: (1) funding for medical residency positions that are not funded by the federal Centers for Medicare and Medicaid Services or other established funding source; (2) technical assistance for entities that wish to establish a residency program; and (3) startup funding for entities that wish to establish a residency program. Sets forth provisions concerning the application process and priority. Requires the Board to establish an application process for an entity seeking funding. Provides that the State Healthcare Workforce Council shall provide information annually to the Board related to workforce shortages to assist in the development of the application and shall be responsible for reviewing applications and making recommendations to the Board regarding funding recipients. Creates the Medical Residency Education Fund to expand graduate medical education opportunities in the State and maximize the delivery of medical care and physician services to specific areas of the State where there is a recognized unmet priority need for medical care and physician services. Makes other changes. Makes a conforming change in the State Finance Act.

Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or a managed care plan to provide coverage for at least one early egg allergen introduction dietary supplement and one early peanut allergen introduction dietary supplement. Provides that the required coverage shall be provided at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met. Except as otherwise provided, nothing in the provisions prevents the operation of such a policy provision as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility. Provides that the required coverage does not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies, and that the cost-sharing limitation does not apply to a catastrophic health plan to the extent the cost-sharing limitation would cause the plan to fail to be treated as a catastrophic plan under federal law. Provides that the cost-sharing limitation does not apply to a high deductible health plan to the extent this cost-sharing limitation would cause the plan to fail to be treated as a high deductible health plan under specified provisions of the Internal Revenue Code. Provides that, if the cost-sharing limitation would result in an enrollee becoming ineligible for a health savings account under federal law, the cost-sharing limitation only applies to a qualified high deductible health plan after the enrollee's deductible has been met. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions.

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.

Creates the Support for Family Home Health Aides and Caregivers Act. Requires the Director of Healthcare and Family Services to establish, no later than one year after the effective date of the Act, a Family Home Health Aide Program for the purposes of training a family caregiver of an eligible relative on the provision of qualified home health services to supplement home health and private duty nursing services in the State. Provides that under the program, the Director must certify a family caregiver of an eligible relative who has successfully completed the approved training for family home health aides, and meets all other applicable requirements established by the State, and is determined to be in compliance with any federal law concerning family home health aides. Provides that, subject to federal approval by the Centers for Medicare and Medicaid Services, a certified family home health aide shall be eligible to provide qualified home health services to an eligible relative under any home and community-based services waiver program authorized under the Social Security Act. Contains provisions concerning the development of training requirements for family home health aides; certification requirements for family home health aides; employment opportunities; the different types of home health services; a requirement to triage services based on clinical acuity; the development of a clinical acuity tool to assist in determining the care needs of medically fragile individuals; the establishment of a respite program for family home health aides and other nursing professionals; reimbursement rates for home health aide services; utilization of the Department of Healthcare and Family Services' electronic verification system; reporting requirements; and rulemaking.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that subject to federal approval, for dates of service on and after January 1, 2026, the Department of Healthcare and Family Services shall reimburse diagnostic testing facilities that provide long-term ambulatory electrocardiogram monitoring services at a rate not less than 80% of the Medicare Physician Fee Schedule rate for such services. Defines "long-term ambulatory electrocardiogram monitoring services".

Creates the Ensuring Essential Services Act. Provides that the purpose of the Act is to ensure the State meets its obligation to provide certain essential services for individuals with developmental disabilities at consistent quality levels in accordance with its waiver agreement with the Centers for Medicare and Medicaid Services, all while allocating scarce taxpayer resources. Provides that any contract entered into between the Department of Human Services and an agency shall include a provision assuring the State of the uninterrupted delivery of the contracted-for services. Provides that such assurance shall provide that the agency has entered into a binding labor peace agreement with any labor organization that is the exclusive representative of the agency's frontline and direct support staff or, where no exclusive representation has been established, that the agency has or will enter into an agreement with any labor organization that seeks to become the agency's frontline and direct support staff's exclusive representative. Provides that the assurance shall become a condition of any contract entered into, renewed, or amended on or after the effective date of the Act. Requires the Department of Healthcare and Family Services to, no later than 90 days after the effective date of the Act, apply to the Centers for Medicare and Medicaid Services for a waiver or State Plan amendment to allow implementation of the contracting requirements. Requires the Department of Human Services, no later than 60 days after the effective date of the Act, to adopt rules implementing the requirements of the Act. Contains provisions on contract requirements for Department of Human Services' contracts; enforcement of contractual assurances; remedial actions for noncompliance; and other matters. Effective June 1, 2025.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires hospitals and birthing centers to adopt and maintain written policies and procedures authorizing a patient enrolled in the medical assistance program to select an Illinois Medicaid certified and enrolled doula of the patient's choice to accompany the patient within the facility's premises for the purposes of providing support before, during, and after labor and childbirth, and during the patient's entire postpartum stay. Provides that the doula shall be considered part of the patient's care team and shall not be counted as a support person or against any guest quota. Requires hospitals and birthing centers to provide a written copy of their policies and procedures to maternity patients, the facilities' maternity health care providers, and any other person at the patient's request. Requires publication of the written policies on each facility's website. Contains provisions concerning hospital and birthing center liaisons and doulas certification acknowledgment requirements. Permits the Department of Healthcare and Family Services and the Department of Public Health to establish standing recommendations to meet Centers for Medicare and Medicaid Services requirements and ensure access to preventive services, including Medicaid-covered maternal and reproductive health supports and services.

Creates the Psychiatric Residential Treatment Facilities (PRTF) Act. Requires the Department of Healthcare and Family Services to establish an Illinois Psychiatric Residential Treatment Facilities (PRTF) program that is family-driven, youth-guided, and trauma-informed, and includes youth and family involvement in all aspects of care planning. Requires the Department to submit a State Plan Amendment, by January 1, 2026, to the Centers for Medicare and Medicaid Services to establish coverage of federally authorized, medically necessary inpatient psychiatric services delivered by a certified PRTF to medical assistance beneficiaries under 21 years of age. Provides that the Department shall adopt rules to implement the PRTF program that at a minimum shall include: (i) certification and participation requirements for PRTF providers in compliance with all applicable federal laws, regulations, requirements, and policies; (ii) monitoring and oversight of PRTF services; (iii) a limit on allowable beds at any one PRTF, not to exceed 40 total beds; and other matters. Requires the Department to establish, and update as needed, a methodology for completing a statewide PRTF capacity analysis for the purposes of identifying capacity needs for PRTF services under the Illinois Medical Assistance Program. Requires the Department to establish a PRTF Advisory Committee responsible for reviewing and providing guidance on the Department's policies and implementations of the PRTF program. Requires the Department to publish on its website counts of reported emergency safety interventions and serious occurrences by State fiscal year and quarter. Makes conforming changes to the Specialized Mental Health Rehabilitation Act of 2013, the Child Care Act of 1969, and other various Acts. Effective immediately.