Healthcare (Medicare)

Amends the Administration Article of the Illinois Public Aid Code. Provides that beginning July 1, 2025, and for subsequent years thereafter, the Prospective Payment System rates for Federally Qualified Health Centers (FQHC) shall be increased by $100,000,000 using an alternative payment method acceptable to the federal Centers for Medicare and Medicaid Services and a trade association representing a majority of FQHCs operating in Illinois, including a rate increase that is an equal percentage increase to the rates paid to each FQHC. Effective July 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.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, in accordance with federal guidance issued by the federal Centers for Medicare and Medicaid Services, the Department of Healthcare and Family Services shall exempt from electronic visit verification requirements all live-in caregivers who provide Medicaid-funded personal care services or home health care services under the Illinois Title XIX State Plan or a waiver of the plan, including personal care services and home health care services provided under various home and community-based services waiver programs authorized under the Social Security Act. Defines "live-in caregiver". Grants the Department rulemaking authority. Effective immediately.

Amends the Property Tax Code. In a provision concerning the Low-Income Senior Citizens Assessment Freeze Homestead Exemption, provides that, beginning in taxable year 2026, the taxpayer's annual household income for purposes of determining eligibility for the exemption shall be reduced by any amounts paid by the taxpayer as Medicare premiums during the calendar year. Effective immediately.

Amends the Illinois Health Facilities Planning Act. Provides that general review criteria shall include a requirement that nursing homes operated by a county, regardless of whether the nursing homes operated by a county are skilled and intermediate long-term care facilities licensed under the Nursing Home Care Act, provide a Safety Net Impact Statement. Provides that a Safety Net Impact Statement shall also be filed with an application to change ownership of a nursing home operated by a county. Includes nursing homes operated by a county in a list of safety net service providers. Provides that nursing homes operated by a county shall also provide the number of the facility's Medicaid and Medicare certified beds for the 3 fiscal years prior to the application. The State Board Staff Report shall also include a statement of findings about an application's safety net impact under specified circumstances, and that the State Board Staff's assessment shall be considered in determining whether the project fulfills the public interest requirements. Amends the County Homes Division of the Counties Code. Removes a requirement that two-thirds of the county board is required sell, dispose of, or lease for any term, any part of the home properties, and requires a referendum before selling any home (rather than requiring a referendum only for homes that were erected after referendum approval by the voters of the county). Provides referendum language for the selling, disposition of, or lease of a home. Removes language providing that, if a county nursing home was erected after referendum approval by the voters of the county, the county nursing home may be leased upon the vote of a 3/5 majority of all the members of the board.

Amends the Administration Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to provide persons lawfully admitted for permanent residence under the Immigration and Nationality Act and other people of all immigration statuses the same medical coverage for family planning and family planning-related services and supplies as provided under the Medical Assistance Program to eligible persons who are United States citizens. Provides that to be eligible for family planning and related services, lawful permanent residents or other people of all immigration statuses must meet all other eligibility qualifications under the HFS Family Planning Program established in accordance with the Illinois' Family Planning State Plan Amendment as approved by the federal Centers for Medicare and Medicaid Services. Provides that the Department shall not require lawful permanent residents or other people of all immigration statuses who are otherwise eligible for family planning and related services under the amendatory Act to complete a mandatory waiting period as a condition of receiving medical coverage.

Creates the Health Care Availability and Access Board Act. Establishes the Health Care Availability and Access Board to protect State residents, State and local governments, commercial health plans, health care providers, pharmacies licensed in the State, and other stakeholders within the health care system from the high costs of prescription drug products. Contains provisions concerning Board membership and terms; staff for the Board; Board meetings; circumstances under which Board members must recuse themselves; and other matters. Provides that the Board shall perform the following actions in open session: (i) deliberations on whether to subject a prescription drug product to a cost review; and (ii) any vote on whether to impose an upper payment limit on purchases, payments, and payor reimbursements of prescription drug products in the State. Permits the Board to adopt rules to implement the Act and to enter into a contract with a qualified, independent third party for any service necessary to carry out the powers and duties of the Board. Creates the Health Care Availability and Access Stakeholder Council to provide stakeholder input to assist the Board in making decisions as required by the Act. Contains provisions concerning Council membership, member terms, and other matters. Provides that the Board shall adopt the federal Medicare Maximum Fair Price as the upper payment limit for a prescription drug product intended for use by individuals in the State. Prohibits the Board from creating an upper payment limit that is different from the Medicare Maximum Fair Price for the prescription drug product that has a Medicare Maximum Fair Price. Requires the Board to implement an upper payment limit that is the same as the Medicare Maximum Fair Price no sooner than the Medicare implementation date. Provides that Medicare Part C and D plans are not required to reimburse at the upper payment limit. Provides that the Attorney General may enforce the Act and may pursue any available remedy under State law when enforcing the Act. Effective 180 days after becoming law.

Creates the Health Care Availability and Access Board Act. Establishes the Health Care Availability and Access Board to protect State residents, State and local governments, commercial health plans, health care providers, pharmacies licensed in the State, and other stakeholders within the health care system from the high costs of prescription drug products. Contains provisions concerning Board membership and terms; staff for the Board; Board meetings; circumstances under which Board members must recuse themselves; and other matters. Provides that the Board shall perform the following actions in open session: (i) deliberations on whether to subject a prescription drug product to a cost review; and (ii) any vote on whether to impose an upper payment limit on purchases, payments, and payor reimbursements of prescription drug products in the State. Permits the Board to adopt rules to implement the Act and to enter into a contract with a qualified, independent third party for any service necessary to carry out the powers and duties of the Board. Creates the Health Care Availability and Access Stakeholder Council to provide stakeholder input to assist the Board in making decisions as required by the Act. Contains provisions concerning Council membership, member terms, and other matters. Provides that the Board shall adopt the federal Medicare Maximum Fair Price as the upper payment limit for a prescription drug product intended for use by individuals in the State. Prohibits the Board from creating an upper payment limit that is different from the Medicare Maximum Fair Price for the prescription drug product that has a Medicare Maximum Fair Price. Requires the Board to implement an upper payment limit that is the same as the Medicare Maximum Fair Price no sooner than the Medicare implementation date. Provides that Medicare Part C and D plans are not required to reimburse at the upper payment limit. Provides that the Attorney General may enforce the Act and may pursue any available remedy under State law when enforcing the Act. Effective 180 days after becoming law.

Creates the Illinois Medicare for All Health Care Act. Provides that all individuals residing in the State are covered under the Illinois Health Services Program for health insurance. Sets forth the health coverage benefits that participants are entitled to under the Program. Sets forth the qualification requirements for participating health providers. Sets forth standards for provider reimbursement. Provides that it is unlawful for private health insurers to sell health insurance coverage that duplicates the coverage of the Program. Provides that investor-ownership of health delivery facilities is unlawful. Provides that the State shall establish the Illinois Health Services Trust to provide financing for the Program. Sets forth the requirements for claims billing under the Program. Provides that the Program shall include funding for long-term care services and mental health services. Provides that the Program shall establish a single prescription drug formulary and list of approved durable medical goods and supplies. Creates the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open bid competitive basis. Sets forth provisions concerning patients' rights. Provides that the employees of the Program shall be compensated in accordance with the current pay scale for State employees and as deemed professionally appropriate by the General Assembly. Effective January 1, 2026.

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.