Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after January 1, 2027, the reimbursement rates for all orthodontic services for children shall be increased 50% above the rates in effect on December 31, 2026. Requires the Department of Healthcare and Family Services to do an evaluation of the network adequacy of Medicaid providers of orthodontic services statewide, and give priority consideration to rural/Downstate areas of the State. Effective January 1, 2027.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that on and after January 1, 2027, the rates paid for children's dental comprehensive oral exams, periodic oral exams, problem focused exams, behavior management codes, sealants, resin-based composites-posterior teeth, and extraction and surgical extraction codes shall be increased by 33% above the rates in effect on December 31, 2025. Effective January 1, 2027.
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 Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to authorize coverage for screening by low-dose mammography for the presence of occult breast cancer for individuals 25 (rather than 35) years of age or older who are otherwise eligible for medical assistance. Requires the Department to convene 2 separate expert panels to review quality standards for mammography and establish quality standards for breast cancer treatment. Provides that subject to Department approval, rate methodology for screening and diagnostic mammography shall be based on the quality standards established by the expert panels and State qualified ACR Designated Comprehensive Breast Imaging Centers (formerly known as Breast Imaging Centers of Excellence). Requires the expert panels to establish a comprehensive and clinical methodology to inform women who are age-appropriate for screening mammography, but who have not received a mammogram within the previous 18 months, of the importance and benefits of screening mammography. Provides that within 2 years after the completion of a pilot program providing case-managing or patient navigation services for women diagnosed with breast cancer, the Department shall establish as a permanent initiative the Patient Assistance for Beneficiaries Diagnosed with Breast Cancer. Requires the Department to submit annual reports to the General Assembly detailing program outcomes, financial expenditures, and any recommendations for adjustments to maintain or enhance the program's effectiveness. Requires the Department to establish or facilitate training and continuing education opportunities specific to breast health and mammography for radiologists. Makes other changes. Effective immediately.
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.
Creates the Catch Heart Disease Early Act. Provides that all Illinois residents, 20 years of age or older, are entitled to heart disease screenings at no cost according to the following schedule: one screening every 6 years for individuals aged 20 through 39 years; and one screening every 2 years for individuals aged 40 years and older. Provides that no individual shall be charged any co-payment, co-insurance, deductible, out-of-pocket fee, or other cost-sharing amount or required to enter into any cost-sharing agreement in order to access heart disease screenings. Provides that the State of Illinois shall be the payer of last resort and only cover any outstanding screening costs for eligible uninsured or underinsured individuals whose public or private insurance, including Medicaid or Medicare, does not cover the full cost of heart disease screenings. Provides that service providers of heart disease screenings for eligible uninsured or underinsured Illinois residents shall be reimbursed through a voucher program. Requires the Department of Healthcare and Family Services to perform certain functions to implement the Act, including, but not limited to: (i) establishing a confidential registry to track screening dates and prevent duplicate heart disease screenings outside the authorized frequency; and (ii) provide a mechanism for individuals and providers to verify screening eligibility. Requires health care providers to verify an individual's age, residency, date of last heart disease screening, and other matters prior to administering a screening and recording it in the individual's medical record. Contains provisions on Department rules. Provides that, subject to appropriation, the Department shall implement the voucher program by July 1, 2027. Adds conforming language to the State Employees Group Insurance Act, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Public Aid Code, and the Illinois Insurance Code. 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 low volume add-on payment of $200 for each inpatient General Acute and Psychiatric day of care, removes the December 31, 2026 sunset date for such add-on payments. Effective immediately.
Amends the Mental Health and Developmental Disabilities Administrative Act. Requires the Department of Human Services to file an amendment to the Home and Community-Based Services Waiver Program for Adults with Developmental Disabilities that shall include an increase in the rate methodology sufficient to provide for a wage rate of 150% of the statewide, regional, or local minimum wage for services delivered on or after January 1, 2027, for all direct support personnel and all other frontline personnel who are not subject to the Bureau of Labor Statistics' average wage increases and who work in residential and community day services settings. Provides that for services delivered on or after January 1, 2027, the rates shall include adjustments to employment-related expenses as defined by rule by the Department. Requires the Department to adopt rules, including emergency rules, to implement the rate increases. Contains provisions on benchmark rates for therapy and counseling for adults with intellectual and developmental disabilities; tiered rates for community day services; community integration supports for community day services; and benchmark rates for CILA transportation cost and for the supported employment program for adults with intellectual and developmental disabilities. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to submit a Title XIX State Plan amendment to the federal Centers for Medicare and Medicaid Services that shall include an increase in the rate methodology sufficient to provide for a wage rate of 150% of the statewide, regional, or local minimum wage for services delivered on or after January 1, 2027, for all direct support personnel and all other frontline personnel at ID/DD and MC/DD facilities. Provides that the State Plan amendment shall provide wage increases for all residential non-executive direct care staff. 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 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.
