Healthcare (Insurance)

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 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 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 Illinois Income Tax Act. Creates an income tax credit for a qualified employer who makes a qualified contribution toward a health reimbursement arrangement for the qualified taxpayer's employees. Provides that the amount of the credit is $400 per covered employee in the first taxable year and $200 per covered employee in the second taxable year. Effective immediately.

Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2028 to provide coverage for medically necessary assistive technology devices. 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 the provisions of those Acts.

Amends the Illinois Insurance Code. Provides that no policy of accident or health insurance that is issued, amended, delivered, or renewed on or after January 1, 2027 may limit or otherwise alter coverage available to an insured based solely on that insured's weight or body mass index. Amends the Medical Patient Rights Act. Provides that no physician may make a diagnosis or determination of treatment based solely on a patient's body mass index. Establishes disclosure requirements for hospitals concerning the use of body mass index in diagnosis and treatment. Provides that any physician, medical student, resident, advanced practice registered nurse, registered nurse, physician assistant, licensed behavior analyst, licensed assistant behavior analyst, or clinical psychologist who conducts medical, behavioral, or psychological assessments shall only use methodology recommended by peer-reviewed clinical practice guidelines or methodology established through evidence-based standards that are widely recognized by professional medical, behavioral, or psychological organizations, respective to the form of assessment, when conducting those assessments.

Amends the Genetic Information Privacy Act. Removes language exempting insurers that are issuing a long-term care policy from specified provisions. Provides that, with regard to any policy, contract, or plan offered, entered into, issued, amended, or renewed on or after January 1, 2027 by a health insurer, life insurer, disability insurer, or long-term care insurer authorized to transact insurance in this State, a health insurer, life insurer, disability insurer, or long-term care insurer may not: (1) cancel, limit, or deny coverage or establish differentials in premium rates based on a person's genetic information; or (2) require or solicit an individual's genetic information, use an individual's genetic test results, or consider an individual's decisions or actions relating to genetic information or a genetic test in any manner for any insurance purpose. Provides that the provisions may not be construed as: (1) preventing a life insurer, disability insurer, or long-term care insurer from accessing an individual's medical record as part of an application; or (2) prohibiting a life insurer, disability insurer, or long-term care insurer from considering a clinical diagnosis, such as a manifest disease or disorder, included in an individual's medical record for insurance purposes to the extent otherwise allowable by law. Effective July 1, 2026.

Amends the Illinois Insurance Code. Provides that, in conducting utilization review of all covered health care services for the diagnosis, prevention, and treatment of mental, emotional, and nervous disorders or conditions, an insurer shall apply the criteria and guidelines set forth in the most recent version of the treatment criteria developed by an unaffiliated professional organization (instead of an unaffiliated nonprofit professional association) for the relevant clinical specialty or, for Medicaid managed care organizations, criteria and guidelines determined by the Department of Healthcare and Family Services that are consistent with generally accepted standards of mental, emotional, nervous or substance use disorder or condition care. Provides that insurers may not apply utilization review criteria developed by any entity that has a financial stake in the outcome of the utilization review decisions. Makes changes to provisions concerning utilization review relating to level of care placement, continued stay, transfer, discharge, or any other patient care decisions that are within the scope of the specified sources.