Healthcare

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall not enter into a contract with a managed care organization that relies on a pharmacy benefit manager that does not do the following: (i) utilize a pharmacy reimbursement methodology of the lesser of national average drug acquisition cost plus a professional dispensing fee as determined by the Department, the wholesale acquisition cost plus a professional dispensing fee as determined by the Department, or the usual and customary charge by the pharmacy; (ii) reimburse for a legally valid claim at a rate not less than the rate in effect at the time the original claim adjudication was submitted at the point of sale; (iii) agree to move to a transparent pass-through pricing model, in which the pharmacy benefit manager discloses the administrative fee as a percentage of the professional dispensing costs to the Department; (iv) agree to not create new pharmacy administration fees and to not increase current fees more than the rate of inflation; and (v) agree to not terminate an existing contract with a pharmacy licensed under the Pharmacy Practice Act for the sole reason of the additional professional dispensing fee authorized under item (i). Requires each pharmacy benefit manager that receives reimbursement for medical services, either directly or through a Medicaid managed care health plan, to submit by January 15, 2027, and each January 15 thereafter, certain data and information to the Department for the previous fiscal year, including: (1) the total number of prescriptions that were dispensed; (2) the aggregate wholesale acquisition cost for each drug on its formulary; (3) the aggregate amount of rebates, discounts, and price concessions that the pharmacy benefit manager received for each drug on its formulary; (4) the aggregate amount of administrative fees that the pharmacy benefit manager received from all pharmaceutical manufacturers; and (5) any other information considered necessary by the Department. Requires the Department to submit such data and information to the General Assembly and to the Governor's Office of Management and Budget. Provides that such information is confidential and not subject to disclosure under the Freedom of Information Act.

Amends the Nursing Home Care Act. Adds infection preventionists, minimum data set assessment nurses, other social workers, certified nursing assistant interns, and medication aides to the list of direct care staff used to compute staff to resident ratios. Provides that, except as otherwise provided by law, 100% of the hours worked by the specified staff shall be counted toward the staff to resident ratio. Provides that no monetary penalties shall be imposed unless the variance between a facility's minimum staffing ratios and the Department of Public Health's computations exceeds 20%. Removes a provision prohibiting waiver of a monetary penalty for non-compliance. In provisions concerning reporting requirements for facilities that violate the minimum staffing requirements, provides that the facility must have a variance that exceeds 20% of the requirements. Makes other changes. Effective immediately.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that beginning January 1, 2026, for a person who is a resident in a facility licensed under the ID/DD Community Care Act, the Community-Integrated Living Arrangements Licensure and Certification Act, or the MC/DD Act for whom payments are made under the Article throughout a month and who is determined to be eligible for medical assistance, the State shall pay an amount in addition to the minimum monthly personal needs allowance authorized under the Social Security Act so that the person's total monthly personal needs allowance from both State and federal sources equals $90. Provides that beginning January 1, 2027, the personal needs allowance described in the amendatory Act shall increase annually at the same rate as the Social Security cost-of-living adjustment to take effect on January 1 of each year.

Amends the Nurse Practice Act. Makes changes to the requirements for a registered professional nursing education program in provisions concerning the establishment of a new program, program policies, faculty members, training and development, the program's curriculum, the program's use of simulation, the accreditation process, approval by the Board of Nursing, and the program closure process. Makes a conforming change. Provides that the Department of Financial and Professional Regulation may, without hearing, rescind the license of any person who obtain a license after completing a program or obtaining credit from a program that does not meet the requirements of the provisions regarding registered professional nursing education programs. In provisions concerning nursing licensure by examination, removes the provision regarding the good standing period for professional nursing programs on probationary status.

Amends the Illinois Food, Drug and Cosmetic Act. Provides that any health care practitioner authorized by applicable law to issue prescriptions for Schedule II controlled substances shall, prior to issuing an initial prescription for a Schedule II controlled substance or any other opioid pain reliever during a course of treatment for acute or chronic pain shall discuss with the patient or the patient's parent or guardian, if the patient is under 18 years of age and is not an emancipated minor, the risks associated with the drugs being described. Provides that the discussion required by this provision shall take place before issuing an initial prescription, and again prior to issuing the third prescription during a course of treatment. Provides that the prescribing health care practitioner shall include a note in the patient's medical record that the patient or the patient's parent or guardian, as applicable, has discussed with the practitioner the risks of developing a physical or psychological dependence on the controlled dangerous substance and on alternative treatments that may be available. Provides that these provisions do not apply to prescriptions for a patient who is currently in an active treatment for cancer, receiving hospice care from a licensed hospice or palliative care provider, for a patient who is a resident of a long-term care facility, or to any medications being prescribed for use in the treatment of substance abuse or opioid dependence.

Amends the Illinois Insurance Code, the Dental Care Patient Protection Act, and the Dental Service Plan Act. Provides that no insurer, dental service plan corporation, professional service corporation, insurance network leasing company, company offering a managed care dental plan, company offering a point-of-service plan, or any company that amends, delivers, issues, or renews an individual or group policy of accident and health insurance that provides dental insurance in this State may deny coverage for replacement of teeth to any insured on the basis of those teeth having been extracted or otherwise lost prior to the person becoming covered under the plan.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that any person who is at least 18 years of age shall be qualified to provide community-based mental health services under the medical assistance program as a rehabilitative services associate or peer support worker if the person meets all other applicable eligibility requirements for certification. Requires the Department of Healthcare and Family Services to adopt rules to implement the amendatory Act.

Amends the Compassionate Use of Medical Cannabis Program Act. Provides that the Department of Financial and Professional Regulation and the Department of Agriculture may share with the Department of Commerce and Economic Opportunity any licensee information necessary to support the administration of social equity programming. Amends the Cannabis Regulation and Tax Act. Adds a definition. In various provisions, adds Social Equity Lottery Licensees to provisions that include Social Equity Applicants. Provides that the Cannabis Business Development Fund shall be exclusively used for certain purposes, to include providing financial assistance to support lending to, or private investment in, Qualified Social Equity Applicants and Social Equity Lottery Licensees, or to facilitate access to the facilities needed to commence operations as a cannabis business establishment. In provisions regarding loans and grants to Social Equity Applicants, adds financial assistance to provisions that include loans and grants. Provides that the Department of Commerce and Economic Opportunity has the power to enter into financial intermediary agreements to facilitate lending to or investment in Qualified Social Equity Applicants, Social Equity Lottery Licensees, or their subsidiaries or affiliates, to ensure the availability of facilities necessary to operate a cannabis business establishment. Provides that certain loans made shall contain terms and provisions with respect to forgiveness. Provides that those loans also may be distributed by lot if the Department of Commerce and Economic Opportunity determines that the amount of funding available is insufficient. Provides that, to the extent registration with the federal System for Award Management requires a grant applicant to certify compliance with all federal laws, the grant applicants shall not be required to register for a unique entity identifier through the federal System for Award Management. Makes other and conforming changes.

Amends the Community Behavioral Health Care Professional Loan Repayment Program Act. Requires the Illinois Student Assistance Commission to award a $15,000 per year grant to qualified applicants who are licensed occupational therapists or licensed occupational therapy assistants.

Amends the Health Care Worker Background Check Act. Prohibits persons who fail to report to the Department of Public Health individuals who commit certain violations from being involved in direct care for clients, patients, or residents, or access to the living quarters or the financial, medical, or personal records of clients, patients, or residents unless they have been issued a waiver under the Act. Provides that reports of violations shall be made no later than 5 days after the incident constituting the violation. Amends the Criminal Code of 2012. Provides that a person commits aggravated battery when the person battered, other than by the discharge of a firearm, is known to be a patient at a Department of Human Services facility and the person who commits the battery is an employee of the Department of Human Services; and a recipient at a community-integrated living arrangement, as defined in the Community-Integrated Living Arrangements Licensure and Certification Act, who is battered by an employee of the community-integrated living arrangement. Provides that the offense is a Class 2 felony.