Healthcare

Amends the Managed Care Reform and Patient Rights Act. Sets forth requirements for carriers that offer a provider panel. Requires notice of the development of a provider panel to be filed with Department of Public Health prior to establishment. Provides that a carrier that uses a provider panel shall establish procedure for notifying an enrollee of the termination of a health care provider. Sets forth provisions permitting, under certain circumstances, a health care provider to continue to render health care services following termination from the carrier's provider panel. Requires a carrier to provide a list of members in the carrier's provider panel. Establishes notice requirements for benefit reductions and termination of health care providers from the carrier's provider panel. Requires any carrier requiring preauthorization for medical treatment to have personnel available to provide preauthorization at all times when the preauthorization is required. Provides that no contract between a health care provider and a carrier shall include provisions that require a health care provider to deny covered services that the provider knows to be medically necessary and appropriate that are provided with respect to a specific enrollee or group of enrollees with similar medical conditions. Sets forth prohibited provisions in a contract between a carrier and a health care provider. Defines terms. Makes other and conforming changes.

Amends the Illinois Insurance Code. Provides that no later than July 1, 2026, each health plan and pharmacy benefit manager operating in this State shall, upon request of a covered individual, his or her health care provider, or an authorized third party on his or her behalf, furnish specified cost, benefit, and coverage data to the covered individual, his or her health care provider, or the third party of his or her choosing and shall ensure that the data is: (1) current no later than one business day after any change is made; (2) provided in real time; and (3) in a format that is easily accessible to the covered individual or, in the case of his or her health care provider, through an electronic health records system. Provides that the format of the request shall use specified industry content and transport standards. Provides that a facsimile is not an acceptable electronic format. Provides that upon request, specified data shall be provided for any drug covered under the covered individual's health plan. Makes other changes. Defines terms.

Amends the Community Behavioral Health Care Professional Loan Repayment Act. Adds a licensed occupational therapist and a licensed occupational therapy assistant to the list of health care professionals that may receive a grant of $15,000 or less per year from the Illinois Student Assistance Commission, subject to appropriation, for a maximum of 4 years.

Amends the Nursing Education Scholarship Law. Creates the Nurse Educator Scholarship Fund as a special fund in the State treasury. Provides that all money in the Nurse Educator Scholarship Fund shall be used, subject to appropriation, by the Department of Public Health to provide scholarships to nurse educators. Provides that each fiscal year, beginning July 1, 2025, the State Comptroller shall transfer $1,500,000 from the General Revenue Fund to the Nurse Educator Scholarship Fund to implement the nurse educator scholarship provisions. Makes a conforming change in the State Finance Act. Amends the Nurse Practice Act. Provides that, for fiscal year 2026 and for each fiscal year thereafter, $6,000,000 (instead of $4,000,000) of the moneys deposited in the Nursing Dedicated and Professional Fund each year shall be set aside and appropriated to the Illinois Student Assistance Commission for nursing scholarships awarded pursuant to the Nursing Education Scholarship Law. Effective immediately.

Amends the Acupuncture Practice Act. Provides that "acupuncture" also includes ordering laboratory tests in accordance with State law to check, track, evaluate, and monitor the status and effectiveness of pain management, herbal medicinal plans, dietary and exercise plans, and orders as may be provided to the patient from a physician licensed under the Medical Practice Act. Removes the provision that states that an acupuncturist licensed under the Act who is not also licensed as a physical therapist under the Illinois Physical Therapy Act shall not hold himself or herself out as being qualified to provide physical therapy or physiotherapy services.

Amends the Emergency Medical Services (EMS) Systems Act. In provisions concerning opioid overdose reporting, provides that overdose information reported by a covered vehicle service provider shall not be used in an opioid use-related criminal investigation, prosecution, welfare checks, or warrant checks of the individual who was treated by the covered vehicle service provider personnel for experiencing the suspected or actual overdose. Provides that any misuse of the information reported by a covered vehicle service provider shall result in, but is not limited to, the Department of Transportation reporting misuse to the Washington/Baltimore High Intensity Drug Trafficking Area Overdose Detection Mapping Application or similar technology platform. Permits the Department of Health to adopt rules to set forth standards under which misuse of access may be reported to the Washington/Baltimore High Intensity Drug Trafficking Area Overdose Detection Map or similar platform based on misuse or misconduct by a covered vehicle service provider or other individual or entity at the discretion of the Department. Provides that no data that allows for or creates a risk of identification of an individual or individuals experiencing a suspected or actual overdose treated by the covered vehicle service provider personnel shall be submitted to the Washington/Baltimore High Intensity Drug Trafficking Area Overdose Detection Mapping Application or Similar technology platform. Provides that covered vehicle service provider personnel may report overdose surveillance through an identified technology platform for the use of overdose surveillance under exceptions to HIPAA and the reported data shall only be used to support public safety and public health efforts. Sets forth additional provisions concerning requirements for the Department concerning opioid overdose reporting.

Amends the Public Safety Employee Benefits Act. Provides that, if the injured employee subsequently dies, the employer shall continue to pay the entire health insurance premium for the surviving spouse (rather than the surviving spouse until remarried) and for the dependent children under specified conditions.

Amends the Nurse Practice Act. Provides that the Act does not prohibit the practice of relevant nursing care by a legally responsible caregiver or a person designated by a legally responsible caregiver who has been certified as a certified family health aide for the specified services. Amends the Illinois Public Aid Code. Establishes requirements for the Department of Healthcare and Family Services to apply for a Home and Community-Based Services State Plan amendment and federal waiver amendment necessary to reimburse a legally responsible caregiver or a person designated by a legally responsible caregiver who has achieved certification as a certified family health aide to perform the specified services. Creates the Certified Family Health Aide Program for Children and Adults Act. Establishes certification requirements for a certified family health aide through the Department of Financial and Professional Regulation. Provides that a certified family health aides must be legally responsible caregiver and 18 years or older, have a relationship with a specified family member, and be certified to perform or assist in performing the specified nursing services. Amends the Home Health, Home Services, Home Nursing Act to include a certified family health aide under a home nursing agency and provides training and recordkeeping requirements for home nursing agencies. Amends the Alternative Health Care Delivery Act and the Hospital Licensing Act to require similar training and recordkeeping requirements in children's community-based health care center and in hospitals managing the care of an individual being discharged under the care of a home nursing agency.

Amends the Program of All-Inclusive Care for the Elderly Act. Provides that to ensure that organizations contracted to implement the Program of All-Inclusive Care for the Elderly (PACE) program meet the needs of PACE participants, the Department of Healthcare and Family Services shall reform the rate-setting methodology for the PACE program by establishing a blended rate structure based on a 30% Home and Community-Based Services and 70% Skilled Nursing Facility case-mix which is a more accurate proportion of the comparable population expected to reside in an institution or the community if not enrolled in PACE. Requires the blended rate structure to more accurately reflect the comprehensive nature of care provided by PACE organizations and address the unique needs of PACE participants as a higher risk/acuity population with expected higher costs and frailty than comparable populations. Provides that when developing rates under the blended rate structure, the Department must consider not only the standard cost experiences of PACE participants but also the unique characteristics and specific care needs of the PACE population as well as any additional State plan services or populations that are not included in the State's Medicaid managed care contracts but are required under the PACE program.

Amends the Department of Human Services Act. Creates the Underserved Populations Autism Task Force within the Department of Human Services. Requires the Task Force to develop an Autism Spectrum Disorder Strategic Plan for underserved populations that focuses on: (1) improving awareness, early diagnosis, and intervention; and (2) ensuring delivery of treatment and services for individuals diagnosed with an autism spectrum disorder, including the coordination and accessibility of cost-effective treatments and services throughout the individual's lifetime. Requires the Task Force to submit its strategic plan to the Governor, the General Assembly, and the Department of Human Services by no later December 31, 2030. Requires the Task Force to submit annual reports each July 1 for calendar years 2026, 2027, 2028, 2029, and 2030. Requires the annual reports to detail Task Force meetings and activities, summarize Task Force hearings and findings, and give an account of any progress the Task Force has made towards developing the Autism Spectrum Disorder Strategic Plan. Contains provisions on Task Force membership and meetings. Provides that the Task Force is dissolved on July 1, 2031. Effective July 1, 2025.