Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services, beginning January 1, 2027, to recompute the STAR rating of nursing facilities who had their antipsychotic medication quality measure score suppressed and their STAR rating set to one due to audit action by the federal Centers for Medicare and Medicaid Services. Requires quality payments to such nursing facilities to be made based on the recomputed score. Provides that in order to facilitate the recomputation, nursing facilities may provide the Department with documentation regarding the status of the suppression of the score and STAR rating as well as the quarterly report issued by the federal Centers for Medicare and Medicaid Services that lists the long-stay rating points for the quarter.
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.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services must incorporate minimum standards governing behavioral health pre-payment and post-payment reviews into MCO contracts effective for all services covered on and after January 1, 2027. Requires the Department to develop or adopt behavioral health-specific pre-payment and post-payment review guidelines and incorporate such guidelines by reference into MCO contracts. Provides that the Department-issued guidelines must: (1) define the documentation and clearly specify the discrete data elements that may be requested prior to and during a pre-payment or post-payment review, and applicable response timeframes, ensuring that all requests are specific, reasonable, and directly tied to the review objectives; (2) identify regulatory, statutory, and contractual standards applicable to behavioral health services; (3) establish uniform evaluation criteria and checklists; and (4) be publicly available and updated as necessary. Contains provisions on MCO contracts and required contract terms; pre-payment and post-payment review processes and notice requirements; timeframes for providers to respond to a documentation request; communication protocols; contract transparency and extrapolation from a statistical sampling of claims; the timeliness and closure of claims reviews; submission methods; reviewer qualifications; and enforcement. Effective immediately.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides medical assistance coverage for sickle cell disease (rather than sickle cell anemia).
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall not require recipients of medical assistance to work a minimum amount of hours in order to maintain eligibility for medical assistance. Amends the Administration Article of the Illinois Public Aid Code. Provides that the Department of Human Services shall not require recipients of benefits provided under the Supplemental Nutrition Assistance Program (SNAP) to work a minimum amount of hours in order to maintain eligibility for SNAP benefits.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that on and after January 1, 2027, the reimbursement rates for all dental services for children shall be increased 50% above the rates in effect on December 31, 2025. Effective January 1, 2027.
Creates the Lead-Safe Water for Families Act. Provides that the Department of Healthcare and Family Services shall establish and administer a program to provide lead-reducing water filters at no cost to Medicaid-eligible households with children or expectant mothers. Requires outreach, application procedures, and rulemaking. Requires annual reporting to the General Assembly. Declares findings and states the purpose of the Act. Defines terms.
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.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that on and after January 1, 2027, the reimbursement rates for all dental services for children shall be increased 50% 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 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.
