Amends the Hospital Provider Funding Article of the Illinois Public Aid Code. In provisions requiring the Department to establish the fixed pool directed payment amounts for specific classes of hospitals listed in the Code, provides that, beginning January 1, 2027, the Department of Healthcare and Family Services shall remove from the list the following hospital classes: (i) hospital inpatient services for public hospitals and (ii) hospital outpatient services for public hospitals. Requires the Department to instead, subject to any necessary federal approval, enter into intergovernmental agreements with the respective governing bodies to ensure continued access for those services in rural areas of the State. Provides that the Department shall reinstate the described hospital classes if federal approval is not received. Effective January 1, 2027.
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.
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).
