Healthcare

Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or a managed care plan to provide coverage for at least one early egg allergen introduction dietary supplement and one early peanut allergen introduction dietary supplement. Provides that the required coverage shall be provided at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met. Except as otherwise provided, nothing in the provisions prevents the operation of such a policy provision as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility. Provides that the required coverage does not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies, and that the cost-sharing limitation does not apply to a catastrophic health plan to the extent the cost-sharing limitation would cause the plan to fail to be treated as a catastrophic plan under federal law. Provides that the cost-sharing limitation does not apply to a high deductible health plan to the extent this cost-sharing limitation would cause the plan to fail to be treated as a high deductible health plan under specified provisions of the Internal Revenue Code. Provides that, if the cost-sharing limitation would result in an enrollee becoming ineligible for a health savings account under federal law, the cost-sharing limitation only applies to a qualified high deductible health plan after the enrollee's deductible has been met. 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 those provisions.

Amends the Illinois Insurance Code. Provides that an issuer of a Medicare supplement policy shall not deny coverage to an applicant who voluntarily switches from a Medicare Advantage plan to a Medicare plan under Parts A, B, or D, or any combination of those plans, so long as the application for a Medicare supplement policy is submitted within 30 calendar days after the first effective day of the new plan. Provides that when such an application for a Medicare supplement policy is submitted, the issuer of the Medicare supplement policy may not charge a higher cost than what is normally offered to applicants who have become newly eligible for Medicare, nor raise costs or deny coverage for a preexisting condition.

Appropriates $2 from the General Revenue Fund to the Department of Healthcare and Family Services for its FY26 ordinary and contingent expenses. Effective July 1, 2025.

Creates the Protect Health Data Privacy Act. Provides that a regulated entity shall disclose and maintain a health data privacy policy that clearly and conspicuously discloses specified information. Sets forth provisions concerning health data privacy policies. Provides that a regulated entity shall not collect, share, or store health data, except in specified circumstances. Provides that it is unlawful for any person to sell or offer to sell health data concerning an individual without first obtaining valid authorization from the individual. Provides that a valid authorization to sell individual health data must contain specified information; a copy of the signed valid authorization must be provided to the individual; and the seller and purchaser of health data must retain a copy of all valid authorizations for sale of health data for 6 years after the date of its signature or the date when it was last in effect, whichever is later. Sets forth provisions concerning the consent required for collection, sharing, and storage of health data. Provides that an individual has the right to withdraw consent from the processing of the individual's health data. Provides that it is unlawful for a regulated entity to engage in discriminatory practices against individuals solely because they have not provided consent to the processing of their health data or have exercised any other rights provided by the provisions or guaranteed by law. Sets forth provisions concerning an individual's right to confirm whether a regulated entity is collecting, selling, sharing, or storing any of the individual's health data; an individual's right to have the individual's health data that is collected by a regulated entity deleted; prohibitions regarding geofencing; and individual health data security. Provides that any person aggrieved by a violation of the provisions shall have a right of action in a State circuit court or as a supplemental claim in federal district court against an offending party. Provides that the Attorney General may enforce a violation of the provisions as an unlawful practice under the Consumer Fraud and Deceptive Business Practices Act. Defines terms. Makes a conforming change in the Consumer Fraud and Deceptive Business Practices Act.

Amends the Community Mental Health Act. Authorizes any public library district to construct, repair, operate, maintain, and regulate community mental health facilities. Provides that a public library district authorized to levy an annual tax under the Act shall establish a community mental health board whose members are appointed by the president of the public library district's board of trustees.

Amends the Substance Use Disorder Act. Provides that beginning on the effective date of the amendatory Act, the Department of Human Services shall not approve any initial or renewal application for the licensure of a facility where substance use treatment or intervention services will be provided within 1,000 feet of: (i) any building or buildings or real property comprising a public or private elementary or secondary school, community college, college, or university, including any adjacent school yard, school playing field, or school playground; (ii) a public playground; or (iii) any public park building or real property comprising any public park. Provides that nothing in the amendatory Act shall be construed to invalidate any initial or renewal application for licensure approved prior to the effective date of the amendatory Act.

Amends the Illinois Insurance Code. Provides that, when a beneficiary, insured, or enrollee receives mental health services from a nonparticipating provider or a nonparticipating health care facility, the health insurance issuer shall ensure that the beneficiary, insured, or enrollee shall incur no greater out-of-pocket costs than the beneficiary, insured, or enrollee would have incurred with a participating provider or a participating health care facility. Requires any cost-sharing requirements to be applied as though the mental health services had been received from a participating provider or a participating health care facility. Provides that, if the cost sharing for the same item or service furnished by a participating provider would have been a flat-dollar copayment, that amount shall be the cost-sharing amount unless the provider has billed a lesser total amount. Provides that administrative requirements or limitations shall be no greater than those applicable to emergency services received from a participating provider or a participating health care facility. Permits a beneficiary, insured, or enrollee receiving ongoing mental health services from a nonparticipating provider to continue treatment with the nonparticipating provider for up to one year from the start of services or one year after the effective date of the amendatory Act, whichever is later, as if the mental health services were provided by a participating provider. 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 those provisions. Effective January 1, 2027.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that upon application to the Department of Healthcare and Family Services, supportive living program settings may convert non-dementia care setting units to dementia care setting units. Provides that all conversions must be operational within one year of approval and meet criteria specific to certification for dementia care setting units outlined in the Illinois Administrative Code.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that beginning January 1, 2026, a supportive living dementia care setting shall not limit resident access to the sink, microwave, and refrigerator located within the respective resident's room. Provides that social and recreational programming shall be provided no less than daily at a time and location separate from a meal service. Provides that beginning January 1, 2026, a newly constructed supportive living dementia care setting shall provide no less than 300 square feet for a single occupancy apartment or no less than 450 square feet for a double occupancy apartment. Provides that the square footage requirement may include the closets and bathroom. Requires each apartment to include a sink, microwave, and refrigerator within the unit. Provides that beginning January 1, 2026, a newly constructed supportive living dementia care setting shall provide a common area completely separate from the dining area.

Amends the Illinois Insurance Code. Requires any pharmacy benefit manager or health insurer to provide notice of a change in prescription drug coverage or pricing, including instructions on appeals and exceptions, to beneficiaries of health plans in the State who would be affected by the change. Provides that any pharmacy benefit manager or health insurer must, on or before July 30, 2026, submit to the Department for approval a plan by which beneficiaries may appeal, or request an exception to, a contemplated change in coverage. Provides that this process must allow beneficiaries to present evidence for their appeal or exception. Provides that if the Department of Insurance determines that the processes for requesting appeals or exceptions are insufficient, or do not adequately rely on medical necessity, the Department shall set forth required changes to the process within 90 days of receipt. Provides that if the pharmacy benefit manager or health insurer disputes the changes, a hearing may be requested within 10 days after receipt of the changes, and the Department shall enter a final written decision within 5 days of the hearing.