Healthcare (Mental Health)

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 Emergency Medical Services (EMS) Systems Act. In provisions concerning when EMS personnel may contact Online Medical Control or an EMS Medical Director or Emergency Communications Registered Nurse to request bypass or diversion of the closest emergency department and request transport to the closest or appropriate EMS System-approved mental health facility, removes the requirement that the patient must not be under the influence of drugs or alcohol.

Creates the Substance Use Disorder and Mental Health Program Transparency Act. Provides that, within 6 months after the effective date of the Act, the Department of Healthcare and Family Services, in coordination with the Department of Human Services, shall compile a report concerning all substance use disorder and mental health programs in the State. Provides that the report shall identify each State-funded substance use disorder and mental health program in the State and provide specified information about each program. Provides that the Department of Healthcare and Family Services, in coordination with the Department of Human Services, shall collaborate with relevant State agencies to ensure the timely and accurate collection of information required for the report. Provides that the Department of Healthcare and Family Services, in coordination with the Department of Human Services, shall submit the report to the General Assembly. Requires both Departments to make the report accessible to the public on their respective websites no later than 6 months after the effective date of the Act. Effective immediately.

Amends the Illinois Controlled Substances Act. Provides that, if any substance, scheduled as a Schedule I controlled substance by the United States Drug Enforcement Administration, is rescheduled for the purpose of treating mental health disorders, including, but not limited to, anxiety, depression, and post traumatic stress disorder, the Department of Human Services shall reschedule the substance accordingly within 30 days from the publication in the Federal Register of the final order rescheduling the substance.

Amends the Nursing Home Care Act and the Specialized Mental Health Rehabilitation Act of 2013. Provides that, to facilitate timely applications for Supplemental Security Income or Social Security Disability Insurance, facilities shall assess residents using the Social Security Administration screener to check eligibility for Social Security benefits within 30 days after admission to a facility. If the resident is likely eligible, requires the facility to assist the resident with completing an application within 60 days after admission to a facility. Provides that, within 6 months after the effective date of the amendatory Act, facilities shall conduct a one-time assessment of all current residents and complete a Social Security Administration screener for all residents without income and without a pending Supplemental Security Income or Social Security Disability Insurance application. Twice per year, requires each facility to publicly post on the facility's website the number of residents screened and the number of applications initiated. Effective immediately.

Amends the Developmental Disability and Mental Disability Services Act. Provides that in one's "own home" means that an adult with a mental disability lives alone; or that an adult with a mental disability is in full-time residence with his or her parents, legal guardian, or other relatives; or that an adult with a mental disability is in full-time residence in a setting not subject to licensure under the Nursing Home Care Act, the Specialized Mental Health Rehabilitation Act of 2013, the ID/DD Community Care Act, the MC/DD Act, or the Child Care Act of 1969 with 5 (rather than 3) or fewer other adults unrelated to the adult with a mental disability who do not provide home-based services to the adult with a mental disability.

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 Specialized Mental Health Rehabilitation Act of 2013. Provides that each consumer shall be offered at least 15 hours of treatment programming per week and encouraged to attend the treatment domains that meet the consumer's needs, as reflected in the consumer's treatment plans. Provides that each consumer's program engagement and attendance shall be documented in the consumer's clinical record, and each consumer shall be prompted to attend programming regularly as documented in the consumer's clinical record at least quarterly. Effective July 1, 2026.

Amends the Hospital Licensing Act and the University of Illinois Hospital Act. Provides that, unless otherwise required by Illinois law, no hospital, individual affiliated with a hospital, or person contracted with a hospital shall release information related to any person or entity that allows a child to receive gender-affirming health care or gender-affirming mental health care in response to any criminal or civil action, including a foreign subpoena, based on another state's law that authorizes a civil action to be brought against any person or entity that allows a child to receive gender-affirming health care or gender-affirming mental health care. Amends the Illinois Insurance Code, 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 prohibit the same release of information from an issuer of a policy of accident or health insurance.

Amends the Mental Health and Developmental Disabilities Administrative Act and the Rehabilitation of Persons with Disabilities Act. Required the Department of Human Services to provide informational materials about the Senator Scott Bennett ABLE Program to: persons who are placed in a facility licensed under the ID/DD Community Care Act, the MC/DD Act, or the Specialized Mental Health Rehabilitation Act of 2013; persons with disabilities who receive services funded by or administered in conjunction with the Department, including, but not limited to, home and community based services, home-based support services, PUNS services, home care services, and services at a Center for Independent Living. Provides that the informational materials shall be provided when a person first enrolls for such services and as part of any annual process required for the person to maintain eligibility for such services. Requires the Office of the State Treasurer to prepare and deliver the informational materials in an electronic format to the Department and distribute the materials to eligible persons.