Healthcare

Provides that the total payments under a provision concerning the Board providing partial reimbursement of health insurance costs may not exceed $100,000,000 (instead of $65,000,000) in any year. Provides that the amount shall annually thereafter be increased by the annual unadjusted percentage increase (but not less than zero) in the consumer price index for the 12 months ending with the September preceding each November 1, including all previous adjustments. Defines "consumer price index".

Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning applications for the expansion of supportive living dementia care settings, removes language permitting the Department of Healthcare and Family Services to approve such applications only if the application has no more than one non-dementia care unit for each dementia care unit.

Amends the Use Tax Act, the Service Use Tax Act, the Service Occupation Tax Act, and the Retailers' Occupation Tax Act. Provides that, beginning on January 1, 2026, hearing aids are exempt from the taxes under those Acts. Effective immediately.

Amends the Mental Health and Developmental Disabilities Code. Makes changes to a provision concerning initial Department of Human Services investigations of a facility employee's alleged abuse, neglect, or financial exploitation of a recipient of mental health or developmental disability services. Expands the provision to include allegations of material obstruction of an investigation, physical abuse, sexual abuse, non-de minimis financial exploitation (such as financial exploitation totaling a cumulative value equal to or greater than $100), or egregious neglect. Adds provisions concerning Department investigations where a facility employee is the perpetrator of, at most, neglect, de minimis financial exploitation (such as financial exploitation totaling a cumulative value of less than $100), or mental abuse.

Amends the Illinois Insurance Code. Provides that a group health plan or an accident and health insurer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable State law. Provides that nothing in the provisions shall be construed as preventing a group health plan, an accident and health insurer, or the Director of Insurance from establishing varying reimbursement rates based on quality or performance measures.

Amends the Long-Term Care Provider Funding Article of the Illinois Public Aid Code. Provides that any increase in any authorized long-term care provider assessment must: (1) comply with all federal regulations for provider assessments; (2) require that all revenues from an increase in the assessed rates are applied to nursing facility rates for staffing incentives and to improve the quality of care as described in specified provisions under Article V of the Code; (3) not increase the assessed rate of $7 per occupied bed day for non-profit nursing facilities without Medicaid-certified beds or any nursing facility owned and operated by a county government; (4) maintain the 2.1 to 1 ratio between the highest tax rate and lowest tax rate; and (5) not increase any tax rate proportionally more than any other tax rate. Effective immediately.

Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning Medicaid Access Adjustment payments to nursing facilities, provides that, for dates of service beginning July 1, 2025, the Medicaid Access Adjustment shall be increased to $5.75. Effective immediately.

Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision prohibiting prior authorization mandates and utilization management controls under the fee-for-service and managed care medical assistance programs for FDA-approved prescription drugs that treat mental illness, requires the Department of Healthcare and Family Services and managed care organizations to report quarterly on compliance with the specified prohibitions beginning with dates of service on and after July 1, 2025. Requires the Department to post on its website a report on fee-for-service prescriptions and the reports from each managed care organization. Sets forth the information that must be contained in the quarterly reports, including, but not limited to: (i) the number of denied prescriptions and estimated net cost to the State for those covered prescriptions summarized by each of the allowed categories specified in the Code; (ii) the number of denied prescriptions and estimated net cost to the State for those prescriptions summarized by each of the non-allowed categories specified in the Code; and (iii) the number of denied prescriptions and estimated gross cost to the State for those prescriptions summarized by any other reason not specified in the Code. Requires the Department to sanction those managed care organizations that do not file the required reports. Effective immediately.

Appropriates $209,000,000 from the General Revenue Fund to the State Board of Education for costs associated with the Healthy School Meals for All Program. Effective July 1, 2025.

Amends the Illinois Insurance Code. Provides that an individual or group health benefit plan shall not impose any prior authorization requirements on outpatient services for the prevention, screening, diagnosis, or treatment of mental, emotional, nervous, or substance use disorders or conditions.