Healthcare

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to create an add-on payment for safety-net hospitals with a Level 1 Trauma designation, equal to at least $35,000,000 per hospital, per year.

Provides legislative findings. Appropriates specified amounts to the Department of Public Health for grants, expenses, and administrative costs of programs relating to acquired immunodeficiency syndrome and human immunodeficiency virus; the Getting to Zero-Illinois plan to end the HIV epidemic by 2030; the prevention, screening, and treatment services to address sexually transmitted infection cases; and the PrEP4Illinois Program to provide client navigation for pre-exposure prophylaxis services and medication access. Contains other provisions. Effective July 1, 2025.

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident or health insurance that is issued, amended, delivered, or renewed on or after January 1, 2027 shall not charge insured persons a copayment as a method of cost-sharing or include a deductible greater than $1,000. Provides that yearly out-of-pocket expenses for insured persons must be less than or equal to $1,500. 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. Requires an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in the State after June 1, 2026 to provide coverage for expenses for standard fertility preservation services and follow-up services related to that coverage. Defines "standard fertility preservation services" as procedures based upon current evidence-based standards of care established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other national medical associations that follow current evidence-based standards of care. Makes conforming changes in 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, and the Illinois Public Aid Code. Effective immediately.

Declares May 4 through May 10, 2025 as Tardive Dyskinesia Awareness Week (TDAW) in the State of Illinois. Expresses support for TDAW in recognition of the importance of early detection and intervention to improve outcomes for people living with mental health conditions and prescribed antipsychotics. Expresses support towards efforts to raise awareness about the causes and symptoms of tardive dyskinesia (TD) and the importance of routine TD screening.

Makes appropriations for the ordinary and contingent expenses of the Department of Public Health for the fiscal year beginning July 1, 2025, as follows: General Funds $292,182,000; Other State Funds $302,071,874; Federal Funds $1,120,531,838; Total $1,714,785,712.

Amends the Illinois Insurance Code. In a provision concerning coverage of certain cancer screenings, adds having a high level of CA-125, as indicated by a blood test screening, to the definition of "at risk for ovarian cancer". Provides that "surveillance tests for ovarian cancer" means all medically viable methods for the detection and diagnosis of ovarian cancer, including, but not limited to, ultrasounds, magnetic resonance imagings (MRIs), x-rays, computed tomography (CT) scans, and CA-125 blood test screenings (instead of an annual screening using (i) CA-125 serum tumor marker testing, (ii) transvaginal ultrasound, (iii) pelvic examination). Effective January 1, 2027.

Amends the Illinois Insurance Code. Provides that a group or individual plan of accident and health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2026 must provide coverage, no less than once every 12 months, for a peripheral artery disease screening test for any at-risk individual. 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. Establishes reimbursement rates for mental health and substance use disorder treatment services for all group or individual policies of accident and health insurance or managed care plans that are amended, delivered, issued, or renewed on or after January 1, 2027 or for any contracted third party administering the behavioral health benefits for the insurer. Requires a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 or any contracted third party administering the behavioral health benefits for the insurer to cover certain medically necessary mental health and substance use disorder treatment services. Provides that, if the Department of Insurance determines that an insurer or a contracted third party administering the behavioral health benefits for the insurer has violated a provision concerning mental health and substance use parity, the Department shall by order assess a civil penalty of $1,000 for each violation. Excludes certain health care plans serving Medicaid populations who are enrolled under the Illinois Public Aid Code or under the Children's Health Insurance Program Act from provisions concerning mental health and substance use parity. Requires the Department to review the impact of the proposed mental health and substance abuse mandate on network adequacy for mental health and substance use disorder treatment and access to affordable mental health and substance use care. Permits the Department to examine out-of-network utilization and out-of-pocket costs for insureds for mental health and substance use treatment and services for all plans to compare with in-network utilization. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code to require coverage under those provisions. Effective immediately.

Amends the Higher Education Student Assistance Act. Provides that, subject to appropriation, the Illinois Student Assistance Commission shall develop and administer a medical education grant program. Provides that the goal of the program shall be to attract capable and promising students to the medical profession, increase the employment and retention of individuals who are receiving additional clinical training in medicine, and reduce any financial barriers in the medical profession. Provides that under the program, grants shall be awarded to eligible medical students and eligible resident or fellow physicians and be used to cover the nontuition costs of attending a medical or osteopathic college or school or receiving specialty or residency training, including, but not limited to, living expenses. Effective July 1, 2025.