Healthcare (Mental Health)

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.

Provides that the Act may be referred to as the Safe Place to Go Act. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services, in collaboration with the Department of Human Services' Division of Behavioral Health and Recovery, to apply for a Medicaid State Plan amendment or federal waiver within 12 months after the effective date of the amendatory Act to draw federal financial participation for crisis triage and stabilization services provided by behavioral health urgent care centers to support adults or children 5 years of age and older who are in an active mental health crisis and adults 18 years of age and older in a substance use crisis. Sets forth the services provided by behavioral health urgent care centers that shall be covered, including, but not limited to, crisis triage services, crisis stabilization services, and medication monitoring. Contains provisions concerning the use of the Illinois Mental Health Crisis Assessment Tool to determine an individual's eligibility or medical need for crisis stabilization services; telehealth and on-site services; safe sobering services; linkages to enable rapid transition to next level of care; length of stay; the development of a single bundle rate for crisis triage services and 2 separate per diem reimbursement rates for crisis stabilization services and safe sobering services; no prior authorization requirements; and the establishment of a working group to provide meaningful input on the establishment, operations, staffing, and financing of behavioral health urgent care centers. Requires the Department to adopt rules within 6 months after federal approval of its State Plan amendment or federal waiver application, if granted. Effective immediately.

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.

Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2027 to cover up to 12 mental health provider visits per plan year, with no visitation restrictions, if a local or State emergency is declared due to immigration enforcement activity and the insured has experienced loss, trauma, or displacement due to such activity. Provides that the coverage shall not be subject to deductibles, copayments, or other forms of cost sharing. Effective immediately.

Amends the Mental Health and Developmental Disabilities Administrative Act. Requires the Department of Human Services to establish reimbursement rates that build toward livable wages for frontline personnel in residential and day programs and service coordination agencies serving persons with intellectual or developmental disabilities. Provides that for community-based providers serving persons with intellectual or developmental disabilities, subject to federal approval of any relevant Waiver Amendment, the rates taking effect for services delivered on or after January 1, 2027 shall include an increase in the rate methodology sufficient to provide a $1.20 per hour wage rate increase for all direct support professionals 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. Prohibits community-based providers from using the rate increases for operational or administrative expenses. Requires rate increases that are sufficient to provide wages for all residential non-executive direct care staff. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the rates for ID/DD and MC/DD facilities for services delivered on or after January 1, 2027 shall include a $1.20 per hour wage increase for all direct support professionals and other frontline personnel who are not subject to the Bureau of Labor Statistics' average wage increases. Provides that changes to the rate methodologies are subject to federal approval. Grants emergency rulemaking authority to the Departments of Human Services and Healthcare and Family Services to implement the rate increases. Effective immediately.

Creates the Health Care for All Illinois Act. Provides that all individuals residing in this State are covered under the Illinois Health Services Program for health insurance. Sets forth requirements and qualifications of participating health care providers. Sets forth the specific standards for provider reimbursement. Provides that it is unlawful for private health insurers to sell health insurance coverage that duplicates the coverage of the program. Requires the State to establish the Illinois Health Services Trust to provide financing for the program. Sets forth the specific requirements for claims billed under the program. Provides that the program shall include funding for long-term care services and mental health services. Creates the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open bid competitive basis. Provides that patients in the program shall have the same rights and privacy as they are entitled to under current State and federal law. Establishes the Illinois Health Services Governing Board to administer the program. Provides that the Commissioner, the Chief Medical Officer, the public board members, and employees of the program shall be compensated in accordance with the current pay scale for State employees and as deemed professionally appropriate by the General Assembly. Effective January 1, 2027.

Provides that the amendatory Act may be referred to as the Strengthen Linkage to Follow-Up Care after a Behavioral Health Crisis Act. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for purposes of timely linking an individual to follow-up mental health care immediately after a behavioral health crisis, when mobile crisis response services are provided to someone in a behavioral health crisis, the Illinois Medicaid-Crisis Assessment Tool approved by the Department of Healthcare and Family Services shall enable the delivery of community support services, medication monitoring, and other specified services when delivered by the same provider, for up to 30 days without beginning, performing, or completing an integrated assessment and treatment plan. Provides that such services shall be billed separate from mobile crisis response services. Prohibits the Department from imposing more stringent requirements on its Illinois Medicaid-Crisis Assessment Tool than those requirements that exist on the effective date of the amendatory Act, as long as the services provided are delivered under the supervision of a licensed practitioner of the healing arts. Requires the Department to file any rules necessary to implement the amendatory Act. Effective immediately.