Amends the Rebuild Illinois Mental Health Workforce Act. Provides that beginning January 1, 2026, for each State fiscal year, a monthly directed payment shall be paid to each community mental health provider of community support individual services based on the number of Medicaid users of community support individual services documented by Medicaid fee-for-service and managed care encounter claims delivered by the provider in the base year. Sets forth how the monthly directed payment shall be calculated. Requires the Department of Healthcare and Family Services to adjust and pay community mental health providers for any payments authorized for all services from a community mental health provider which have been paid by a Medicaid managed care organization but no encounter claim has been recorded in the Departments' Enterprise Data Warehouse. Provides that the Department must develop a process for community mental health providers to reconcile these payments and submit claims for which the Department has not used for making payments. Permits the Department to sanction Medicaid managed care organizations for services not received by the Department.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to establish and administer, by January 1, 2027, a Certified Family Health Aide Program that permits a legally responsible family caregiver or family member to receive specific training from a participating licensed home health agency, home nursing agency, or home services agency on the provision of private duty nursing services. Provides that a legally responsible family caregiver or family member who successfully completes training and meets all other applicable requirements under State or federal law shall receive certification as a certified family health aide and be eligible to provide private duty nursing services to a qualifying family member under the Early and Periodic Screening, Diagnostic and Treatment benefit or through any home and community-based services waiver program for medically fragile and technology dependent children. Provides that no home health agency, home nursing agency, home services agency, or legally responsible family caregiver or family member is required to participate in the program. Contains provisions on training and instruction requirements for certification; additional hands-on training provided by participating agencies; competency requirements for certified family health aides; background check requirements; reimbursement rates for certified family health aide services; Department rules and reporting requirements; monthly meetings between the Department and participating agencies during the implementation phase of the program; and other matters. Effective immediately.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that on and after January 1, 2026, the rates paid for children's dental comprehensive oral exams, periodic oral exams, problem focused exams, behavior management codes, sealants, resin-based composites-posterior teeth, and extraction and surgical extraction codes shall be increased by 33% above the rates in effect on December 31, 2025. Effective January 1, 2026.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that on and after January 1, 2026, the reimbursement rates for all dental services for children shall be increased 50% above the rates in effect on December 31, 2025. Effective January 1, 2026.
Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions listing the classes of persons eligible for medical assistance, provides that, to the extent permitted by federal law, the Department of Healthcare and Family Services shall by rule eliminate the consideration of assets when determining eligibility for any program of medical assistance. Requires the Department to seek federal authority to disregard all resources, including real and personal property, as authorized by the flexibilities provided under a specified federal law or other available authorities. Provides that if adjustment or elimination of the asset limit results in any disadvantage to receiving medical assistance in a community setting, the Department shall adopt rules rebalancing the programs so that, where medical assistance is available in a community setting, a medical assistance beneficiary has free choice between receiving those services in the community or in a long-term care facility. Makes conforming changes by: (i) removing a provision that requires the Department to establish, by rule, the amounts of assets to be disregarded in determining eligibility for medical assistance; (ii) removing a provision that permits the Department to establish resource standards for pregnant individuals applying for medical assistance that are more restrictive than those resource standards established under the Temporary Assistance for Needy Families program; and (iii) removing a provision that permits the Department to allow non-exempt assets up to $25,000 during periods of medical assistance eligibility for employed persons with disabilities and employed persons with a medically improved disability.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for the calendar year beginning January 1, 2026, and each calendar year thereafter, a nursing facility must spend at least 90% of its adjusted total revenue on resident care and other resident-related costs, as defined. Requires each nursing facility to provide as part of its financial reporting information necessary for the Department of Healthcare and Family Services to administer and enforce the provisions of the amendatory Act. Provides that such information shall be subject to audit provisions and comply with any applicable uniform standards under the Code. Provides that all non-allowable costs, related party adjustments, or compensation to owners reported shall be excluded from the calculation of the amount spent on resident care and other resident-related costs. Requires 25% of costs associated with contract nursing staff to be deducted from the amount spent on resident care and other resident-related costs. Provides that for the calendar year beginning January 1, 2027, and each calendar year thereafter, the Department shall use the required financial reporting submissions to determine whether each nursing facility has met the minimum resident care percent requirement. Provides that if a facility has not met the minimum resident care percent requirement, the amount defined by the facility's total adjusted revenue shall be treated as a vendor overpayment. Requires the Department to recover the full amount of any vendor overpayment by reducing future payments, requiring direct payment to the Department, or any other method permitted under the Code. Requires the Department to adopt rules.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that subject to federal approval, within 12 months after the effective date of the amendatory Act, nutrition care services and medical nutrition therapy provided by a registered dietitian licensed under the Dietitian Nutritionist Practice Act who is acting within the scope of his or her license shall be covered under the medical assistance program. Provides that the covered services may be aimed at prevention, delay, management, treatment, or rehabilitation of a disease or condition and include nutrition assessment, nutrition intervention, nutrition counseling, and nutrition monitoring and evaluation. Requires the Department of Healthcare and Family Services to submit a Title XIX State Plan amendment, if required, to implement the amendatory Act. Provides that the Department shall adopt rules to implement the amendatory Act, including rules that ensure coverage for individuals with chronic conditions without prior authorization.
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that on and after January 1, 2026, the rates paid for children's dental comprehensive oral exams, periodic oral exams, problem focused exams, behavior management codes, sealants, resin-based composites-posterior teeth, and extraction and surgical extraction codes shall be increased by 33% above the rates in effect on December 31, 2025. Effective January 1, 2026.
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 for dates of service starting July 1, 2025, reimbursement calculations and direct payment for services provided by facilities licensed under the ID/DD Community Care Act are the responsibility of the Department of Healthcare and Family Services instead of the Department of Human Services. Requires appropriations for the facilities licensed under the ID/DD Community Care Act to be shifted from the Department of Human Services to the Department of Healthcare and Family Services. Provides that nothing shall prohibit the Department of Healthcare and Family Services from paying more than the rates specified in the Code. Requires the Department of Healthcare and Family Services to work with the Department of Human Services to study and review the reimbursement calculations and direct payments for facilities licensed under the ID/DD Community Care Act and for facilities licensed under the MC/DD Act. Effective July 1, 2025.
