Healthcare

Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions prohibiting prior authorization mandates and utilization management controls under the fee-for-service and managed care medical assistance programs on specified FDA-approved prescription drugs for mental illness, provides that the prohibition shall apply if a preferred or non-preferred drug is prescribed to an adult patient to treat a serious mental illness and (i) during the preceding 60 days, the patient who experienced an inadequate response was prescribed and unsuccessfully treated with a 14-day treatment trial of a drug for the same clinical condition that is included on the preferred drug list and (ii) one of the statutory conditions apply.

Urges the implementation of interventions to support vaccine uptake and reduce disparities in vaccine coverage among children. Urges the Illinois Department of Health, the Illinois State Board of Education, and the Illinois Department of Healthcare and Family Services to work with pediatricians, clinicians, families, and other stakeholders to ensure infants and children are vaccinated on time and students begin school fully vaccinated. Urges the Illinois Department of Health, the Illinois State Board of Education, and the Illinois Department of Healthcare and Family Services to continue to invest in immunization initiatives and infrastructure to ensure timely reporting of vaccine coverage to ensure children are protected from vaccine-preventable illness in public and private schools, child care facilities, and pre-kindergarten programs and beyond.

Amends the Department of Insurance Law of the Civil Administrative Code of Illinois. Requires the Department of Insurance to conduct a study to better understand the gaps in health insurance coverage for uninsured residents, including the reasons why individuals are uninsured and whether insured individuals are insured through an employer-sponsored plan or through the Illinois health insurance marketplace. Requires the Department to submit a report of its findings and recommendations to the General Assembly 12 months after the effective date of the amendatory Act. Amends the Hospital Licensing Act and the University of Illinois Hospital Act. Provides that hospitals licensed under the Act shall provide health insurance coverage to all of their workforce.

Amends the Medical Patient Rights Act and the Veterinary Medicine and Surgery Practice Act of 2004. Provides that a health care provider and a person engaged in the practice of veterinary medicine shall not charge a patient or client or require the patient or client to pay a fee for a missed or late appointment. Provides that nothing in the provisions shall be construed to prohibit health care providers and a persons engaged in the practice of veterinary medicine from developing and implementing an incentive program to encourage patients or clients to adhere to scheduled appointments. Provides that any health care provider or person engaged in the practice of veterinary medicine that violates the provisions concerning missed and late appointment fees is guilty of a petty offense and shall be fined $500 per violation.

Creates the Prescription Drug Purchasing Task Force Act. Creates a Prescription Drug Purchasing Task Force in the Department of Healthcare and Family Services to study the different ways that other states are using multi-state prescription drug purchasing pools to increase the State's negotiating power and lower prices for patients. Provides for duties of the Task Force. Provides that the Department of Healthcare and Family Services shall provide administrative and other support to the Task Force. Provides that, on or before July 31, 2026, the Task Force shall report its findings and recommendations to the General Assembly and to the Governor. Provides that the Prescription Drug Purchasing Task Force is abolished and the Act is repealed on January 1, 2027.

Amends the Illinois Insurance Code. In a provision concerning coverage for the treatment of mental, emotional, nervous, or substance use disorders or conditions, requires certain insurers to ensure, prior to policy issuance, that there is no limit on the number of visits per week for outpatient mental health treatment.

Amends the Illinois Insurance Code to require an insurance policy to provide coverage for medically necessary treatments for genetic, rare, unknown or unnamed, and unique conditions, including Ehlers-Danlos syndrome and altered drug metabolism. Provides that an insurance policy that provides coverage for prescription drugs shall include coverage for opioid alternatives, coverage for medicines included in the Model List of Essential Medicines published by the World Health Organization, and coverage for custom-made medications and medical food. Provides that an insurance policy that limits the quantity of a medication in accordance with applicable State and federal law shall not require pre-approval for the treatment of patients with rare metabolism conditions that may need a higher dose of medication than what is otherwise allowed within a time frame or prescription schedule. Provides that the burden of proving that treatment is medically necessary shall not lie with the insured in cases of rejections for filing claims, preauthorization requests, and appeals related to coverage required under the Section.

Amends the Nurse Practice Act. Provides that a certified nurse midwife with full practice authority may enter into a written collaborative agreement with an advanced practice registered nurse. Provides that an advanced practice registered nurse certified as a nurse midwife may enter into a written collaborative agreement with an advanced practice registered nurse with full practice authority who is certified as a nurse midwife or a physician. Provides that, for an advanced practice registered nurse certified as a nurse midwife, the clinical experience shall be in collaboration with a certified nurse midwife with full practice authority. Makes conforming changes in provisions concerning written collaborative agreements, prescriptive authority under a written collaborative agreement, and full practice authority.

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, 2026.

Amends the Illinois Insurance Code. In a provision concerning services provided by nonparticipating providers, provides that "health care facility" in the context of non-emergency services, includes a facility or office in which a patient receives reproductive health care, as defined in the Reproductive Health Act.