Healthcare

Amends the State Employees Group Insurance Act of 1971. Provides that beginning January 1, 2026, the Director of Central Management Services shall implement a program providing choice to Medicare-primary members and their Medicare-primary dependents. Provides that the program shall include a monthly voucher in the amount that the State would have contributed toward that member's monthly premium if the Medicare-primary member elected to participate in the group health benefits program. Provides that the voucher shall be used by the Medicare-primary member to pay the monthly premium cost of an individual Medicare Advantage plan of his or her choosing. Effective immediately.

Amends the Hospital Licensing Act. Provides that, if an individual is treated at a hospital and the hospital conducts a urine drug screening to assist in diagnosing the individual's condition, the hospital shall include testing for fentanyl in the individual's urine screening. Provides that if the urine drug screening, conducted in accordance with the provisions, detects fentanyl, the hospital shall report the test results, which shall be deidentified, to the Department of Public Health through the State-designated health information exchange. Provides that a hospital that does not have chemical analyzer equipment is not subject to the provisions. Provides that the provisions do not affect any State law which provides civil or criminal immunity to an individual who is in need of medical assistance after ingesting or using alcohol or drugs or to an individual who, in good faith, assists another who is in need of medical assistance after ingesting or using alcohol or drugs. Effective immediately.

Makes appropriations for the ordinary and contingent expenses of the Department of Healthcare and Family Services for the fiscal year beginning July 1, 2025, as follows: General Funds $9,358,579,800; Other State Funds $35,543,402,100; Federal Funds $400,000,000; Total $45,301,981,900.

Creates the Access to Prescription Drugs Act. Provides that any State agency may enter into partnerships to increase competition, lower prices, and address shortages in the market for generic prescription drugs; to reduce the cost of prescription drugs for public and private purchasers, taxpayers, and consumers; and to increase patient access to affordable drugs. Requires the partnerships to result in the production or distribution of generic prescription drugs with the intent that these drugs be made widely available to public and private purchasers, providers and suppliers, and pharmacies. Provides that the State agency shall comply with specified requirements when entering into partnerships or setting prices for generic prescription drugs. Requires a State agency that elects to enter into a partnership under the Act to submit separate reports to the General Assembly that (1) assess the feasibility of directly manufacturing generic prescription drugs and selling generic prescription drugs at a fair price; and (2) describe the status of all drugs targeted under the Act and analyze how the activities of the State agency may impact competition, access to targeted drugs, the costs of those drugs, and the costs of generic prescription drugs to public and private purchasers. Contains other provisions. Amends the Freedom of Information Act to exempt certain information disclosed under Access to Prescription Drugs Act from inspection and copying under the Act. Contains a severability provision. Effective July 1, 2025.

Amends the Illinois Insurance Code. Provides that 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 July 1, 2025 shall provide coverage for the full cost of an annual PET scan for insureds age 35 or older who elect to get a PET scan, regardless of whether the PET scan was ordered by a physician licensed to practice medicine in all its branches and regardless of whether the insured displays symptoms. Sets forth findings and definitions. Effective immediately.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that hypoallergenic formula shall be covered under the medical assistance program for persons otherwise eligible for medical assistance who have been prescribed hypoallergenic formula by a physician. Requires the Department of Healthcare and Family Services to apply for any federal waivers or approvals necessary to implement the amendatory Act. Provides that upon federal approval, the Department shall at a minimum determine by rule the amount of hypoallergenic formula an eligible person shall receive coverage for per day.

Appropriates $4,500,000 to the State Board of Education for grants to school districts to contract with organizations that directly provide students and school-based staff with mental telehealth services that are billed to Medicaid and commercial insurance plans. Effective July 1, 2025.

Creates the Artificial Intelligence Systems Use in Health Insurance Act. Provides that the Department of Insurance's regulatory oversight of insurers includes oversight of an insurer's use of AI systems to make or support adverse determinations that affect consumers. Provides that any insurer authorized to operate in the State is subject to review by the Department in an investigation or market conduct action regarding the development, implementation, and use of AI systems or predictive models and the outcomes from the use of those AI systems or predictive models. Provides that an insurer authorized to do business in Illinois shall not issue an adverse consumer outcome with regard to the denial, reduction, or termination of insurance plans or benefits that result solely from the use or application of any AI system or predictive model. Provides that any decision-making process for the denial, reduction, or termination of insurance plans or benefits that results from the use of AI systems or predictive models shall be meaningfully reviewed, in accordance with review procedures determined by Department rules, by an individual with authority to override the AI systems and determinations. Authorizes the Department to adopt emergency rules to implement the Act and to adopt rules concerning standards for full and fair disclosure of an insurer's use of AI systems. Makes a conforming change in the Illinois Administrative Procedure Act.

Amends the Illinois Public Aid Code. In a provision in the Medical Assistance Article concerning safety-net hospitals, provides that, subject to federal approval, reimbursement rates for inpatient hospital services in effect January 1, 2025 under the All Patient Refined-Diagnosis Related Groups system shall be increased by 10% for safety-net hospitals; and reimbursement rates for outpatient hospital services in effect January 1, 2025 under the Enhanced Ambulatory Procedure Grouping system shall be increased by 10% for safety-net hospitals. Requires the Department of Healthcare and Family Services to take all actions necessary to ensure the rate increases for safety-net hospitals are in effect for dates of service on and after January 1, 2026, including publishing all appropriate public notices, applying for federal approval of amendments to the Illinois Title XIX State Plan, and adopting administrative rules if necessary. In the Hospital Services Trust Fund Article, provides that, subject to federal approval, reimbursement rates for inpatient hospital services in effect January 1, 2025 under the All Patient Refined-Diagnosis Related Groups system shall be increased by 10%; and reimbursement rates for outpatient hospital services in effect January 1, 2025 under the Enhanced Ambulatory Procedure Grouping system shall be increased by 10%. Requires the Department of Healthcare and Family Services to take all actions necessary to ensure the rate increases are in effect for dates of service on and after January 1, 2026, including publishing all appropriate public notices, applying for federal approval of amendments to the Illinois Title XIX State Plan, and adopting administrative rules if necessary. Effective immediately.

Amends the School Code. In provisions concerning student mental health screenings, requires the State Board of Education's model school district procedures to facilitate the implementation of mental health screenings to include the option to opt in (rather than opt out) and a minimum of 3 written notifications each school year about the use of mental health screenings, one of which must be delivered by first-class mail, to a student's parent or guardian. Effective January 1, 2026.