Healthcare (Medicare)

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to seek a State Plan amendment from the Centers for Medicare and Medicaid Services regarding a prospective cost-reimbursement methodology for services provided by federally qualified health centers (FQHC) and FQHC Look-Alikes (LALs). Requires the State Plan amendment to include the following: (1) Prospective Payment System (PPS) rates for FQHCs; (2) a rate adjustment process; (3) a rate setting for new FQHCs; (4) payment in the event of Medicaid managed care; (5) payment in the event of dual enrollment in Medicare and Medicaid; and (6) appeal rights.

Creates the Community Supported Living Arrangement Services Act. Provides that the Department of Human Services, Division of Developmental Disabilities shall work in coordination with the Department of Healthcare and Family Services to develop, implement, and operate, and to submit, through the Department of Healthcare and Family Services, amendments to the Illinois Adults with Developmental Disabilities Section 1915(c) Home and Community-Based Services Waiver, subject to approval by the Centers for Medicare and Medicaid Services. Provides for establishment of provider licensing, certification, and oversight standards for Community Supported Living-24 Hour services consistent with existing State authority for community-based residential services, but with the person's own home not requiring licensing or Bureau of Accreditation, Licensure and Certification reviews. Provides for 24-hour availability of trained personnel for individuals with intense physical, medical, or behavioral support needs. Contains provisions regarding: covered services; enrollment; the use of tools such as the Health Risk Screening Tool; housing independence; staffing and workforce standards; phased implementation; Person-Centered Plans; dignity of risk; compliance with mandates; quality assurance; evaluations; a Community Supported Living Advisory Council; reports; fiscal issues; administrative issues; and other matters. Effective immediately.

Amends the Department of Central Management Services Law of the Civil Administrative Code of Illinois. Creates the Disability Benefits Maximization Program. Provides that, within 6 months after the effective date of the amendatory Act, the Department of Central Management Services, in conjunction with the 5 State-funded retirement systems, shall enter into a contract with an administrator to establish and conduct a Disability Benefits Maximization Program to identify individuals eligible for but not enrolled in Medicare, and to assist those individuals with enrolling in Social Security and Medicare. Provides that the Disability Benefits Maximization Program shall conduct an annual audit of the State health benefits program for everyone covered under the State Employees Group Insurance Program, the Teachers' Retirement Insurance Program, and the College Insurance Program for the purpose of identifying participants and their dependents who are eligible for Medicare under federal law and shall also ensure that those annuitants, retirees, benefit recipients, survivors, and dependents who are eligible for Medicare are enrolled in Medicare with Medicare as their primary health care benefits coverage and the State health benefits program being the secondary provider of their health care benefits coverage. Provides that the Disability Benefits Maximization Program shall assist annuitants, retirees, benefit recipients, and their survivors and dependents who become disabled and are not enrolled in Social Security Disability Insurance and Medicare with enrolling in and obtaining Social Security Disability Insurance and Medicare benefits. Provides that the administrator of the Disability Benefits Maximization Program shall provide the Department, the 5 State-funded retirement systems, and the General Assembly with an annual report. Effective January 1, 2027.

Amends the Mental Health and Developmental Disabilities Administrative Act. Requires the Department of Human Services to file an amendment to the Home and Community-Based Services Waiver Program for Adults with Developmental Disabilities that shall include an increase in the rate methodology sufficient to provide for a wage rate of 150% of the statewide, regional, or local minimum wage for services delivered on or after January 1, 2027, for all direct support personnel 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. Provides that for services delivered on or after January 1, 2027, the rates shall include adjustments to employment-related expenses as defined by rule by the Department. Requires the Department to adopt rules, including emergency rules, to implement the rate increases. Contains provisions on benchmark rates for therapy and counseling for adults with intellectual and developmental disabilities; tiered rates for community day services; community integration supports for community day services; and benchmark rates for CILA transportation cost and for the supported employment program for adults with intellectual and developmental disabilities. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to submit a Title XIX State Plan amendment to the federal Centers for Medicare and Medicaid Services that shall include an increase in the rate methodology sufficient to provide for a wage rate of 150% of the statewide, regional, or local minimum wage for services delivered on or after January 1, 2027, for all direct support personnel and all other frontline personnel at ID/DD and MC/DD facilities. Provides that the State Plan amendment shall provide wage increases for all residential non-executive direct care staff. Effective immediately.

Amends the Medicare-Medicaid Alignment Initiative (MMAI) Nursing Home Residents' Managed Care Rights Law of the Illinois Public Aid Code. Provides that the Article applies to a fully integrated dual eligible special needs plan and any managed care plan for persons who are dually eligible for Medicare and Medicaid. Adds to the definition of "Demonstration Project", a fully integrated dual eligible special needs plan and any managed care plan for persons who are dually eligible for Medicare and Medicaid. Provides that the Department of Healthcare and Family Services shall provide each managed care organization with the quarterly facility-specific nursing component (instead of RUG-IV nursing component) per diem along with any add-ons for enhanced care services, support component per diem, and capital component per diem effective for each nursing home under contract with the managed care organization. Effective immediately.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for dates of service beginning on and after January 1, 2027, the Department of Healthcare and Family Services shall, for healthcare common procedure coding system codes relating to complex rehabilitation technology wheelchair repair and accessories, apply a reimbursement rate under the Medical Assistance program equivalent to the maximum fee paid in Illinois under the federal Medicare program, including fees under the KU modifier, if applicable. Effective immediately.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services, beginning January 1, 2027, to recompute the STAR rating of nursing facilities who had their antipsychotic medication quality measure score suppressed and their STAR rating set to one due to audit action by the federal Centers for Medicare and Medicaid Services. Requires quality payments to such nursing facilities to be made based on the recomputed score. Provides that in order to facilitate the recomputation, nursing facilities may provide the Department with documentation regarding the status of the suppression of the score and STAR rating as well as the quarterly report issued by the federal Centers for Medicare and Medicaid Services that lists the long-stay rating points for the quarter.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, in accordance with federal guidance issued by the federal Centers for Medicare and Medicaid Services, the Department of Healthcare and Family Services shall exempt from electronic visit verification requirements all live-in caregivers who provide Medicaid-funded personal care services or home health care services under the Illinois Title XIX State Plan or a waiver of the plan, including personal care services and home health care services provided under various home and community-based services waiver programs authorized under the Social Security Act. Defines "live-in caregiver". Grants the Department rulemaking authority. Effective immediately.

Creates the Catch Heart Disease Early Act. Provides that all Illinois residents, 20 years of age or older, are entitled to heart disease screenings at no cost according to the following schedule: one screening every 6 years for individuals aged 20 through 39 years; and one screening every 2 years for individuals aged 40 years and older. Provides that no individual shall be charged any co-payment, co-insurance, deductible, out-of-pocket fee, or other cost-sharing amount or required to enter into any cost-sharing agreement in order to access heart disease screenings. Provides that the State of Illinois shall be the payer of last resort and only cover any outstanding screening costs for eligible uninsured or underinsured individuals whose public or private insurance, including Medicaid or Medicare, does not cover the full cost of heart disease screenings. Provides that service providers of heart disease screenings for eligible uninsured or underinsured Illinois residents shall be reimbursed through a voucher program. Requires the Department of Healthcare and Family Services to perform certain functions to implement the Act, including, but not limited to: (i) establishing a confidential registry to track screening dates and prevent duplicate heart disease screenings outside the authorized frequency; and (ii) provide a mechanism for individuals and providers to verify screening eligibility. Requires health care providers to verify an individual's age, residency, date of last heart disease screening, and other matters prior to administering a screening and recording it in the individual's medical record. Contains provisions on Department rules. Provides that, subject to appropriation, the Department shall implement the voucher program by July 1, 2027. Adds conforming language to the State Employees Group Insurance Act, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Public Aid Code, and the Illinois Insurance Code. Effective immediately.

Amends the Mental Health and Developmental Disabilities Administrative Act. Requires the Department of Human Services to file an amendment to the Home and Community-Based Services Waiver Program for Adults with Developmental Disabilities that shall include an increase in the rate methodology sufficient to provide for a wage rate of 150% of the statewide, regional, or local minimum wage for services delivered on or after January 1, 2027, for all direct support personnel 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. Provides that for services delivered on or after January 1, 2027, the rates shall include adjustments to employment-related expenses as defined by rule by the Department. Requires the Department to adopt rules, including emergency rules, to implement the rate increases. Contains provisions on benchmark rates for therapy and counseling for adults with intellectual and developmental disabilities; tiered rates for community day services; community integration supports for community day services; and benchmark rates for CILA transportation cost and for the supported employment program for adults with intellectual and developmental disabilities. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to submit a Title XIX State Plan amendment to the federal Centers for Medicare and Medicaid Services that shall include an increase in the rate methodology sufficient to provide for a wage rate of 150% of the statewide, regional, or local minimum wage for services delivered on or after January 1, 2027, for all direct support personnel and all other frontline personnel at ID/DD and MC/DD facilities. Provides that the State Plan amendment shall provide wage increases for all residential non-executive direct care staff. Effective immediately.