Rep. Lisa Hernandez

Creates the Prior Authorization Reform Act. Provides requirements concerning disclosure and review of prior authorization requirements, denial of claims or coverage by a utilization review organization, and the implementation of prior authorization requirements or restrictions. Provides requirements concerning a utilization review organization's obligations with respect to prior authorizations in nonurgent circumstances, urgent health care services, and emergency health care services. Provides that a utilization review organization shall not require prior authorization under specified circumstances. Provides requirements concerning the length of prior authorizations. Provides that health care services are automatically deemed authorized if a utilization review organization fails to comply with the requirements of the Act. Provides that the Director of Insurance may impose an administrative fine not to exceed $250,000 for violations of the Act. Defines terms. Amends the Illinois Insurance Code to change the definition of "emergency medical condition". Amends the Managed Care Reform and Patient Rights Act to provide that companies that transact accident and health insurance shall comply with specified requirements of the Managed Care Reform and Patient Rights Act. Amends the Illinois Public Aid Code to provide that all managed care organizations shall comply with the requirements of the Prior Authorization Reform Act. Makes other changes. Effective January 1, 2022. House Floor Amendment No. 1 Replaces everything after the enacting clause with the provisions of the introduced bill with the following changes. Changes references from "utilization review organization" to "health insurance issuer" or "health insurance issuer or its contracted utilization review organization". Provides that a health insurance issuer or its contracted utilization review organization must ensure that all adverse determinations are made by a physician when the request is by a physician or a representative of a physician. Provides that a health insurance issuer shall periodically review its prior authorization requirements and consider removal of prior authorization requirements in specified circumstances (rather than a utilization review organization shall not require prior authorization in specified circumstances). In provisions concerning length of prior authorization approval, provides that a prior authorization approval shall be valid for the lesser of 12 months after the date the health care professional or health care provider receives the prior authorization approval or the length of treatment as determined by the patient's health care professional. In provisions concerning clinical review criteria of prior authorization requirements, removes language that provides that a utilization review organization shall seek input from actively practicing physicians representing major areas of the specialty who are not employees of the utilization review organization or consultants to the utilization review organization before establishing or substantially or materially altering written clinical review criteria. Removes language that provides that a utilization review organization shall not deny prior authorization of a health care service solely based on the grounds that a health care professional or health care provider judges a service, product, or procedure is medically appropriate for his or her patient even if it has not been formally approved for the specific condition being treated. In provisions concerning statistics that shall be made available regarding prior authorization approvals and denials, removes specified categories of information. In provisions concerning requirements applicable to the physician who can review consultations and appeals, removes language that provides that the physician must not be employed by a utilization review organization, be under contract with the utilization review organization other than to participate in one or more of the utilization review organization's health care professional networks or to perform reviews of appeals, or otherwise have any financial interest in the outcome of the appeal. Makes other changes. Effective January 1, 2022. House Floor Amendment No. 2 Deletes reference to: 215 ILCS 134/65 Adds reference to: 215 ILCS 5/155.36 Replaces everything after the enacting clause with the provisions of the introduced bill, and makes the following changes: In the Prior Authorization Reform Act, deletes a Section concerning obligations with respect to prior authorization concerning emergency health care services, and makes changes in provisions governing applicability; definitions; disclosure and review of prior authorization requirements; obligations with respect to prior authorizations; personnel qualified to make adverse determinations of a prior authorization request; adverse determinations; review of appeals; denials; length of prior authorization approval; continuity of care; effect of failure to comply with the Act; and administration and enforcement. Makes further changes in the Illinois Insurance Code in a Section concerning obligations under the Managed Care Reform and Patient Rights Act. Deletes changes made to the Managed Care Reform and Patient Rights Act in a Section concerning emergency services prior to stabilization. Effective January 1, 2022.

Amends the School Code. In the provisions relating to holidays, adds January 17 (the birthday of Muhammad Ali) to the list of commemorative holidays. In the provisions relating to courses of study, provides that the teaching of history of the United States shall include the study of the contributions made by Muslims and Muslim Americans to society. House Committee Amendment No. 1 In the provisions relating to courses of study, provides that the teaching of history of the United States shall include the contributions made to society by Americans of different faith practices, including, but not limited to, Muslim Americans, Jewish Americans, Christian Americans, Hindu Americans, Sikh Americans, Buddhist Americans, and any other collective community of faith that has shaped America (rather than the study of the contributions made by Muslims and Muslim Americans to society).

Amends the Department of Human Services Act. Requires the Department of Human Services, in consultation with other specified State agencies, to conduct a public information campaign to educate immigrants, refugees, asylum seekers, and other noncitizens residing in Illinois of their rights under the U.S. Constitution and Illinois laws that apply regardless of immigration status. Requires the public information campaign to include resources and contact information for organizations that can aid residents in protecting and enforcing these rights. Requires the Department of Human Services, in consultation with the Department of Transportation and other agencies, when necessary, to post resources and other information regarding immigrant, refugee, and asylum seekers' rights in high-traffic public areas, including, but not limited to, train stations, airports, and highway rest stops. Permits the Department of Human Services to adopt rules or joint rules with other agencies to implement the requirements of the amendatory Act.

Amends the School Code. Provides that a pupil shall be excused from engaging in a physical education course during a period of religious fasting if the pupil's parent or guardian notifies the school principal in writing that the pupil is participating in religious fasting. Effective immediately. House Floor Amendment No. 1 Provides that a pupil shall be excused from engaging in any physical activity components of a physical education course (rather than from engaging in a physical education course) during a period of religious fasting.

Amends the Counties Code. Provides that, in counties with a population over 3,000,000, the Public Defender, without fee or appointment and with the approval of the county board, may act as attorney to noncitizens in immigration cases related to or resulting from an underlying court matter in which the Public Defender served as attorney before he or she became the Public Defender. Provides that representation by the Public Defender in immigration cases is limited to those arising in immigration courts located within the geographical boundaries of the county where the Public Defender has been appointed to office unless the board authorizes the Public Defender to provide representation outside the county. House Committee Amendment No. 1 Deletes reference to: 55 ILCS 5/3-4004.2 55 ILCS 5/3-4004.5 new Adds reference to: 55 ILCS 5/3-4006 from Ch. 34, par. 3-4006 Replaces everything after the enacting clause. Amends the Counties Code. Provides that, in counties with a population over 3,000,000, the public defender, without fee or appointment and with the concurrence of the county board, may act as attorney to noncitizens in immigration cases. Provides that representation by the public defender in immigration cases shall be limited to those arising in immigration courts located within the geographical boundaries of the county where the public defender has been appointed to office unless the board authorizes the public defender to provide representation outside the county.

Amends the Managed Care Reform and Patient Rights Act. Requires health insurance carriers that provide coverage for prescription drugs to ensure that, within service areas and levels of coverage specified by federal law, at least half of individual and group plans meet one or more of the following criteria: apply a pre-deductible and flat-dollar copayment structure to the entire drug benefit, limit a beneficiary's monthly out-of-pocket financial responsibility for prescription drugs to a specified amount, or limit a beneficiary's annual out-of-pocket financial responsibility for prescription drugs to a specified amount. Provides that all plans for prescription drugs offered under the amendatory Act must be clearly and appropriately named, marketed in the same manner as other plans offered by the health insurance carrier, and offered for purchase to any individual and group plan sponsor. Effective January 1, 2022. House Committee Amendment No. 1 Replaces everything after the enacting clause. Amends the Managed Care Reform and Patient Rights Act. In provisions concerning individual health plans that provide coverage for prescription drugs, provides that beginning January 1, 2023, health insurance carriers shall ensure that at least 10% of individual health care plans offered in each applicable service area apply a flat-dollar copayment structure to the entire drug benefit; and beginning January 1, 2024, health insurance carriers shall ensure that at least 25% of individual health care plans offered in each applicable service area apply a flat-dollar copayment structure to the entire drug benefit. In provisions concerning group health plans that provide coverage for prescription drugs, provides that beginning January 1, 2023, health insurance carriers shall offer at least one group health plan in each applicable service area that applies a flat-dollar copayment structure to the entire drug benefit; and beginning January 1, 2024, health insurance carriers shall offer at least 2 group health plans in each applicable service area that apply a flat-dollar copayment structure to the entire drug benefit. Provides that the flat-dollar copayment structure for prescription drugs must be applied pre-deductible and be reasonably graduated and proportionately related in all tier levels such that the copayment structure as a whole does not discriminate against or discourage the enrollment of individuals with significant health care needs. Requires the health insurance carriers to clearly and appropriately name the plans to aid in individual or group plan selection. Requires the health insurance carriers to market the plans in the same manner as their other plans. Requires the Department of Insurance to adopt rules necessary to implement and enforce the provisions. Effective January 1, 2023.

Creates the Prescription Drug Repository Program Act. Requires the Department of Public Health to, by rule, establish a prescription drug repository program, under which any person may donate a prescription drug or supplies needed to administer a prescription drug for use by an individual who meets eligibility criteria specified by the Department. Sets forth requirements that prescription drugs or supplies must meet in order to be accepted and dispensed under the program. Provides that no drugs or supplies donated under the prescription drug repository program may be resold. Provides that nothing in the Act requires that a pharmacy or pharmacist participate in the prescription drug repository program. Provides for civil and criminal immunity for drug and supply manufacturers and individuals in relation to the donation, acceptance, or dispensing of prescription drugs or supplies under the prescription drug repository program. Imposes conditions on any rulemaking authority. Amends the Pharmacy Practice Act, the Wholesale Drug Distribution Licensing Act, the Senior Pharmaceutical Assistance Act, the Illinois Food, Drug and Cosmetic Act, the Illinois Controlled Substances Act, and the Cannabis and Controlled Substances Tort Claims Act to provide that persons engaged in donating or accepting, or packaging, repackaging, or labeling, prescription drugs to the extent permitted or required under the Prescription Drug Repository Program Act are exempt from provisions of those other Acts that might prohibit or otherwise regulate such activity. House Committee Amendment No. 1 Replaces everything after the enacting clause. Creates the Illinois Drug Reuse Opportunity Program Act. Provides that, notwithstanding any other law or rule, donors may donate drugs to recipients and recipients may receive donated drugs from donors. Provides that recipients shall only dispense or administer drugs to eligible patients, further donate drugs to another recipient, or dispose of drugs in accordance with specified provisions. Provides that drugs donated for use under the Act are considered nonsaleable. Provides that, when dispensing a drug to an eligible patient, the recipient must do so at no cost to the eligible patient, except that a reasonable handling fee may be charged. Provides that recipients may only dispense or administer a prescription drug or provide an over-the-counter drug if specified requirements are met. Provides that recipients shall, to the greatest extent practicable, dispense drugs received under the Act to priority patients. Provides that drugs may be accepted under the Act only if specified requirements are met. Contains requirements for the further donation of drugs by a recipient. Contains provisions regarding the disposition of specified drugs. Provides that nothing in the Act requires that a pharmacy or pharmacist be a recipient of drugs under the Act. Provides that the Act shall supersede any inconsistent law or rule for activities conducted under the Act. Contains other provisions. Amends the Pharmacy Practice Act, the Wholesale Drug Distribution Licensing Act, the Senior Pharmaceutical Assistance Act, the Illinois Food, Drug and Cosmetic Act, the Illinois Controlled Substances Act, and the Cannabis and Controlled Substances Tort Claims Act to provide that persons engaged in donating or accepting, or packaging, repackaging, or labeling, prescription drugs to the extent permitted or required under the Illinois Drug Reuse Opportunity Program Act are exempt from provisions of those other Senate Committee Amendment No. 1 Replaces everything after the enacting clause. Reinserts the provisions of the engrossed bill with the following changes. Provides that "prescription drug" does not include a drug for the treatment of cancer that can only be dispensed to a patient registered with the drug manufacturer in accordance with the federal Food and Drug Administration's requirements. Provides that when dispensing a drug to an eligible patient, the recipient must do so at no cost to the eligible patient, except that a uniform reasonable handling fee (rather than a reasonable handling fee) may be charged.

Amends the Medical Practice Act of 1987. Provides that not later than 12 months after the effective date of the amendatory Act, the Department of Financial and Professional Regulation shall adopt rules that require a person seeking licensure to practice medicine in all of its branches to have completed 3 hours of education on the diagnosis, treatment, and care of individuals with cognitive impairments, including, but not limited to, Alzheimer's disease and other dementias. Specifies that the education requirement shall only apply to applicants who serve or will serve adult populations and have or will have direct patient interactions in their capacity as physicians. Provides that not later than 12 months after the effective date of the amendatory Act, the Department shall adopt rules that require any continuing education for persons licensed to practice medicine under all of its branches to include an average of one hour of continuing education per license year on the diagnosis, treatment, and care of individuals with cognitive impairments, including, but not limited to, Alzheimer's disease and other dementias. Specifies that the continuing education requirement shall only apply to persons who serve adult populations and have direct patient interactions in their capacity as physicians. Provides that the curriculum used for the education and continuing education requirements shall cover the diagnosis of Alzheimer's disease and other dementias, including recognizing the signs and symptoms of dementia; person-centered care; assessment and care planning; and culturally competent health care. Senate Committee Amendment No. 2 Deletes reference to: 225 ILCS 60/11 225 ILCS 60/20.1 new Adds reference to: 20 ILCS 2105/2105-365 new Replaces everything after the enacting clause. Amends the Department of Professional Regulation Law of the Civil Administrative Code of Illinois. Provides that for license or registration renewals occurring on or after January 1, 2023, a health care professional who has continuing education requirements must complete at least a one-hour course in training on the diagnosis, treatment, and care of individuals with Alzheimer's disease and other dementias per renewal period. Provides that the training shall include, but not be limited to, assessment and diagnosis, effective communication strategies, and management and care planning. Provides that the requirement shall only apply to health care professionals who provide health care services to adult populations age 26 or older in the practice of their profession. Provides that a health care professional may count that one hour for completion of the course toward meeting the minimum credit hours required for continuing education. Provides that any training on Alzheimer's disease and other dementias applied to meet any other State licensure requirement, professional accreditation or certification requirement, or health care institutional practice agreement may count toward the continuing education requirement. Provides that the Department of Financial and Professional Regulation may adopt rules for the implementation of the continuing education requirement. Effective immediately. Senate Floor Amendment No. 4 Provides that the continuing education requirements shall only apply to health care professionals who provide health care services to, and have direct patient interactions with (rather than who provide health care services to), adult populations age 26 or older in the practice of their profession.

Amends the Voices of Immigrant Communities Empowering Survivors (VOICES) Act. Provides that if the Designated Certifying Official cannot determine that the requester is a victim of a qualifying criminal activity, the Designated Certifying Official shall provide written notice to the person or the person's representative explaining why the available evidence does not support a finding that the person is a victim of qualifying criminal activity. Provides that the Designated Certifying Official shall submit the notice to the address provided in the request and shall provide contact information should the requester desire to appeal the decision. Provides that the Designated Certifying Official shall accept all appeals and must respond to the appeals within 60 business days. Senate Committee Amendment No. 1 Deletes reference to: 5 ILCS 825/20 new Adds reference to: 5 ILCS 825/10 5 ILCS 825/11 new Replaces everything after the enacting clause. Amends the Voices of Immigrant Communities Empowering Survivors (VOICES) Act. Provides that the certifying official shall submit the notice explaining why the available evidence does not support a finding that the person is a victim of qualifying criminal activity to the address provided in the request and shall provide contact information should the requester desire to appeal the decision. Provides that the certifying agency or certifying official shall accept all appeals and must respond to the appeals within 30 business days. Provides that notwithstanding this provision no requester is required to file an administrative appeal or otherwise exhaust administrative remedies before filing a mandamus action or seeking other equitable relief in circuit court for a completed certification form.

Amends the Children and Family Services Act. Provides that no later than December 31, 2022, and no later than December 31 of each year thereafter, the Department of Children and Family Services shall prepare and submit an annual report, covering the previous fiscal year, to the General Assembly regarding racial disparities for children and families involved in the child welfare system. Provides that the report shall be conducted by a research institution at a public university and must include, at a minimum, the following de-aggregated data by race as compared, where appropriate, to population-level data: (1) education success, health and behavioral health, housing, jobs or economic justice, criminal justice, and other key metrics that serve as indicators of child and family well-being and can measure socioeconomic conditions in communities; and (2) children and families involved in a safety plan, the number of protective custodies, the number of investigations of each type of abuse and neglect allegation described in a specified provision of the Illinois Administrative Code and the findings of such investigations, the number of Department recommended court filings for each allegation type, the number of intakes into the foster care system, placement settings, lengths of stay, and permanency outcomes. House Committee Amendment No. 1 Deletes reference to: 20 ILCS 505/41.5 new Adds reference to: 20 ILCS 505/1.1 from Ch. 23, par. 5001.1 Replaces everything after the enacting clause. Amends the Children and Family Services Act. Makes a technical change in a Section concerning the short title. House Floor Amendment No. 2 Deletes reference to: 20 ILCS 505/1.1 from Ch. 23, par. 5001.1 Adds reference to: 705 ILCS 35/1 from Ch. 37, par. 72.1 705 ILCS 35/2f-2 705 ILCS 35/2f-12 new 705 ILCS 35/37 new 705 ILCS 40/2 from Ch. 37, par. 72.42 Replaces everything after the enacting clause. Amends the Circuit Courts Act. Reorganizes the counties (other than Cook County) into 24 (currently 23) judicial circuits. Provides that the General Assembly shall divide the 19th circuit into at least 10 subcircuits. Provides that, upon the division of the 19th circuit: each resident judgeship shall be assigned to the newly drawn subcircuit in which the judge of the resident judgeship in question resides; and each at-large judgeship shall be converted to a resident judgeship and be assigned to the subcircuit in which the judge of the converted judgeship in question resides. Provides that, when a vacancy occurs in a resident judgeship, the resident judgeship shall be allotted by the Supreme Court and filled by election. Provides that the 19th judicial circuit shall have additional resident judgeships to be allotted by the Supreme Court. Provides that in addition to the 2 judgeships filled by election at the 2022 election, any judgeship that became vacant after January 1, 2020 and on the effective date of the amendatory Act is held by an individual appointed by the Supreme Court shall also be filled by election at the 2022 general election. Provides that nothing in the provisions shall affect the tenure of any circuit judge serving on the effective date of the amendatory Act. Provides that no circuit judge serving on the effective date of the amendatory Act shall be required to change his or her residency in order to continue serving in office or to seek retention or reappointment. Provides that any circuit judge elected to that office prior to the effective date of the amendatory Act who files to run for retention after the effective date of the amendatory Act shall have the right to seek retention in the circuit the judge was elected from or to seek retention in the circuit created by the amendatory Act. Makes a conforming change in the Judicial Vacancies Act. Effective immediately.