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.
Sponsored bills
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 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 State Treasurer Act. Provides that for purposes of the ABLE account program, a designated beneficiary means the ABLE account owner. Provides that upon the death of a designated beneficiary, proceeds from an account may be transferred pursuant to a payable on death account agreement. Provides that upon the death of a designated beneficiary, the State Treasurer may require verification that the funeral and burial expenses of the designated beneficiary have been paid. Makes conforming changes. Effective immediately.
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.
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 Illinois Holocaust and Genocide Commission Act. Extends the repeal of the Act from January 1, 2022 to January 1, 2032. Effective immediately.
Creates the Access to Basic Mental Health Information Act. Provides definitions for "mental health facility", "physician", and "recipient". Provides that specified individuals are entitled, upon request, to obtain certain information regarding a recipient in a mental health facility if the individual declares that he or she is involved in the recipient's care or paying for the recipient's care and the individual meets specified requirements. Provides that an individual requesting information must submit to the mental health facility specified information. Provides that a mental health facility is required to receive information relevant to the recipient's mental health treatment. Provides that if the recipient requests the mental health record from the mental health facility, any information that was tendered to the mental health facility under a promise of confidentiality may be withheld from the recipient if disclosure of the information would be reasonably likely to reveal the source of the mental health information. Provides that whenever access or modification is requested, the request, the grounds for its acceptance or denial, and any action taken thereon shall be noted in the recipient's record. Provides that a mental health facility and its employees or agents are not liable for any action under the Act unless the release was made deliberately or the release constituted gross negligence. Provides that nothing in the Act constitutes an infringement on an individual's right to obtain mental health records of the recipient if the individual has another right to the mental health records by law, regulation, or consent of the recipient. Provides that the Act shall be liberally construed to allow receipt of mental health information to individuals entitled to a recipient's information. Provides that the Act supersedes the Mental Health and Developmental Disabilities Code and any other law that would be viewed to limit the access of an individual to a recipient's mental health records to the extent necessary to give the Act full implementation. Effective immediately. Senate Floor Amendment No. 2 Deletes reference to: New Act Adds reference to: 405 ILCS 5/2-113.5 new 740 ILCS 110/5.5 new Replaces everything after the enacting clause. Amends the Mental Health and Developmental Disabilities Code. Requires a mental health facility to accept information from the recipient's family and friends concerning the recipient's treatment for mental illness. Amends the Mental Health and Developmental Disabilities Confidentiality Act. Allows certain individuals to obtain specified information pertaining to a recipient of mental health facility care if the individual resides with the recipient or is paying for the recipient's care. Provides that an individual who receives the information shall not use the information provided by the mental health facility regarding the recipient to the individual's advantage in any legal proceeding or other transaction. Provides that if access or modification of the information is requested, the request, the grounds for its acceptance or denial, and any action taken thereon shall be noted in the recipient's record. House Floor Amendment No. 3 Deletes reference to: 405 ILCS 5/2-113.5 new Replaces everything after the enacting clause. Amends the Mental Health and Developmental Disabilities Confidentiality Act. Provides for the limited disclosure of protected mental health information of a recipient who is an inpatient of a mental health facility related to an individual's involvement with the recipient's mental health care or payment related to the recipient's mental health care. Provides eligibility factors for an individual seeking the disclosure of the information. Provides that whenever the disclosure of information is made without consent, the recipient shall be provided with written disclosure and afforded an opportunity to designate an agent or an attorney-in-fact, and documentation of the disclosure or use shall be noted in the recipient's record. Provides that once the recipient regains the capacity for informed consent, the provisions no longer apply and any allowance for the exchange of information between individuals and the medical personnel is terminated. Restricts an individual who receives information from redisclosing the information except under limited circumstances. Provides that any person who knowingly and willfully violates the provisions is guilty of a Class A misdemeanor. Provides that nothing in the new provisions shall be interpreted to allow a disclosure that is otherwise prohibited under any other State law or any federal law concerning informed consent.
Amends the Dual Credit Quality Act. Makes a technical change in a Section concerning the short title. Senate Floor Amendment No. 1 Deletes reference to: 110 ILCS 27/1 Adds reference to: 105 ILCS 5/2-3.182 new Replaces everything after the enacting clause. Amends the School Code. Requires the State Board of Education to develop and implement a School Unused Food Program that allows public schools in this State to provide food that is unused by the school to needy children who are students of that school. Provides that unused food under the Program shall be provided at no cost to the student. Provides that a school participating in the Program may contract with third parties to provide services under the Program. Provides for the adoption of rules. Defines "needy children". Effective immediately. House Committee Amendment No. 1 Adds reference to: 110 ILCS 805/3-8 from Ch. 122, par. 103-8 110 ILCS 805/3-10 from Ch. 122, par. 103-10 110 ILCS 805/3-33.6 from Ch. 122, par. 103-33.6 Replaces everything after the enacting clause. Reinserts the contents of the engrossed bill with the following addition. Amends the Public Community College Act. Provides that the position of secretary of a board of trustees of a community college district may be held by a member of the board. Provides that if the secretary is not a member of the board, the secretary may receive compensation as fixed by the board prior to the election of the secretary. Provides that if a district abolishes its working cash fund, the transfer of any balance must take place at the close of the then current fiscal year. Allows a community college district to abate its working cash fund upon the adoption of a resolution and transfer part of the balance at any time. Provides that if a community college district elects to abolish or abate its working cash fund, it shall have the authority to again create a working cash fund at any time (rather than if a district elects to abolish its working cash fund, it shall not establish another working cash fund unless approved by the voters). Effective immediately. House Committee Amendment No. 2 Deletes reference to: 110 ILCS 805/3-8 110 ILCS 805/3-10 110 ILCS 805/3-33.6 Replaces everything after the enacting clause. Amends the School Code. Requires school districts to establish a food sharing plan for unused food with a focus on needy students. Provides that each school district shall incorporate the plan into its local wellness policy. Requires the plan to be developed and supported jointly by the district's local health department. Provides that participants in the child nutrition programs, the National School Lunch Program and National School Breakfast Program, the Child and Adult Care Food Program (CACFP), and the Summer Food Service Program (SFSP) shall adhere to the provisions of the Richard B. Russell National School Lunch Act, as well as accompanying guidance from the U.S. Department of Agriculture on the Food Donation Program, to ensure that any leftover food items are properly donated in order to combat potential food insecurity in their communities. Effective immediately.
Amends the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to increase rates and reimbursements in effect on June 30, 2021 payable to Illinois not-for-profit community-based agencies in order to increase access utilization of individual and group supported employment, increase acuity-based rate differentials in on-site and off-site community day services, and other matters. Provides that beginning January 1, 2022, for a medical assistance recipient who is a resident in a facility licensed under the Community-Integrated Living Arrangements (CILA) Licensure and Certification Act, the State shall pay an amount in addition to the minimum monthly personal needs allowance authorized under the Social Security Act so that the person's total monthly personal needs allowance from both State and federal sources equals $90. Provides that beginning no later than October 1, 2022, residents of CILA facilities who are eligible for medical assistance and are enrolled in the State's home and community-based services waiver program for adults with developmental disabilities shall retain all earned income from employment or community day services activities. Amends the Illinois Procurement Code. In a provision requiring the State Use Committee to review the pricing of supplies and services procured by the State from a qualified not-for-profit agency for persons with significant disabilities, provides that the Committee may consider during its review certain factors including, but not limited to, amounts private businesses would pay for similar products or services. Effective immediately. House Committee Amendment No. 1 Deletes reference to: 305 ILCS 5/5-5.4i 305 ILCS 5/5-35 Further amends the Illinois Procurement Code. Removes language stating that the purpose of the Code's provisions concerning not-for-profit agencies for persons with significant disabilities is to further the State's Employment First Policy via the Illinois Employment First Act by maximizing its investment in job opportunities that afford individuals with disabilities competitive wages and allow those individuals to achieve maximum independence through employment. Removes language requiring that supplies and services be procured without advertising or calling for bids from any qualified not-for-profit agency for persons with significant disabilities that pays at least minimum wage or better. Removes the amendatory changes made to the Illinois Public Aid Code concerning an increase in rates and reimbursements to not-for-profit community-based agencies and an increase in personal needs allowances for residents of Community-Integrated Living Arrangements. Senate Committee Amendment No. 1 Provides that beginning July 1, 2021 (rather than October 1, 2022) residents of community-integrated living arrangements who meet specified criteria shall retain all earned income from employment or community day services activities.