Good morning, Healthcare Council. This week the 101st Illinois General Assembly convened in Springfield. We've seen a flurry of bill introductions thus far and more will be on the way. Governor-elect Pritzker and the statewide constitutional officers will be sworn in on Monday, and the Illinois congressional delegation received some plum committee assignments in the U.S. House. The General Assembly will be back in action on Jan. 29. On to the update!
New General Assembly Legislation
While committee assignments have not been announced yet, new bill introductions continue to pile up. Below is a synopsis of legislation we have started to track. To help sort the legislation, we've created several broad categories - however, some bills may have overlapping issues. Many of the problematic introduced bills, including pharmaceutical pricing transparency, a health insurance claims assessment, hospital metal detector mandates and telehealth requirements had versions introduced last General Assembly. As always, if your organization is tracking, supporting or opposing specific bills, please let us know so we can be better advocates for you in Springfield.
HB2 - Flowers -
Amends the Medical Patient Rights Act. Provides that every woman has certain rights with regard to pregnancy and childbirth, including the right to receive care that is consistent with current scientific evidence about benefits and risks, the right to choose her birth setting, the right to be provided with certain information, and the right to be treated with respect at all times before, during, and after pregnancy by her health care professionals and to have a health care professional that is culturally competent and treats her appropriately regardless of her ethnicity, sexual orientation, or religious background. Requires the Department of Public Health, Department of Healthcare and Family Services, Department of Children and Family Services, and Department of Human Services to post information about these rights on their publicly available websites. Requires every health care provider, day care center, Head Start, and community center to post information about these rights in a prominent place and on their websites, if applicable. Requires the Department of Public Health to adopt rules to implement the provisions. Effective immediately.
HB3 - Flowers - Amends the Hospital Report Card Act to require that each hospital include in its quarterly report instances of preterm infants, infant mortality, and maternal mortality. Requires the reporting of racial and ethnic information of the infants' mothers, along with the disparity of occurrences across different racial and ethnic groups. Effective immediately.
HB14 - Flowers -
Amends the Sexual Assault Evidence Submission Act. Provides that the Department of State Police shall create and operate a statewide sexual assault evidence kit tracking system. Provides that on and after the effective date of the amendatory Act, each sexual assault evidence kit created shall have a tracking mechanism attached to the kit for input into the statewide sexual assault evidence kit tracking system. Provides that every sexual assault evidence kit shall have the tracking mechanism attached to the kit for input into the statewide sexual assault evidence kit tracking system on or before January 1, 2020. Provides that the statewide sexual assault evidence kit tracking system shall: (1) track the location and status of sexual assault evidence kits throughout the criminal justice process, including the initial collection in examinations performed at medical facilities, receipt at local law enforcement agencies, and receipt and analysis at forensic laboratories; (2) allow medical facilities performing sexual assault forensic examinations, law enforcement agencies, prosecutors, State and local crime laboratories, and other entities who have physical custody of sexual assault evidence kits to update and track the status and location of sexual assault evidence kits; (3) allow victims of sexual assault to anonymously track and receive updates regarding the status of their sexual assault evidence kits; and (4) use technology to allow continuous access for appropriate personnel. Effective July 1, 2019.
HB161 - Flowers -
Amends the Hospital Licensing Act and the Code of Criminal Procedure of 1963. Provides that each licensed hospital shall designate patient-care areas under rules adopted by the Department of Public Health. These areas shall include examination and operating rooms and out-patient care areas of the hospital. Provides that each licensed hospital shall post a sign of a type and size specified by the Department of Public Health in a conspicuous place at the entrance of each patient-care area of the hospital stating that peace officers may not enter the area without the knowing consent of the health supervisor or a valid search warrant. Provides that each hospital shall designate one of its staff as a health supervisor. Provides that the health supervisor shall be the person designated by the hospital to communicate and interact with peace officers including about the treatment and care being provided at the hospital to a person in the peace officer's custody who is being treated at the hospital. Provides that the health supervisor shall be a hospital administrator or other person in charge of supervising nurses at the hospital but who is not providing treatment to patients. Amends the Unified Code of Corrections and the Sex Offender Registration Act. Deletes provisions that require DNA submissions of persons charged with certain offenses and of each registered sex offender to the Department of State Police for DNA analysis. Deletes provisions that the detention, arrest, or conviction of a person based upon a database match or database information is not invalidated if it is determined that the specimen was obtained or placed in the database by mistake.
HB191 - Ford - Creates the Safe Spaces in Public Places Act. Defines terms. Among other changes, the legislation amends the Hospital Licensing Act. Provides that a hospital shall maintain a metal detector at each point of entry into the hospital; defines "point of entry". Provides that a hospital shall ensure that all members of the public, other than the employees of the hospital who display proper credentials, who enter the hospital at a point of entry are subjected to screening by a metal detector. Effective immediately.
HB225 - Flowers -
Amends the Medical Practice Act of 1987. Removes provisions prohibiting the Department of Financial and Professional Regulation from disciplining a physician for experimental treatments for Lyme disease or other tick-borne diseases.
SB25 - Morrison -
Amends the Mental Health and Developmental Disabilities Code. Provides that as soon as possible but not later than 24 hours, excluding Saturdays, Sundays and holidays, after emergency admission of a respondent to a mental health facility on an inpatient basis, the respondent shall be personally examined (rather than examined) by a psychiatrist. Provides that for the purpose of this provision, a personal examination includes an examination performed in real time (synchronous examination) via an Interactive Telecommunication System as defined in the Illinois Administrative Code.
HB4 - Flowers - Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that doula services shall be covered under the medical assistance program. Sets forth certain certification and training requirements a doula must satisfy to qualify for reimbursement under the medical assistance program.
HB7 - Flowers -
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires services provided by community midwives, doulas, and breastfeeding peer counselors to be covered and reimbursed under the medical assistance program for persons who are otherwise eligible for medical assistance. Effective immediately.
HB41 - Flowers -
Amends the Medical Assistance Article of the Illinois Public Aid Code. Extends medical assistance coverage to all women of childbearing age regardless of income level.
HB176 - Flowers -
Amends the Illinois Public Aid Code. Provides that a redetermination of eligibility for medical assistance benefits shall be conducted once every 12 months. Effective January 1, 2020.
HB315 - McSweeney -
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to establish, by rule, minimum quality standards for providers of medical supplies, equipment, and related services applicable to contracted managed care organizations for all services rendered to MCO enrollees. Requires the Department to set a rate of reimbursement payable by contracted managed care organizations to contracted, in-network providers of medical supplies, equipment, and related services at the default rate of reimbursement paid under the Illinois Medicaid fee-for-service program methodology for such medical supplies, equipment, and related services in effect as of June 30, 2017. Requires contracted managed care organizations to offer a reimbursement rate to contracted, in-network providers of medical supplies, equipment, and related services at not less than 90% of the default rate of reimbursement paid under the Illinois Medicaid fee-for-service program methodology, including all policy adjusters, for such medical supplies, equipment, and related services of similar quality. Provides that these provisions shall not be construed to allow the Department or its contracted MCOs to enter into sole source contracts for the provision of durable medical equipment, supplies, or related services to Medicaid beneficiaries and Medicaid managed care enrollees. Effective immediately.
HB8 - Flowers -
Creates the Illinois Medicare for All Health Care Act. Provides that all individuals residing in the State are covered under the Illinois Health Services Program for health insurance. Sets forth the health coverage benefits that participants are entitled to under the Program. Sets forth the qualification requirements for participating health providers. Sets forth 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. Provides that investor-ownership of health delivery facilities is unlawful. Provides that the State shall establish the Illinois Health Services Trust to provide financing for the Program. Sets forth the requirements for claims billing under the Program. Provides that the Program shall include funding for long-term care services and mental health services. Provides that the Program shall establish a single prescription drug formulary and list of approved durable medical goods and supplies. 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. Sets forth provisions concerning patients' rights. Provides that the 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, 2020.
HB207 - Flowers - 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. Provides that the Commissioner, the Chief Medical Officer, the public State 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 July 1, 2019.
HB272 - Harris -
Creates the Health Insurer Claims Assessment Act. Imposes an assessment of 1% on claims paid by a health insurance carrier or third-party administrator. Provides that the moneys received and collected under the Act shall be deposited into the Healthcare Provider Relief Fund and used solely for the purpose of funding Medicaid services provided under the medical assistance programs administered by the Department of Healthcare and Family Services.
HB273 - Willis - Amends the Illinois Insurance Code. In provisions concerning coverage for anesthetics provided in conjunction with dental care to an individual diagnosed with autism spectrum disorder, removes the requirement that the individual be under age 19. Amends the Illinois Public Aid Code. Provides that the medical assistance program shall include coverage for anesthetics provided in conjunction with dental care to an individual diagnosed with autism spectrum disorder.
SB27 - Manar -
Amends the Illinois Insurance Code. In provisions concerning coverage for telehealth services, provides that certain health benefit policies or plans may not exclude from coverage a medically necessary health care service or procedure delivered by certain providers solely because the health care service or procedure is provided through telehealth (rather than requiring certain policies to meet specified criteria if they provide coverage for telehealth services). Provides the requirements of coverage for telehealth services. Provides that an individual or group policy of accident or health insurance that provides coverage for telehealth services delivered by contracted licensed dietitian nutritionists and contracted certified diabetes educators must also provide coverage for in-home services for senior diabetes patients (rather than requiring an individual or group policy of accident or health insurance that provides coverage for telehealth services to provide coverage for licensed dietitian nutritionists and certified diabetes educators who counsel senior diabetes patients in the patients' homes). Amends the Illinois Public Aid Code. Provides payment, reimbursement, and service requirements for telehealth services provided under the State's fee-for-service or managed care medical assistance programs. Provides that "telehealth" includes telepsychiatry. Provides that the Department of Healthcare and Family Services shall implement the new provisions 60 days after the effective date of the amendatory Act. Repeals a provision requiring the Department to reimburse psychiatrists and federally qualified health centers for mental health services provided by psychiatrists to medical assistance recipients through telepsychiatry. Makes other changes.
SB35 - Bush -
Amends the Illinois Insurance Code. Provides that, for purposes of treatment in the early stages of a mental health condition, a group or individual policy of accident and health insurance or managed care plan shall provide coverage for the treatment of serious mental illnesses and serious emotional disturbances. Provides that coverage shall include, but not be limited to, certain evidence-based and evidence-informed bundled treatment approaches. Provides that payment for the services performed under the treatment models shall be based on all the components of the treatment model combined, rather than for each separate service. Provides that disability or functional impairment shall not be a precondition to receive treatment under the provisions. Provides that if federal regulations require the State to defray the cost of coverage for serious mental illnesses or serious emotional disturbances, then the provisions are inoperative and the State shall not assume any obligation for the cost of the coverage. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act. Provides that the amendatory Act may be referred to as the Fair Insurance Coverage for Early Treatment of Serious Mental Health Conditions Act. Effective immediately.
HB53 - Flowers -
Amends the Illinois Food, Drug and Cosmetic Act. Requires manufacturers of brand name or generic prescription drugs to notify State purchasers, health insurers, health care service plan providers, pharmacy benefit managers, and the General Assembly of specified increases in drug prices at least 60 days before such increase and the cost of specified new prescription drugs within 3 days after approval by the U.S. Food and Drug Administration. Provides that within 30 days after such notifications, prescription drug manufacturers shall report specified information to State purchasers, health insurers, health care service plan providers, pharmacy benefit managers, and the General Assembly. Provides that failure to report such information shall result in a specified civil penalty. Requires the General Assembly to conduct an annual public hearing on aggregate trends in prescription drug pricing. Provides that if the manufacturer of a prescription drug or its agent meets or otherwise communicates with a prescriber for the purpose of marketing a drug, then the manufacturer or its agent shall disclose to the prescriber if any ingredient in the drug it is marketing is known to pose a risk of dependency in humans. Makes other changes.
HB156 - Flowers -
Creates the Prescription Drug Pricing Transparency Act. Requires health insurers to disclose certain rate and spending information concerning prescription drugs and certain prescription drug pricing information to the Department of Public Health. Requires the Department and health insurers to create annual lists of prescription drugs on which the State spends significant health care dollars and for which costs have increased at a certain rate over time. Requires the Department and health insurers to provide their lists to the Attorney General. Requires prescription drug manufacturers to notify the Attorney General if they are introducing a new prescription drug at a wholesale acquisition cost that exceeds the threshold set for a specialty drug under the Medicare Part D program. Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance that provides coverage for prescription drugs to apply the same cost-sharing requirements to interchangeable biological products as apply to generic drugs under the policy. Amends the Pharmacy Practice Act. Provides that when a pharmacist receives a prescription for a biological product, the pharmacist shall select the lowest priced interchangeable biological product (rather than allowing a pharmacist to substitute an interchangeable biological product only if certain requirements are met). Requires that when a pharmacist receives a prescription from a Medicaid recipient, the pharmacist shall select the preferred drug or biological product from the State's preferred drug list. Makes other changes. Makes conforming changes in the Freedom of Information Act. Effective immediately.
HB204 - Ford -
Amends the Senior Citizens and Persons with Disabilities Property Tax Relief Act by reinstituting the pharmaceutical assistance program that was eliminated by Public Act 97-689 and changing the short title to the Senior Citizens and Persons with Disabilities Property Tax Relief and Pharmaceutical Assistance Act. Makes conforming changes in various Acts.
HB10 - Flowers -
Amends the Pharmacy Practice Act. Requires that at least one registered pharmacy technician be on duty whenever the practice of pharmacy is conducted. Requires that pharmacies fill no more than 10 prescriptions per hour. Requires 10 pharmacy technician hours per 100 prescriptions filled. Prohibits pharmacies from requiring pharmacists to participate in advertising or soliciting activities that may jeopardize patient health, safety, or welfare and any activities or external factors that interfere with the pharmacist's ability to provide appropriate professional services. Provides that a pharmacist shall receive specified break periods. Provides that a pharmacy may not require a pharmacist to work during a break period, shall make available a break room meeting specified requirements, shall keep a complete and accurate record of the break periods and may not require a pharmacist to work more than 8 hours a workday. Provides for enforcement and penalties. Provides whistleblower protections for an employee of a pharmacy if the pharmacy retaliates against the employee for certain actions. Requires pharmacies to maintain a record of any errors in the receiving, filling, or dispensing of prescriptions.
HB163 - Stuart -
Amends the Illinois Controlled Substances Act. Provides that the information required to be transmitted under the prescription monitoring program must be transmitted not later than the end of the business day on which a controlled substance is dispensed, or at such other time as may be required by the Department of Human Services by administrative rule (rather than, at the end of the next business day on which the controlled substance is dispensed).
HB13 - Flowers - Amends the Illinois Insurance Code, the Pharmacy Practice Act, and the Wholesale Drug Distribution Licensing Act. Prohibits the licensure, transference, use, or sale of any records relative to prescription information containing patient-identifiable or prescriber-identifiable data by any licensee or registrant of the Acts for commercial purposes.
HB197 - Flowers -
Amends the Pharmacy Practice Act. Requires that at least one registered pharmacy technician be on duty whenever the practice of pharmacy is conducted. Requires that pharmacies fill no more than 10 prescriptions per hour. Requires 10 pharmacy technician hours per 100 prescriptions filled. Prohibits pharmacies from requiring pharmacists to participate in advertising or soliciting activities that may jeopardize patient health, safety, or welfare and any activities or external factors that interfere with the pharmacist's ability to provide appropriate professional services. Provides that a pharmacist shall receive specified break periods. Provides that a pharmacy may not require a pharmacist to work during a break period, shall make available a break room meeting specified requirements, shall keep a complete and accurate record of the break periods, and may not require a pharmacist to work more than 8 hours a workday. Provides for enforcement and penalties. Provides whistleblower protections for an employee of a pharmacy if the pharmacy retaliates against the employee for certain actions. Requires pharmacies to maintain a record of any errors in the receiving, filling, or dispensing of prescriptions.
HB178 - Flowers - Amends the Community-Integrated Living Arrangements Licensure and Certification Act. Provides that licenses for community mental health or developmental services agencies are valid for one year (rather than 3 years). Provides that an agency licensed under the Act or a community-integrated living arrangement certified by an agency must maintain for public inspection copies of investigative reports and surveys conducted by the Department of Human Services. Provides that the Department must prepare a quarterly report detailing violations of the Act by an agency licensed under the Act or a community-integrated living arrangement certified by an agency and must publish the report on its website. Provides that the report must include the name and address of each agency and community-integrated living arrangement that violates the Act.
HB1 - Flowers -
Creates the Task Force on Infant and Maternal Mortality Among African Americans Act. Creates the Task Force on Infant and Maternal Mortality Among African Americans. Provides for the membership of the Task Force. Provides for the election of a chairperson of the Task Force. Requires the Department of Public Health to provide technical support and assistance to the Task Force and to be responsible for administering its operations and ensuring that the requirements of the Act are met. Provides that members of the Task Force shall receive no compensation for their services as members of the Task Force. Provides for the meetings and duties of the Task Force. Provides that beginning December 1, 2020, and for each year thereafter, the Task Force shall submit a report of its findings and recommendations to the General Assembly. Provides findings. Effective immediately.
HB5 - Flowers -
Amends the Department of Human Services Act. Requires the Department of Human Services to ensure access to substance use and mental health services statewide for pregnant and postpartum women, and to ensure that programs are gender-responsive, are trauma-informed, serve women and young children, and prioritize justice-involved pregnant and postpartum women. Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Requires the Department of Public Health to establish a classification system for specified levels of maternal care. Requires the Department to implement substantive measures that benefit maternal care and provide a greater amount of available information in order to further medical research. Amends the Emergency Medical Services (EMS) Systems Act. Requires the Department of Public Health to ensure that EMS systems are transporting pregnant women to the appropriate facilities based on the Department of Public Health's classification system for levels of maternal care. Effective immediately.
HB6 - Flowers -
Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Requires the Department of Public Health to establish women's health clinics throughout the State to provide affordable health care for women. Requires the services provided at the women's health clinic to be offered at an affordable price and to include specified services, including women's health examinations, pregnancy confirmation, prenatal care, labor and delivery services, postpartum care, family planning examinations and birth control services, and care for sexually transmitted diseases and infections.
HB205 - Conroy -
Amends the Critical Health Problems and Comprehensive Health Education Act to require the instruction on mental health and illness to evaluate the multiple dimensions of health by reviewing the relationship between physical and mental health so as to enhance student understanding, attitudes, and behaviors that promote health, well-being, and human dignity.
HB219 - Flowers -
Creates the Children's Mental Health Local Integrated Fund Act. Creates local children's mental health collaboratives. Defines "local children's mental health collaborative" as an entity formed by the agreement of representatives of the local system of care, including mental health services, social services, correctional services, education services, health services, and vocational services for the purpose of developing and governing an integrated service system. Provides that, to qualify as a local children's mental health collaborative and be eligible to receive start-up funds, the representatives of the local system of care and nongovernmental entities such as parents of children in the target population; parent and consumer organizations; community, civic, and religious organizations; private and nonprofit mental and physical health care providers; culturally specific organizations; local foundations; and businesses, or at a minimum one county, one school district or special education cooperative, one mental health entity, and one juvenile justice or corrections entity, must agree to the following: (1) to establish a local children's mental health collaborative and develop an integrated service system; (2) to commit resources to providing services through the local children's mental health collaborative; and (3) to develop a plan to contribute funds to the children's mental health collaborative.
As many ideas that originate in California eventually come to Illinois (and the Chicago City Council), we wanted to flag a few new proposals being discussed in the Golden State. This week Gov. Gavin Newsom proposed a healthcare expansion that would cover undocumented young adults, create a state-based insurance mandate and expand health insurance subsidies for the middle class. If the proposal becomes law, California would be the first state in the nation to cover undocumented immigrants who are younger than 26. While the proposal is not as expansive as a single-payer style healthcare program, the Governor has stated it is a first step. Elsewhere, New York City Mayor de Blasio announced his own comprehensive healthcare for all plan this week. As a reminder, Governor-elect Pritzker campaigned on a public healthcare option for all Illinois residents by allowing a buy into the state's Medicaid system.
Congressional Delegation Committee Update
Several Illinois congressional delegation members received committee assignments this week that have implications for healthcare legislation. Rep. Brad Schneider was named to the Ways and Means Committee, which is in charge of revenue, and Rep. Robin Kelly was named to the Energy and Commerce Committee, which has wide jurisdiction over healthcare, insurance, pharmaceuticals and other issues.
There have been several new healthcare-related rules proposed since our last update.
Last week HFS proposed amendments to Medical Payment (89 IAC 140; 42 Ill Reg 24574) implementing Public Act 100-646 by instituting updated requirements for medi-car, service car and non-emergency ambulance transportation effective 2/1/19. A physician's certification statement (currently, discharge order) documenting that the patient's condition meets HFS criteria for medi-car, service car or ambulance transportation is required whenever a patient is being transported (currently, discharged) from a hospital, nursing home or other facility. If the patient is being transported from a long-term care facility, the medical director or another medical professional (physician assistant, nurse practitioner, clinical nurse specialist, registered professional nurse, or discharge planner) responsible for the patient's diagnosis and treatment must complete the certification statement. The certification statement should be completed prior to transport, but must be submitted to the transportation provider no later than 10 days after the transportation provider requests it. Medical transportation providers, hospitals and longterm care facilities are affected by this rulemaking.
HFS also proposed amendments to Specialized Health Care Delivery Systems (89 IAC 146; 42 Ill Reg 24603) establishing Better Care Illinois, a 5-year pilot program for mental illness and substance abuse treatment that will be funded through a federal Medicaid demonstration waiver. The program includes homebased visiting services up to 60 days postpartum for women whose infants are born with symptoms of substance use withdrawal; services for affected children may continue up to age 5. Other services include mental health crisis intervention; community integration services for persons at risk of becoming homeless due to recurrent physical or mental health conditions; supported employment services for persons with mental illness or substance use disorder; intensive in-home services for youth age 3 to 21 with a history of crisis episodes or psychiatric hospital admissions; and respite services for family caregivers of emotionally disturbed or mentally ill youth ages 3 to 21. Enrollment and duration of services will be limited and some services will not become available until the second or third year of the pilot program. Mental health and substance abuse treatment providers may be affected by this rulemaking.