Joint Healthcare and Employment Law Council Meeting
In September the Healthcare Council and the Employment Law Council hosted a joint meeting with State Sen. Heather Steans and Peter Steinmeyer with Epstein Becker & Green, P.C. to discuss the prospects of marijuana legalization and implications for employers in the workplace. It was a fascinating conversation - Sen. Steans indicated her desire to pass legislation next session to legalize marijuana and the considerable effort that has gone into bill development. Much of the conversation was focused on employer liability concerns, specifically with regard to workers' compensation. If you'd like a copy of Sen. Steans' presentation, just reply to this email and we will provide you a copy.
Veto Session Watch List
Below are the healthcare-related bills that Governor Rauner either vetoed or amendatory vetoed over the summer, along with vote totals in the House and the Senate. As a reminder, it takes 71 votes in the House and 36 votes in the Senate to override a veto. Amendatory veto messages can be found via the bill links. Expect a very active Veto Session - all but three of the healthcare-related bills that were vetoed passed in May with a veto-proof majority.
If you'd like a list of all the healthcare-related bills the Governor signed over the summer, click here (fair warning - it's lengthy). Tracking something else that isn't on this list? Just let us know.
HB 2624
- Vetoed (62-45 in the House and 50-0 in the Senate) - Insurance
Creates a regulatory structure for short-term medical health insurance policies. Identical language is also included in
SB1737
, which was also vetoed. Veto session is still over a month away, but as of now SB1737 is the likely override vehicle based on the fact that more stakeholders are engaged with SB1737 and the vote total in the General Assembly was veto-proof when passed.
HB 4096
-
Vetoed (70-37 in the House and 47-9 in the Senate) - Medicaid
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires Medicaid managed care organizations to use a pharmacy formulary that is no more restrictive by drug class than HFS' preferred drug list. Provides that beginning January 1, 2019 and continuing through January 1, 2022, the Department shall require each MCO to list as preferred on the Medicaid managed care organization's preferred drug list at least the same number, and no fewer, of drugs per drug class as are listed on the Department's preferred drug list. Prohibits the Department from adopting any rules or policies that prohibit a Medicaid managed care organization from: (1) covering additional drugs that are not listed on the Department's preferred drug list; (2) submitting all covered drugs listed on the Department's preferred drug list and additional drugs covered by the Medicaid managed care organization as qualified encounters to be used for appropriate purposes; or (3) removing from the Medicaid managed care organization's preferred drug list any prior approval requirements, step therapy, or other utilization controls applicable under the Department's preferred list.
HB 4165
- Vetoed - (67-48 in the House and 35-20 in the Senate) Insurance/Medicaid
Prohibits the State from applying for any federal waiver that would reduce or eliminate any protection or coverage required under the Patient Protection and Affordable Care Act (ACA) that was in effect on January 1, 2017, including, but not limited to, any protection for persons with pre-existing conditions and coverage for services identified as essential health benefits under the ACA. Provides that the State or an agency of the executive branch may apply for such a waiver only if granted authorization by the General Assembly through joint resolution. Applies to the Medicaid code, Insurance Code and state employees group health program.
HB4515
- Amendatory Veto - (103-2 in the House and 56-0 in the Senate) - DPH/DFPR Lyme Disease Program
Creates the Lyme Disease Prevention and Protection Act. Provides that the Department of Public Health shall establish the Lyme Disease Prevention, Detection, and Outreach Program to advise the Department on disease prevention and surveillance and provider and public education relating to the disease. Provides that the Department shall continue to support the vector-borne disease epidemiologist coordinator who is responsible for overseeing the program. Provides that the program shall meet specified requirements to raise awareness about and to promote prevention of Lyme disease. Creates the Lyme Disease Task Force. Provides language concerning the duties and membership of the Task Force. Provides that the Department shall prepare a report annually indicating all efforts under the Act, and the report shall be posted on the Department's website and distributed to the General Assembly and the Task Force. Amends the Medical Practice Act of 1987. Provides that the Department of Financial and Professional Regulation shall not take disciplinary or non-disciplinary actions against a physician for experimental treatment for Lyme Disease or other tick-borne diseases.
SB904
- Amendatory Veto (105-11 in the House and 38-7 in the Senate)
The Employment Law Council worked this bill. The Chamber is opposed. Amends the Workers' Compensation Act in relation to fees and electronic claims. Requires a provider to bill an employer or its designee directly. Provides that the employer or the insurer must send to the provider an explanation of benefits. Requires employers and insurers to pay interest to providers at the rate of 1% per month for services rendered on and after the effective date of this amendatory Act if the bill is not paid promptly. Authorizes providers to bring an action in circuit court to enforce the payment procedures with regard to services rendered on and after the effective date of this amendatory Act. Requires the Director of Insurance to adopt rules to ensure that providers have the opportunity to comply with requests for records by employers and insurers. Imposes penalties upon employers and insurers that fail to comply with the electronic claims process.
SB1737
- Amendatory Veto - (85-28 in the House and 42-5 in the Senate) - Insurance
Insurance omnibus including the short-term medical insurance provisions found in HB2624. While we were neutral on HB2624, the Chamber supports SB1737.
SB2419
- Amendatory Veto (52-0 in the Senate and 85-25 in the House) - Surgical Assistant
Amends the Registered Surgical Assistant and Registered Surgical Technologist Title Protection Act. Provides that a person qualifies for registration as a surgical assistant if he or she is currently certified by the National Commission for the Certification of Surgical Assistants (rather than the National Surgical Assistant Association). Provides that in order for a registrant to renew his or her surgical assistant registration or surgical technologist registration, he or she must maintain certain current certification. Effective immediately.
HB4771
- Amendatory Veto (107-0 in the House and 56-0 in the Senate) - Medicaid/Long Term Care
Amends the Illinois Public Aid Code. Provides that, beginning on June 29, 2018, provisional eligibility, in the form of a recipient identification number and any other necessary credentials to permit an applicant to receive benefits, must be issued to any applicant who has not received a final eligibility determination on his or her application for Medicaid or Medicaid long-term care benefits or a notice of an opportunity for a hearing within the federally prescribed deadlines for the processing of such applications. Requires the Department of Healthcare and Family Services to maintain the applicant's provisional Medicaid enrollment status until a final eligibility determination is approved or the applicant's appeal has been adjudicated and eligibility is denied. Provides that the Department or the managed care organization, if applicable, must reimburse providers for services rendered during an applicant's provisional eligibility period. Provides: (i) that claims for services rendered to an applicant with provisional eligibility status must be submitted and processed in the same manner as those submitted on behalf of beneficiaries determined to qualify for benefits; (2) that an applicant with provisional enrollment status must have his or her benefits paid for under the State's fee-for-service system until the State makes a final determination on the applicant's Medicaid or Medicaid long-term care application; and that the Department, within 10 business days of issuing provisional eligibility to an applicant, must submit to the Office of the Comptroller for payment a voucher for all retroactive reimbursement due. Requires the Department to adopt rules. Effective immediately.
JCAR Update
There have been several healthcare-related rules proposed since our last update.
DPH
proposed
amendments to the Certified Local Health Department Code (77 IAC 600; 42 Ill Reg 16622) updating the process of certifying local health departments.
DPH
also proposed
amendments to Birth Center Demonstration Program Code (77 IAC 265; 42 Ill Reg 16604) implementing Public Act 99-834, which requires bilateral hearing screening of newborns prior to discharge. The rulemaking also updates various incorporated and referenced materials.
HFS
proposed
an amendment to Medical Payment (89 IAC 140; 42 Ill Reg 17067) implementing a provision of PA 100-587 that establishes Critical Access Care Pharmacy (CAP) payments for certain pharmacy providers. Qualifying pharmacies must have an Illinois location open to the public with staff available to fill prescriptions, in a county of fewer than 50,000 residents or a county designated by the federal government as a medically underserved area. Additionally, the pharmacy's owners must have controlling interest in fewer than 10 pharmacies and the majority of its business cannot be by mail order. CAP payments will be made quarterly based on each pharmacy's CAP-eligible claims billed to and paid by a Medicaid Managed Care Organization and for which a paid claim record can be found in HFS' electronic data warehouse. The number of CAPeligible claims multiplied by the lesser of the individual payment amount or the HFS dispensing fee as of 4/1/18 determines the quarterly CAP payment to the pharmacy. Pharmacies meeting CAP program criteria are affected by this rulemaking.
2019 Planning
If you organization is planning
on introducing legislation in Veto Session or next session, please let us know. Because of the diverse nature of the Healthcare Council, advance notice helps us be better advocates for your legislative initiatives.
