AARON WINTERS
Executive Director
Healthcare Council
847-334-6411
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June 6, 2018
Good morning, Healthcare Council. Regularly scheduled session is over and the November campaign is officially in full swing. Gov. Rauner and Democratic nominee JB Pritzker are up on TV with competing advertisements in what promises to be the most expensive gubernatorial race ever. On to the update!
End of Session Recap
Whew - what a whirlwind! The General Assembly adjourned for the summer on May 31, passing a bipartisan full-year budget which was signed by the Governor on Monday. This represents the first signed budget of Gov. Rauner's first term. Not only did we get a full-year budget, but the General Assembly also authorized supplemental spending to address prior fiscal year bill backlogs at state agencies. State Rep. Greg Harris, the lead negotiator for House Democrats, released a very helpful summary of key funding priorities - here are just a few in the healthcare space.
- Adds therapeutic bed holds for SMHRF residents
- Supportive living rate increase
- Funding for psych hospitals treating DCFS wards who are kept beyond medical necessity and have not found placement
- Rate increase for institutions serving Medically Complex and Developmentally Disabled children
- Emergency add for critical access pharmacies
- One year ambulance rate increase
- Addition of Adult Dental to the Medicaid program
- $2 million in funding for Special Olympics
- CCP program for seniors fully funded, with incentive program to enroll eligible seniors in Medicaid to bring in Federal matching dollars
- Restoration of funding for lines eliminated or reserved by the Governor in the Human Services Department including immigrant/refugee programs, homeless youth services, Autism Program, Teen Reach, Summer Jobs for Youth, Infant Mortality prevention, Children's Place, Addiction Prevention, and others
- Restoration of wage increases for frontline workers in aging, disability, home services, mental health, substance abuse, etc. that were not implemented by the Governor
- Fully funded HIV/AIDS, IBCCP and African-American AIDS Response programs
- Funding mechanism for payment of backlog of unprocessed Long Term Care claims
$1,245,584,500 in supplemental appropriations was authorized, including
a
$442 million deposit to the Healthcare Provider Relief Fund.
On the legislative front, it was mostly a "defense" year. We led or supported negotiations on a variety of issues across the healthcare spectrum, including the following:
HB 5464
(Feigenholtz) requires that an insurance policy provides unlimited benefits for inpatient and outpatient treatment of mental, emotional, nervous, or substance use disorders or conditions. This would significantly add to health insurance costs. The Chamber was opposed to this legislation. We successfully negotiated a compromise that removed prior authorization for substance abuse treatments, but preserved a health plan's ability to ensure that treatments are medically necessary. The language was included in
SB 682
which passed both the House and Senate after the Chamber went neutral.
HB68
(Lang) was a particularly anti-business bill that created a private right of action to sue health plans to enforce state mental health parity laws. The Chamber led negotiations on behalf of employers and commercial insurers, which resulted in an acceptable amendment that codifies additional enforcement provisions at the Department of Insurance as well as creates a workgroup to study insurance reporting requirements regarding mental health parity. The language was attached to
SB1707
and passed both the Illinois House and Senate after the Chamber went neutral.
HB4900
(Guzzardi) regulates generic drug price "gouging" and brings the government into the decision-making process regarding how pharmaceuticals are priced. The Chamber opposed and testified against the legislation in committee. The House passed the bill, but was never called in committee in the Senate. The bill sponsor is committed to this issue, so expect future attempts at action.
HB 4146
(Fine/Steans) amends the Managed Care Reform and Patient Rights Act. During an enrollee's plan year, prohibits a health care plan from removing a drug from its formulary or negatively changing its preferred or cost-tier sharing unless, at least 60 days before making the formulary change, the health care plan provides certain notifications to current and prospective enrollees and prescribing providers. After session-long negotiations led by PCMA, an amendment was adopted that preserved patient access to drugs but still allowed a health plan to make formulary changes. The bill passed both the House and Senate the last week of session.
SB 2334
(Murphy) would require that a hospital maintains a metal detector at each point of entry into the hospital. The Chamber opposed this bill and was never called for a vote in committee.
HB 3479
(Feigenholtz/Manar) would mandate pharmacy reimbursement rates for Medicaid (and a filed amendment would extend that provision to private health plans). The Chamber believes that reimbursement rates should remain a contractual and market-based provision and not legislatively mandated. The bill passed the House but was never taken up for a final vote in the Senate, although supplemental pharmacy payments were included in the budget.
HB 1796
(G. Harris)
creates the Health Insurance 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. This bill has been introduced in the past, but failed to gain much traction this session.
Thanks to all the Healthcare Council members that provided legislative feedback and assisted in negotiations. As always, we greatly appreciate any information on bills that your organization is either supporting or opposing - it helps us do our job better and ensures that we are representing the interests of our members.
Norwood Out
Illinois Department of Healthcare and Family Services Director Felicia Norwood announced she is leaving the department this month to accept a senior executive job at Anthem. Director Norwood presided over the department during a time of considerable change in the Medicaid space - from MCO consolidation to a new hospital assessment to a new behavioral health 1155 waiver. The Governor's office is currently reviewing potential replacements. Several potential names are floating out in the ether, but sufficed to say the good betting line is a promotion from within the ranks at HFS, a retiring legislator or perhaps a healthcare executive looking for a capstone on a career.
And by the way, this obviously complicates our next scheduled Healthcare Council Quarterly Meeting which was to feature Director Norwood. Standby for future announcements on our next speaker and time.
JCAR Update
One new proposed healthcare-related rule has been announced since our last update.
HFS proposed an amendment to Hospital Reimbursement Changes (89 IAC 152; 42 Ill Reg 8711) amending HFS' Potentially Preventable Readmissions (PPR) policy to include encounter data from Medicaid Managed Care Organizations (MCOs). (PPR policies impose payment penalties upon hospitals that are deemed to have excessively high incidences of readmissions that could have been prevented had proper care been given during the original admission.) Although analyses will be performed on both fee-for-service and encounter rate data, and reported to both the MCO and the hospital, no penalty payments will be collected. The amendment also excludes admissions for treatment of sickle cell anemia from being included in PPR data.
IS AN EDIE AWARD IN YOUR FUTURE?
The Illinois Chamber of Commerce is now accepting nominations for the 10th Annual Economic Development in Illinois Awards - the Edies. The Edies honor outstanding economic development projects completed in the calendar year of 2017 that imagine, design, invest, build and bring jobs, growth and prosperity to Illinois communities. More information can be found at the Edie homepage.
Nominations are being accepted now until 5 p.m. June 15, 2018. For additional questions, please contact Katie Stonewater at [email protected].
Upcoming Events
June 20:
Illinois Chamber of Commerce President & CEO Todd Maisch is a featured panelist a the
Mid-Year Economic Breakfast Summit
, presented by the Illinois Chamber of Commerce and multiple suburban Chambers of Commerce
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