Lori Cowdrey Benso | Executive Director, Healthcare Council | 217-725-6522
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The purpose of the Healthcare Council is to develop and take actions to achieve affordable, accessible, efficient, high-quality healthcare options for the employers and residents of our state. We advocate for market-based solutions that encourage innovation in healthcare delivery – and work against costly mandates and burdensome regulations. Through quarterly meetings, the Council brings together the diverse voices of the healthcare community and provides a forum to interact with government and private sector leaders at the highest levels. |
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Happy Friday and I hope everyone has a great NFL kickoff weekend.
Illinois front:
Recap of Healthcare Related Bills Signed into Law:
SB 499 TMJ Disorders was signed into law on June 25, 2021. Amends 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, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to provide that the medical assistance program and a group accident and health insurance policy providing coverage for hospital, medical, or surgical treatment on an expense-incurred basis shall offer, for an additional premium and subject to the insurer's standard of insurability, optional coverage for the reasonable and necessary medical treatment of temporomandibular joint disorder and craniomandibular disorder.
SB 194 Pharmacies was signed into law on July 9, 2021. This bill provides that a student pharmacist or licensed pharmacy technician engaged in remote prescription processing of dialysate or devices necessary to perform home peritoneal renal dialysis at a licensed pharmacy shall be permitted to access an employer pharmacy's database from his or her home or other remote location while under the supervision of a pharmacist for the purpose of performing certain prescription processing functions, provided that the pharmacy establishes controls to protect the privacy and security of confidential records.
SB 332 Telehealth was signed into law on July 9, 2021. This bill provides that a network plan shall make available, through a directory, information about whether a provider offers the use of telehealth or telemedicine to deliver services to patients for whom it would be clinically appropriate and what modalities are used and what types of services may be provided via telehealth or telemedicine.
HB 3308, Telehealth was signed into law on July 22, 2021. This bill provides that an individual or group policy of accident or health insurance that is amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall cover telehealth services, e-visits, and virtual check-ins rendered by a health care professional when clinically appropriate and medically necessary to insureds, enrollees, and members in the same manner as any other benefits covered under the policy. Provides that an individual or group policy of accident or health insurance may provide reimbursement to a facility that serves as the originating site at the time a telehealth service is rendered. Sets forth provisions with which coverage for telehealth services shall comply. Provides that an individual or group policy of accident or health insurance shall notify health care professionals and facilities of any instructions necessary to facilitate billing for telehealth services, e-visits, and virtual check-ins. Provides that the Department of Insurance and the Department of Public Health shall commission a report to the General Assembly and shall submit the report by December 31, 2026. Provides that the Department of Insurance may adopt rules to implement the provisions. Provides that specified provisions are inoperative on and after January 1, 2028. Removes provisions concerning the Telehealth Payment Parity Task Force. Defines terms. Further amends the Telehealth Act. Changes a reference to "telehealth" to "telehealth services." Removes language that provides that health care professionals shall maintain documentation and recordkeeping in accordance with specified provisions of the Illinois Administrative Code.
HB 135 Birth Control was signed into law on July 22, 2021. Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Provides that the Director of Public Health, if a physician licensed to practice medicine in all its branches in Illinois, shall establish a standing order complete with the issuance of a prescription for a hormonal contraceptive in accordance with the requirements of the provisions. Provides that if the Director is not a physician licensed to practice medicine in all its branches in Illinois, the Medical Director of the Department of Public Health shall establish the standing order. Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or managed care plan to provide coverage for patient care services provided by a pharmacist. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code. Amends the Pharmacy Practice Act. Provides that the definition of "practice of pharmacy" includes the dispensing of hormonal contraceptives pursuant to the standing order under provisions of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Amends the Illinois Public Aid Code. Requires the medical assistance program to cover patient care services provided by a pharmacist for hormonal contraceptives assessment and consultation. Effective January 1, 2022.
HB 1957 Insurance was signed into law on July 23, 2021. Amends the Illinois Insurance Code. Changes the filing due date applicable to actuarial opinions as to the sufficiency of the loss and loss adjustment expense reserves for group workers' compensation pools from June 1 to March 1 of each year. In provisions concerning the bond required of insurance producers, changes a reference from "agent contact" to "agency contract". Provides that the corporate governance annual disclosure must attest to the best of the signatory's belief and knowledge that the insurer has implemented the corporate governance practices (rather than the corporate governance practices required by the provisions concerning disclosure requirements) and that a copy of the disclosure has been provided to the insurer's board of directors or the appropriate committee thereof. Provides that an insurer must ensure that it has complied with the financial requirements and treatment limitations applicable to mental, emotional, nervous, or substance use disorder or condition benefits prior to policy issuance. Provides that pre-licensing course of study hours required to be completed in a classroom setting in order to obtain an insurance producer license may also be completed in a webinar setting. Provides that 3 hours of classroom ethics instruction required for renewal of a public adjuster license may also be completed by webinar. Defines "webinar". Repeals an Article concerning public insurance adjusters and registered firms. Effective immediately, except that provisions concerning the filing due date applicable to actuarial opinions take effect January 1, 2022.
HB 33 Substance Use Treatment was signed into law on July 23, 2021. Amends the Illinois Insurance Code. Provides that a company authorized to transact life insurance in this State may not: (1) cancel, terminate, or refuse to renew an individual's life insurance policy because of that individual's participation in a substance use disorder treatment or recovery support program; (2) charge an individual a different rate for life insurance coverage because of that individual's participation in a substance use disorder treatment or recovery support program; (3) deny a claim by a beneficiary because of an individual's participation in a substance use disorder treatment or recovery support program; or (4) ask an insured whether he or she is participating or has participated in a substance use disorder treatment or recovery support program. Contains provisions regarding confidentiality. Provides that the new provisions do not prohibit a company authorized to transact life insurance in this State from: (1) refusing to insure, refusing to continue to insure, limiting the amount, extent, or kind of coverage available to an individual, or charging a different rate for the same coverage on the basis of that individual's physical or mental condition regardless of the underlying cause of such condition; or (2) inquiring about a physical or mental condition, even if that condition was caused by or is related in any manner to a substance use disorder. Contains provisions regarding liability. Provides that the new provisions do not require a company authorized to transact life insurance to issue a life insurance policy to an applicant. Provides that the new provisions do not apply to a life insurance policy issued to an individual who is abusing drugs, is not seeking any form of treatment, and is not taking part in a substance use disorder treatment or recovery support program.
SB 567, Optometric Telehealth was signed into law on July 23, 2021. This bill provides that an optometrist licensed under the Act may practice optometry through telehealth as authorized by the Act and the Telehealth Act. Provides that an optometrist treating a patient located in Illinois through telehealth must be licensed under the Act. Provides that an optometrist practicing optometry through telehealth is subject to the same standard of care and practice standards that are applicable to optometric services provided in a clinic or office setting. Provides that an optometrist may not provide telehealth services unless the optometrist has established a provider-patient relationship with the patient.
SB1753, Surplus Line was signed into law on July 30, 2021. Amends the Illinois Insurance Code. Adds provisions concerning making diligent efforts to procure surplus line insurance contracts through authorized insurers, including for master policy insurance contracts and program business. Makes changes to provisions concerning reports on surplus line insurance and fire insurance that must be filed by licensed surplus line producers with the Director of Insurance. Changes the date by which a surplus line producer shall file a report on all fire insurance procured from unauthorized insurers and submitted to the Surplus Line Association of Illinois to February 1 (rather than March 31) of each year. Adds provisions concerning submission and recording of premium-bearing endorsements. Provides that an individual officer or partner must be a licensed surplus line producer to represent a member of the Surplus Line Association of Illinois in the exercise of association affairs. Makes other changes. Defines terms. Effective January 1, 2022.
HB 1779, Biomarker Testing was signed into law July 31, 2021. This bill provides that a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after January 1, 2022 shall include coverage for biomarker testing. Provides that biomarker testing shall be covered and conducted in an efficient manner to provide the most complete range of results to the patient's health care provider without requiring multiple biopsies, biospecimen samples, or other delays or disruptions in patient care. Provides that biomarker testing must be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition when the test is supported by medical and scientific evidence. Provides that when coverage of biomarker testing for the purpose of diagnosis, treatment, or ongoing monitoring of any medical condition is restricted for use by health insurers, nonprofit health service plans, or health maintenance organizations, the patient and prescribing practitioner shall have access to a clear, readily accessible, and convenient processes to request an exception, and the process shall be made readily accessible on the insurer's website.
SB1876, Group Life Insurance was signed into law on August 13, 2021. Amends the Illinois Insurance Code. Provides that a policy of group life insurance shall contain, if replacing another policy of group life insurance in force with another insurance carrier immediately prior to the effective date of the new policy, a provision preventing loss of coverage, subject to premium payments, for those active employees who are not actively at work on the effective date of the new policy if specified conditions are met. Makes other changes.
HB 2405 Insurance Guaranty Fund was signed into law on August 16, 2021. Amends the Illinois Insurance Code. Authorizes the Illinois Insurance Guaranty Fund, at the direction of its board of directors and subject to the approval of the Director of Insurance, to form and own a not-for-profit corporation to which the Fund may delegate certain of its powers and duties provided by the Code. Allows the not-for-profit corporation to contract to provide services to the Office of Special Deputy Receiver or any other person or organization authorized by law to carry out the duties of the Director in the capacity of receiver under specified provisions of the Code, the Illinois Life and Health Insurance Guaranty Association, an organizations in another state similar to the Illinois Insurance Guaranty Fund or the Illinois Life and Health Insurance Guaranty Association. Effective immediately.
HB 1955 Holding Company Systems was signed into law on August 16, 2021. Amends the Illinois Insurance Code. In provisions requiring the Director of Insurance to approve specified acquisitions of control, provides that the Director shall deny the acquisition if the competence, experience, and integrity of those persons who would control the operation are such that it would not (rather than would) be in the best interests of specified individuals. Provides specified procedures by which the Director may designate a group-wide supervisor of an internationally active insurance group and supervise internationally active insurance groups. In provisions concerning confidential treatment of certain information, excludes information submitted pursuant to specified provisions concerning mergers and acquisitions that is not personal financial information. Provides that the Director may share confidential and privileged documents, materials, or other information with third-party consultants to assist in the performance of the Director's duties. Makes other changes. Defines "group-wide supervisor", "internationally active insurance group", "NAIC", and "securityholder". Repeals certain provisions concerning exemptions and provisions concerning confidentiality of documents, materials, and other information. Effective immediately.
HB 1745 Prescription Drug Benefits was signed into law on August 16, 2021. 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.
HB 711, Prior Authorization was signed into law on August 19, 2021. This bill, as amended does the following: 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. Read the full public act here.
HB 2653, Colonoscopy Coverage was signed into law on August 20, 2021. Amends the Illinois Insurance Code to require a group policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2022 to provide coverage for a colonoscopy that is a follow-up exam based on an initial screen where the colonoscopy was determined to be medically necessary by a physician licensed to practice medicine in all its branches, an advanced practice registered nurse, or a physician assistant. Provides that a group insurance policy shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on colonoscopy coverage, except to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account under the Internal Revenue Code. Makes conforming changes in the Counties Code, the Illinois Municipal Code, and the Health Maintenance Organization Act. Effective January 1, 2022.
HB 3175, Wellness Insurance Coverage was signed into law on August 20, 2021. This bill provides that a group or individual policy of accident and health insurance or managed care plan that offers a program for wellness coverage must not provide a total incentive that exceeds 30% (rather than 20%) of the cost of self-only or employee-only coverage (rather than only employee-only coverage). Provides that the incentive may be increased by up to an additional 20%, for a total incentive of 50%, to the extent that the additional percentage is in connection with a program designed to prevent or reduce tobacco use. Amends the Navigator Certification Act. Provides that certified application counselors are subject to the same certification requirements as navigators. Provides that navigators or certified application counselors may not engage in any unfair method of competition or any fraudulent, deceptive, or dishonest act or practice related to the health insurance marketplace or to that individual's or entity's absence of a conflict of interest in connection with the enrollment of any individuals or employees in a particular private health benefit plan. Provides that a navigator or certified application counselor who fails to timely file for certificate renewal shall be charged a late fee in an amount prescribed by the Director of Insurance.
HB 2595, Mental Health Coverage was signed into law on August 25, 2021. This bill, as amended, provides that every insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace in the State and Medicaid managed care organizations providing coverage for hospital or medical treatment shall provide coverage for medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions on or after January 1, 2023 (rather than January 1, 2022). Provides that an insurer or Medicaid managed care organization shall not be required to pay for services if the individual was not the insurer's enrollee or eligible for Medicaid at the time the service was rendered. Provides that an insurer shall not be required to cover benefits that have been authorized and provided for a covered person by a public entitlement program. Provides that for medical necessity determinations (rather than in conducting utilization review of covered health care services and benefits) relating to level of care placement, continued stay, and transfer or discharge of insureds diagnosed with mental, emotional, and nervous disorders or conditions, insurers and Medicaid managed care organizations shall apply specified patient placement criteria. Makes various changes to provisions concerning requirements for insurers regarding education of the insurer's staff and other stakeholders, publishing of utilization review criteria, and documentation of interrater reliability testing and remediation actions.
HB 3598, Local Chambers of Commerce was signed into law on August 27, 2021. This bill provides that companies that issue group policies of accident and health insurance must offer such policies to local chambers of commerce.
HB 3709, Insurance Infertility Coverage was signed into law on August 27, 2021. This bill provides that a policy, contract, or certificate may not impose any exclusions, limitations, or other restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications, nor may it impose any exclusions, limitations, or other restrictions on coverage of any fertility services based on a covered individual's participation in fertility services provided by or to a third party, nor may it impose deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for the diagnosis of infertility, treatment for infertility, and standard fertility preservation services, except as provided in the Section, that are different from those imposed upon benefits for services not related to infertility. Changes the definition of "infertility."
SB 1874. Health Care Recoupment was signed into law on August 27, 2021. Amends the Illinois Insurance Code. Provides that an insurer, health maintenance organization, independent practice association, or physician hospital organization may not attempt a recoupment or offset until all appeal rights of a health care professional or health care provider are exhausted. Provides that no recoupment or offset may be requested or withheld from future payments 6 months or more after the original payment is made (rather than 18 months or more after the original payment is made). Effective January 1, 2022.
Floor Action:
HB 684, Ambulance Service veto was overridden by a vote of 112-1-0. This bill requires the Department of Healthcare and Family Services to exempt ground ambulance services from the State's managed care medical assistance program.
Federal front:
We are carefully tracking the $3.5 trillion reconciliation package. This package includes calls for legislation to bring generic and biosimilar drugs to market more quickly, including shortening exclusivity periods, and creating incentives for doctors to prescribe biosimilars instead of brand name drugs.
The Hill reported yesterday that the Biden administration unveiled a detailed blueprint for lowering prescription drug prices. The plan includes a proposal to allow Medicare to directly negotiate drug prices and also drug importation from Canada.
List of Key Dates:
October 19 - 21, 26 – 28 - Veto Session
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