Clark Kaericher | Executive Director, Healthcare Council & Sr. VP of Government Affairs | 618-806-1501
|
|
|
|
August 18, 2023
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.
|
|
How has school started already? That 7:15 elementary school drop off felt awful early this week.
New Bill Signings
HB 1565, Insurance Coverage/Estrogen signed into law. This bill provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 (rather than January 1, 2024) and that provides coverage for prescription drugs shall include coverage for one or more therapeutic equivalent versions of vaginal estrogen in its formulary.
HB 2089, Insurance signed into law. This bill amends the Illinois Insurance Code. Changes fee amounts for failure of an industrial insured or surplus line producer to file a tax return or report. Removes provisions added by Public Act 94-677, which has been held unconstitutional. In provisions concerning coverage for medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions, removes language that provides that a request for expedited external review must be initiated within 24 hours following the adverse determination notification by the insurer, and failure to request an expedited external review within 24 hours shall preclude a covered person or a covered person's authorized representative from requesting an expedited external review. Makes other changes. Amends the Small Employer Health Insurance Rating Act. Provides that the provisions shall not apply to any health benefit plan for a small employer that is delivered, issued, renewed, or continued in the State on or after January 1, 2022, unless specified federal law is repealed. Amends the Health Maintenance Organization Act. Provides that health maintenance organizations shall be subject to specified provisions of the Illinois Insurance Code mandating coverage for certain services. Amends the Managed Care Reform and Patient Rights Act. Changes the definition of "health care plan" to include specified not-for-profit voluntary health services plans.
HB 2189, Insulin signed into law. This bill provides that an insurer that provides coverage for prescription insulin drugs under the terms of a health coverage plan the insurer offers shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription insulin drugs at an amount not to exceed $35 (rather than $100).
HB 3030, Insurance/Billing signed into law. This bill amends the Illinois Insurance Code. In provisions concerning billing for services provided by nonparticipating providers or facilities, provides that if attempts to negotiate reimbursement for services provided by a nonparticipating provider do not result in a resolution of the payment dispute within 30 days after receipt of written explanation of benefits by the health insurance issuer, then the health insurance issuer, nonparticipating provider, or the facility may initiate binding arbitration to determine payment for services provided on a per-bill or a batched-bill basis (instead of only a per-bill basis).
HB 3202, Insurance/Testing signed into law. This bill provides that an individual or group policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2025 shall cover a medically necessary home saliva cancer screening every 24 months if the patient is asymptomatic and at high risk for the disease being tested for or demonstrates symptoms of the disease being tested for at a physical exam.
HB 3631, PBM signed into law. This bill amends the Pharmacy Benefit Managers Article of the Illinois Insurance Code. Provides that a pharmacy benefit manager may not retaliate against a pharmacist or pharmacy for disclosing information in a court, in an administrative hearing, before a legislative commission or committee, in any other proceeding, or to a government or law enforcement agency, if the pharmacist or pharmacy has reasonable cause to believe that the disclosed information is evidence of a violation of a State or federal law, rule, or regulation. Provides that a pharmacist or pharmacy shall make commercially reasonable efforts to limit the disclosure of confidential and proprietary information. Provides that retaliatory actions against a pharmacy or pharmacist include specified actions. Provides that the provisions apply to contracts entered into or renewed on or after July 1, 2022 (rather than July 1, 2023).
|
|
Annual Meeting and Reception Sponsorship
The Illinois Chamber is now seeking sponsors for our 2023 annual luncheon! The 2023 annual luncheon and pre-event reception will be held on September 28 at the Doubletree Hotel in Oak Brook. We are seeking sponsors for the reception preceding the event as well as the meeting itself.
Please see the attached document for reception sponsorship information as well as a tentative agenda. The annual meeting is our biggest event of the year and I look forward to seeing you all there.
|
|
Rulemaking
Health Center Grants The CAPITAL DEVELOPMENT BOARD proposed amendments to the Part titled Community Health Center Construction (71 IAC 42; 47 Ill Reg 11860) that clarify various aspects of CDB’s grant program for community health centers. The rulemaking increases the maximum grant award from $3 million to $6 million; clarifies that grant funds cannot be used for lease payments or to make leasehold improvements; limits grant applications to improvements at a single location; clarifies the scoring system for grant applications; and removes language giving geographical preference when awarding grants (CDB will instead use targeted Notices of Funding Opportunity to achieve this goal). The rulemaking also incorporates and references the Grant Accountability and Transparency Act (GATA) and related State and federal regulations; requires applicants to be qualified as awardees under GATA; and removes incorporations of federal regulations that are not applicable to the program. Community health centers eligible for CDB grants are affected by this rulemaking.
Mental Health Facilities The DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES proposed an amendment to Specialized Health Care Delivery Systems (89 IAC 146; 47 Ill Reg 11994) implementing PAs 101-0010 and 102-0699. The PAs and this rulemaking increase payment rates to Specialized Mental Health Rehabilitation Facilities (SMHRFs) by 5%; increase an add-on payment for certain single occupancy rooms from $10 to $15 per day; and establish a new $10 per day add-on for certain double occupancy rooms. The add-on payments will not apply to days when the room occupant is on a leave of absence. Providers that had 3 or more licensed beds in at least half of their facility rooms prior to 11/1/22 but have since reduced all rooms to no more than 2 licensed beds will receive a $32 add-on to their facility rates. Specialized mental health rehabilitation facilities are affected by this rulemaking. Questions/requests for copies/ comments through 9/25/23: Steffanie Garrett, HFS, 201 S. Grand Ave. East, 3rd Floor, Springfield IL 62763-0002, HFS.Rules@illinois.gov
Veto Session Dates
Veto Session will be here before you realize. Lawmakers announced the 2023 dates for October 24-26 and November 7-9. View the calendar here.
Articles of Interest
|
|
Not a member and want to learn more about the Illinois Chamber?
|
|
|
|
|
|
|
