Clark Kaericher | Executive Director, Healthcare Council & Sr. VP of Government Affairs | 618-806-1501
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July 7, 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.
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Hopefully everyone had a wonderful 4th of July celebration. Due to the storms last week, my small town postponed the festivities until tomorrow. The good news is that I’ll have a much better view of the fireworks from my backyard after the storm took out my fence…
Recent Bill Signings
HB 579, State-Based Exchange signed into law. This bill sets forth provisions concerning the Marketplace Director of the Illinois Health Benefits Exchange. Amends the Illinois Procurement Code. Sets forth provisions concerning an exemption regarding any procurements necessary for the Department of Insurance to implement the Illinois Health Benefits Exchange Law. Amends the Illinois Health Benefits Exchange Law. Provides that the Department of Insurance shall operate the Illinois Health Benefits Exchange as a State-based exchange using the federal platform by plan year 2025 and as a State-based exchange by plan year 2026. Provides that, except where inconsistent with State law, the Department shall enforce health plan coverage requirements under the federal Patient Protection and Affordable Care Act that apply to the individual and small group markets. Provides that the Director of Insurance may elect to add a small business health options program to the Illinois Health Benefits Exchange. Provides that the General Assembly shall appropriate funds to establish the Illinois Health Benefits Exchange. Provides that issuers must remit an assessment in monthly installments to the Department. Sets forth provisions concerning State medical assistance program coordination and provisions concerning the authority of the Department of Insurance and the Department of Healthcare and Family Services. Provides that through the adoption of rules, the Director of Insurance may require that plans offered on the exchange conform with standardized plan designs. Makes a change concerning the purpose of the assessment. Provides that in no case shall the assessment be applied at a rate that exceeds 3.5%.
HB 1186, Insurance/Referral-Support signed into law. This bill provides that the powers of a health maintenance organization include the voluntary use of a referral system for enrollees to access providers under contract with or employed by the health maintenance organization. Provides that the provisions shall not be construed as requiring the use of a referral system to obtain a certificate of authority. Provides that the Director may prescribe by rule the language that must be included in the plan name, marketing, advertising, or other consumer disclosure requirements to differentiate a health care plan that does not use a referral system for such providers from a health care plan that does use a referral system for such providers. Provides that the provisions shall not be construed as requiring the use of a referral system with the health maintenance organization's contracted or employed providers to obtain a certificate of authority.
HB 2296, Health Insurance signed into law. This bill provides that beginning before or on May 1, 2026, and each May 1 thereafter, the Department of Insurance shall report to the Governor and the General Assembly on health insurance coverage, affordability, and cost trends. Amends the Illinois Insurance Code. Provides that any forms and rates filed for large employer group accident and health insurance shall be automatically deemed approved after 90 days after filing. Provides that beginning plan year 2026, rate increases for all individual and small group accident and health insurance policies must be filed with the Department for approval. Provides that unreasonable rate increases or inadequate rates shall be modified or disapproved. Provides that beginning plan year 2025, the Department shall post all insurers' rate filings and summaries on the Department's website. Provides that the Department shall open a 30-day public comment period on the date that a rate filing is posted on the website. Provides that after the close of the public comment period, the Department shall issue a decision to approve, disapprove, or modify a rate filing within 60 days, and post the decision on the Department's website. Provides that the Department shall adopt rules implementing specified procedures.
SB 1298, Medicaid Omnibus was signed into law. This bill Creates the Substance Use Disorder Residential and Detox Rate Equity Act. Requires the General Assembly to appropriate sufficient funds to the Department of Human Services, for State Fiscal Year 2024 and for each State fiscal year thereafter, to ensure reimbursement rates will be increased and subsequently adjusted upward by an amount equal to the Consumer Price Index-U from the previous year, not to exceed 5% in any State fiscal year, for licensed or certified community-based substance use disorder treatment providers under community service grant programs for persons with substance use disorders, including, but not limited to, certain residential and withdrawal management services provided in accordance with criteria established by the American Society of Addiction Medicine. Amends the Illinois Public Aid Code. In the Medical Assistance Article of the Code, provides that on and after January 1, 2024, the inpatient, per diem rate to be paid to a hospital for inpatient psychiatric services shall be not less than 90% of the per diem rate established under a specified provision of the Code. Makes changes to provisions concerning funding to the human poison control center designated under the Poison Control System Act; hospital reimbursement rates for specified inpatient and outpatient services; medical assistance coverage for cognitive assessment and care planning services provided to a person who experiences signs or symptoms of cognitive impairment; the supportive living program rate for dementia care; and Prospective Payment System rates increases for federally qualified health centers. Amends the Specialized Mental Health Rehabilitation Act of 2013. Provides that beginning July 1, 2023, for improving the quality of life and the quality of care at specialized mental health rehabilitation facilities, a payment of no less than $10.50 per day, per single room occupancy shall be added to the existing $15 additional per day, per single room occupancy rate for a total of at least $25.50 per day, per single room occupancy. Sets forth a rate increase for each Medicaid-occupied bed in dual-occupancy rooms. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, subject to federal approval, on and after July 1, 2023, the reimbursement rates paid to providers of private duty nursing services for medically fragile and technology dependent children shall be at a specified percentage rate higher than the reimbursement rates in effect for nursing services on June 30, 2023. Amends the Illinois Act on the Aging. Increases rates for homemaker services, subject to federal approval. Requires providers of in-home services to be required to certify to the Department on Aging that they remain in compliance with the mandated wage increase for direct service workers. Provides that fringe benefits shall not be reduced in relation to the rate increases described in the amendatory Act. Amends the Medical Assistance Article of the Illinois Public Aid Code. Increases the reimbursement rate for ventilator services, speech therapy services, physical therapy services, and occupational therapy services. Establishes a $60 personal needs allowance for nursing home residents who are eligible for medical assistance. Amends the Rebuild Illinois Mental Health Workforce Act. Increases the Mobile Crisis Response Medicaid Payment rate, the Crisis Intervention Medicaid Payment rate, and other specified rates. In a provision concerning reimbursement rates for ambulance services, provides that ambulance services includes medical transportation services provided by means of air ambulance. Provides for an increase in the base rate for both base charges and mileage charges for medical transportation services provided by means of an air ambulance. In a provision concerning the tiered exceptional care per diem rates for medically complex for the developmentally disabled facilities, provides that, subject to federal approval, each tier rate shall be increased 6% over the amount in effect on the effective date of the amendatory Act. Provides that, subject to federal approval, the Department of Healthcare and Family Services shall increase the base rate of reimbursement for both base charges and mileage charges for ground ambulance service providers not participating in the Ground Emergency Medical Transportation (GEMT) Program for medical transportation services provided by means of a ground ambulance to a level not lower than 140% (rather than 112%) of the base rate in effect as of January 1, 2023 (rather than July 30, 2018).
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Illinois Chamber Releases Quarter 2 Business Leader
The Illinois Chamber recently released its June edition of the Business Leader magazine. In this installment, the Chamber was able to get exclusive stories and insight from member companies such as Bristol Myers Squibb, CPKC, EVBox, Microsoft, and onShore Security.
We thank our members for their participation and highly encourage you to read these fantastic articles at the link below.
To read the full stories click HERE.
Rulemaking
Hospitals: The DEPARTMENT OF PUBLIC HEALTH adopted emergency amendments to Hospital Licensing Requirements (77 IAC 250; 47 Ill Reg 8896) effective 6/ 8/23 for a maximum of 150 days. Identical proposed amendments appear in this week’s Illinois Register at 47 Ill Reg 8873. The emergency and proposed rulemakings implement Public Act 102-1118, which establishes a new licensing category (in addition to general acute care and specialty hospitals) for rural emergency hospitals that meet criteria established by the federal Centers for Medicare and Medicaid Services. A rural emergency hospital (REH) is defined in this rulemaking as an entity that operates for the purpose of providing emergency department services, observation care, and outpatient services, and in which the average patient stay CHILD CARE The DEPARTMENT OF HUMAN SERVICES proposed amendments to Child Care (89 IAC 50; 47 Ill Reg 8806) that clarify which types of income will or will not be counted in determining eligibility for the Child Care Assistance Program. Tips and commissions earned on a regular basis will be counted as part of gross wages or salary, which is non-exempt income. Income that is now exempt from consideration includes alimony; child support received by the family (unless paid in a lump sum, which is not exempt); public assistance and welfare payments; ongoing monthly adoption assistance payments from the Department of Children and Family Services; Social Security payments, including SSI and pensions, to all family members; survivor’s does not exceed 24 hours. An REH does not provide inpatient services except in a distinct part unit licensed as a skilled nursing facility to provide post-hospital extended care. An REH must have an agreement with at least one Level I or II trauma center for referral and transfer of patients who require emergency medical care beyond the capabilities of the REH. These rulemakings also establish which provisions of this Part do not apply to REHs. Hospitals that meet the criteria for rural emergency hospitals are affected by these rulemakings. Questions/requests for copies/ comments on the proposed rulemaking through 8/7/23: Tracey Trigillo, DPH, 524 S. Second Street, 6th Floor, Springfield IL 62701, 217/7821159, dph.rules@illinois.gov
Immigrant Healthcare: The DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES adopted emergency amendments to Special Eligibility Groups (89 IAC 118; 47 Ill Reg 9114) effective 6/16/23 for a maximum of 150 days. Identical proposed amendments appear in this week’s Illinois Register at 47 Ill Reg 8994. The emergency and proposed amendments impose limitations on the Health Benefits for Immigrant Adults (HBIA) and Health Benefits for Immigrant Seniors (HBIS) programs, which provide medical assistance to noncitizens ages 42-64 (HBIA) and 65 and older (HBIS) who meet income criteria and do not qualify for federally matched Medicaid assistance. The rulemakings provide that HFS may limit or suspend enrollment in either program with at least 14 days’ notice posted on its website. (HFS has announced that enrollment in HBIA will be suspended on July 1 and that enrollment in HBIS will be capped at 16,500 recipients.) HFS may also limit or suspend backdated coverage (for dates of service up to 3 months prior to the date of application) if necessary to keep the costs of these programs within the amount appropriated. Additionally, healthcare providers may charge copayments of up to $250 per stay for inpatient hospitalizations and up to $100 for hospital emergency visits. For outpatient services received at hospitals or ambulatory surgical treatment centers, the maximum copayment is 10% of the established provider reimbursement rate for the same service under the Veterans’ Health Care Program (89 IAC 128.320). Providers are responsible for collecting copayments and may charge no copayment or a lesser copayment than the maximum permitted under these rulemakings. The rulemakings also require any large public hospital that has received payments from these programs in excess of the rates paid to non-large public hospitals to reimburse the State for these excess payments in a method and amount determined by HFS. Healthcare providers who serve HBIA or HBIS recipients are affected by these rulemakings. Questions/requests for copies/ comments on the proposed rulemaking through 8/14/23: Steffanie Garrett, HFS, 201 S. Grand Ave. East, 3rd Floor, Springfield IL 62763-0002, HFS.Rules@illinois.gov
Pharmacies: The DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION adopted amendments to the Part titled Pharmacy Practice Act (68 IAC 1330; 46 Ill Reg 9199) effective 6/ 2/23 concerning continuing education (CE) for pharmacy technicians, administration of vaccines, and other matters. The rulemaking requires a new pharmacy application to DFPR whenever more than 50% (formerly 10%) of ownership changes hands; the name, location, or legal status of a pharmacy changes; or any substantial change in pharmacy operations occurs. Pharmacy technicians must complete 10 hours of CE from an approved or accredited CE provider during the last 12 months of each licensing period after the initial licensing period. At least 1 hour must address pharmacy laws, rules and ethics and at least 1 hour must address patient safety. The rulemaking also allows pharmacists, pharmacy students under a pharmacist’s direct supervision, and pharmacy technicians to administer vaccinations ordered by a physician to persons age 7 or older. (Previously, pharmacists and pharmacy students under direct supervision were allowed to administer influenza and tetanus/ diphtheria/pertussis vaccines to persons age 10 and older, and other vaccines to persons age 14 and older, pursuant to a physician’s order.) A pharmacy student or technician must complete DFPR-approved training on vaccine administration prior to administering vaccines. The supervising pharmacist is responsible for ensuring that a student or technician is properly trained in vaccine administration, for evaluating the appropriateness of vaccinations administered by a student or technician, and for reporting each vaccination to the person’s primary health care provider. Student pharmacists and pharmacy technicians may transmit and receive transferred prescriptions, and pharmacies must obtain the consent of the patient or the patient’s agent for automated refills. A home pharmacy may supervise no more than 3 remote dispensing sites that are open at one time; records must be maintained at the remote site (formerly, at the home pharmacy). Other provisions establish procedures for cancelling electronically transmitted prescriptions; allow prescriptions to be dispensed only when a pharmacist is physically present (formerly, present and on duty) and no more than 15 months (formerly 1 year) after the date of the original prescription; and eliminate fees for scoring examinations, for obtaining duplicate licenses, wall certificates, or rosters of registered pharmacists, and for obtaining licensing or disciplinary records pursuant to a subpoena. Pharmacists, student pharmacists, pharmacy technicians and their employers are affected by this rulemaking.
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Upcoming Illinois Chamber Webinar on Antitrust
Title: HR Has to Worry About Antitrust? The Intersection of Employment and Antitrust Laws
Date/Time: July 13, 2023 | 10:30 am – 11:30 am
Description: This webinar will explore recent developments in the relationship between employment and antitrust laws. The Department of Justice-Antitrust Division has actively pursued civil and criminal enforcement actions concerning employer restrictions in labor markets due to hiring practices and policies, and the FTC is proposing to bar Non-Compete Agreements. You will get practical do’s and don’ts to keep your organization out of hot water.
Presenter: Glenn Davis, Heplerbroom LLC
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Veto Session Dates
The Spring Session might have just ended, but 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
City turning to local community organizations to staff migrant shelters, save costs
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