Lori Cowdrey Benso | Executive Director, Healthcare Council | 217-725-6522
|
|
|
|
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. |
|
June 10, 2022
Hope everyone is having a nice summer so far.
The General Assembly released their Veto Schedule. Lawmakers will be back in Springfield Tuesday, November 15- Thursday, November 17 as well as November 29-December 1.
View and download the calendar here.
Legislative Update: Bills of Interest Signed into Law
HB 4433, Insurance was signed into law on April 22, 2022. This bill amends the Managed Care Reform and Patient Rights Act. In provisions concerning a requirement that a health care plan shall apply any third-party payments, financial assistance, discount, product vouchers, or any other reduction in out-of-pocket expenses made by or on behalf of an insured for prescription drugs toward a covered individual's deductible, copay, cost-sharing responsibility, or out-of-pocket maximum associated with the individual's health insurance, provides that if application of that requirement would result in ineligibility of a health savings account under federal law, the requirement applies to health savings account-qualified high deductible health plans with respect to the deductible of a plan after the enrollee has satisfied a specified minimum deductible, except with respect to specified items or services, in which case the requirement applies regardless of whether the minimum deductible has been satisfied.
HB 4271, INS Coverage was signed into law on May 6, 2022. 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, 2024 (rather than January 1, 2023) shall provide coverage for medically necessary breast reduction surgery.
SB 2963, Life Insurance was signed into law on May 6, 2022. This bill amends the Illinois Insurance Code. Provides that if active employment is a condition of a policy of group life insurance, in order to be delivered in the State the policy must contain provisions that state that continued coverage for specified active employees will remain in effect until the earliest of specified dates, and specified obligations of the replacing carrier may be limited to the amount for which the employee was covered under the prior carrier's group life insurance policy and may be reduced by any amounts payable under the prior carrier's group life insurance policy.
SB 145, Physician Assistants was signed into law on May 6, 2022. This bill amends the Physician Assistant Practice Act of 1987. Provides that the collaborating physician shall file with the Department of Financial and Professional Regulation notice of employment, discharge, or collaboration with a physician assistant within 60 days (rather than at the time) of employment, discharge, or assumption of collaboration with a physician assistant. Provides that nothing in the provisions shall prevent a physician assistant from beginning his or her employment before the notice of employment or collaboration has been filed.
HB 4595, 340B/PBM was signed into law on May 13, 2022, This bill provides that a contract between a pharmacy benefit manager or third-party payer and a 340B entity or 340B pharmacy shall not contain specified provisions. Provides that a violation by a pharmacy benefit manager constitutes an unfair or deceptive act or practice in the business of insurance, and that a provision that violates the prohibition on certain provisions in a contract between a pharmacy benefit manager or a third-party payer and a 340B entity that is entered into, amended, or renewed after July 1, 2022 shall be void and unenforceable. In provisions concerning pharmacy benefit managers, provides that the provisions apply to contracts entered into or renewed on or after July 1, 2022 (rather than July 1, 2020). In provisions concerning pharmacy benefits, provides that a Medicaid managed care organization or pharmacy benefit manager administering or managing benefits on behalf of a Medicaid managed organization shall not include specified provisions in a contract with a 340B entity or 340B pharmacy. Provides that a provision that violates the prohibition on certain provisions in a contract between a Medicaid managed care organization or its pharmacy benefit manager and a 340B entity entered into, amended, or renewed after July 1, 2022 shall be void and unenforceable.
SB 3819, Pediatric Palliative Care was signed into law on May 13, 2022. This bill provides that a group or individual policy of accident and health insurance or a managed care plan amended, delivered, issued, or renewed on or after January 1, 2024 (rather than after the effective date of the amendatory Act) shall provide coverage for community-based pediatric palliative care and hospice care and that the care shall be delivered to any qualifying child with a serious illness by a trained interdisciplinary team that allows a child to receive community-based pediatric palliative and hospice care while continuing to pursue curative treatment and disease-directed therapies for the qualifying illness.
HB 5585, INS Coverage was signed into law on May 13, 2022. 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, 2024 shall provide coverage for access to home health services for the duration of medically necessary care.
HB 1950, Hospital Assessment was signed into law on May 17, 2022. In a provision concerning safety-net hospitals, provides that beginning July 1, 2020 and ending on December 31, 2026, a hospital that would have qualified for the rate year beginning October 1, 2020 and was designated a federal rural referral center on October 1, 2020 shall be a Safety-Net Hospital. In provisions concerning hospital provider funding, provides that certain annual assessments on inpatient services and outpatient services shall be imposed on each hospital provider for calendar years 2021 through 2026 (rather than for calendar years 2021 and 2022). Makes changes to the definition of "Assessment Adjustment". Extends the period during which certain transfers shall be made from the Hospital Provider Fund. Contains provisions concerning: (i) the applicable reimbursement factor from July 1, 2020 through December 31, 2022 and January 1, 2023 through December 31, 2026; and (ii) fee for-service supplemental payments beginning January 1, 2023. In a provision concerning the classification of Illinois hospitals for the purpose of allocating the funds included in capitation payments to managed care organizations, defines "critical access hospital" and "public hospital". Provides that, beginning January 1, 2023 and each calendar year thereafter, assignment to the safety-net class shall be based on the annual safety-net rate year beginning 15 months before the beginning of the first Payout Quarter of the calendar year. Makes changes to provisions concerning high Medicaid hospitals and defines "regional high volume hospital". Provides that, from January 1, 2023 through December 31, 2023, the Department of Healthcare and Family Services shall establish the amounts that shall be allocated to the hospital class directed payment fixed pools identified under a specified provision of the Code for the quarterly development of a uniform per unit add-on. Requires the Department to ensure that hospitals assigned to the fixed pools are paid no less than 95% of the annual initial rate for each 6-month period of each annual payout period. Contains provisions concerning directed payment amounts established by the Department for the Payout Quarter beginning January 1, 2023; pass-through payments for calendar year 2023; the sum of the total estimated annual payments to each hospital class for calendar year 2023; and other matters. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that a general acute care hospital is authorized to file a notice with the Department of Public Health and the Health Facilities and Services Review Board to establish an acute mental illness category of service in accordance with the Illinois Health Facilities Planning Act and add authorized acute mental illness beds if the following conditions are met: (i) the general acute care hospital qualifies as a safety-net hospital as determined by the Department of Healthcare and Family Services at the time of filing the notice or for the year immediately prior to the date of filing the notice; (ii) the notice seeks to establish no more than 24 authorized acute mental illness beds; and (iii) the notice seeks to reduce the number of authorized beds in another category of service to offset the number of authorized acute mental illness beds. In provisions requiring the Department of Healthcare and Family Services to pay certain amounts to the human poison control center designated under the Poison Control System Act, provides that not less than $3,750,000 shall be paid for State fiscal years 2021 through 2026 (rather than for State fiscal year 2021 and 2022) and not less than $1,875,000 shall be paid for the period July 1, 2026 through December 31, 2026 (rather than for the period July 1, 2022 through December 31, 2022). Amends the Department of Public Health Powers and Duties Law. Provides that, by February 1, 2023, the Department of Public Health and the Department of Healthcare and Family Services shall provide a joint report to the General Assembly on options and recommendations for the establishment of a permanent Safety-Net Hospital Health Equity and Access Leadership (HEAL) Grant Program. Provides that the Departments of Public Health and Healthcare and Family Services may consult with the statewide association representing a majority of hospitals and safety-net hospitals on the report. Sets forth information that may be included in the report, including, but not limited to: (1) criteria for a safety-net hospital to be eligible for the program; (2) potential projects eligible for grant funds, which may include projects to reduce health disparities, advance health equity, or improve access to or the quality of healthcare services; and (3) potential strategies to generate federal Medicaid matching funds for expenditures under the program. Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions requiring the Department of Healthcare and Family Services to make adjustment payments for inpatient services to hospitals that meet certain requirements, provides that such adjustment payments shall be made to a hospital that reopens a previously closed hospital facility within 4 (rather than 3) calendar years of the hospital facility's closure. Amends the Illinois Income Tax Act. Extends the income tax credit for certain hospitals through taxable years ending on or before December 31, 2027 (currently, December 31, 2022). Amends the Use Tax Act, the Service Use Tax Act, the Service Occupation Tax Act, and the Retailers' Occupation Tax Act. Provides that certain hospital exemptions apply on a continuous basis. Effective immediately.
HB 836, Health Insurance was signed into law on May 26, 2022. This bill creates the Health Insurance Coverage Premium Misalignment Study Act. Sets forth provisions concerning the purpose of the Act and findings. Provides that the Department of Insurance shall oversee a study to explore rate setting approaches that may yield a misalignment of premiums across different tiers of coverage in Illinois' individual health insurance market. Provides that the study shall produce cost estimates for Illinois residents addressing metal-level premium misalignment policy along with the impact of the policy on health insurance affordability and access and the uninsured rates for low-income and middle-income residents, with break-out data by geography, race, ethnicity, and income level. Provides that the study shall evaluate how premium realignment if implemented would affect costs and outcomes for Illinoisans. Provides that the Department shall develop and submit, no later than January 1, 2024, a report to the General Assembly and the Governor concerning the design, costs, benefits, and implementation of premium realignment to increase affordability and access to health care coverage that leverages existing State infrastructure.
HB 4703, Insurance/Billing was signed into law May 26, 2022. This bill provides that when an insured receives emergency services or covered ancillary services from a nonparticipating provider or a nonparticipating facility, the health insurance issuer shall ensure that cost-sharing requirements are applied as though the services had been received from a participating provider or facility, and that the insured or any group policyholder or plan sponsor shall not be liable to or billed by the health insurance issuer, the nonparticipating provider, or the facility beyond the cost-sharing amount. Provides that a beneficiary who receives care at a participating health care facility shall not be required to search for participating providers under certain circumstances. Amends the Managed Care Reform and Patient Rights Act. Provides that prior authorization or approval by the plan shall not be required for post-stabilization services that constitute emergency services. Amends the Health Maintenance Organization Act and the Voluntary Health Services Plans Act to provide that health maintenance organizations and voluntary health services plans are subject to provisions of the Illinois Insurance Code concerning billing and cost sharing. In provisions concerning cost sharing for emergency services and cost sharing for non-emergency services, provides that if the cost sharing for the same item or service furnished by a participating provider would have been a flat-dollar copayment, that amount shall be the cost-sharing amount unless the provider has billed a lesser total amount. Provides that upon receipt of the provider's bill or facility's bill, the health insurance issuer shall provide the nonparticipating provider or the facility with a written explanation of benefits (rather than the health insurance issuer shall provide the nonparticipating provider or the facility with a written explanation of benefits).
SB 3910 Uniform Prescription Drug Information Card Act was signed into law on May 26, 2022. Provides that a uniform prescription drug information card issued by a health benefit plan shall display on the card the regulatory entity that holds authority over the plan, whether the plan is fully insured or self-insured, the issuer's National Association of Insurance Commissioners company code, any deductible applicable to the plan, any out-of-pocket maximum limitation applicable to the plan, and a toll-free telephone number and Internet website address through which the cardholder may seek consumer assistance information. Provides that a discounted health care services plan administrator shall issue to its beneficiaries a card that contains information about the regulatory entity that holds authority over the plan and whether the plan is fully insured or self-insured. Amends the Uniform Health Care Service Benefits Information Card Act. Provides that a health care benefit information card or other technology containing uniform health care benefit information issued by a health benefit plan or a dental plan shall specifically identify and display on the card the regulatory entity that holds authority over the plan, whether the plan is fully insured or self-insured, the issuer's National Association of Insurance Commissioners company code, any deductible applicable to the plan, any out-of-pocket maximum limitation applicable to the plan, and a toll-free telephone number and Internet website address through which the cardholder may seek consumer assistance information. Makes other changes. Effective January 1, 2023.
HB 4338, INS Coverage was signed into law on May 27, 2022. This bill provides that a group or individual policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2024 that provides coverage for prescription drugs shall provide coverage for prenatal vitamins when prescribed by a physician licensed to practice medicine in all of its branches or an advanced practice registered nurse licensed under the Nurse Practice Act (rather than only a physician).
HB 5012, Midwife Practice was signed into law on May 27, 2022. This bill amends the Licensed Certified Professional Midwife Practice Act. Provides that a "licensed certified professional midwife" means a person who has successfully met the requirements in the provisions concerning licensure and has been licensed by the Department of Financial and Professional Regulation. Provides that the Illinois Midwifery Board shall have one member who is an Illinois licensed advanced practice registered nurse who is a certified nurse midwife who provides home birth services. Removes a provision providing that applicants for licensure have 3 years from the date of application to complete the application process. Removes provisions providing that the Board shall maintain the confidentiality of annual reports. Removes a provision providing that exhibits shall be certified without cost. Removes a provision providing that the Board shall have 60 days after receipt of the report to review the report from the hearing office. Repeals a provision concerning the certification of records by the Department.
HB 5334, INS Testing Coverage was signed into law on May 27, 2022. This bill provides that a group or individual policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for the cost of the genetic testing of the BRCA1 and BRCA2 genes to detect an increased risk for breast and ovarian cancer if recommended by a health care provider in accordance with the United States Preventive Services Task Force's recommendations for testing.
SB 3682, Cancer Screening was signed into law on May 27,2022. This bill creates the Reducing Cervical Cancer and Saving Lives Act. Provides that hospitals, outpatient departments, clinics, mobile units, or other entities that provide a cervical cancer screening service shall prepare a written report of the results of any cervical cancer screening service provided to a patient. Requires a summary of the written report to be sent directly to the patient in terms easily understood by a lay person. Provides that the Department of Public Health, in collaboration with experts in cervical cancer and cervical cancer screening, shall develop suggested cervical cancer screening reporting language, in terms easily understood by a lay person, to be sent to patients with the summary of the written report. Requires the Department to establish a pilot program to provide for the administration of human papillomavirus (HPV) vaccines to persons enrolled in the Department's Illinois Breast and Cervical Cancer Program and who meet other specified requirements. Requires the pilot program to be implemented no later than July 1, 2024. Allows lead agencies of the Illinois Breast and Cervical Cancer Program to participate in the pilot program. Repeals the provisions regarding the pilot program on June 30, 2027. Contains other provisions. Amends the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall provide coverage and reimbursement for a human papillomavirus (HPV) vaccine that is approved for marketing by the Food and Drug Administration for specified persons. Requires the Department to disallow any preauthorization requirements for the administration of the human papillomavirus (HPV) vaccine.
HB 246, Nursing was signed into law on May 31, 2022 . This bill provides that notwithstanding any other provisions of the Code, the methodologies for reimbursement of nursing services shall no longer be applicable for bills payable for nursing services rendered on or after a new reimbursement system based on the Patient Driven Payment Model (PDPM) has been fully operationalized, which shall take effect for services provided on or after the implementation of the PDPM reimbursement system begins. Establishes an implementation date for the PDPM reimbursement system if certain conditions are met. Contains provisions concerning the establishment of a variable per diem staffing add-on for nursing facilities with specified staffing levels; utilization of the Staff Time and Resource Intensity Verification study; the PDPM nursing component per diem for nursing facilities for certain dates of services; a Medicaid Access Adjustment; incentive payments determined by facility performance on specified quality measures; payments based on CNA tenure, promotion, and CNA training for the purpose of increasing CNA compensation; and other matters. In the Long-Term Care Provider Funding Article, provides that for the privilege of engaging in the occupation of long-term care provider for each occupied non-Medicare bed day, beginning July 1, 2022, an assessment is imposed upon each long-term care provider in an amount varying with the number of paid Medicaid resident days per annum in the facility with the following schedule of occupied bed tax amounts. Makes changes concerning reporting requirements, the Long-Term Care Provider Fund, and other matters. In the Nursing Home License Fee Article, provides that a specified provision imposing licensing fees on nursing home providers is repealed on July 1, 2024.
Upcoming Conferences and Webinars:
Business Conference
Illinois women are Second to No One. We have amazing talent, determination,
intelligence, and resolve. This year's theme will be Challenge Accepted.
The Illinois Chamber welcomes you to our women's conference as we come together to discuss and further dreams of our already strong women for a stronger Illinois. This year's theme is "Challenge Accepted." The robust agenda will provide time for networking and connecting with professionals, and topics providing takeaways for all to take back to the office or home.
When: Wednesday, June 22, 2022 from 8:30 AM to 2:30 PM CDT
Where: NIU Center 1120 E. Diehl Road Naperville, IL 60563
Assessing the Impact of COVID-19 - SAVE THE DATE
The Healthcare Council and Employment Law Council have an upcoming webinar: Assessing the Impact of COVID-19. I will send registration information next week.
Leaders from the health system, pharmaceutical, insurance and employment industry will assess the impact of COVID-19 on consumers, payors and healthcare providers including the clinical, financial and operational implications.
Where: Virtual (Microsoft Teams)
Date and Time:
● Wednesday June 29th
● 1:30 - 3:00 pm CST
We look forward to Healthcare Council members joining us and submitting questions prior to the webinar.
|
|
Not a member and want to learn more about the Illinois Chamber?
|
|
|
|
|
|
|
