Healthcare Council Update

Aaron Winters | Executive Director, Healthcare Council | 847-334-6411

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Greetings, Healthcare Council. We're back at it in Springfield next week, albeit still at a slow start. Gov. Pritzker's State-of-the-State address from last week was light on healthcare priorities, outside of accomplishments from last session. Instead, most of his forward-looking efforts were directed at ethics and energy. If you've got some free time, you can view his full remarks here. On to the update!

Healthcare Committees Scheduled for Next Week

House Committees

Insurance Committee

Date: Feb 04, 2020 2:00PM

Location: Room 114 Capitol Building, Springfield, IL

HB4137 - Morgan - Creates the Flood Insurance Act. Allows the Department of Insurance to require, through prior form approval, that an authorized insurer issues an insurance policy, contract, or endorsement that meets the private flood insurance requirements in a specified provision of federal law. Provides that flood coverage rates are not subject to prior approval by the Department of Insurance, but the Department may audit an insurer's residential flood insurance rates to ensure that rates are based on actuarial data, methodologies, and standards that are not excessive, inadequate, or unfairly discriminatory. Requires insurers to notify the Department at least 30 days before writing flood insurance in this State, to notify the Department of any changes in rates within 30 days after the effective date of the change, and to file a plan of operation and financial projections, or revisions to the plan. Requires an agent of an insurer to maintain certain evidence in his or her records. Authorizes the Department of Insurance to certify that a private flood insurance policy provides flood coverage which equals or exceeds the coverage offered by the National Flood Insurance Program, or that a private flood insurance policy meets federal requirements. Provides that an insurer or agent who knowingly misrepresents that a flood insurance policy is certified under this Act commits an unfair or deceptive act under the Uniform Deceptive Trade Practices Act.

Human Services Committee

Date: Feb 05, 2020 8:30AM

Location: Room C-1 Stratton Building, Springfield, IL

HB3889 - Ford - Amends the Illinois Controlled Substances Act. Provides that the requirements for transmitting information to the central repository under the Prescription Monitoring Program also apply to opioid treatment programs that prescribe Schedule II, III, IV, or V controlled substances for the treatment of opioid use disorder.

HB3948 - Gabel - Creates the Over the Counter Diet Pills Act. Prohibits the sale of over the counter diet pills to any person under 18 years of age. Provides that retail establishments selling over the counter diet pills must limit access, display, and provide access to over the counter diet pills designated by the Department of Public Health in specified manners. Provides that violations of the Act's provisions shall be punished as a business offense with a fine of no more than $2,000 and shall constitute an unfair method of competition and an unfair or deceptive act or practice under the Illinois Insurance Code. Requires the Department, in consultation with the United States Food and Drug Administration and stakeholders, to determine which over the counter diet pills shall have limited accessibility. Amends the Illinois Insurance Code to make a conforming change. Effective 180 days after becoming law.

HB3993 - Stuart - Amends the Adult Protective Services Act. Expands the definition of "mandated reporter" to include investment advisors and insurance adjusters. Effective immediately.

Appropriations-Human Services Committee

Date: Feb 05, 2020 10:00AM

Location: Room C-1 Stratton Building, Springfield, IL

HB4 - Greenwood - Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that doula services shall be covered under the medical assistance program. Sets forth certain certification and training requirements a doula must satisfy to qualify for reimbursement under the medical assistance program.

HB204 - Ford - Amends the Senior Citizens and Persons with Disabilities Property Tax Relief Act by reinstituting the pharmaceutical assistance program that was eliminated by Public Act 97-689 and changing the short title to the Senior Citizens and Persons with Disabilities Property Tax Relief and Pharmaceutical Assistance Act. Makes conforming changes in various Acts.

HB2191 - Conroy - Amends the Early Intervention Services System Act. Provides that, for State fiscal years 2020 through 2022, the Department of Human Services shall increase reimbursement rates for early intervention services and related services by 3% each State fiscal year; except that, for State fiscal years 2020 through 2022, the Department of Human Services shall increase reimbursement rates for developmental therapy services by 6% each State fiscal year.

HB2815 - Costa Howard - Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that beginning no later than October 1, 2019, and for each State fiscal year thereafter, the monthly personal needs allowance required under Title XIX of the Social Security Act for any person residing in a facility licensed under the Community-Integrated Living Arrangements Licensure and Certification Act who is determined to be eligible for medical assistance under the Code and who is enrolled in the State's Home and Community-Based Services Waiver Program for adults with developmental disabilities shall be no less than 15% of the individual's monthly Supplemental Security Income benefits or Social Security Disability Insurance benefits, or both, for the previous calendar year. Establishes a similar personal needs allowance amount for any person residing in a facility licensed under the ID/DD Community Care Act who is determined to be eligible for medical assistance under the Code beginning no later than October 1, 2019 and for each State fiscal year thereafter. Effective immediately.

HB3967 - Kifowit - Amends the Department of Healthcare and Family Services Law. Provides that the Department of Healthcare and Family Services shall approve veteran support specialists who are certified by, and in good standing with, the Illinois Alcohol and Other Drug Abuse Professional Certification Association, Inc. to provide peer support services to recipients of medical assistance under Article V of the Illinois Public Aid Code.

Cybersecurity, Data Analytics, & IT Committee

Date: Feb 05, 2020 10:00AM

Location: Room 115 Capitol Building, Springfield, IL

HB2736 - Buckner - Right to Know Act - cross cutting data privacy bill with a private right of action. While the Chamber's Tech Council runs point on data privacy issues, this legislation certainly has cross-cutting implications for a host of industries.

Senate Committees

Human Services

Date: Feb 04, 2020 10:30AM
Location: 212 Capitol - Springfield, IL
Subject Matter On: Transition of DCFS youth to Managed Care
Joint Hearing with Senate Special Committee On Oversight of Medicaid Managed Care

Human Services

Feb 05, 2020 10:00AM

409 Capitol
Springfield, IL

Subject Matter On: SB 2541

SB2490 - Steans - Amends the Mental Health and Developmental Disabilities Code. Provides that the notice of a recipient's rights includes, if applicable, the recipient's right to request a transfer to a different Department of Human Services facility. Provides that a recipient, his or her attorney, guardian, if any, and responsible relative, in any Department facility may make a written application to the facility director of the recipient's current facility to transfer to another Department facility. Provides that the Department shall provide the form to make such an application to a recipient, his or her attorney, guardian, if any, and responsible relative upon request. Provides that a recipient of services shall not include a person with the primary diagnosis of a developmental disability. Provides that upon receipt of the recipient's application, the facility director shall promptly schedule a hearing to be held within 7 days. Provides that the hearing shall be held at the recipient's current facility. Establishes the recipient's burden of proof at the transfer hearing. Provides that if a recipient's application for transfer is denied, no application may be filed for 180 days. Provides that the recipient does, however, have the right to administratively appeal any decision of the utilization review committee. Effective immediately.

SB2499 - Manar - Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the medical assistance program shall provide coverage for routine care costs that are incurred in the course of an approved clinical trial if the medical assistance program would provide coverage for the same routine care costs not incurred in a clinical trial. Defines "approved clinical trial" to mean a phase I, II, III, or IV clinical trial involving the prevention, detection, or treatment of cancer or any other life-threatening disease or condition. Defines "routine care cost" to mean the cost of medically necessary services related to the care method that is under evaluation in a clinical trial, including the cost of services related to the detection and treatment of any complications arising from the patient's medical care and any complications related to participation in the clinical trial. Defines other terms.

Insurance

Date: Feb 05, 2020 5:00PM

Location: 212 Capitol , Springfield, IL

SB2457 - Morrison - requires insurance coverage of medically necessary epi pens (currently for children under the age of 18.)

SB2462 - Holmes - (Property/Casualty) - Amends the Illinois Insurance Code. Provides that an insurer that issues a policy or contract insuring against liability for injury to any person or against liability for injury to or destruction of property, arising out of ownership or lease of residential one, 2, 3, or 4 dwelling real property, may cancel, charge, or impose an increased premium or rate for or refuse to issue or renew that kind of policy or contract based in whole or in part upon the harboring of a dog found to be vicious under the Animal Control Act upon the insured property. Provides that an insurer that issues a policy or contract insuring against liability for injury to any person or against liability for injury to or destruction of property, arising out of ownership or lease of residential one, 2, 3, or 4 dwelling real property, may not cancel, charge, or impose an increased premium or rate for or refuse to issue or renew that kind of policy or contract based in whole or in part upon the harboring of a specific breed of dog upon the insured property.

New Healthcare-Related Bills Introduced

SB2501 - Murphy - Amends the Illinois Insurance Code. Provides that a Medicare supplement policyholder is entitled to an annual open enrollment period lasting 60 days or more, commencing with the individual's birthday, during which time that person may purchase any Medicare supplement policy that offers benefits equal to or lesser than those provided by the previous coverage. Provides that, during the open enrollment period, an issuer of a Medicare supplement policy shall not deny or condition the issuance or effectiveness of Medicare supplemental coverage, nor discriminate in the pricing of coverage, because of health status, claims experience, receipt of health care, or a medical condition of the individual if, at the time of the open enrollment period, the individual is covered under another Medicare supplement policy or contract. Requires an issuer to notify a policyholder of his or her rights under this subsection at least 30 days and no more than 60 days before the beginning of the open enrollment period, and on any notice related to a benefit modification or premium adjustment.

SB2520 - Aquino - Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that on and after July 1, 2020, the Department of Healthcare and Family Services shall administer a school-based dental program that allows for the out-of-office delivery of preventative dental services in a school setting to children under 19 years of age. Requires the Department to establish guidelines for participation by providers and set requirements for follow-up referral care based on each caries risk assessment code required for each student. Provides that every effort shall be made to ensure that children enrolled in the school-based dental program are assigned a primary dentist by allowing local dentists who practice within each school district the opportunity to participate in the school dental program prior to utilizing mobile dental services or dental providers outside the individual school boundaries. Provides that no provider shall be charged a fee by any unit of local government to participate in the school-based dental program administered by the Department. Effective immediately.

SB2529 - Hastings - Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that on or after July 1, 2020, to receive the additional Long-Acting Injectable for Mental Health or Addiction Medicaid payment, a hospital shall submit a separate professional claim specifying "place of service 21 - Inpatient Hospital". Provides that the professional claim shall include the hospital as the billing provider and list the practitioner performing the procedure as the rendering provider. Requires the hospital to use the appropriate Healthcare Common Procedure Coding System Level II procedure code and the National Drug Code. Requires facilities participating in the federal 340B Drug Pricing Program to continue to bill the 340B actual acquisition cost for the medication. Provides that long-acting injectable medications for mental health or addiction shall not be subject to prior authorization under the medical assistance program or under any Medicaid managed-care plans when initiated at an inpatient hospital setting or when continued at an outpatient treatment facility.

SB2541 - Steans - Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for facilities licensed by the Department of Public Health under the ID/DD Community Care Act as ID/DD Facilities and under the MC/DD Act as MC/DD Facilities, subject to federal approval, the rates taking effect on the latter of the approval date of the State Plan Amendment for these facilities or the Waiver Amendment for the home and community-based services settings shall include an increase sufficient to provide a $0.26 per hour wage increase to the base wage for non-executive staff. Requires the Department to adopt emergency rules. Amends the Illinois Administrative Procedure Act. Provides that emergency rules may be adopted to implement the provisions of the amendatory Act. Effective immediately.

SB2558 - Cunningham - Amends the Alzheimer's Disease and Related Dementias Services Act. Provides that, in lieu of specified training requirements, a licensed home services agency may accept proof that a staff member has successfully completed an Alzheimer's training program that satisfies the requirements of specified provisions of the Illinois Administrative Code at or through another licensed home services agency within the 365 days before the staff member's date of employment.

SB2561 - Fine - Amends the Illinois Insurance Code. Requires an individual or group policy of accident and health insurance that provides telehealth services to provide reimbursement for such services at the same rate that such services are reimbursed for an in-person consultation and to reimburse a facility fee to the originating site. Allows the Director of Insurance to alter the dollar amount of this facility fee, and requires the Director to review the amount of the fee at least once every 5 years. Defines "originating site". Amends the Illinois Public Aid Code. Provides that services provided through telehealth shall be reimbursed at the same rate that such services are reimbursed for an in-person consultation. Effective immediately. The Chamber is opposed to this bill - telehealth can provide cost savings to employers, but not if reimbursement is just as expensive as in-person visits.

SB2739 - Harris - 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, and organizations in another state similar to the Illinois Insurance Guaranty Fund or the Illinois Life and Health Insurance Guaranty Association. Effective immediately.

SB2740 - Fine - Amends the Illinois Insurance Code. Provides that an insurer that amends, delivers, issues, or renews group accident and health policies providing coverage for hospital or medical treatment or services for illness entered into on or after January 1, 2021 shall ensure that the insured have timely and proximate access to treatment for mental, emotional, nervous, or substance use disorders or conditions. Provides that network adequacy standards for timely and proximate access to treatment for mental, emotional, nervous, or substance use disorders or conditions must satisfy specified minimum requirements. Provides that if there is no in-network facility or provider available for an insured to receive timely and proximate access to treatment for mental, emotional, nervous, or substance use disorders or conditions in accordance with the minimum network adequacy standards, the insurer shall provide necessary exceptions to its network to ensure admission and treatment with a provider or at a treatment facility in accordance with those network adequacy standards. Effective immediately.

HB4252 - Meyers - Martin - Amends the Mental Health and Developmental Disabilities Code. Provides that the notice of a recipient's rights includes, if applicable, the recipient's right to request a transfer to a different Department of Human Services facility. Provides that a recipient, his or her attorney, guardian, if any, and responsible relative, in any Department facility may make a written application to the facility director of the recipient's current facility to transfer to another Department facility. Provides that the Department shall provide the form to make such an application to a recipient, his or her attorney, guardian, if any, and responsible relative upon request. Provides that a recipient of services shall not include a person with the primary diagnosis of a developmental disability. Provides that upon receipt of the recipient's application, the facility director shall promptly schedule a hearing to be held within 7 days. Provides that the hearing shall be held at the recipient's current facility. Establishes the recipient's burden of proof at the transfer hearing. Provides that if a recipient's application for transfer is denied, no application may be filed for 180 days. Provides that the recipient does, however, have the right to administratively appeal any decision of the utilization review committee. Effective immediately.

HB4275 - Tarver - Amends the Department of Healthcare and Family Services Law of the Civil Administrative Code of Illinois. Requires the Department of Healthcare and Family Services to designate one or more health care telementoring entities based on an application to be developed by the Department. Allows approved applicants from Illinois to be eligible for State funding in accordance with rules developed by the Department. Provides that funding shall be provided based on the number of physicians who are assisted by each approved health care telementoring entity and the hours of assistance provided to each physician. Defines "health care telementoring".

HB4314 - Lilly - Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the medical assistance program shall provide coverage for routine care costs that are incurred in the course of an approved clinical trial if the medical assistance program would provide coverage for the same routine care costs not incurred in a clinical trial. Defines "approved clinical trial" to mean a phase I, II, III, or IV clinical trial involving the prevention, detection, or treatment of cancer or any other life-threatening disease or condition. Defines "routine care cost" to mean the cost of medically necessary services related to the care method that is under evaluation in a clinical trial, including the cost of services related to the detection and treatment of any complications arising from the patient's medical care and any complications related to participation in the clinical trial. Defines other terms.

HB4325 - Willis - Amends the Court of Claims Act. Provides that the Court of Claims has exclusive jurisdiction to hear and determine all quantum meruit claims by medical vendors for medical services rendered by the claimant to a person eligible for medical assistance under programs administered by the Department of Healthcare and Family Services if: (1) the services or goods were provided between January 1, 2015 and June 30, 2019; (2) at the time the services or goods were provided, the vendor was certified by Medicaid to provide medical services to persons eligible for medical assistance; (3) the State accepted the services or goods provided; (4) the State has been unjustly enriched or benefited from the services or goods; and (5) the claim was filed with the Court of Claims before March 31, 2020. Provides that the existence of a vendor agreement between a vendor and the State shall not be a bar, defense, or otherwise defeat a quantum meruit claim. Provides that the amount due to a vendor shall not exceed the Medicaid fee for service rates that would have otherwise been paid to the vendor for a valid claim at the time the services were rendered. Makes a corresponding change. Effective immediately.

HB4342 - Bennett - Amends the Nursing Home Care Act. Allows long-term care facilities to provide an opioid treatment program if they receive written approval from the Department of Public Health. Provides requirements for such an opioid treatment program.

HB4362 - Moeller - Creates the Wholesale Importation of Prescription Drugs Act. Requires the Department of Public Health to design an importation program where the State is the licensed wholesaler of imported drugs from licensed, regulated Canadian suppliers. Requires the program to address specified issues, including billing issues, cost savings issues, and safety and regulatory issues. Contains auditing and reporting requirements. Provides that the Department shall enlist the assistance of the Attorney General to identify the potential for anti-competitive behavior in industries that would be affected by an importation program. Requires the Department to submit a formal request to the Secretary of the United States Department of Health and Human Services for certification of the importation program. Requires the Department to have the program operational within 6 months after receiving the certification. Contains provisions concerning implementation requirements. The Chamber is opposed.

HB4372 - Jones - Amends the Illinois Insurance Code. In provisions concerning approval of a plan of division of a domestic stock company, removes language limiting the requirements of notice and a public hearing to situations in which the Director of Insurance deems them to be in the public interest or occasions where a public hearing is requested by the dividing company. Requires the Director to hold a public hearing regarding the plan of division. Provides that the dividing company shall give notice of the filing of the plan of division and of the date of the hearing to all policyholders and to each guaranty association and guaranty fund of which the dividing company is a member. Removes a provision that allows the use of proposed assets to support a determination of solvency or adequacy of assets of the new companies created by the division, and a provision treating business, financial, and actuarial information as confidential in order to allow a domestic stock company to make that information available for public inspection.

HB4399 - Davis - Amends the Medical Assistance Article of the Illinois Public Aid Code. Exempts transportation services, including those transportation services provided by ground ambulance service providers, medi-car providers, service car providers, and taxi service providers, from the State's managed care medical assistance program. Provides that these services shall continue to be paid under the State's traditional fee-for-service program.

HB4412 - Harper - Creates the Outdoor Rx Program Act. Creates the Outside Rx Program to provide funds, through grants established by the Department of Public Health, for outdoor environmental, ecological, agricultural, or other natural resource or outdoor-based therapy programs serving the citizens of the State of Illinois. Requires the Department to establish an advisory committee to assist and advise the Department in the development and administration of the Outdoor Rx Program, including developing the form for an application for receipt of a grant. Provides that the Department shall set priorities and develop criteria for the awarding of grants to natural resource or outdoor-based therapy programs. Provides criteria for grant eligibility and selection. Provides that the Director of Public Health shall make the final decision on funding a program. Amends the State Finance Act. Creates the Outdoor Rx Program Fund as a special fund in the State treasury.

HB4431 - Amends the Illinois Health Facilities Planning Act. Provides a fine for a permit or exemption holder who fails to comply with specified requirements of the Illinois Administrative Code. Effective immediately.

HB4433 - Morgan - Amends the Voluntary Health Services Plans Act. Provides that if a health services plan corporation furnishes dental services to the plan's subscribers and beneficiaries and these services are rendered by dentists licensed in Illinois, the board of trustees of the corporation shall appoint a Dental Director who shall be a dentist licensed to practice dentistry in Illinois. Provides that the Dental Director, under the board of trustees, shall have control of and responsibility for the dental and dental-related scientific aspects of the business of the corporation. Effective immediately.

JCAR Update

IDPH proposed amendments to Hospital Licensing Requirements (77 IAC 250; 44 Ill Reg 2221) implementing Public Act 100-1051. The PA and this rulemaking require hospitals to create workplace violence prevention programs that comply with federal Occupational Safety and Health Administration (OSHA) workplace violence prevention guidelines for health care and social service workers. Hospitals must post notices stating that verbal aggression will not be tolerated and that physical assaults (against staff, patients or visitors) will be reported to law enforcement.

DOI also proposed a new Part titled Pharmacy Benefit Managers (50 IAC 3145; 44 Ill Reg 2207) and proposed amendments to the Part titled Third Party Prescription Administrators (50 IAC 3150; 44 Ill Reg 2211). The new Part requires pharmacy benefit managers doing business in Illinois to register with DOI through the National Insurance Producer Registry and pay a registration fee of $500. This registration must be renewed every 2 years with a renewal fee of $500. Amendments to Part 3150 change the annual registration renewal date for third party prescription administrators from April 1 to the anniversary of the license issuance date. Companies that manage prescription drug benefits are affected.

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Illinois Chamber of Commerce | | aaron@wintersllc.com | http://www.ilchamber.org
215 E Adams St.
Springfield, IL 62701

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