Clark Kaericher | Executive Director, Healthcare Council & Sr. VP of Government Affairs | 618-806-1501
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March 3, 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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This Week’s Committee Recap
House Insurance Committee met this Tuesday. On a partisan roll call, HB 1229 (Jones) which creates a state based exchanged passed out of the committee. Also passing out of committee:
HB 1384 (Cassidy)- Insurance mandate for reconstructive services
HB 1565 (Stuart) – Insurance mandate for vaginal estrogen
These two measures were held:
HB 2070 (Mah) – Dental Loss Ratio Act
HB 2472 (Morgan) – Insurance adverse determination appeals
Health care Availability and Accessibility met on Tuesday. HB 1348 (Collins) McKesson real time benefit tool mandate passed out of committee 8-1. It is now on 2nd Reading.
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Chamber Day Information. Sponsors Wanted.
We still have a few sponsorship slots available. Chamber Day is a great way to get in front of lawmakers and meet local business leaders. The Chamber is grateful to all our sponsors- We can’t do what we do without your support. Sponsorship information can be found HERE
Please remember to register for Chamber Day on April 18th. We have confirmed all four legislative leaders will be on hand to give their thoughts on this session and answer a few questions from those present. Registration information is here:
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Register Today - Chamber Day 2023
When: Tuesday, April 18, 2023 from 9:30 AM to 1:00 PM CDT
Where: President Abraham Lincoln A Double Tree by Hilton
701 East Adams Street
Springfield, IL 62701
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Posted for Next Week
Senate Public Health Tuesday 1:30 pm
SB 1774 (Johnson) - Amends the Cancer Clinical Trial Participation Program Act. Changes the short title of the Act to the Clinical Trial Participation Program Act. Throughout the Act, replaces references to "cancer clinical trial" with references to "clinical trial" and makes conforming changes. Provides that "clinical trial" includes a voluntary research study conducted on people and designed to answer specific questions about the safety or effectiveness of a drug, vaccine, therapy, medical device, medical diagnostic, or new way of using an existing treatment to treat or diagnose a condition. Effective immediately.
House Insurance Tuesday 2 pm
HB 2070 (Gong-Gershowitz)- Dental Loss Ratio Act. The Chamber opposes- this bill should be in Insurance Main Subcommittee.
HB 2385 (Nichols) – Insurance Mandate. 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, 2024 shall provide coverage for a colonoscopy determined to be medically necessary for persons aged 39 years old to 75 years old.
HB 2443 (Chung) – Insurance Mandate. Amends the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of the amendatory Act must provide coverage for medically necessary hearing instruments and related services for all individuals (rather than all individuals under the age of 18) when a hearing care professional prescribes a hearing instrument to augment communication. Makes conforming changes, including repealing provisions concerning optional coverage or optional reimbursement for hearing instruments and related services. Effective January 1, 2025.
HB 2472 (Morgan) – Insurance Adverse Determination Appeals.
HB 2799 (Hammond) – Insurance Mandate. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of the amendatory Act that provides coverage for the treatment of cancer shall not apply a higher standard of clinical evidence for the coverage of proton beam therapy than the insurer applies for the coverage of any other form of radiation therapy treatment. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of the amendatory Act that provides coverage or benefits to any resident of this State for radiation oncology shall include coverage or benefits for physician-prescribed proton beam therapy for the treatment of cancer as recommended by the patient's physician
HB 2814 (Lilly) - Provides that a health benefit plan amended, delivered, issued, or renewed on or after January 1, 2023 that provides prescription drug coverage or its contracted pharmacy benefit manager shall not engage in or require an enrollee to engage in specified prohibited acts. Provides that a clinician-administered drug supplied shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act. Provides that the Department of Insurance may adopt rules as necessary to implement the provisions. Defines terms. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization, and the Voluntary Health Services Plans Act.
HB 3030 (Morgan-Hauter)- Provides that a health benefit plan amended, delivered, issued, or renewed on or after January 1, 2023 that provides prescription drug coverage or its contracted pharmacy benefit manager shall not engage in or require an enrollee to engage in specified prohibited acts. Provides that a clinician-administered drug supplied shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act. Provides that the Department of Insurance may adopt rules as necessary to implement the provisions. Defines terms. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization, and the Voluntary Health Services Plans Act.
HB 3631 (Huynh) - Amends the Pharmacy Benefit Managers Article of the Illinois Insurance Code. Provides that a pharmacy benefit manager shall not prohibit a pharmacist or pharmacy from, or indirectly punish a pharmacist or pharmacy for, making any written or oral statement or otherwise disclosing information to any federal, State, county, or municipal official, including the Director of Insurance or law enforcement, or before any State, county, or municipal committee, body, or proceeding under specified circumstances. Provides that the provisions apply to contracts entered into or renewed on or after July 1, 2023 (rather than July 1, 2022).
HB 3920 (Meyers- Martin) - 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 the effective date of the amendatory Act shall provide coverage for cranial prostheses when prescribed as part of a course of rehabilitative treatment by a physician licensed to practice medicine in all of its branches. Makes conforming changes in the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code.
Senate Health and Human Services Tuesday 3:30
SB 48 (Syverson) - In a provision concerning vendor enrollment in the medical assistance program, provides that nothing in the provision shall be construed to require a vendor or provider who exclusively offers telehealth services or any telehealth provider group to maintain a physical address or office in Illinois or have an Illinois mailing address in order to be eligible to enroll as a vendor or provider in the medical assistance program, if the vendor, provider, or telehealth provider group is licensed or authorized to practice in Illinois and has a principal place of business located in the United States.
House Consumer Protection Committee Tuesday 4 pm
HB 3452 (Avelar) - Amends the Consumer Fraud and Deceptive Business Practices Act. Provides that it is an unlawful practice under the Act for a person to report to a consumer reporting agency any medical debt incurred by a consumer or any collection action against the consumer to collect that medical debt.
House Health Care Availability & Accessibility
Tuesday 4 pm
HB 2719 (Avelar) - Amends the Fair Patient Billing Act. Provides that a hospital shall screen each uninsured patient for eligibility in State and federal health insurance programs, financial assistance offered by the hospital, and other public programs that may assist with health care costs and provide information about those programs. For an insured patient, requires the hospital to screen the patient for discounted care in specified circumstances. Provides that the screenings and all follow-up assistance must be culturally competent, in the patient's primary language, in plain language, and in an accessible format. Requires a hospital to implement an operational plan and trainings relating to screenings. Prohibits hospitals from pursuing collection actions against uninsured patients if they have not completed the screening requirements. Includes a prohibition on the sale of medical debt, limitations on collection actions, penalties for violating the Act's provisions, and defenses against collection actions pursued in violation of the provisions. Makes other changes. Amends the Hospital Uninsured Patient Discount Act. Provides that a patient declining to apply for a public health insurance program on the basis of concern for immigration-related consequences shall not be grounds for denying financial assistance under a hospital's financial assistance policy.
Senate Insurance Tuesday 5:30 pm
SB 130 (Fine) - 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. Changes the definition of "health care plan". Defines "referral system". Effective January 1, 2024. The Chamber supports.
SB 1559 (Murphy) - Creates the Access to Affordable Insulin Act. Sets forth provisions concerning an insulin urgent-need program. Provides that the Department of Public Health shall establish procedures and applications for the insulin urgent-need program. Sets forth provisions concerning insulin urgent-need program exceptions, eligibility, forms, applications, claims and reimbursement, copayments, information sheets, and navigators. Defines terms. Amends the Illinois Insurance Code. In provisions concerning cost sharing in prescription insulin drugs, 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). Effective immediately. The Chamber opposes.
SB 1925 (Holmes) - Provides that nothing in the provisions shall require an ambulance provider to bill a beneficiary, insured, enrollee, or health insurance issuer when prohibited by any other law, rule, ordinance, contract, or agreement. Limits home rule powers. Changes the definition of "emergency services" and "health care provider". Amends the Health Maintenance Organization Act. Removes language providing that upon reasonable demand by a provider of emergency transportation by ambulance, a health maintenance organization shall promptly pay to the provider, subject to coverage limitations stated in the contract or evidence of coverage, the charges for emergency transportation by ambulance provided to an enrollee in a health care plan arranged for by the health maintenance organization.
SB 2080 (Fine) - Amends the Fair Patient Billing Act. Requires hospitals to screen patients for health insurance and financial assistance. Prohibits the sale of a patient's medical debt by a hospital. Prohibits hospitals from offering a payment plan to an uninsured patient without first exhausting any discount available to the uninsured patient under the Hospital Uninsured Patient Discount Act and from entering into a payment plan for a bill that is eligible to be discounted by 100% under the Hospital Uninsured Patient Discount Act.
SB 2195 (Gillespie) – Insurance Mandate. Provides that with respect to an enrollee at any age, in addition to coverage of a prosthetic or custom orthotic device, benefits shall be provided for a prosthetic or custom orthotic device determined by the enrollee's provider to be the most appropriate model that is medically necessary for the enrollee to perform physical activities, as applicable, such as running, biking, swimming, and lifting weights, and to maximize the enrollee's whole body health and strengthen the lower and upper limb function.
House Judiciary Committee Wednesday 8 am
HB 1137 (Caulkins) - Amends the Code of Civil Procedure. Requires a health care facility or health care practitioner to notify the patient in writing when the health care facility or health care practitioner alters the patient's record within 3 business days of the alteration. Requires a health care facility or health care practitioner to provide an electronic copy of an altered record within 7 calendar days of the receipt of a written request by a patient. Requires any health care facility that accepts Medicaid to, upon written request, provide an electronic copy of an altered record within 4 business days. Provides that the failure to comply with the time limit requirements of the new provisions shall result in a rebuttable presumption that the health care record was altered to fraudulently conceal a failure to meet the applicable standard of care.
HB 1230 (Jones) – BIPA Healthcare exemption. The Chamber supports.
HB 2252 (Ugaste) – Broad BIPA Reform. The Chamber supports.
HB 2259 (Ugaste) – BIPA Security Purpose. Chamber initiative.
HB 3199 (Keicher) – Broad BIPA reform bill. The Chamber supports.
HB 3204 (McCombie) – BIPA one year statute of limitations. The Chamber supports.
HB 3603 (A. Williams) - Amends the Protect Health Data Privacy Act. Provides that a regulated entity shall disclose and maintain a health data privacy policy that, in plain language, clearly and conspicuously disclosures specified information. Provides that a regulated entity shall prominently publish its health data privacy policy on its website homepage. Provides that a regulated entity shall not collect, share, sell, or store categories of health data not disclosed in the health data privacy policy without first disclosing the categories of health data and obtaining the consumer's consent prior to the collection, sharing, selling, or storing of such data. Prohibits the collection, sharing, selling, or storing of health data. Describes the regulated entity's duty to obtain consent; the consumer's right to withdraw consent; prohibitions on discrimination; prohibitions on geofencing; a private right of action; enforcement by the Attorney General; and conflicts with other laws. The Chamber opposes.
House Human Services Wednesday 8 am
HB 2046 (Cassidy) - Provides that all decisions regarding the treatment of patients experiencing pain, including chronic pain, shall be made by the prescriber. Provides that ordering, prescribing, dispensing, administering, or paying for controlled substances, including opioids, shall not in any way be predetermined by specific morphine milligram equivalent guidelines. Provides that, before the Department of Human Services releases confidential information from the central repository, the applicant, in addition to other requirements of the Act, must demonstrate in writing to the Department that the applicant has a valid court order or subpoena for the release of the confidential information requested.
House Executive Committee 10 am
HB 1054 (Flowers) - Provides that a group or individual policy of accident and health insurance amended, delivered, issued, or renewed on or after January 1, 2024 that provides coverage for prescription drugs shall require that a covered individual's defined cost sharing for each prescription drug shall be calculated at the point of sale based on a price that is reduced by an amount equal to at least 100% of all rebates received in connection with the dispensation or administration of the prescription drug. Provides that an insurer shall apply any rebate amount in excess of the defined cost sharing amount to the health plan to reduce premiums. Provides that the provisions shall not preclude an insurer from decreasing a covered individual's defined cost sharing by an amount greater than the stated amount at the point of sale. Provides that the Department of Insurance may adopt rules to implement the provisions.
House Labor and Commerce 2 pm
HB 1622 (Spain) – Nurse Licensure Compact.
HB 3783 (Crespo) - Amends the Illinois Wage Payment and Collection Act. Provides that each workday a nurse is required to report for work, based upon a previously approved and distributed work schedule, and either (1) does report, but is not put to work, or (2) was directed to not report, the nurse shall be paid for half the usual or scheduled day's work at the nurse's regular rate of pay, which shall not be less than the minimum wage. Provides that the requirement applies to nurses who are directed not to report to work and to nurses engaged in telemedicine. Provides that the report-to-work requirement is to be based upon an approved and distributed work schedule. Effective January 1, 2024.
House Prescription Drug Affordability & Accessibility Wednesday 4 pm
HB 2189 (Guzzardi) – Insulin copay cap at $35. Illinois Chamber opposes.
HB 3256 (Syed) - Creates the Affordable Drug Manufacturing Act. Provides that the Department of Public Health shall enter into partnerships to increase competition, lower prices, and address shortages in the market for generic prescription drugs, to reduce the cost of prescription drugs for public and private purchasers, taxpayers, and consumers, and to increase patient access to affordable drugs. Requires the partnerships to result in the production or distribution of generic prescription drugs with the intent that these drugs be made widely available to public and private purchasers, providers and suppliers, and pharmacies. Provides that the Department shall comply with specified requirements when entering into partnerships or setting prices for generic prescription drugs. Requires the Department to submit separate reports to the General Assembly that (1) assess the feasibility of directly manufacturing generic prescription drugs and selling generic prescription drugs at a fair price; and (2) describe the status of all drugs targeted under the Act and analyze how the activities of the Department may impact competition, access to targeted drugs, the costs of those drugs, and the costs of generic prescription drugs to public and private purchasers. Contains other provisions. Amends the Freedom of Information Act to exempt certain information disclosed under the Affordable Drug Manufacturing Act from inspection and copying under the Act. Contains a severability provision. Effective July 1, 2023.
HB 3490 (Huynh) – Creates Canadian Drug Importation Act. Illinois Chamber opposes.
HB 3639 (Mason) - Provides that an insurer that provides coverage for medically necessary epinephrine injectors shall limit the total amount that an insured is required to pay for a twin-pack of medically necessary epinephrine injectors at an amount not to exceed $60, regardless of the type of epinephrine injector.
HB 3761 (Guzzardi) – PBM restrictions
HB 3797 (Lilly) - Amends the Pharmacy Benefit Managers Article of the Illinois Insurance Code. Provides that a pharmacy benefit manager shall not: steer a beneficiary; order a covered individual to fill a prescription or receive pharmacy care services from an affiliated pharmacy; reimburse a pharmacy or pharmacist for a pharmaceutical product or pharmacist service in an amount less than the amount that the pharmacy benefit manager reimburses itself or an affiliate for providing the same product or services; offer or implement plan designs that require patients to use an affiliated pharmacy; or advertise, market, or promote a pharmacy by an affiliate to patients or prospective patients.
Rulemaking
Hospitals: The DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES adopted an amendment to Hospital Reimbursement Changes (89 IAC 152; 46 Ill Reg 16346) effective 2/ 14/23 that removes obsolete provisions related to the SMART Act of 2012 (which generally reduced hospital reimbursement rates by 3.5%) and restores preSMART Act reimbursement rates effective 7/1/21. Questions/requests for copies: Steffanie Garrett, HFS, 201 S. Grand Ave. East, 3rd Floor, Springfield IL 62763-0002, HFS.Rules@illinois.gov
HOSPITALS: The DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES proposed amendments to Hospital Services (89 IAC 148; 47 Ill Reg 2556) implementing several Public Acts, State Medicaid Plan Amendments, and other policy changes. This rulemaking establishes a minimum inpatient psychiatric per diem rate of $630 for a general acute care hospital with more than 9,500 inpatient psychiatric Medicaid days in any calendar year; establishes an outpatient add-on payment of no less than $113 for a general acute care hospital with more than 500 outpatient psychiatric Medicaid services to persons under age 19 in any calendar year; excludes U.S. Navy recruits/trainees who are covered by TRICARE military health insurance from Medicaid Inpatient Utilization Rate (MIUR) calculations; provides that if a closed hospital that qualified for MIUR-based payments at the time of its closure is reopened within 3 calendar years, the reopened/new hospital will qualify for the same payments until new MIUR data is available; and changes the beginning and ending dates for Medicaid percentage determination years. The Medicaid percentage determination year that began on 10/1/22 will continue through 12/31/23, after which Medicaid percentage determination years will begin on 1/1 and end on 12/31. Questions/requests for copies/ comments through 4/10/23: Steffanie Garrett, HFS, 201 S. Grand Ave. East, 3rd Floor, Springfield IL 62763-0002, HFS.Rules@illinois.gov
Articles of Interest
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Register Today - Chamber Day 2023
When: Tuesday, April 18, 2023 from 9:30 AM to 1:00 PM CDT
Where: President Abraham Lincoln A Double Tree by Hilton
701 East Adams Street
Springfield, IL 62701
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Not a member and want to learn more about the Illinois Chamber?
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