Lori Cowdrey Benso | Executive Director, Healthcare Council | 217-725-6522
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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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April 1, 2022
It's hard to believe there is only one week of session left! Have a nice weekend everyone!
Session Update:
The House and Senate were both in session this week with a lot of floor action. There was a hearing regarding the BCBS and Springfield Clinic contract dispute in the House State Government Administration Committee. We are watching for an amendment to HB 1463 that contains network adequacy language.
The House returns on Sunday at 4:00 pm and the Senate returns on Monday at 3:00 pm. Scheduled adjournment is April 8th.
Bills we are watching closely this week:
HB 4175 INS-HEALTH BENEFIT EXCHANGE, deadline was extended to March 31, 2022. Amends the Illinois Health Benefits Exchange Law. Provides that the Department of Insurance has the authority to operate the Illinois Health Benefits Exchange. Provides that the Director of Insurance may require plans in the individual market to be made available for comparison on the exchange, but may not require all plans be purchased exclusively on the exchange. Provides that the Director may require that plans offered on the exchange conform with standardized plan designs. Provides that the Director may apply a monthly assessment to each health benefits plan sold in the Illinois Health Benefits Exchange according to specified rates. Provides that the Director shall establish an advisory committee to provide advice to the Director concerning the operation of the exchange and that the advisory committee shall include specified members. Provides that the Department shall also have the authority to coordinate the operations of the exchange with the operations of the State Medicaid program and the FamilyCare Program to determine eligibility for those programs as soon as practicable. Provides that the Department shall adopt rules. Removes provisions concerning small employer health insurance coverage and markets. Makes other changes. Effective January 1, 2023.
We anticipate this bill will become HB 1463 with several changes:
HB 5729 Amends the Illinois Insurance Code. Adds provisions concerning market analysis and market conduct actions. Makes changes to provisions concerning market conduct and non-financial examinations, examination reports, insurance compliance self-evaluative privilege, confidentiality, fees and charges, examination, and fiduciary and bonding requirements. Amends the Network Adequacy and Transparency Act. Adds definitions. Establishes minimum ratios of providers to beneficiaries for network plans issued, delivered, amended, or renewed during 2023. Makes changes to provisions concerning network adequacy, notice of nonrenewal or termination, transition of services, network transparency, administration and enforcement, and provider requirements. Creates the Network Adequacy Advisory Council. Provides that the Council shall consider the standards required pursuant to the Act and any related rules and may recommend additional or alternative standards for determining whether a network plan is adequate. Contains provisions concerning the membership and responsibilities of the Council. Amends the Managed Care Reform and Patient Rights Act. Makes changes to provisions concerning notice of nonrenewal or termination and transition of services. Amends the Illinois Administrative Procedure Act to authorize the Department of Insurance to adopt emergency rules implementing federal standards for provider ratios, time and distance, or appointment wait times when such standards apply to health insurance coverage regulated by the Department of Insurance and are more stringent than the State standards extant at the time the final federal standards are published. Effective immediately.
Bills of Interest with Action this week:
Bill Status for HB4430 HB 4430 passed the Senate 37-12 and has arrived in the House and placed on calendar order of concurrence Senate Amendment 1. The bill amends the Pharmacy Practice Act. Provides that in accordance with a standing order by a physician licensed to practice medicine in all its branches or the medical director of a county or local health department, a pharmacist may provide patients with prophylaxis drugs for human immunodeficiency virus pre-exposure prophylaxis or post-exposure prophylaxis. Provides that a pharmacist may provide initial assessment and dispensing of prophylaxis drugs for human immunodeficiency virus pre-exposure prophylaxis or post-exposure prophylaxis. Contains requirements for the standing order. Provides that a pharmacist must communicate the services provided under the provisions to the patient and the patient's primary health care provider or other health care professional or clinic, if known. Provides that if there is no primary health care provider provided by the patient, then the pharmacist must give a list of primary health care providers or clinics in the area. Provides that a pharmacist shall complete an educational training program accredited by the Accreditation Council for Pharmacy Education or Department of Financial and Professional Regulation related to human immunodeficiency virus pre-exposure prophylaxis and human immunodeficiency virus post-exposure prophylaxis. Makes conforming and other changes. Makes corresponding changes in the Illinois Clinical Laboratory and Blood Bank Act. Amends the Illinois Insurance Code. Provides that an insurance carrier or third-party payor shall reimburse a pharmacist or other health care professional for dispensing HIV prophylaxis medications and providing other services to a covered person in accordance with the current version of the guidelines of the Centers for Disease Control and Prevention and the United States Preventive Services Task Force. Provides that reimbursement shall provide an adequate consultation fee or, if medical billing is not available, an enhanced dispensing fee that is equivalent to 85% of the fees for services provided by an advanced practice registered nurse or physician. Amends the Illinois Public Aid Code. Provides that services provided by the pharmacist under the provisions concerning HIV prophylaxis in the Pharmacy Practice Act shall be covered and reimbursed at no less than 85% of the rate that the services are reimbursed when provided by a physician. Makes other changes. Effective January 1, 2023.
HB 4929, Optometric/Vaccines passed out of the Senate Licensed Activities Committee by a vote of 6-0-0. This bill provides that a licensed optometrist may independently administer the COVID-19 vaccine upon completion of the required training.
SB 3926, Short Term Health Insurance passed out of the Senate Insurance Committee by a vote of 14-0-0. This bill provides that any failure to make a disclosure or obtain a signed confirmation required under specified provisions of the Short-Term, Limited-Duration Health Insurance Coverage Act is an unfair method of competition and an unfair and deceptive act or practice in the business of insurance. Provides that the Director of Insurance shall have the power to examine and investigate into the affairs of every person subject to specified provisions of the Short-Term, Limited-Duration Health Insurance Coverage Act. Provides that the Director may place on probation, suspend, revoke, or refuse to issue or renew an insurance producer's license or may levy a civil penalty or take any combination of actions for any failure to make a disclosure or obtain a signed confirmation required or any unlawful practice described under specified provisions of the Short-Term, Limited-Duration Health Insurance Coverage Act. Provides that the Act applies to health insurance issuers that offer short-term, limited-duration health insurance coverage to groups and individuals (rather than only individuals) in the State. Sets forth provisions concerning duration of coverage; cancellation; and disclosure, filing, and coverage requirements of short term, limited-duration health insurance coverage. Sets forth provisions concerning unfair or deceptive practices relating to the sale of supplemental or short-term, limited-duration health insurance coverage.
Bills that have passed both houses:
HB 1780, Drug Takeback passed out of the Senate by a vote of 46-2-0. This bill provides that the Act may be cited as the Drug Take-Back Act. Provides that each covered manufacturer must, beginning January 1, 2024 (rather than no later than July 1, 2022) or 6 months after becoming a covered manufacturer, individually or collectively implement (rather than participate in) an approved drug take-back program. Requires a drug take-back program to provide for the collection, transportation, and disposal of covered drugs. Provides that specified requirements shall be undertaken by a drug take-back program or a covered manufacturer (rather than a manufacturer program operator). Requires the Environmental Protection Agency to provide a 30-day public comment period on drug take-back program proposals and revised proposals during specified 90-day periods. Provides that the reason for the Agency's rejection of a drug take-back program proposal must be provided in the written notification to the manufacturer program operator.
HB 4271, INS Coverage passed out of the Senate by a vote of 53-0-0 and has now passed both houses.. 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.
HB 4324, Insurance Association passed out of the Senate by a vote of 55-0-0 and has now passed both houses. This bill provides that an insurance producer's active participation in a State or national professional insurance association may be approved by the Director of Insurance for up to 4 hours of continuing education credit per biennial reporting period. Provides that the hours shall be credited upon timely filing with the Director or his or her designee on a biennial basis, the credit shall not be used to satisfy ethics education requirements, and active participation in a State or national professional insurance association is defined by specified methods.
HB 4338, INS Coverage passed out of the Senate by a vote of 55-0-0. 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 4433, Insurance passed out of the Senate by a vote of 56-0-0 and has now passed both houses. 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 4595, 340B/PBM passed out of the Senate by a vote of 55-0-0. 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.
HB 4703, Insurance/Billing passed out of the Senate by a vote of 55-0-0 and has now passed both chambers. 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).
HB 5585, INS Coverage passed out of the Senate by a vote of 55-0-0 and has now passed both chambers. 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.
SB 145, Physician Assistants passed out of the House by a vote of 103-0-0 and has now passed both houses. 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.
SB 2963, Life Insurance passed the House by a vote of 103-0-0 and has now passed both chambers. 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 3819, Pediatric Palliative Care passed out of the House by a vote of 109-0-0 and has now passed both chambers. 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.
SB 4018, Pharmacies passed out of the House by a vote of 104-1-0. This bill provides that the Pharmacy Practice Act is repealed on January 1, 2028 (instead of January 1, 2023). Provides that a registered pharmacy technician may be delegated to perform any task within the practice of pharmacy if specifically trained for that task except for final prescription verification except where a registered certified pharmacy technician verifies a prescription dispensed by another pharmacy technician using technology-assisted medication verification. Removes a provision that provides that additional licensure rules may provide for a reasonable annual fee, not to exceed $20, to fund the cost of recordkeeping. Provides that if a pharmacy temporarily closes for more than 72 hours, it is the duty of the pharmacist in charge and the owner of such pharmacy to report to the Department of Financial and Professional Regulation within 72 hours of temporary closure. Provides that the citation the Department may issue to any licensee for any violation of the Act or the rules shall not exceed $3,000 (instead of $1,000). Provides that nothing shall prohibit an individual employee licensed as a pharmacist, pharmacy technician, or student pharmacist (rather than only licensed as a pharmacist) from accessing the employer pharmacy's database from a home (rather than a pharmacist's home) or other remote location or pharmacist's home verification (rather than home verification) for the purpose of performing certain prescription processing functions, provided that the pharmacy establishes controls to protect the privacy and security of confidential records.
Committees Scheduled the Week of April 4th:
View the Senate Committee schedule for next week here. View the House committee schedule here.
Weekly GAP Call
The Chamber will host a Government Affairs Professionals (GAP) call on Monday, April 4th at 3:00 pm. We will provide you the latest updates on what legislation we are watching this Spring. Call in information is provided below.
Microsoft Teams meeting
Join on your computer or mobile app
Or call in (audio only)
Phone Conference ID: 463 563 254#
Seminar: Avoiding the Wrong Buyers in Export - Understanding denied parties and Vetting your Importers
Alex Sonifrank, Affinity and Partnerships Manager at the American World Trade Chamber of Commerce, has worked to vet registrations against their global trade platform for issuing trade documents and worked directly with US exporters experiencing challenges and risks in the global market. The AWTCC is focused on expanding US trade internationally.
When: Thursday, April 7, 2022 from 10:30 AM to 11:30 AM CDT
Registration for this online event can be found here.
List of Key Dates:
Adjournment: April 8
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