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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March 5, 2022
Good evening!
Session Update:
The House was very busy this week with third reading deadline. The House returns on Monday, March 7th for 5 days of session. The Senate returns on March 8th. It was a slower Committee week last week.
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.
Bills of Interest with Floor Action:
HB 4349, INS Coverage passed out of the House by a vote of 103-0-1. This bill provides that coverage for congenital defects shall include the treatment of cleft lip and cleft palate. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide coverage for the medically necessary care and treatment of cleft lip and palate for children under the age of 19. Provides that coverage for cleft lip and palate care and treatment may impose the same deductible, coinsurance, or other cost-sharing limitation that is imposed on other related surgical benefits under the policy.
HB 4433, Health Savings passed out of the House by a vote of 104-0-0. This bill 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 4493, INS Various passed out of the House by a vote of 104-0-0. This bill among other things provides that no health insurance coverage issued, amended, delivered, or renewed on or after the effective date of the amendatory Act may impose any preexisting condition exclusion with respect to the plan or coverage. Removes language concerning preexisting condition exclusion limitations.
HB 4595, PBM passed out of the House by a vote of 104-0-1. This bill provides that a contract between a pharmacy benefit manager or third-party payer and a covered entity under Section 340B of the federal Public Health Service Act 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 covered entity that is entered into, amended, or renewed after July 1, 2022 shall be void and unenforceable. 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 covered entity or with any pharmacy owned by or contracted with the covered entity. Provides that a violation by a Medicaid managed care organization or its 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 Medicaid managed care organization or its pharmacy benefit manager and a 340B covered entity entered into, amended, or renewed after July 1, 2022 shall be void and unenforceable.
HB 4703, Insurance Billing passed out of the House by a vote of 105-0-0. 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. Contains provisions concerning a notice and consent process for out-of-network coverage; billing for reasonable administrative fees; assignment of benefits to nonparticipating providers; and cost-sharing amounts and deductibles. Amends the Illinois Insurance Code and the Health Maintenance Organization Act to make a change in provisions concerning disclosure of nonparticipating provider benefits. Amends the Network Adequacy and Transparency Act. 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). Provides that the arbitrator shall not establish a rebuttable presumption that the qualifying payment amount should be the total amount owed to the provider or facility by the combination of the issuer and the insured, beneficiary, or enrollee.
HB 4941. INS CD-CONTRACTING PROCEDURES, passed out of the House by a vote of 101-0-0. Amends the Illinois Insurance Code. Provides that, beginning January 1, 2023, with respect to nonroutine changes to the fee schedule, the insurer, health maintenance organization, independent practice association, or physician hospital organization shall provide all contracted health care professionals or health care providers impacted by the nonroutine change with notice of the change at least 60 days before the effective date of the change, that the right to advance notice of nonroutine changes to the fee schedule may not be waived by the health care professional or provider, and that, for nonroutine changes, the information directing the health care professional or health care provider to the information provided by newsletter, website listing, or other reasonable method shall be provided by email or, if requested by the health care professional or health care provider, by mail. Defines "nonroutine change".
HB 5318, INS-PROSTATE CANCER SCREENING, passed out of the House by a vote of 108-0-0. The bill provides that a group policy of accident and health insurance that provides coverage for hospital or medical treatment or services for illness on an expense-incurred basis and is amended, delivered, issued, or renewed after January 1, 2024 (rather than the effective date of the amendatory Act) shall provide coverage, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement, for specified methods of cancer testing. Specifies that the provisions do not apply to coverage of prostate cancer screenings to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account under the Internal Revenue Code. Defines "prostate cancer screening" to include medically necessary subsequent follow-up testing as directed by a health care provider (rather than subsequent follow-up testing as directed by a health care provider).
HB 5334, INS Coverage passed out of the House by a vote of 104-0-0. 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 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.
Committees Scheduled the Week of March 7th:
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, March 7th 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#
Chamber Day 2022 Recap
On March 2nd the Illinois Chamber of Commerce held its’ 5th Annual Chamber Day at the Abraham Lincoln Hotel where we were honored to welcome the House Speaker, Emanuel “Chris” Welch, House Republican Leader Jim Durkin and finally, Mayor of Springfield, Jim Langfelder to the event. Senate President Harmon and Senate Republican Leader McConchie gave brief virtual addresses as they were not in town for Session this week.
Each of the guest speakers engaged our attendees on various topics including unemployment insurance, Governor Pritzker’s proposed budget, and discussions on crime. I gave an update on PBMs and current healthcare legislation in the the General Assembly.
List of Key Dates:
Bills Out of Committee, Second Chamber: House & Senate-March 25
Third Reading Substantive Bills, Second Chamber: House & Senate-April 1
Adjournment: April 8
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