Clark Kaericher | Executive Director, Healthcare Council & Sr. VP of Government Affairs | 618-806-1501
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March 24, 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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Both the Senate and the House were in this week. Today is the 3rd Reading deadline for the House. The Senate’s deadline is a week from today.
Committee Recap
Senate Insurance met on Tuesday and passed out one bill of interest:
HB 1282 (Simmons) – Insurance mandate for coverage for preventative screenings for individuals 18 years of age or older and under the age of 65 at high risk for liver disease every 6 months without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided.
The sponsor promised to bring the bill back to committee with an amendment to remove opposition. As a result, the bill passed out of committee unanimously.
There was also a subject matter hearing on health insurance rate review (SB 1912) and Dental Loss Ratio Act (SB 1287). It is a bit worrisome that the Department of Insurance came out in favor of rate review and prior approval. The Chamber opposes both bills.
SB 218 (Gillespie) which expands the powers of Physicians Assistants was not heard in committee this week. It has been reposted for next Wednesday at 3 pm.
HB 3631 (Huynh) is a PBM bill that the Chamber initially opposed. The sponsor amended the bill which was adopted unanimously in House Insurance committee this week. It’s a great amendment that removes our opposition. That bill is on the floor for a vote from the full chamber.
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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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A New Bill to Watch Very Closely
HB 579 (Leader Gabel) was given a subject matter hearing yesterday in House Insurance. House Amendment 1 and House Amendment 2 both create a state-run health care exchange. The Chamber does not oppose the concept of a state-run exchange outright. However, we have many concerns about this bill as it stands. Among the chief concerns are insufficient cost and staffing estimates, and no cap on the amount that may be assessed to pay for this endeavor. Furthermore, the $10 million budgeted in startup costs is woefully inadequate to cover the true cost.
Even more concerning, there was mention made of running this bill on the floor in the near future rather than bringing it back to committee. That's an awful lot to "fix in the Senate".
Some Good BIPA News!
It feels much better to be on the winning side of a BIPA Case. Yesterday the Supreme Court unanimously affirmed the First District in Walton v. Roosevelt, ruling that where a collective bargaining agreement contains a broad management rights clause, and an employer invokes that clause in response to a BIPA claim, “there is an arguable claim for preemption,” and therefore the claim must be handled pursuant to the collective bargaining agreement.
The ruling follows the federal cases that previously held that, where a defendant makes an arguable claim for preemption, the claim is preempted by federal labor law. The practical effect of these decisions is that to bring a BIPA claim, unionized BIPA plaintiffs have to go through the grievance or other similar process required by their collective bargaining agreement. The BIPA plaintiffs’ bar had tried to avoid the federal cases by arguing before Illinois state courts that the federal cases were wrongly decided. Walton puts an end to that strategy.
The Illinois Chamber filed an amicus brief in this case. We are pleased and slightly encouraged with this outcome.
On the legislative front, Senate Leadership had another round of meetings with groups interested in BIPA reform. I participated last week with a number of other business groups and while nothing was promised, I was encouraged with the discussion. Now if we can see the same sort of progress in the House…
Floor Votes of Note
HB 1186, (Croke) 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. The Chamber supported this bill. It passed 111-0-0.
HB 1565, Insurance Coverage/Estrogen passed out of the House 108-0-1. 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, 2025 (rather than January 1, 2024) and that provides coverage for prescription drugs shall include coverage for one or more therapeutic equivalent versions of vaginal estrogen in its formulary.
HB 2072, Dental passed the House 110-0-0. This bill provides that no dental carrier may automatically enroll a provider in a leased network without allowing any provider that is part of the dental carrier's provider network to choose to not participate by opting out. Provides that the provisions do not apply if access to a provider network contract is granted to a dental carrier or an entity operating in accordance with the same brand licensee program as the contracting entity or to a provider network contract for dental services provided to beneficiaries of specified health plans. Provides that any contract entered into or renewed on or after the effective date of the amendatory Act that allows the rights and obligations of the contract to be assigned or leased to another insurer shall provide for notice that informs each provider in writing via certified mail 60 days before any scheduled assignment or lease of the network to which the provider is a contracted provider (rather than shall provide notice of that assignment or lease within 30 days after the assignment or lease to the contracting dentist). Provides that no insurer, dental service plan corporation, professional service corporation, insurance network leasing company, or any company that amends, delivers, issues, or renews an individual or group policy of accident and health insurance on or after the effective date of the amendatory Act shall require a dental care provider to incur a fee to access and obtain payment or reimbursement for services provided. Provides that a dental plan carrier shall provide a dental care provider with 100% of the contracted amount of the payment or reimbursement. Provides that fees incurred directly by a dental care provider from third parties related to transmitting an automated clearing house network claim, transaction management, data management, or portal services and other fees charged by third parties that are not in the control of the dental plan carrier shall not be prohibited by the provisions.
HB 2189, Insulin passed the House 109-0-0. This bill 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).
HB 2238, Stroke Centers passed the House by a vote of 112-0-0. This bill provides for the certification and designation of Thrombectomy Capable Stroke Centers, Thrombectomy Ready Stroke Centers, and Primary Stroke Centers Plus and makes conforming changes throughout the Act.
HB 2267, Dental passed the House by a vote of 112-0-0. This bill provides that without the supervision of a dentist, a dental hygienist may perform dental health education functions, including instruction in proper oral health care and dental hygiene in, for example, a school setting, a long-term care facility, and a health fair (rather than just either a school setting and a long-term care facility). Provides that a dental hygienist may record case (rather than care) histories and oral conditions. Provides that a dentist may enter into an agreement for public health supervision with 4 (rather than 2) public health dental hygienists. Provides that the Department of Public Health Oral Health Section shall compile and publicize public health dental hygienist service data annually.
HB 2350, INS Coverage passed the House 78-32-0. This bill amends the Accident and Health Article of the Illinois Insurance Code. In provisions concerning pap tests and prostate cancer screenings, provides that required coverage includes an annual cervical smear or Pap smear test for all (rather than female) insureds. Provides that required coverage includes an annual prostate cancer screening for insureds (rather than male insureds) upon the recommendation of a physician licensed to practice medicine in all of its branches for specified individuals. Provides that required coverage includes an annual prostate cancer screening for insureds who are age 40 and over with a genetic predisposition to prostate cancer.
HB 2443, Hearing Aid Coverage passed the House 83-25-1. This bill 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 2519, Hospitals/Milk passed the House 107-0-0. This bill requires hospitals licensed under the Act to provide information and instructional materials regarding the option to voluntarily donate milk to nonprofit milk banks that are accredited by the Human Milk Banking Association of North America. Provides that the information and instructional materials shall be provided to the parents of each newborn upon discharge from the hospital after the newborn's birth.
HB 3030, Insurance/Billing passed the House 113-0-0. This bill amends the Illinois Insurance Code. In provisions concerning billing for services provided by nonparticipating providers or facilities, provides that if attempts to negotiate reimbursement for services provided by a nonparticipating provider do not result in a resolution of the payment dispute within 30 days after receipt of written explanation of benefits by the health insurance issuer, then the health insurance issuer, nonparticipating provider, or the facility may initiate binding arbitration to determine payment for services provided on a per-bill or a batched-bill basis (instead of only a per-bill basis).
HB 3202, Insurance/Testing passed the House 107-0-0. This bill provides that an individual or group policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2025 shall cover a medically necessary home saliva cancer screening every 24 months if the patient is asymptomatic and at high risk for the disease being tested for or demonstrates symptoms of the disease being tested for at a physical exam.
SB 1665, Hospitals/Income passed the Senate 38-19-0. This bill Defines "guaranteed income program" to mean a publicly or privately funded program that provides one-time or recurring unconditional cash transfers or payments, or gifts to individuals or households, for a defined number of months or years for the purposes of reducing poverty, promoting economic mobility, or increasing the financial stability of Illinois residents. Amends the Illinois Public Aid Code. Provides that for purposes of determining eligibility and the amount of assistance under the Code, the Department of Human Services and local governmental units shall exclude from consideration any financial assistance, including cash transfers or gifts, that is provided to a person through a guaranteed income program (rather than the Department of Human Services and local governmental units shall exclude from consideration, for a period of no more than 60 months, any financial assistance, including wages, cash transfers, or gifts, that is provided to a person who is enrolled in a program or research project that is not funded with general revenue funds and that is intended to investigate the impacts of policies or programs designed to reduce poverty, promote social mobility, or increase financial stability for Illinois residents if there is an explicit plan to collect data and evaluate the program or initiative that is developed prior to participants in the study being enrolled in the program and if a research team has been identified to oversee the evaluation). Provides that in determining eligibility under this Act, a hospital subject to the Act shall exclude from consideration any unconditional cash transfers, payments, or gifts received under a guaranteed income program if: (A) such cash transfers, payments, or gifts are excluded from consideration for determining eligibility under public health insurance programs administered by the State in which the State has the authority to waive guaranteed income; and (B) the guaranteed income program is a program for a defined number of months or years designed to reduce poverty, promote social mobility, or increase financial stability for program participants and if there is an explicit plan to collect data. Provides that the preceding provision is inoperative on and after July 1, 2026. Adds the Health Benefits for Immigrants program to the list of public health insurance programs that an uninsured patient must first apply to before seeking any available hospital discounts under the Act.
Rulemakings of Note
Newborn Screening: DPH also repealed the Part titled Newborn Metabolic Screening and Treatment Code (77 IAC 661; 46 Ill Reg 15454) and adopted a new Part titled Newborn and Infant Screening and Treatment Code (77 IAC 661; 46 Ill Reg 15473), both effective 3/2/23. The new Part reorganizes and clarifies DPH’s rules regarding testing of newborns for metabolic disorders and other conditions, including cardiac screening and hearing tests, at or shortly after birth. The new Part also includes provisions for newborn hearing tests, a registry for hearing test results and outcomes, and referrals for related services. Hospitals, birth centers and other healthcare providers may be affected.
Medical Payments: The DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES adopted amendments to Medical Payment (89 IAC 140; 46 Ill Reg 16307 and 17804) effective 3/1/23, combining two separately proposed rulemakings. These amendments implement Public Act 102-43 by removing a provision limiting coverage of specified chiropractic services to patients under age 21, so that these services can be authorized for medical assistance recipients of any age. Additionally, the rulemaking increases the managed care organization (MCO) assessment rate for fiscal years 2023 through 2025. The Tier 1 Medicaid MCO assessment rate (applicable to the first 4,195,000 member months recorded in the base year of 2018) is being raised from $69.70 to $74.40 per member per month. Assessment rates for Tier 2 (Medicaid MCO member months beyond the first 4,195,000 in 2018) and Tier 3 (non-Medicaid MCOs) are unchanged. The rulemaking also clarifies that the base year for MCOs that began doing business in Illinois after 2018 will be the first year for which HFS has sufficient data to calculate an assessment. Questions/requests for copies: Steffanie Garrett, HFS, 201 S. Grand Ave. East, 3rd Floor, Springfield IL 62763-0002, HFS.Rules@illinois.gov
Chamber BIPA Webinar
Sean Darke from Dykema will moderate the virtual panel discussion on “The Good, Bad, and Ugly of BIPA!” The panel will focus on recent developments in BIPA lawsuits and best practices to avoid being caught in the wave of lawsuits, which have typically resulted in outsized class settlements. As litigation continues to explode in BIPA, Dykema has assembled a panel to discuss the recent changes to BIPA and recent case law that continues to shape BIPA for companies and legislatures across the country. Concerning is that over 1,000 BIPA lawsuits involve every day workplace issues like time tracking and employee verification. Although we see the ugly in BIPA through litigation, this panel will discuss the positives of biometrics that have been lost during this litigation explosion and how companies should not shy away from using this amazing technology. The panel will also discuss the future of biometrics and the much needed BIPA reform. Join Sean Darke and panel members Abad Lopez from Dykema, Doug O’Gordon from Find Biometrics, and Jake Parker from The Security Industry Association as they explore the “Good, Bad, and Ugly of BIPA!”
Panel Discussion Will Include:
- 2022 case law that reshaped BIPA
- How companies can comply with BIPA to avoid exposure
- How to reform BIPA to work for employees, consumers, and companies
BIPA and beyond, what does the future of BIPA look like….or should look like
And More!
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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