IAFP Legislative Tracking

Creates comprehensive additions and changes to healthcare related statutes with numerous areas of focus, including:

• Access to Healthcare

• Hospital Closures

• Hospital Reform

• Managed Care Organization (MCO) Reforms

• Community Health Workers

• Maternal & Infant Mortality

• Mental & Substance Abuse Treatment

• Medical Implicit Bias

Comment: contains part of the Illinois Legislative Black Caucus 2020-21 healthcare package, see IAFP's full bill review; amendments were monitored regarding implicit bias, hospital closings, behavioral health workforce, consistency with the Synchronicity Report showcasing the Mental Health Collaborative Care Model, FQHC promotion to include family physicians, and dementia training for non-physicians

Prior authorization reform legislation, as introduced, seeks to accomplish the following:

• Require payers to maintain and publicly post a list of services for which prior authorization is required;

• Reduces the number of medically necessary services that are subjected to prior authorization requirements;

• Establish important maximum timelines for urgent and non-urgent prior authorization requests;

• Define qualifications of individuals designated to review and make prior authorization determination;

• Ensure the request for prior authorization is using appropriate medically accepted, clinically valid, evidence based criteria;

• Ensure that prior authorization approvals also include reasonably related supplies or services;

• Requiring that prior authorization approvals remain in effect for the course of the treatment; and

• Ensures that prior authorization approvals also confirm medical necessity requirements for payment of the health care service;

Comment: legislative activity to be coordinated with the Illinois State Medical Society; click here for Your Care Can't Wait coalition information; click here for the 2020 IAFP position statement, click here for the 2020 coalition position statement, and click here for AAFP Guidance; see companion SB158 & SB177; refiling of HB5510 & SB3822 from 101st GA (note: 2020 positions statements to be converted to 2021 references)

In 2021, the Illinois legislature codified some aspects of the Governor's 2020 telehealth executive order. While Public Act 102-104 recognizes telehealth as a modality for delivering otherwise in-person healthcare services, there will still be more work necessary to (1) justify telehealth costs for those seeking payment parity from private carriers and (2) preserve Medicaid telehealth payment parity beyond the current pandemic related administrative rules. More specifically, the legislation, effective July 22, 2021:

• Recognizes telehealth payment parity as a concept for private carriers through December 2027 (note: mental health and substance abuse services are not subject to the sunset), see 215 ILCS 5/356z.22(d)(new);

• Authorizes a study on the effectiveness of telehealth, subject to appropriation, and by January 2027, see 215 ILCS 5/356z.22(e)(new); and

• Subjects telehealth payment parity to conditions that provide for negotiated rates and cost justifications, see 215 ILCS 5/356z.22(f)(new).

"The Department of Healthcare and Family Services, in consultation with the Department of Insurance, shall oversee a feasibility study to explore options to make health insurance more affordable for low-income and middle-income residents. The study shall include policies targeted at increasing health care affordability and access, including policies being discussed in other states and nationally. The study shall follow the best practices of other states and include an Illinois-specific actuarial and economic analysis of demographic and market dynamics."

Comment: click here for IAFP's feasibility study submission and click here for DHFS-IDOI response

Creates the Act to the Underserved Physician Workforce Act. Provides that the Act applies to primary care physicians, general surgeons, emergency medicine physicians, or obstetricians (rather than primary care physicians and other eligible primary care providers). Defines "primary care physician". Makes conforming and other changes, including amending the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois, Nurses in Advancement Law, Private Medical Scholarship Agreement Act, and Illinois Public Aid Code.

Comment: click here for related information regarding Illinois Family Medicine Residency Programs; click here for IAFP's administrative rules submission.