IAFP Legislative Tracking

Creates the Family Care Plans for Infants and Families Act:

• Requires the Department of Public Health, in consultation with specified agencies and entities, to develop guidelines for hospitals, birthing centers, medical providers, Medicaid managed care organizations, and private insurers on how to conduct a family needs assessment and create a family care plan for an infant who may exhibit clinical signs of withdrawal from a controlled substance or medication. Requires an infant's family care plan to include a family needs assessment performed by a social worker or any other appropriate and trained individual or agency.

• Requires a licensed health care professional or social worker to complete a family care plan that shall include supports and services to be provided to the infant and the infant's parent or caregiver. Contains provisions concerning information that must be provided under a family care plan; notice to the Department of Public Health when an infant's parent or caregiver fails to adhere to a family care plan; exceptions to a finding of nonadherence; educational materials and training for hospital employees and others on the difference between notification requirements to report the birth of a substance-exposed infant and notification requirements to report alleged child abuse and neglect; and other matters.

• Provides that notice to the Department of Public Health on the birth of a substance-exposed infant shall not be construed to mean that prenatal substance use is intrinsically considered child abuse or neglect. Amends the Abused and Neglected Child Reporting Act and the Juvenile Court Act of 1987.

• Removes from the definition of "neglected child" a newborn infant whose blood, urine, or meconium contains any amount of a controlled substance.

• Removes a provision requiring the Department of Children and Family Services to report to the State's Attorney whenever the Department receives a report that a newborn infant's blood contains a controlled substance. Effective immediately.

Note: review amendment considerations regarding administrative burdens; see national policy regarding eliminating hurdles to substance abuse counseling

Amends the Smoke Free Illinois Act. Defines "electronic smoking device". Changes the definition of "retail tobacco store" to include references to "electronic smoking devices". Provides that "smoke" or "smoking" includes the use of an electronic smoking device.

Note: see also Senate Bill 1561 (Sen. Julie Morrison); click here for coalition support position paper

Amends the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to adopt policies and rates for long-acting reversible contraception by January 1, 2024 to ensure that reimbursement is not less than actual acquisition cost. Requires the Department to submit any necessary application to the federal Centers for Medicare and Medicaid Services for the purposes of implementing such policies and rates. Effective immediately.

Note: see also Senate Bill 1724 (Sen. Paul Feraci); IAFP Statement on Reproductive Health (August 2022)

Amends the Department of Professional Regulation Law of the Civil Administrative Code of Illinois. Requires health care professionals who have continuing education requirements to complete cultural competency training, which shall include information on sensitivity relating to and best practices for providing affirming care to people in the person's preferred language, people with disabilities, documented or undocumented immigrants, people who are intersex, people living with HIV, and people of diverse sexual orientations and gender identities. Provides that for every license or registration renewal occurring on or after the effective date of the amendatory Act, a health care professional who has continuing education requirements must complete at least 5 hours in cultural competency training. Provides that for every license or registration renewal occurring on or after the effective date of the amendatory Act, a person licensed or registered by the Department under the Medical Practice Act of 1987 and who has continuing education requirements must complete at least 10 hours in cultural competency training. Provides that these continuing education hours may count toward meeting the minimum credit hours required for continuing education. Provides for rulemaking. Effective January 1, 2024.

Amends the Nurse Practice Act. Ratifies and approves the Nurse Licensure Compact, which allows for the issuance of multistate licenses that allow nurses to practice in their home state and other compact states. Provides that the Compact does not supersede existing State labor laws. Provides that the State may not share with or disclose to the Interstate Commission of Nurse Licensure Compact Administrators or any other state any of the contents of a nationwide criminal history records check conducted for the purpose of multistate licensure under the Nurse Licensure Compact.

Amends the Nurse Practice Act. Removes a provision providing that the scope of practice of an advanced practice registered nurse with full practice authority includes prescribing benzodiazepines or Schedule II narcotic drugs.

Note: review APRN authorization for benzo and schedule II scripts without physician consultation

Amends the Physician Assistant Practice Act of 1987:

• Changes the definition of "physician assistant", "physician assistant practice", "board", and "collaborating physician".

• Provides that a physician assistant shall be deemed by law to possess the ability to prescribe, dispense, order, administer, and procure drugs and medical devices without delegation of such authority by a physician.

• Provides that such ability shall include the prescribing of Schedule II, III, IV, and V controlled substances.

• Provides that to prescribe Schedule II, III, IV, or V controlled substances under the Act, a physician assistant shall obtain a mid-level practitioner controlled substances license.

• Provides that when a written collaboration agreement is required under the Act, delegation of prescriptive authority by a physician is not required.

• Provides that a physician assistant who files with the Department of Financial and Professional Regulation a notarized attestation of completion of at least 250 hours of continuing education or training and at least 2,000 hours of clinical experience after first attaining national certification shall not require a written collaborative agreement.

• Provides the specified scope of practice of a physician assistant with optimal practice authority.

• Provides that a physician assistant shall be able to hold more than one professional position.

• Makes changes in provisions concerning the physician assistant title, collaboration requirements, and the written collaborative agreement. Makes other changes and corresponding changes to the Act and to the Illinois Controlled Substances Act.

Note: opposition coordinated with Illinois State Medical Society, see ISMS opposition position paper

Amends the School Code. Provides that the Department of Public Health shall adopt a rule requiring informational material about testicular cancer to be provided as part of the health examination of any male child entering the ninth grade. Provides that the Department of Public Health shall develop the content of the informational material to be provided. Effective immediately.

Note: review administrative burden impact and ICAAP opposition

Amends the Illinois Insurance Code and the Health Maintenance Organization Act:

• Provides that all individual and small group accident and health policies written subject to certain federal standards must file rates with the Department of Insurance for approval.

• Provides that unreasonable rate increases or inadequate rates shall be disapproved.

• Provides that when an insurer files a schedule or table of premium rates for individual or small employer health benefit plans, the Department of Insurance shall post notice of the premium rate filings, rate filing summaries, and other information about the rate increase or decrease online on the Department's website.

• Provides that the Department shall open a 30-day public comment period on the date that a rate filing is posted on the website.

• Provides that after the close of the public comment period, the Department shall issue a decision to approve, disapprove, or modify a rate filing, and post the decision on the Department's website.

• Provides that the Department shall adopt rules implementing specified procedures.

• Defines "inadequate rate" and "unreasonable rate increase".

Amends the Clinical Psychologist Licensing Act:

• In provisions concerning written collaborative agreements, removes a provision prohibiting a prescribing psychologist from prescribing medications to patients who are less than 17 years of age or over 65 years of age.

• Provides that no prescriptive authority for any Schedule II opioid shall be delegated.

• Provides that after the collaborating physician files a notice delegating authority to prescribe any nonnarcotic, nonopioid Schedule II through V controlled substances (rather than any nonnarcotic Schedule III through V controlled substances), the licensed clinical psychologist shall be eligible to register for a mid-level practitioner controlled substance license under the Illinois Controlled Substances Act. Defines "opioid". Makes corresponding changes in the Illinois Controlled Substances Act.

Amends the Medical Assistance Article of the Illinois Public Aid Code:

• Provides that the Department of Healthcare and Family Services shall provide coverage and reimbursement for prescription management services provided by prescribing psychologists for persons who are otherwise eligible for medical assistance under the Article.

Effective immediately.

Amends the Medical Practice Act of 1987. Provides that the written collaborative agreement between a physician licensed to practice medicine in all its branches and an advanced practice registered nurse shall be for services for which the collaborating physician can provide adequate collaboration (rather than for services in the same area of practice or specialty as the collaborating physician in his or her clinical medical practice).

Amends the Fair Patient Billing Act. Provides that before pursuing a collection action against an insured patient for the unpaid amount of services rendered, a health care provider must review a patient's file to ensure that the patient does not have a Medicare supplement policy or any other secondary payer health insurance plan. Provides that if, after reviewing a patient's file, the health care provider finds no supplemental policy in the patient's record, the provider must then provide notice to the patient and give that patient an opportunity to address the issue. Provides that if a health care provider has neither found information indicating the existence of a supplemental policy nor received payment for services rendered to the patient, the health care provider may proceed with a collection action against the patient in accordance with specified provisions. Defines "supplemental policy". Makes a conforming change.

Note: review impact on administrative practices, and difference in current billing practices

Amends the Rebuild Illinois Mental Health Workforce Act:

• In a provision concerning Medicaid funding for community mental health services, sets forth rate increases, to begin on and after January 1, 2024, for the following rates and services:

  • the Mobile Crisis Response Medicaid Payment rate for all services provided under the S9484 procedure code; the Crisis Intervention Medicaid Payment rate for all levels of services provided under the H2011 procedure code;

  • the Integrated Assessment and Treatment Planning Medicaid Payment rate for all levels of services provided under the H2000 procedure code;

  • the Group and Family Therapy Medicaid Payment rate for all levels of services provided under the H0004 procedure code;

  • the Community Support - Group Medicaid Payment rate for all levels of services provided under the H2015 procedure code;

  • the Telepsychiatry Originating Site Medicaid Payment rate for services provided under the Q3014 procedure code; and

  • the Medication Monitoring Medicaid Payment rate for services provided under the H2010 procedure code for medication monitoring provided by a physician, an advanced practice registered nurse, and all other levels of provider.

• Provides that no base Medicaid rate payment or any other payment for the provision of Medicaid community mental health services in place on January 1, 2023 shall be diminished or changed to make the reimbursement changes required by the amendatory Act.

• Provides that any payments required under the amendatory Act that are delayed due to implementation challenges or federal approval shall be made retroactive to January 1, 2024 for the full amount required by the amendatory Act.

Note: support community mental health service medicaid rate increase

Amends the Medical Assistance Article of the Illinois Public Aid Code:

• Requires managed care organizations (MCOs) to pay a clean claim (rather than claim) within 30 days of receiving a claim.

• Defines "clean claim" as a claim that contains all the essential information needed to adjudicate the claim or a claim for which a managed care organization does not request within 30 days of receipt any additional information to adjudicate the claim.

• Contains provisions concerning MCO reports to providers on the receipt and payment of claims; MCO data collection requirements; providers' right to file suit to recover outstanding payments; quarterly audits of each MCO's requests for provider information to adjudicate claims; MCO claims processing and performance analysis; quarterly audits of MCOs payments to hospitals; the segregation of State-issued Medicaid funds received by MCOs for payments to providers; and other matters.

Amends the Hospital Provider Funding Article of the Code:

• Requires the Department of Healthcare and Family Services to calculate, at least quarterly, all Hospital Assessment Program-related funds paid to each hospital, whether paid by the Department or an MCO, including the amounts integrated into rate increases and distributed as provided under the Code.

Note: coordinate with Illinois State Medical Society initiative regarding clean claim legislation

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.