IAFP Legislative Tracking
IAFP prepares for a range of advocacy issues in each legislative session, from scope of practice to tobacco cessation. Click here for an overview of this IAFP advocacy, and see below for legislative and regulatory initiatives being tracked.
Priority Legislative & Administrative Actions Tracked by IAFP
Amends the Immunization Data Registry Act. Provides that health care providers, physician's designees, or pharmacist's designees shall (rather than may) provide immunization data to be entered into the immunization data registry. Provides that the written information and the immunization data exemption forms must include information that the health care provider shall (rather than may) report immunization data to the Department of Public Health to be entered into the immunization data registry. Effective January 1, 2023.
Comment: coordinate with ICAAP; partial refiling of House Bill 347; see 77 Ill.Adm.Cd. 689 for rule implementation
Amends the Pharmacy Practice Act. Provides that the definition of "practice of pharmacy" includes the initiation, dispensing, or administration of drugs, laboratory tests, assessments, referrals, and consultations for human immunodeficiency virus pre-exposure prophylaxis and human immunodeficiency virus post-exposure prophylaxis. Provides that as applicable to the State's Medicaid program and other payers, patient care services ordered and administered by a pharmacist shall be covered and reimbursed at no less than 85% of the rate that the services are covered and reimbursed when ordered or administered by physicians. Provides that a pharmacist shall provide patient care services for human immunodeficiency virus pre-exposure prophylaxis and human immunodeficiency virus post-exposure prophylaxis to a patient after satisfying specified requirements. Amends the Illinois Public Aid Code. Provides that specified provisions concerning coverage of patient care services provided by a pharmacist shall apply to all patient care services provided by a pharmacist (rather than patient care services for hormonal contraceptives assessment and consultation only). Effective immediately.
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.
Comment: House Amendment No. 1 amends scope of practice expansion in bill as introduced to preserve screening/testing and role of physician (i.e. although initial assessment and dispensing is authorized, a medical standing order must be followed along with a referral to the PCP for reactive test results, privacy requirements, and training; see companion SB3209; partial refiling of House Bill 2499 - Senate Amendment 1 page 550 subsection 14)
Synopsis As Introduced:
Amends the Overdose Prevention and Harm Reduction Act. Provides that a pharmacist or physician may dispense drug adulterant testing supplies, such as reagents, test strips, or quantification instruments, to any person. Provides that no employee or volunteer of or participant in a program established under the Act or any employee or customer of a pharmacy, hospital, clinic, or other health care facility or medical office dispensing drug adulterant testing supplies in accordance with the Act shall be charged with or prosecuted for possession of specified materials. Provides that a law enforcement officer who, acting on good faith, arrests or charges a person who is thereafter determined to be entitled to immunity from prosecution shall not be subject to civil liability for the arrest or filing of charges. Provides that any record of a person that is created or obtained for use by a needle and hypodermic syringe access program or by a pharmacy, hospital, clinic, or other health care facility or medical office in connection with the dispensing of drug adulterant testing supplies must be kept confidential. Contains other provisions. Effective immediately.
Replaces everything after the enacting clause with the provisions of the introduced bill with the following changes. Removes provisions regarding waiver of criminal penalties and confidentiality. Restores language prohibiting employees or volunteers of or participants in a program established under the Act from being charged with or prosecuted for possession of certain items. Removes references to reagents, test strips, and quantification instruments. Provides that no quantity of drug adulterant testing supplies greater than necessary to conduct 5 assays of substances suspected of containing adulterants shall be dispensed in any single transaction. Removes language providing that the amendatory Act is effective immediately. Makes other changes.
Provides that provisions regarding the dispensing of drug adulterant testing supplies apply to advanced practice registered nurses and physician assistants. Provides that the amendatory Act is effective immediately.
Comment: public access to controlled substance adulterant testing; see also companions HB4334 & SB3918
Amends the Illinois Insurance Code. 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). Defines terms. Amends the Illinois Public Aid Code. 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. Effective July 1, 2022 (note: HFA#1).
Comment: see companion SB3729; IPHCA initiative goals: (1) Enact anti-discrimination language that prohibits PBMs and MCOs from treating 340B drugs differently than non-340B, to preserve the benefit to FQHCs and their patients; (2) Require a different, better process by which 340B drugs billed to MCOs are identified as 340B, without this, the fear is that contract pharmacies will exit the program and the benefit will dry up overnight; see also IPHCA Support Paper
Creates the Equity and Representation in Health Care Act. Contains the findings of the General Assembly. Creates the Equity and Representation in Health Care Workforce Repayment Program and the Equity and Representation in Health Care Workforce Scholarship Program to be administered by the Department of Public Health. Provides that a health care professional, medical facility, or behavioral health provider may apply to the Department for loan repayment assistance under the Program. Provides that, in order to be eligible for loan repayment under the Act, the health care professional or behavioral health provider shall comply with specified requirements. Requires the Department to submit an annual report with specified requirements to the General Assembly and the Governor. Contains provisions regarding the adoption of rules by the Department. Contains other provisions.
Comment: see companion SB3734; Cook County Health initiative goals: (1) Providing new and increased funding to support loan repayment and scholarship programs; (2) Filling gaps by adding health care professions eligible to participate; and (3) Prioritizing populations that continue to be underrepresented in the health care workforce; see coalition support paper
Creates the Behavior Analyst Licensing Act. Provides for licensure of behavior analysts, assistant behavior analysts, and behavior technicians by the Department of Financial and Professional Regulation. Contains provisions concerning licensure requirements, qualifications, the Board of Behavior Analysts, provisional licenses, and rules. Amends the Public Aid Code to provide that treatment of autism spectrum disorder through applied behavior analysis shall be covered under the medical assistance program for children with a diagnosis of autism spectrum disorder when ordered by a behavior analyst licensed by the Department of Financial and Professional Regulation to practice applied behavior analysis in the State of Illinois. Effective immediately.
Comment: education similar to licensed clinical psychology counselor and licensed clinical social worker
Repeals the Naprapathic Practice Act on January 1, 2028 (instead of January 1, 2023). Amends the Naprapathic Practice Act. Defines "Board" and "email address of record". Provides that all applicants and licensees shall provide a valid address and email address to the Department of Financial and Professional Regulation and inform the Department of any change of address or email address within 14 days. Provides that naprapathic practice means identification, evaluation, and treatment (rather than only the evaluation) of persons with connective tissue disorders through the use of naprapathic case history and palpation or treatment. Provides that a naprapath shall order additional screening if the patient does not demonstrate measurable or functional improvement after 6 visits and continued improvement thereafter. Provides that a naprapath shall refer a patient to the patient's treating health care profession of record if the patient's condition is determined to be beyond the scope of practice of the naprapath. Provides that a person may be qualified to receive a license as a naprapath if he or she is at least 21 years of age (rather than 18 years of age) and, for licenses granted on or after January 1, 2028, has graduated from a 4-year college level program or its equivalent approved by the Department. Creates the Board of Naprapathy. Provides for membership and duties of the Board. Provides that the Department shall assign a customer's identification number to each applicant for a license. Provides that making a material misstatement in furnishing information to the Department is grounds for disciplinary action. Provides that a person not licensed under the Act and engaged in business of offering naprapathy services shall not aid, assist, procure, advise, employ, or contract with any unlicensed person to practice naprapathy contrary to the Act. Provides that the Department may refuse to issue or may suspend the license of any person who fails to file a tax return, to pay the tax, penalty, or interest shown in a filed tax return, or to pay any final assessment of tax, penalty, or interest. Makes changes to the provisions regarding physical and mental examinations of a licensee or applicant. Removes a provision that provides that if the Secretary of Financial and Professional Regulation fails to issue a final order within 30 days after receipt of the hearing officer's findings of fact, conclusions of law, and recommendations, then the hearing officer's determinations become a final order. Provides that the Board shall review the report of the hearing office and present its findings of fact, conclusions of law, and recommendations to the Secretary. Provides that an order shall be prima facie proof that the Board and its members are qualified to act. Removes a provision that provides that exhibits shall be certified without cost. Repeals a provision regarding rosters. Makes conforming and other changes. Section 5 and Section 99 take effect upon becoming law.
Comment: see companion SB4016; see also HB5027 (note: increases regulation of unlicensed practice with no scope expansion as introduced; HA1 page 5 differential diagnosis inclusion limited by scope definition with only treat/evaluate)
Creates the Task Force on Internationally-Licensed Health Care Professionals Act. Provides the Task Force is created within the Department of Financial and Professional Regulation. Provides that the Task Force shall have the following members: 2 members appointed by the President of the Senate; 2 members appointed by the Speaker of the House of Representatives; 2 members appointed by the Governor; the Secretary of Financial and Professional Regulation; the Director of the Division of Professional Regulation; and 2 members appointed from the nonprofit organization Upwardly Global. Provides that the Task Force shall meet at least once a month until the Task Force votes to dissolve itself. Provides that the Department shall provide administrative support. Provides that the subject matter of the Task Force is intended to address health care professionals but also other professionals as needed, to be focused on professionals already licensed and practicing in another country and seeking licensure in the State, and to not include students. Provides that the Task Force shall prepare an annual report to address barriers to licensure and practice for health care professionals in the State and address strategies for reducing the barriers. Provides the report shall be submitted to the Governor and General Assembly, and the first report shall be submitted one year after the effective date of the Act.
Comment: Amend to include healthcare representation on task force; see also Foreign Trained Physician Emegency Order (Jan. 10, 2022) and related International Medical Graduate Temporary Practice Application
Creates the Naturopathic Medical Practice Act. Provides for the licensure of naturopathic physicians. Creates the Naturopathic Physician Medical Board. Provides that the Board shall oversee the licensure of naturopathic physicians and matters relating to training and licensure of naturopathic physicians. Provides for membership of the Board and duties of the Board. Requires the Board to adopt rules concerning specified matters. Contains provisions concerning definitions; qualifications for licensure; approval of naturopathic medical educational programs; display of license; scope of practice; referral requirements; prohibited conduct by licensees; exemptions from the Act; title protection; license expiration, renewal, denial, revocation, and continuing education; and issuance of first licenses. Amends the Illinois Controlled Substances Act. Adds internal references to naturopathic physicians. Effective immediately.
Comment: opposition focuses on licensure as a “physician,” expanded scope of practice beyond current naturopath practices, and insufficient education related to authorized scope of practice; see AAFP Naturopath Scope of Practice; but see e.g. North Shore integrated care with naturopaths; see also Chiropractor & APRN statutes for reference to "doctor"; see companion HB4294
Creates the Flavored Tobacco Ban Act. Provides that a tobacco retailer or his or her agents or employees may not sell, offer for sale, or possess with the intent to sell or offer for sale, a flavored tobacco product, flavored related tobacco product, flavored alternative nicotine product, or flavored solution or substance intended for use with electronic cigarettes. Provides that (1) "tobacco product" includes products containing tetrahydrocannabinol and products containing a mixture of tetrahydrocannabinol and nicotine, and (2) "tobacco retailer" includes dispensing organizations and dispensing organization agents, as those terms are defined in the Cannabis Regulation and Tax Act. Creates a presumption that a tobacco product, related tobacco product, alternative nicotine product, or solution or substance intended for use with electronic cigarettes is a banned product, solution, or substance intended for use with electronic cigarettes if it has or produces a characterizing flavor. Establishes penalties for violations. Provides that all moneys collected as fines and civil penalties for violations of the Act shall be distributed: one-half to the State agency or unit of local government that successfully prosecuted the offender; and one-half to the Department of Revenue to be used for enforcing the Act and the Prevention of Tobacco Use by Persons under 21 Years of Age and Sale and Distribution of Tobacco Products Act. Provides that the Act does not preempt or otherwise prohibit the adoption of a local standard that imposes greater restrictions on the access to specified products, solutions, or substances than the restrictions imposed by the Act. Amends the Tobacco Products Tax Act of 1995. Permits the Department of Revenue to suspend the license of any distributor that violates the Flavored Tobacco Ban Act.
Comment: see IAFP Flavored Tobacco Statement (Oct. 2019) in support of similar legislation
Amends the Illinois Controlled Substances Act. Provides that the Department of Human Services must provide for a Prescription Monitoring Program for all prescription medications (rather than Schedule II, III, IV, and V controlled substances). Provides that the dispenser must transmit to the central repository the diagnosis code (ICD-10). Deletes provision that the dispenser must transmit to the central repository the date the controlled substance is dispensed. Provides that the Department may release prescription record information to a person who medically coordinates, directs, supervises, or establishes standard operating procedures for a prescriber or dispenser; if the person is evaluating the job performance of the prescriber or dispenser; or is performing quality assessment and improvement activities, including outcomes evaluation or development of clinical guidelines, and if the disclosure does not contain personally identifiable information of a patient and is limited to only those records about the prescriber or dispenser the person medically coordinates, directs, or supervises, or for whom the person establishes standard operating procedures.
Comment: expansion of PMP to all prescriptions and prescribing assessments (note: preserve opioid use disorder added by PA 102-527)
Recent History of Administrative Actions & Legislative Initiatives
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).
Governor Pritzker issued an executive order with coinciding emergency rulemaking from the Department of Insurance, regarding the state's response to COVID-19, predominately around telehealth. The order covers non-ERISA commercial insurers and requires the following:
In-network coverage requirement for telehealth services
Prohibits unnecessary utilization control for telehealth
No cost-sharing for in-network telehealth (high-deductible plan exception)
Telehealth may be provided by any in-network provider regardless if they were previously designated as a telehealth provider
Comment: the accompanying emergency rules also require Medicaid providers to be reimbursed at the same rate at which they are reimbursed for in-person visits; click here for futher details; click here for 2020 IAFP telehealth statement
"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."
The Governor's Office in conjunction with the state's Opioid Crisis Response Advisory Council created an Opioid Social Equity Committee as one of several sub-committees to make policy recommendations regarding how to address social and racial disparities in the opioid crisis response. They have also been tasked with establishing local recovery-oriented systems of care councils in communities that have been disproportionately impacted by the crisis in order to reach out to and engage individuals in all stages of recovery. For more information, click here regarding the Illinois Opioid Action Plan and click here for the executive order press release.
Effective February 5, 2020, the Illinois Governor's office announced the release of $50 million in funding for the first round of matching grants of Connect Illinois, the state's $420 million statewide broadband expansion. "Applicants are anticipated to include internet service providers, rural cooperatives, nonprofits and local governments. Grant responses for the initial $50 million round of funding can be submitted through Friday, April 3, 2020. Up to $5 million per project will be available during the first round, and subsequent rounds will follow over the course of the next several years."
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.