IAFP Legislative Tracking
While IAFP tracks priority legislative and administrative actions during each legislative session, IAFP prepares each year for a range of advocacy issues, from scope of practice to tobacco cessation. This past year has also focused on a few particular areas of importance with ongoing regulatory interactions including healtchare equity, telehealth, and workforce development. Click here for an overview of this IAFP advocacy.
Creates the Health Care for All Illinois Act. Provides that all individuals residing in this State are covered under the Illinois Health Services Program for health insurance. Sets forth requirements and qualifications of participating health care providers. Sets forth the specific standards for provider reimbursement. Provides that it is unlawful for private health insurers to sell health insurance coverage that duplicates the coverage of the program. Requires the State to establish the Illinois Health Services Trust to provide financing for the program. Sets forth the specific requirements for claims billed under the program. Provides that the program shall include funding for long-term care services and mental health services. Creates the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open bid competitive basis. Provides that patients in the program shall have the same rights and privacy as they are entitled to under current State and federal law. Provides that the Commissioner, the Chief Medical Officer, the public State board members, and employees of the program shall be compensated in accordance with the current pay scale for State employees and as deemed professionally appropriate by the General Assembly. Effective July 1, 2021.
Comment: Illinois Chapter of the American Academy of Pediatrics initiative; monitor ICARE mandate for IAFP Public Health committee, changed to opt-out with HFA2
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, and click here for the 2020 coalition position statement; see companion SB158 & SB177; refiling of HB5510 & SB3822 from 101st GA (note: 2020 positions statements to be converted to 2021 references)
Amends the Medical Practice Act of 1987. Provides that rules adopted by the Department of Financial and Professional Regulation establishing continuing education requirements shall require that licensees complete a course in maternal mental health that addresses specified topics. Effective immediately.
Provides for the following:
Bars insurers from requiring patients to prove a hardship or access barrier in order to receive healthcare services through telehealth.
Prohibits geographic or facility restrictions on telehealth services, allowing patients to be treated via telehealth in their home.
Protects patient preference by establishing that a patient cannot be required to use telehealth services.
Ensures patients will not be required to use a separate panel of providers or practitioners to receive telehealth services.
Aligns telehealth practice with privacy laws for in-person practice, while giving healthcare providers the professional latitude to determine the appropriateness of specific sites and technology platforms for telehealth services.
Aligns telehealth coverage and payment with in-person care, making appropriate patient access to care the priority and removing harmful barriers that shift costs to the patient and healthcare provider.
Equal coverage eliminates policy loopholes that allow insurers to create separate telehealth networks which ship tax dollars to out-of-state providers that work outside of a patient’s care team.
Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill with the following changes: In a provision concerning clinical experience for an advanced practice registered nurse, provides that completion of the clinical experience must be attested to by the collaborating physician or physicians or employer (rather than the collaborating physician or physicians) and the advanced practice registered nurse. Provides that if the collaborating physician or physicians or employer is unable to attest to the completion of the clinical experience, the Department of Financial and Professional Regulation may accept other evidence of clinical experience as established by rule. Restores language concerning prescribing benzodiazepines or Schedule II narcotic drugs that was stricken in the introduced bill.
Comment: Oppose as introduced (note: disruption/overriding of existing agreement on APRN independence); coordinate with ISMS; Neutral on HCA1 replacement amendment regarding qualifications and final decision making responsibilities
Recent History Administrative Actions & Legislative Initiatives
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."
IDPH Immunization Standards
The 2020 proposed legislation intended to comprehensively address immunization standards and thresholds in Illinois:
Elimination of religious exemption
Strengthen medical objection
Mandate immunization registry by mandating all providers who administer vaccines in the state of Illinois to become a certified I-CARE user and enter specific data about their patients who receive the vaccines
Reduce age for consent by allowing minors 14 and over to seek out immunizations
Comment: see Senate Bill 3668 from the 101st General Assembly; further review necessary regarding I-Care programming efficiencies and application of data entry to all providers
Illinois Federally Qualified Health Centers Coverage
Unfiled 2020 legislation was intended to clarify and update Illinois law regarding coverage through Federally Qualified Health Centers (FQHCs):
Provide needed protection and clarity in the federal 340B drug discount program
Establish rates that reimburse Illinois FQHCs at 100% of their reasonable costs
Direct HFS and IPHCA to collaborate in the development of a value-based Alternative Payment Methodology (APM) for FQHCs
Ensure FQHCs receive necessary supplemental or wrap-around payments
Allow FQHCs to bill vaccines at a FFS rate outside of their encounter rate, so that patients can receive their vaccines in the clinical setting
Require MCOs to reimburse FQHCs for services rendered to a Medicaid patient, regardless of whether they are empaneled with the FQHC
Prohibit Medicaid managed care organizations (MCOs) operating in Illinois from denying FQHC claims for medical and behavioral health services rendered on the same day
Establish $50 million in new state resources for provider student loan forgiveness
Allow licensed providers who are relocating to Illinois from other states to temporarily practice under their originating state license until the Illinois Department of Financial and Professional Registration process their Illinois license
Comment: legislative activity to be coordinated with the Illinois Primary Health Care Association; click here for the IPHCA summary of legislation
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.
The Health Care Right of Conscience Act (HCRCA) in Illinois generally protects health care providers from liability and professional discipline for withholding care because of a religious or conscience-based belief. In 2016, the Illinois General Assembly amended HCRCA to require that health care providers have policies in place to ensure that patients receive enough information about their conditions and treatment options to make intelligent choices about their care. Unless such policies are adopted and followed, providers may not claim the protections of HCRCA when denial of treatment leads to injury. Litigation regarding the Illinois Health Care Right of Conscience Act is ongoing. Click here for more background and click here for the related ACLU amicus brief.