Several areas of legislative and regulatory advocacy were prioritized by ILOTA during the spring legislative session, all of which are covered in the various subject areas below, and are also provided in this section for reference.

Occupational Therapy Direct Access – House Bill 3769: A priority initiative of ILOTA, this legislation improves health care access by codifying a safe scope of practice for OTPs to evaluate and provide services without a referral. Specifically, the bill removes a previous 15-business-day referral requirement, which avoids artificially short windows for care. To preserve patient safety and proper scope of practice, the legislation maintains the requirement that an OTP must refer a patient to a treating health care professional if the patient does not demonstrate measurable or functional improvement after 10 visits. The bill passed the legislature unanimously and after being signed into law this summer, will be effective January 1, 2027.

Occupational Therapy Licensure Compact – House Bill 4976: This legislation ratifies and approves the Occupational Therapy Licensure Compact in Illinois. The Compact is designed to facilitate the interstate practice of occupational therapy and improve public access to services. It preserves the State's authority to protect public health and safety through its current licensure system while allowing a remote state to hold a provider with a Compact Privilege accountable to that state's practice standards. However, the OTP proposal and compact proposals for other professions, such as nurses, continue to be held up as a result of political pressures unique to Illinois; click here for a review of the competing concerns by interest groups and legislators applicable to all compact legislation being proposed in Illinois.

Behavioral Health Loan Repayment – Senate Bill 1273: As a priority of ILOTA this legislative session, this bill amends the Community Behavioral Health Care Professional Loan Repayment Act by adding licensed occupational therapists and licensed occupational therapy assistants to the list of eligible health care professionals. Under the program, OTPs could receive a grant of up to $15,000 per year for a maximum of 4 years to help pay off educational loans. (Note: While this legislation was not included in the final state budget revenue package this spring, it remains a priority and will be pushed again by ILOTA in the next legislative session)

Multidisciplinary Clinics and Behavior Analysis – Senate Bill 712: Proposed as a narrow "cleanup" trailer bill to the 2022 Behavior Analyst Licensure Act, SB 712 explicitly adds occupational therapists to the list of professionals exempt from the Act, and is effective upon being signed into law by the Governor this summer. This corrects an earlier omission and clarifies that occupational therapists may perform applied behavior analysis (ABA) activities consistent with their training, scope of practice, and code of ethics without needing a behavior analyst license. Furthermore, to preserve team-based care, the bill allows licensed behavior analysts to participate in multidisciplinary clinics by adding applied behavior analysis to the list of professional services that can be combined under a single professional limited liability company or professional service corporation alongside occupational therapy, physical therapy, and speech-language therapy (SLP). Finally, the legislation confirms that public schools and nonprofits are not subject to ownership restrictions to employ or contract with licensed behavior analysts. However, there remain issues regarding ABA services provided by a business that is owned by a licensed OT and SLP practitioner, where those owners are not separately licensed under the Behavior Analyst Licensure Act, see state regulator administrative clarification stating in part, “By or before January 15, 2027 anyone who is not licensed as a behavior analyst or assistant behavior analyst pursuant to the Illinois Behavior Analyst Licensing Act, and who currently owns a business providing applied behavior analysis services must divest from the business.” While some legislative intent clarifications were provided during House floor debate (click here for transcript excerpts), additional advocacy with the state regulator and legislature is likely necessary this summer to avoid disruption in services provided by ILOTA members.

Autism Diagnosis in Early Intervention – House Bill 5225: Aimed at addressing a "bottleneck" of children waiting to receive an autism diagnosis, this bill, effective January 1, 2028, permits speech-language pathologists (SLPs) to diagnose autism spectrum disorders in children under three years of age, and was a priority initiative of Start Early in partnership with Northwestern University as part of the Reduce the Wait project. For an SLP to diagnose autism, the diagnosis must occur as part of the Illinois Early Intervention Program and the SLP must complete specific continuing education training in age-appropriate autism diagnostic evaluation methods. The bill also amends the Insurance and Public Aid Codes to mandate coverage for autism treatments, such as applied behavior analysis, when ordered by an appropriately qualified SLP. By accelerating the diagnostic process, this legislation proposes to help children access some interdisciplinary Early Intervention services for autism much sooner, where OTPs are key team members; however, there remain significant concerns regarding structural early intervention capacity issues and co-occurring conditions other than autism that will also remain necessary to address. While some legislative intent was clarified during Senate floor debate (click here for transcript excerpts), ILOTA will prioritize remaining involved in the rulemaking process and engage members for their expertise in preserving OTP’s role in EI interventions.

Occupational therapy practitioners (OTPs) play a vital role in school-based settings by supporting students' social-emotional well-being and participation in daily school routines. Legislation passed this spring intersects significantly with the occupational therapy scope of practice by focusing on trauma-informed care, expanding play-based learning, and bolstering mental health support for school staff. Furthermore, policies addressing classroom accommodations, such as individualized exemptions to wireless device bans and targeted support for twice-exceptional students, directly involve OTPs in developing and implementing integrated care strategies and Individualized Education Programs (IEPs) within educational environments.

House Bill 4536 (Trauma-Informed Practices): This legislation, effective upon being signed into law by the Governor this summer, amends the School Code to require school institutes to provide instruction on trauma-informed practices and trauma-responsive learning environments before the first student attendance day of each school year. This aligns closely with OTPs' roles in addressing social-emotional functioning and supporting students impacted by developmental and relational trauma through multi-tiered systems of support.

House Bill 4577 (Play-Based Learning): This bill, effective January 1, 2027, mandates that school boards establish full-day kindergartens by the 2027-2028 school year that provide developmentally appropriate opportunities for play-based learning. The legislation defines play-based learning to include both intentional teacher-directed play aligned to learning goals and student-initiated play.

House Bill 4862 (Staff Mental Health Support): By January 1, 2028, each school board must develop a procedure to support employee mental health in the workplace. This includes providing opportunities for staff feedback and annual communications regarding available mental health resources.

Senate Bill 2427 (Wireless Communication Device Policy): This bill, effective upon being signed into law by the Governor this summer, requires school districts and charter schools to adopt policies prohibiting student use of wireless communication devices during school time by the 2027-2028 school year. Crucially for OTPs, the legislation includes exceptions allowing device use if a healthcare professional determines it is necessary for managing a student’s health, or if it is required to fulfill an IEP or Section 504 plan.

Senate Bill 3533 (Twice-Exceptional Students): This legislation, effective upon being signed into law by the Governor this summer, directs state advisory councils to research best practices for twice-exceptional students, defined as those who are gifted and talented while also having a disability. It permits school boards to adopt policies allowing for written education plans that address advanced abilities through individualized services and accommodations while continuing to support the student’s disabilities. OTPs will be instrumental in evaluating and delivering these individualized supports and accommodations across all educational settings.

Occupational therapy practitioners (OTPs) are integral to the early identification, intervention, and holistic care of children from infancy through young adulthood. The legislative proposals impacting early intervention and childhood this session strongly support the role of OTPs in integrated care models. These bills aim to remove barriers to autism diagnoses, foster multidisciplinary practice environments, establish universal newborn home visiting programs, and improve systemic data collection and needs assessments for children's mental and behavioral health. Together, they expand pathways for OTPs to deliver critical, team-based care, addressing social determinants of health and developmental challenges early in a child's life.

House Bill 4606 (Short-Term Universal Newborn Home Visiting Services): This legislation authorizes the Department of Human Services to identify, develop, and manage the administrative infrastructure needed for short-term universal newborn home visiting services. By January 1, 2028, the Department may create a list of voluntary home visiting models that must include an evidence-based assessment of the physical, social, and emotional factors affecting the family. This includes evaluating infant health and wellness, assessing the physical and mental health of the person who has given birth, providing lactation support, and screening for social determinants of health and perinatal mood disorders using validated tools. This aligns with occupational therapy's focus on maternal health, infant development, and establishing healthy home routines early in a child's life.

House Bill 4714 (Children's Mental Health Partnership): This bill, effective January 1, 2027, amends the Children's Mental Health Act to update the duties of the Children's Mental Health Partnership, which advises the State on comprehensive strategies addressing children's mental health needs from birth to age 25. The legislation tasks the Partnership with reviewing and facilitating needs assessments to understand service gaps and regularly reviewing data from the BEACON portal to ensure system transformation is driven by data. It also expands the youth and community representation on the Partnership's adjunct council, requiring representation from community-based organizations focusing on youth mental health. By focusing on social determinants of health, prevention, early identification, and mitigating trauma, this legislation supports OTPs who provide crucial mental and behavioral health services in pediatric and community-based settings.

House Bill 5225 (Autism Diagnosis in Early Intervention): Aimed at addressing a "bottleneck" of children waiting to receive an autism diagnosis, this bill, effective January 1, 2028, permits speech-language pathologists (SLPs) to diagnose autism spectrum disorders in children under three years of age, and was a priority initiative of Start Early in partnership with Northwestern University as part of the Reduce the Wait project. For an SLP to diagnose autism, the diagnosis must occur as part of the Illinois Early Intervention Program and the SLP must complete specific continuing education training in age-appropriate autism diagnostic evaluation methods. The bill also amends the Insurance and Public Aid Codes to mandate coverage for autism treatments, such as applied behavior analysis, when ordered by an appropriately qualified SLP. By accelerating the diagnostic process, this legislation proposes to help children access some interdisciplinary Early Intervention services for autism much sooner, where OTPs are key team members; however, there remain significant concerns regarding structural early intervention capacity issues and co-occurring conditions other than autism that will also remain necessary to address. While some legislative intent was clarified during Senate floor debate (click here for transcript excerpts), ILOTA will prioritize remaining involved in the rulemaking process and engage members for their expertise in preserving OTP’s role in EI interventions.

Senate Bill 712 (Multidisciplinary Clinics and Behavior Analysis): Proposed as a narrow "cleanup" trailer bill to the 2022 Behavior Analyst Licensure Act, SB 712 explicitly adds occupational therapists to the list of professionals exempt from the Act, and is effective upon being signed into law by the Governor this summer. This corrects an earlier omission and clarifies that occupational therapists may perform applied behavior analysis (ABA) activities consistent with their training, scope of practice, and code of ethics without needing a behavior analyst license. Furthermore, to preserve team-based care, the bill allows licensed behavior analysts to participate in multidisciplinary clinics by adding applied behavior analysis to the list of professional services that can be combined under a single professional limited liability company or professional service corporation alongside occupational therapy, physical therapy, and speech-language therapy (SLP). Finally, the legislation confirms that public schools and nonprofits are not subject to ownership restrictions to employ or contract with licensed behavior analysts. However, there remain issues regarding ABA services provided by a business that is owned by a licensed OT and SLP practitioner, where those owners are not separately licensed under the Behavior Analyst Licensure Act, see state regulator administrative clarification stating in part, “By or before January 15, 2027 anyone who is not licensed as a behavior analyst or assistant behavior analyst pursuant to the Illinois Behavior Analyst Licensing Act, and who currently owns a business providing applied behavior analysis services must divest from the business.” While some legislative intent clarifications were provided during House floor debate (click here for transcript excerpts), additional advocacy with the state regulator and legislature is likely necessary this summer to avoid disruption in services provided by ILOTA members.

Occupational therapy practitioners (OTPs) frequently work in home and community settings to foster client independence, safety, and engagement in daily occupations. Legislative proposals in the spring legislative session support this population by enhancing the safety and quality of home care, expanding empowerment resources, codifying community day services, and strengthening legal protections against abuse. Collectively, these bills align with occupational therapy's commitment to support vulnerable individuals in living safely and meaningfully within their chosen communities.

House Bill 4612 (Licensed Home Services Referrals): Taking effect January 1, 2027, this legislation requires assisted living establishments, shared housing, community living facilities, and life care facilities to only refer residents to home service providers that are licensed under the Home Health, Home Services, and Home Nursing Agency Licensing Act. To help residents make informed decisions, the Department of Public Health must create and distribute a one-page flyer detailing how to choose caregivers, the differences between licensed and unlicensed providers, common risks, and how to verify an agency's State licensure. Facilities are mandated to provide this flyer to any resident who requests or receives a referral for home care services.

House Bill 4620 (ABLE Program Information): Effective January 1, 2027, this bill mandates the Department of Human Services to distribute informational materials about the ABLE Program. These materials must be provided to individuals placed in specific licensed facilities or who receive disability services administered or funded by the Department, including home and community-based services, home-based support services, PUNS list enrollees, and services at Centers for Independent Living. The information must be provided by the Office of the State Treasurer and given to clients upon their initial enrollment for services and during any annual eligibility renewal processes.

House Bill 4676 (Caregiver Abuse and Financial Exploitation): Effective January 1, 2027, this legislation amends the Criminal Code of 2012 to broaden the definition of a "caregiver" to include anyone who voluntarily assumes responsibility for an elderly person or a person with a disability by knowingly providing ongoing, primary, and substantial assistance. The bill makes it a Class A misdemeanor for a caregiver to knowingly perform, or fail to perform, acts that create a substantial likelihood that the person's life will be endangered, health will be injured, or a pre-existing physical or mental condition will deteriorate. Additionally, the bill strengthens protections against the financial exploitation of an elderly person or a person with a disability by explicitly defining "undue influence".

Senate Bill 3434 (Community Day Services): This legislation formally defines "community day services" under the Community Services Act as a Home and Community-Based Waiver day program certified by the Department of Human Services. These services assist individuals with developmental disabilities in gaining, maintaining, or improving skills and functioning in a non-residential setting, which can be site-based or located where the general community typically congregates. To ensure safety, the legislation outlines certification and renewal processes, requires site inspections at least once every two years, and mandates rigorous initial and annual employee background checks, including the Health Care Worker Registry, the Illinois Sex Offender Registry, and the Child Abuse and Neglect Tracking System (CANTS).

Occupational therapy practitioners (OTPs) require a modern, supportive regulatory environment to practice effectively and deliver high-quality care. Legislation proposed this session, and some becoming law this summer, directly impact the OTP workforce, administrative requirements, and scope of practice. These measures address critical areas such as direct access to occupational therapy services, interstate licensure portability, student loan support for advanced degrees, mandated reporting requirements, insurance parity for prescribing durable medical equipment, and respectful, modernized terminology for the patients OTPs serve. Together, these bills aim to reduce administrative burdens, increase access to care, and elevate the professional standing of OTPs in Illinois.

House Bill 3711 (Mandatory Reporting of Sexual Misconduct): Effective January 1, 2027, this legislation amends several practice acts, including the Illinois Occupational Therapy Practice Act, to establish strict reporting requirements regarding sexual misconduct. Health professionals are now required to report to the Department of Financial and Professional Regulation within 24 hours if they witness, develop reasonable cause to believe, or receive an allegation that another health professional has engaged in sexual or intimate conduct with a patient or client. Failure to report actual or alleged reportable conduct is explicitly added as a grounds for disciplinary action against an OTP's license. As background on the origins of the initiative, the legislation is the result of criminal abuse by a Chicago gynecologist found guilty in 2021.

House Bill 3769 (Occupational Therapy Direct Access): A priority initiative of ILOTA, this legislation improves health care access by codifying a safe scope of practice for OTPs to evaluate and provide services without a referral. Specifically, the bill removes a previous 15-business-day referral requirement, which avoids artificially short windows for care. To preserve patient safety and proper scope of practice, the legislation maintains the requirement that an OTP must refer a patient to a treating health care professional if the patient does not demonstrate measurable or functional improvement after 10 visits. The bill passed the legislature unanimously and after being signed into law this summer, will be effective January 1, 2027.

House Bill 4284 (Modernization of Disability Terminology): Effective January 1, 2027, this bill updates the Statute on Statutes and various other Acts to replace outdated terminology with respectful, person-first language. It changes terms such as "disabled person" to "person with a disability," "handicapped" to "has a disability," and "mentally handicapped" to "intellectual disability". It also updates references to the "Disabled Person Identification Card" to the "Illinois Person with a Disability Identification Card". The legislation explicitly states that these changes are a modernization of terminology only and do not substantively change, narrow, or expand eligibility for any benefits or coverage.

House Bill 4976 (Occupational Therapy Licensure Compact): This legislation ratifies and approves the Occupational Therapy Licensure Compact in Illinois. The Compact is designed to facilitate the interstate practice of occupational therapy and improve public access to services. It preserves the State's authority to protect public health and safety through its current licensure system while allowing a remote state to hold a provider with a Compact Privilege accountable to that state's practice standards. However, the OTP proposal and compact proposals for other professions, such as nurses, continue to be held up as a result of political pressures unique to Illinois; click here for a review of the competing concerns by interest groups and legislators applicable to all compact legislation being proposed in Illinois.

House Joint Resolution 53 (Federal Student Loan Advocacy): This resolution, adopted by House Democrats on a partisan vote, officially expresses the State's position that occupational therapy, along with several other health and human services fields, is a professional discipline that requires advanced graduate education, professional licensure, and adherence to rigorous clinical standards. It urges the United States Department of Education to formally include Master of Occupational Therapy and Doctor of Occupational Therapy degrees in its definition of "professional degrees" to ensure OTP students have access to adequate federal student loan funding. Furthermore, it commits Illinois to exploring state-level solutions, such as scholarships and loan repayment programs, to support this critical workforce, which will be utilized in future advocacy of Senate Bill 1273.

Senate Bill 1273 (Behavioral Health Loan Repayment): As a priority of ILOTA this legislative session, this bill amends the Community Behavioral Health Care Professional Loan Repayment Act by adding licensed occupational therapists and licensed occupational therapy assistants to the list of eligible health care professionals. Under the program, OTPs could receive a grant of up to $15,000 per year for a maximum of 4 years to help pay off educational loans. (Note: While this legislation was not included in the final state budget revenue package this spring, it remains a priority and will be pushed again by ILOTA in the next legislative session)

Senate Bill 3295 (Durable Medical Equipment Insurance Parity): Taking effect for policies amended, delivered, issued, or renewed on or after January 1, 2028, this legislation mandates that health insurance policies and managed care plans that cover durable medical equipment (DME) prescribed by a physician must provide the exact same level of coverage for DME authorized or prescribed by other lawful health care practitioners. The bill explicitly defines "health care practitioner" to include occupational therapists, ensuring that OTPs can effectively order or use DME to treat their patients without facing insurance coverage disparities.

Senate Bill 3645 (Sunset Extensions and IDEC Clarifications): This omnibus sunset extension package extends the statutory authorization for dozens of professional licensure and related program laws, including the Early Intervention Services System Act and the home visiting program, both under the Department of Human Services (DHS), shifting their sunset dates from July 1, 2026 to July 1, 2027. (Note: These specific programs were initially scheduled to shift to the regulatory authority of the newly created Illinois Department of Early Childhood (IDEC) on July 1, 2026. However, because the State does not expect to receive pending approvals from the federal government by that date, DHS will remain the lead agency for these programs until federal clarification is received)

The Illinois Medicaid program is a massive funder of healthcare services across the state, including many settings where occupational therapy practitioners (OTPs) provide vital care. Of note, the legislative and administrative changes to the State's Medicaid framework this year made relevant policy and administrative changes by stabilizing funding for safety-net and distressed hospitals, expanding telehealth parity for behavioral health interventions, and ensuring coverage for adaptive equipment. Furthermore, sweeping changes to federal Medicaid rules will require OTPs to closely assist vulnerable clients in navigating new administrative burdens, such as work requirements and shortened redetermination windows, to prevent disruptive gaps in their essential rehabilitation and habilitation services.

State Medicaid Omnibus (Senate Bill 3365) - Financial Stabilization & Administration:

• Massive State Investment: The FY27 Medicaid Omnibus represents a $113.8 million gross investment in the upcoming fiscal year, climbing to an annualized gross cost of $226.8 million.

• Hospital and Nursing Home Support: The package establishes an $85 million Distressed Hospital Loan Program, supported by a transfer from the Healthcare Provider Relief Fund, to provide interest-free bridge financing to at-risk public and not-for-profit hospitals to prevent closures. Furthermore, it extends Safety-Net Hospital status eligibility through December 31, 2028, and includes the following targeted annualized gross cost add-on payments:

  • Health Care Equity Add-on: $50 million for safety-net hospitals.

  • Low Volume Add-on: $30 million for safety-net hospitals.

  • Nursing Home Staffing and Access: $120 million

• Mission Shift for MTAC: The Medicaid Technical Assistance Center (MTAC) will undergo a mission shift to focus on eliminating healthcare "service deserts" by prioritizing provider recruitment in underserved geographic areas and supporting health equity.

State Medicaid Omnibus (Senate Bill 3365) - Health Equity & Care Expansion:

• Maternal Health: The package mandates no-cost preeclampsia screening, requiring coverage for advanced biomarker testing for both asymptomatic screening and symptomatic management without deductibles or co-pays across all insurance types.

• Behavioral Health Telehealth Parity: Taking effect January 1, 2027, the omnibus authorizes Medicaid coverage for virtual intensive outpatient program (IOP) services and requires they be reimbursed at the exact same rate as in-person IOP services.

• CILA Medical Absence Protections: To preserve placement stability for individuals with disabilities, 24-hour Community-Integrated Living Arrangement (CILA) providers will receive 100% per diem reimbursement for up to 20 days when a resident requires a temporary medical absence or hospitalization.

• Assistive Technology and Dementia Care: The legislation mandates coverage for medically prescribed, FDA-cleared seizure detection devices starting in FY 2028. It also expands dementia care eligibility in supportive living facilities to include younger individuals (aged 44-64) with Alzheimer's or a related dementia who are determined to have a disability by the Social Security Administration.

Federal HR 1 Medicaid Restrictions and Impact: To comply with the federal HR 1 law signed last July, the Department of Healthcare and Family Services (HFS) is instituting emergency rulemaking that will impose severe new restrictions on Medicaid eligibility, particularly impacting the Affordable Care Act (ACA) adult expansion group (non-disabled adults aged 19-64 without dependent children).

• Work Requirements: Starting January 1, 2027, ACA adults will be required to meet an 80-hour per month work reporting requirement (or volunteer/education equivalent) to maintain their health coverage. HFS estimates that up to 300,000 enrollees are at risk of losing coverage due to this requirement.

• Six-Month Redeterminations: Eligibility redeterminations for ACA adults will occur every six months instead of annually, creating more frequent paperwork burdens and higher chances of coverage disruptions.

• Retroactive Coverage Reductions: Previous rules allowing for three months of retroactive Medicaid coverage prior to an application are being reduced. Retroactive coverage will now be limited to one month for ACA adults and two months for all other eligible populations.

• Immigrant Coverage Cuts: Effective October 2026, the state will lose federal matching funds for certain previously eligible non-citizen categories (such as refugees and asylees), which will place significant financial pressure on state-funded coverage programs.

HFS is also conducting webinars this summer regarding the impact of HR 1; click here to register.

ILOTA Advocacy-Related Workgroups

In coordination with ILOTA Government Affairs and the ILOTA Special Interest Sections, members will continue to have opportunities over the next year to help develop policy and regulatory guidance on several topics relevant to occupational therapy in Illinois, including:

• Multi-Disciplinary, Team-Based Services in Pediatric Early Intervention

• Occupational Therapy Assistant Scope of Practice Authorizations

• State Licensure/Practice Act Renewal and Related Changes

• Commercial Insurance Reimbursement and Related Issues

Additional legislative and regulatory opportunities are likely over the next year, in addition to input in drafting formal public comment in the rulemaking process for many of the above-detailed legislation that passed the legislature this spring.

State and Federal Advocacy Coordination

To help members advocate and connect with state and federal representatives, ILOTA is building targeted outreach opportunities. Stay tuned for ILOTA communications later this year for more details.

For questions, to learn more, or to get more involved in ILOTA advocacy, email Director of Advocacy Pooja A. Patel at papatel308@gmail.com.