SB 2294

Abstract

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan that offers a program for wellness coverage must not provide a total incentive that exceeds 30% (rather than 20%) of the cost of self-only or employee-only coverage (rather than only employee-only coverage). Provides that the incentive may be increased by up to an additional 20%, for a total incentive of 50%, to the extent that the additional percentage is in connection with a program designed to prevent or reduce tobacco use. Amends the Navigator Certification Act. Provides that certified application counselors are subject to the same certification requirements as navigators. Provides that navigators or certified application counselors may not engage in any unfair method of competition or any fraudulent, deceptive, or dishonest act or practice related to the health insurance marketplace or to that individual's or entity's absence of a conflict of interest in connection with the enrollment of any individuals or employees in a particular private health benefit plan. Provides that a navigator or certified application counselor who fails to timely file for certificate renewal shall be charged a late fee in an amount prescribed by the Director of Insurance. Revises the meaning of the terms "certified application counselor" and "navigator". Makes other changes. Effective immediately. House Committee Amendment No. 1 Deletes reference to: 215 ILCS 5/356z.17 215 ILCS 121/5 215 ILCS 121/10 215 ILCS 121/15 215 ILCS 121/30 215 ILCS 121/35 215 ILCS 121/45 215 ILCS 121/20 rep. 215 ILCS 121/25 rep. 215 ILCS 121/40 rep. Adds reference to: 215 ILCS 5/1 from Ch. 73, par. 613 Replaces everything after the enacting clause. Amends the Illinois Insurance Code. Makes a technical change in a Section concerning the short title. House Floor Amendment No. 2 Deletes reference to: 215 ILCS 5/356z.17 215 ILCS 121/5 215 ILCS 121/10 215 ILCS 121/15 215 ILCS 121/30 215 ILCS 121/35 215 ILCS 121/45 215 ILCS 121/20 rep. 215 ILCS 121/25 rep. 215 ILCS 121/40 rep. Adds reference to: New Act 305 ILCS 5/5-5f 305 ILCS 5/5-41 new 305 ILCS 5/5-8 from Ch. 23, par. 5-8 20 ILCS 2205/2205-35 new 305 ILCS 5/5-5.4k new 5 ILCS 100/5-45.8 new 215 ILCS 106/6 new 215 ILCS 170/6 new 305 ILCS 5/5-1.5 305 ILCS 5/5-2 from Ch. 23, par. 5-2 305 ILCS 5/11-4.2 new 305 ILCS 5/11-22d new 305 ILCS 5/11-32 new 305 ILCS 5/12-4.35 305 ILCS 5/5-5 from Ch. 23, par. 5-5 305 ILCS 5/5-5f 305 ILCS 5/5-5 from Ch. 23, par. 5-5 305 ILCS 5/5-42 new 305 ILCS 5/12-4.35 305 ILCS 5/5-5 from Ch. 23, par. 5-5 320 ILCS 40/1 from Ch. 23, par. 6901 320 ILCS 40/6 new 320 ILCS 40/15 from Ch. 23, par. 6915 320 ILCS 40/16 new 320 ILCS 40/20 from Ch. 23, par. 6920 320 ILCS 40/30 rep. 305 ILCS 5/5-19 from Ch. 23, par. 5-19 305 ILCS 5/5-5.01a 20 ILCS 3860/997 new 305 ILCS 5/5-5f 105 ILCS 5/14-15.01 from Ch. 122, par. 14-15.01 305 ILCS 5/5-43 new 305 ILCS 5/5-5.06a new 305 ILCS 5/5-5 from Ch. 23, par. 5-5 305 ILCS 5/5-30.1 Replaces everything after the enacting clause. Creates the Illinois Certified Community Behavioral Health Clinics Act. Requires the Department of Healthcare and Family Services to develop a Comprehensive Statewide Behavioral Health Strategy and to submit this Strategy to the Governor and General Assembly no later than July 1, 2022. Provides that the Strategy shall address key components of current and past legislation as well as current initiatives related to behavioral health services in order to develop a cohesive behavioral health system. Requires the Department to establish, by January 1, 2022, a program for the implementation of certified community behavioral health clinics. Amends the Medical Assistance Article of the Illinois Public Aid Code. Contains provisions concerning inpatient hospitalization for opioid-related overdose or withdrawal patients; services provided by licensed clinical professional counselors and marriage and family therapists; payments for long-acting injectable medications for mental health or substance use disorders; medical assistance benefits for persons determined eligible during the COVID-19 public health emergency; medical assistance coverage for services performed by a chiropractic physician, including, but not limited to, chiropractic manipulative treatment; medical assistance coverage for federally approved tobacco cessation medications and for tobacco cessation counseling services and medications provided through the Illinois Tobacco Quitline; medical assistance coverage for noncitizens for immunosuppressive drugs and related services associated with post-kidney transplant management, excluding long-term care costs; hospital reimbursements for immunizations; supplemental per diem rates for supportive living facilities; a supports waiver program for young adults with developmental disabilities; prior approval for wheelchair repairs; increased funding for dental services; and other matters. Removes a provision that requires the Department of Healthcare and Family Services to post the contracted claims report required by HealthChoice Illinois on its website every 3 months. In a provision requiring vendor payment claims to be received by the Department of Healthcare and Family Services within a specified time period, provides an exception to the filing deadline in cases established by Department rule. Provides that subject to federal approval, children younger than 19 with income at or below 313% of the federal poverty level shall be eligible for medical assistance. Grants the Department of Healthcare and Family Services emergency rulemaking authority. Provides that those provisions under the Illinois Public Aid Code that grant the Department of Healthcare and Family Services the authority to recover the value of health care benefits provided to a recipient under the Children's Health Insurance Program Act or the Covering ALL KIDS Health Insurance Act shall remain in force as to those causes of actions that accrued prior to the date upon which the Children's Health Insurance Program Act or the Covering ALL KIDS Health Insurance Act become inoperative. Permits the Department to forgive, compromise, or reduce any debt owed by a former or current recipient of medical assistance under the Illinois Public Aid Code or health care benefits under the Children's Health Insurance Program or the Covering ALL KIDS Health Insurance Program. Amends the Children's Health Insurance Program Act and the Covering ALL KIDS Health Insurance Act. Makes the Acts inoperative if (i) the Department of Healthcare and Family Services receives federal approval to make children younger than 19 who have countable income at or below 313% of the federal poverty level eligible for medical assistance under the Illinois Public Aid Code and (ii) the Department, upon federal approval, transitions children eligible for health care benefits under the Acts into the medical assistance program. Amends the Department of Healthcare and Family Services Law. Requires the Department of Healthcare and Family Services to recognize veteran support specialists who are certified by, and in good standing with, the Illinois Alcohol and Other Drug Abuse Professional Certification Association, Inc. as mental health professionals as defined in the Illinois Title XIX State Plan and in the Illinois Administrative Code. Amends the All-Inclusive Care for the Elderly Act. Changes the name of the Act to the "Program of All-Inclusive Care for the Elderly Act". Requires the Department of Healthcare and Family Services to prepare and submit a PACE State Plan amendment no later than December 31, 2022 to the federal Centers for Medicare and Medicaid Services to establish the Program of All-Inclusive Care for the Elderly (PACE program) to provide community-based, risk-based, and capitated long-term care services as optional services under the Illinois Title XIX State Plan and under contracts entered into between the federal Centers for Medicare and Medicaid Services, the Department of Healthcare and Family Services, and PACE organizations. Amends the Illinois Health Information Exchange and Technology Act. Changes the repeal date for the Act to January 1, 2027 (rather than January 1, 2022). Amends the Children with Disabilities Article of the School Code. Provides that the Community and Residential Services Authority shall have the power and duty to establish a pilot program to act as a residential research hub to research and identify appropriate residential settings for youth who are being housed in an emergency room for more than 72 hours or who are deemed beyond medical necessity in a psychiatric hospital. Provides that if a child is deemed beyond medical necessity in a psychiatric hospital and is in need of residential placement, the goal of the program is to prevent a lock-out pursuant to the goals of the Custody Relinquishment Prevention Act. Provides that the Executive Director of the Authority or his or her designee shall be added as a participant on the Interagency Clinical Team established in the intergovernmental agreement among the Department of Healthcare and Family Services, the Department of Children and Family Services, the Department of Human Services, the State Board of Education, the Department of Juvenile Justice, and the Department of Public Health, with consent of the youth or the youth's guardian or family pursuant to the Custody Relinquishment Prevention Act. Effective immediately. House Floor Amendment No. 3 Deletes reference to: (305 ILCS 5/5-5 Further amends the Medical Assistance Article of the Illinois Public Aid Code. Removes the language added by House Amendment No. 2 concerning inpatient admissions for persons experiencing opioid-related overdose or withdrawal and instead provides that the Department of Healthcare and Family Services shall ensure that patients, whether enrolled under the Medical Assistance Fee For Service program or enrolled with a Medicaid Managed Care Organization, experiencing opioid-related overdose or withdrawal are admitted on an inpatient status and the provider shall be reimbursed accordingly, when deemed medically necessary, as determined by either the patient's primary care physician, or the physician or other practitioner responsible for the patient's care at the hospital to which the patient presents, using criteria established by the American Society of Addiction Medicine. Provides that if it is determined by the physician or other practitioner responsible for the patient's care at the hospital to which the patient presents, that a patient does not meet medical necessity criteria for admission, then the patient may be treated via observation and the provider shall seek reimbursement accordingly. Provides that nothing shall diminish the requirements of a provider to document medical necessity in the patient's record. Removes the language added by House Amendment No. 2 concerning payments for long-acting injectable medications for mental health or substance use disorders and instead provides that, effective for dates of service on and after January 1, 2022, the medical assistance program shall separately reimburse at the prevailing fee schedule, for long-acting injectable medications administered for mental health or substance use disorder in the hospital inpatient setting, and which are compliant with prior authorization requirements. Provides that the Department of Healthcare and Family Services, in consultation with a statewide association representing a majority of hospitals and managed care organizations shall implement, by rule, reimbursement policy and prior authorization criteria for the use of long-acting injectable medications administered in the hospital inpatient setting for the treatment of mental health disorders. Makes a technical change in a provision concerning payments for long-acting injectable medications for mental health or substance use disorders. Removes language authorizing the Department of Healthcare and Family Services to establish, by rule, exemptions to the filing deadline for vendor payments.