Bill > SB3365

Introduced Session

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides medical assistance coverage for sickle cell disease (rather than sickle cell anemia); coverage for seizure detection devices; and coverage for virtual intensive outpatient program services. Establishes the Distressed Hospital Loan Program under a new Article of the Code to provide interest-free cash flow loans to public hospitals and not-for-profit hospitals in significant financial distress to prevent the closure of or to facilitate the reopening of those hospitals. Requires the Department of Healthcare and Family Services to administer the Distressed Hospital Loan Program in coordination with the Department of Public Health and the Governor's Office of Management and Budget. Amends the Rebuild Illinois Mental Health Workforce Act. Provides that, subject to federal approval, for dates of service on and after July 1, 2026, the Medicaid reimbursement rates for Assertive Community Treatment and Community Support Team services shall be increased by an amount no less than the following targeted pools: (1) Assertive Community Treatment, $10,600,000; and (2) Community Support Team services, $17,500,000. Amends the Hospital Licensing Act. Requires any licensed hospital that has outstanding debts to the State in the form of tax arrears or that maintains debt through the Distressed Hospital Loan Program or other Medicaid advance payments to submit to the Department of Public Health a hospital emergency and financial contingency plan for the rapid and orderly resolution of finances and operations in the event of material financial distress. Amends the Illinois Administrative Procedure Act. Permits the Department of Healthcare and Family Services to adopt emergency rules to implement certain financial and utilization data reporting requirements on hospitals. Amends the Medicaid Technical Assistance Act. Amends the State Finance Act. Requires the Medicaid Technical Assistance Center to collaborate with public and private partners throughout the State to identify, establish, and maintain best practices necessary for health providers to ensure their capacity to participate in the Illinois Medical Assistance Program (rather than ensure their capacity to participate in HealthChoice Illinois or YouthCare). Removes provisions concerning the Medicaid Technical Assistance Center's administration of network adequacy reports, and instead requires the Medicaid Technical Assistance Center to administer a network requirement plan. Repeals a provision creating the Medicaid Technical Assistance Center Fund. In the State Finance Act, provides for the dissolution of the Medicaid Technical Assistance Center Fund on July 1, 2026, or as soon thereafter as practical, after the transfer of all remaining funds into the Healthcare Provider Relief Fund. Amends the Hospital Services Trust Fund Article in the Illinois Public Aid Code. In provisions concerning annual funding for the health care transformation program, provides that funds that had been budgeted but unexpended in State fiscal years 2021 through 2027 may be allocated in State fiscal year 2028 in an amount not to exceed $150,000,000. Amends the Administration Article of the Illinois Public Aid Code. Provides that disbursements shall be made from the Public Aid Recoveries Trust Fund for the payment of contingency fees to third-party entities that the Office of Inspector General authorizes to conduct payment recapture audits and other specified audits under the medical assistance program. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for dates of service starting July 1, 2027, reimbursement calculations and direct payments for services provided by facilities licensed under the ID/DD Community Care Act are the responsibility of the Department of Healthcare and Family Services; and that appropriations for facilities licensed under the ID/DD Community Care Act must be shifted from the Department of Human Services to the Department of Healthcare and Family Services. Extends the period of eligibility within which a hospital, that would have qualified for the rate year beginning October 1, 2011 or October 1, 2012, shall be a Safety-Net Hospital. Amends the Hospital Licensing Act. Removes provisions requiring the Department on Aging to adopt rules to address instances when a case coordination unit is unable to complete an assessment in a hospital prior to the discharge of a patient 60 years or older to a nursing home to ensure that the patient is able to access nursing home care, the nursing home is not penalized for accepting the admission, and the patient's timely discharge from the hospital is not delayed, to the extent permitted under federal law or regulation. Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning prenatal and perinatal care, provides that, for dates of service on and after January 1, 2026, the medical assistance program shall provide coverage, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement, for preeclampsia biomarker testing for predictive screening in asymptomatic individuals, or for diagnosis and management when symptoms are present. Amends the Illinois Act on the Aging. Provides that effective July 1, 2026, subject to federal approval, the Department on Aging shall reimburse Care Coordination Units at specified rates for case management services. Amends the Specialized Mental Health Rehabilitation Act of 2013. Provides that each consumer shall be offered at least 15 hours of treatment programming per week and encouraged to attend the treatment domains that meet the consumer's needs, as reflected in the consumer's treatment plans. Amends the Community-Integrated Living Arrangements Licensure and Certification Act. In provisions concerning per diem reimbursement for a community-integrated living arrangement provider, provides that, if it is determined by third-party medical personnel that a resident that required a medical absence is unable to return to the community-integrated living arrangement, or if the resident dies during the medical absence, the provider shall receive 100% of the per diem reimbursement for up to 20 medical absence days. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, beginning on and after October 1, 2026, for rate year 2027 and thereafter, the Medicaid inpatient utilization rate used in the determination of eligibility for inpatient adjustment payments provided under the Code shall be modified to exclude from both the numerator and denominator all days of care funded by the U.S. Department of Veterans Affairs at a hospital approved to conduct its operations from more than one location within contiguous counties under a single license, if at the time of its licensing application the hospital was located in a county with fewer than 125,000 inhabitants and the hospital's second facility is located in a contiguous county with fewer than 235,000 inhabitants. Amends the Illinois Act on the Aging. Provides that within 30 days after the effective date of the amendatory Act, rates for adult day services shall be increased to $17.84 per hour and rates for each way transportation services for adult day services shall be increased to $13.44 per unit transportation. Amends the Hospital Services Trust Fund Article of the Illinois Public Aid Code. Makes changes to provisions concerning certain add-on payments to safety-net hospitals. Amends the Illinois Public Aid Code. Changes certain deadline dates for adopting permanent rules on guidelines related to the publication of MCO service authorization policies and procedures listed on the Medicare Inpatient Only list that, due to medical complexity, must be reimbursed under the applicable inpatient methodology. Makes changes to provisions concerning (i) quality and compliance audits regarding Medicaid managed care organizations' compliance with nationally recognized clinical decision guidelines for inpatient and outpatient hospital services and (ii) an analysis that compares and contrasts a Medicaid MCO's service authorization determination outcomes for inpatient and outpatient hospital services to the outcomes of each other MCO plan and the State's fee-for-service program model. Makes other changes. Amends the Psychiatric Residential Treatment Facilities (PRTF) Act. Extends the date by which the Department of Healthcare and Family Services shall submit a State Plan Amendment to establish coverage of federally authorized, medically necessary inpatient psychiatric services delivered by a certified PRTF to medical assistance beneficiaries under 21 years of age. Extends the publication deadline for the Department's PRTF capacity analysis. Amends the Illinois Insurance Code. In provisions requiring the Department of Insurance to issue a joint report with the Department of Healthcare and Family Services on the methodology the Departments use to check for compliance with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, changes the reporting deadline date to March 1 (rather than January 1) of each year, beginning in calendar year 2027; and requires the Departments to post the report on their websites. Amends the Medicare-Medicaid Alignment Initiative (MMAI) Nursing Home Residents' Managed Care Rights Law of the Illinois Public Aid Code. Provides that the Article applies to a fully integrated dual eligible special needs plan and any managed care plan for persons who are dually eligible for Medicare and Medicaid. Amends the Nursing Home Care Act. Adds an Article that creates a framework that encourages the construction and operation of skilled nursing facilities that are consistent with State and federal laws and referred to as "cottage style". Amends the Medical Assistance Article of the Illinois Public Aid Code by adding provisions requiring a per diem add on for cottage style nursing homes. Extends the period of eligibility within which a hospital shall be a Safety-Net Hospital if the hospital would have qualified for (i) the rate year beginning October 1, 2011 or October 1, 2012 or (ii) the rate year beginning October 1, 2020, if the hospital was also designated a federal rural referral center. Contains provisions limiting non-citizens eligibility for medical assistance based on federal requirements under Public Law 119-21. Contains provisions on eligibility redeterminations; the duration of retroactive eligibility; emergency rule authority; coverage for proteomic blood tests; MCO behavioral health post-payment reviews; supportive living dementia care services; and other matters. Amends the Specialized Mental Health Rehabilitation Act of 2013. Adds provisions concerning payments to specialized mental health rehabilitation facilities for improving the quality of life and the quality of care of residents; payment rates, beginning January 1, 2027, for facilities with 100 licensed beds to 130 licensed beds; and forensic add-on payments. Amends the Nursing Home Care Act. Contains provisions concerning annual training requirements for facility staff based on the most recurrent citations as specified by the Department of Public Health; rules on monetary penalties for non-compliance with certain requirements; and other matters. Amends the Medical Assistance Article of the Illinois Public Aid Code by adding provisions concerning per diem rate increases based on a facility's STRIVE staffing levels; the enforcement of advance payment agreements; and other matters. Effective immediately, except some provisions take effect July 1, 2026 and some provisions take effect July 1, 2027.

AI Summary

Committee Categories

Omar Aquino (D)*,  Anna Moeller (D)*,  Elgie Sims (D),  Rachel Ventura (D), 

Sent to the Governor (on 06/10/2026)

Taxonomy

Official Document