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Illinois Focus

The Illinois legislature passed 664 bills through both houses for eventual consideration by Governor Pritzker. As of July 19, 563 bills are pending governor action. In Illinois, the General Assembly has 30 calendar days after bill passage to send it to the governor. The governor has 60 days to act, or the bill will automatically become law. Bills passed prior to June 1 that do not provide for an effective date become effective on January 1 of the following year.

Illinois received an upgrade to its bond rating on July 8 due to its improved financial condition. It is the second upgrade the state received as it neared “junk” status. Earlier this year, Illinois achieved a 30-day payment cycle after years of financial issues.

On July 19, Governor Pritzker announced he will run for reelection in 2022. Lieutenant Juliana Stratton will stay on as his running mate.

Telehealth

House Bill 3308 passed unanimously in the Illinois House and Senate and was signed into law by Governor Pritzker on July 22. In its passage, Illinois became one of a handful of states to enact a telehealth law requiring both coverage and reimbursement levels equal to in-person care.

The legislation enhances existing law by codifying telehealth coverage and payment parity with in-person services for state-regulated individual and group commercial health insurance policies. Commercial providers must cover clinically appropriate, medically necessary telehealth services, e-visits, and virtual check-ins rendered by a healthcare professional in the same manner as any other benefits covered under the policy. Insurers may provide reimbursement to a facility that serves as an originating site (facility fee) and may provide coverage of remote patient monitoring. Insurers must reimburse in-network healthcare professionals and facilities on the same basis, in the same manner, and at the same reimbursement rate that would apply to in-person services. It does not preclude insurers and providers from voluntarily negotiating alternate reimbursement rates for telehealth services, as long as any agreed upon rates account for ongoing provider investments in telehealth platforms. A five-year sunset clause of the reimbursement mandate is included. Mental health and substance use disorder telehealth services are excluded from the sunset. 

The legislation clarified and broadened existing patient and provider protections. Insurers are prohibited from requiring in-person contact between a provider and a patient prior to the provision of telehealth (excludes e-visits and virtual check-ins); requiring patients, providers, or facilities to demonstrate a hardship or access barrier to an in-person visit; and requiring telehealth services when a patient’s provider has determined it is not appropriate or when a patient chooses in-person care. Additionally, insurers are prohibited from requiring a healthcare professional to be physically present in the same room as a patient receiving the telehealth service and cannot create geographic or facility restrictions for telehealth services.

Medicaid

Illinois’ 2022 budget repeals the 3.5% hospital cuts from the 2012 SMART Act and restored the funding for dates of services on or after July 1, 2021. IHA estimates the rate cuts cost hospitals over $800 million since enactment and will increase Medicaid funding for hospital services by approximately $175 million per year.

Senate Bill 2006 sought to reform specific policies and practices of the Illinois Managed Care Organizations and state-regulated commercial health plans. It proposed practical reforms to reduce administrative burden and red tape that serve as barriers to care for Medicaid beneficiaries enrolled in MCOs. The Illinois Hospital Association agreed to hold the bill after obtaining key concessions as part of negotiations with Healthcare and Family Services (HFS). HFS has since posted to its website a current version of its master contract with the MCOs, including amendments, and managed care program policies issued to the MCOs since the contract was issued in 2018. Prior to this agreement, hospitals did not have access to most of these documents.

Senate Bill 2294 makes multiple changes to Illinois’ Medicaid program to help address health disparities. The bipartisan legislation provides continued Medicaid eligibility through the COVID-19 Public Health Emergency (PHE) and up to 12 months after the PHE expires regardless of whether federally required or funded. Additionally, the bill provides coverage for Medicaid whole-health programs, veteran support specialists, individual and group programs for tobacco cessation programs, and an expansion of mental health resources. Governor Pritzker signed the bill into law on July 6, 2021.

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Page updated 08/25/2021

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