Rep. Camille Y. Lilly

Filed: 1/10/2021

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 5548

2    AMENDMENT NO. ______. Amend House Bill 5548 by replacing
3everything after the enacting clause with the following:
 
4
"Title I. General Provisions

 
5
Article 1.

 
6    Section 1-1. This Act may be referred to as the Illinois
7Health Care and Human Service Reform Act.
 
8    Section 1-5. Findings.
9    "We, the People of the State of Illinois - grateful to
10Almighty God for the civil, political and religious liberty
11which He has permitted us to enjoy and seeking His blessing
12upon our endeavors - in order to provide for the health, safety
13and welfare of the people; maintain a representative and
14orderly government; eliminate poverty and inequality; assure

 

 

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1legal, social and economic justice; provide opportunity for the
2fullest development of the individual; insure domestic
3tranquility; provide for the common defense; and secure the
4blessings of freedom and liberty to ourselves and our posterity -
5 do ordain and establish this Constitution for the State of
6Illinois."
7    The Illinois Legislative Black Caucus finds that, in order
8to improve the health outcomes of Black residents in the State
9of Illinois, it is essential to dramatically reform the State's
10health and human service system. For over 3 decades. multiple
11health studies have found that health inequities at their very
12core are due to racism. As early as 1998 research demonstrated
13that Black Americans received less health care than white
14Americans because doctors treated patients differently on the
15basis of race. Yet, Illinois' health and human service system
16disappointingly continues to perpetuate health disparities
17among Black Illinoisans of all ages, genders, and socioeconomic
18status.
19    In July 2020, Trinity Health announced its plans to close
20Mercy Hospital, an essential resource serving the Chicago South
21Side's predominantly Black residents. Trinity Health argued
22that this closure would have no impact on health access but
23failed to understand the community's needs. Closure of Mercy
24Hospital would only serve to create a health access desert and
25exacerbate existing health disparities. On December 15, 2020,
26after hearing from community members and advocates, the Health

 

 

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1Facilities and Services Review Board unanimously voted to deny
2closure efforts, yet Trinity still seeks to cease Mercy's
3operations.
4    Prior to COVID-19, much of the social and political
5attention surrounding the nationwide opioid epidemic focused
6on the increase in overdose deaths among white, middle-class,
7suburban and rural users; the impact of the epidemic in Black
8communities was largely unrecognized. Research has shown rates
9of opioid use at the national scale are higher for whites than
10they are for Blacks, yet rates of opioid deaths are higher
11among Blacks (43%) than whites (22%). The COVID-19 pandemic
12will likely exacerbate this situation due to job loss,
13stay-at-home orders, and ongoing mitigation efforts creating a
14lack of physical access to addiction support and harm reduction
15groups.
16    In 2018, the Illinois Department of Public Health reported
17that Black women were about 6 times as likely to die from a
18pregnancy-related cause as white women. Of those, 72% of
19pregnancy-related deaths and 93% of violent
20pregnancy-associated deaths were deemed preventable. Between
212016 and 2017, Black women had the highest rate of severe
22maternal morbidity with a rate of 101.5 per 10,000 deliveries,
23which is almost 3 times as high as the rate for white women.
24    In the City of Chicago, African American and Latinx
25populations are suffering from higher rates of AIDS/HIV
26compared to the general population. Recent data places HIV as

 

 

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1one of the top 5 leading causes of death in African American
2women between the ages of 35 to 44 and the seventh ranking
3cause in African American women between the ages of 20 to 34.
4Among the Latinx population, nearly 20% with HIV exclusively
5depend on indigenous-led and staffed organizations for
6services.
7    Cardiovascular disease (CVD) accounts for more deaths in
8Illinois than any other cause of death, according to the
9Illinois Department of Public Health; CVD is the leading cause
10of death among Black residents. According to the Kaiser Family
11Foundation (KFF), for every 100,000 people, 224 Black
12Illinoisans die of CVD compared to 158 white Illinoisans.
13Cancer, the second leading cause of death in Illinois, too is
14pervasive among African Americans. In 2019, an estimated
15606,880 Americans, or 1,660 people a day, died of cancer; the
16American Cancer Society estimated 24,410 deaths occurred in
17Illinois. KFF estimates that, out of every 100,000 people, 191
18Black Illinoisans die of cancer compared to 152 white
19Illinoisans.
20    Black Americans suffer at much higher rates from chronic
21diseases, including diabetes, hypertension, heart disease,
22asthma, and many cancers. Utilizing community health workers in
23patient education and chronic disease management is needed to
24close these health disparities. Studies have shown that
25diabetes patients in the care of a community health worker
26demonstrate improved knowledge and lifestyle and

 

 

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1self-management behaviors, as well as decreases in the use of
2the emergency department. A study of asthma control among black
3adolescents concluded that asthma control was reduced by 35%
4among adolescents working with community health workers,
5resulting in a savings of $5.58 per dollar spent on the
6intervention. A study of the return on investment for community
7health workers employed in Colorado showed that, after a
89-month period, patients working with community health workers
9had an increased number of primary care visits and a decrease
10in urgent and inpatient care. Utilization of community health
11workers led to a $2.38 return on investment for every dollar
12invested in community health workers.
13    Adverse childhood experiences (ACEs) are traumatic
14experiences occurring during childhood that have been found to
15have a profound effect on a child's developing brain structure
16and body which may result in poor health during a person's
17adulthood. ACEs studies have found a strong correlation between
18the number of ACEs and a person's risk for disease and negative
19health behaviors, including suicide, depression, cancer,
20stroke, ischemic heart disease, diabetes, autoimmune disease,
21smoking, substance abuse, interpersonal violence, obesity,
22unplanned pregnancies, lower educational achievement,
23workplace absenteeism, and lower wages. Data also shows that
24approximately 20% of African American and Hispanic adults in
25Illinois reported 4 or more ACEs, compared to 13% of
26non-Hispanic whites. Long-standing ACE interventions include

 

 

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1tools such as trauma-informed care. Trauma-informed care has
2been promoted and established in communities across the country
3on a bipartisan basis, including in the states of California,
4Florida, Massachusetts, Missouri, Oregon, Pennsylvania,
5Washington, and Wisconsin. Several federal agencies have
6integrated trauma-informed approaches in their programs and
7grants which should be leveraged by the State.
8    According to a 2019 Rush University report, a Black
9person's life expectancy on average is less when compared to a
10white person's life expectancy. For instance, when comparing
11life expectancy in Chicago's Austin neighborhood to the Chicago
12Loop, there is a difference of 11 years between Black life
13expectancy (71 years) and white life expectancy (82 years).
14    In a 2015 literature review of implicit racial and ethnic
15bias among medical professionals, it was concluded that there
16is a moderate level of implicit bias in most medical
17professionals. Further, the literature review showed that
18implicit bias has negative consequences for patients,
19including strained patient relationships and negative health
20outcomes. It is critical for medical professionals to be aware
21of implicit racial and ethnic bias and work to eliminate bias
22through training.
23    In the field of medicine, a historically racist profession,
24Black medical professionals have commonly been ostracized. In
251934, Dr. Roland B. Scott was the first African American to
26pass the pediatric board exam, yet when he applied for

 

 

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1membership with the American Academy of Pediatrics he was
2rejected multiple times. Few medical organizations have
3confronted the roles they played in blocking opportunities for
4Black advancement in the medical profession until the formal
5apologies of the American Medical Association in 2008. For
6decades, organizations like the AMA predicated their
7membership on joining a local state medical society, several of
8which excluded Black physicians.
9    In 2010, the General Assembly, in partnership with
10Treatment Alternatives for Safe Communities, published the
11Disproportionate Justice Impact Study. The study examined the
12impact of Illinois drug laws on racial and ethnic groups and
13the resulting over-representation of racial and ethic minority
14groups in the Illinois criminal justice system. Unsurprisingly
15and disappointingly, the study confirmed decades long
16injustices, such as nonwhites being arrested at a higher rate
17than whites relative to their representation in the general
18population throughout Illinois.
19    All together, the above mentioned only begins to capture a
20part of a larger system of racial injustices and inequities.
21The General Assembly and the people of Illinois are urged to
22recognize while racism is a core fault of the current health
23and human service system, that it is a pervasive disease
24affecting a multiplitude of institutions which truly drive
25systematic health inequities: education, child care, criminal
26justice, affordable housing, environmental justice, and job

 

 

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1security and so forth. For persons to live up to their full
2human potential, their rights to quality of life, health care,
3a quality job, a fair wage, housing, and education must not be
4inhibited.
5    Therefore, the Illinois Legislative Black Caucus, as
6informed by the Senate's Health and Human Service Pillar
7subject matter hearings, seeks to remedy a fraction of a much
8larger broken system by addressing access to health care,
9hospital closures, managed care organization reform, community
10health worker certification, maternal and infant mortality,
11mental and substance abuse treatment, hospital reform, and
12medical implicit bias in the Illinois Health Care and Human
13Service Reform Act. This Act shall achieve needed change
14through the use of, but not limited to, the Medicaid Managed
15Care Oversight Commission, the Health and Human Services Task
16Force, and a hospital closure moratorium, in order to address
17Illinois' long-standing health inequities.
 
18
Title II. Community Health Workers

 
19
Article 5.

 
20    Section 5-1. Short title. This Article may be cited as the
21Community Health Worker Certification and Reimbursement Act.
22References in this Article to "this Act" mean this Article.
 

 

 

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1    Section 5-5. Definition. In this Act, "community health
2worker" means a frontline public health worker who is a trusted
3member or has an unusually close understanding of the community
4served. This trusting relationship enables the community
5health worker to serve as a liaison, link, and intermediary
6between health and social services and the community to
7facilitate access to services and improve the quality and
8cultural competence of service delivery. A community health
9worker also builds individual and community capacity by
10increasing health knowledge and self-sufficiency through a
11range of activities, including outreach, community education,
12informal counseling, social support, and advocacy. A community
13health worker shall have the following core competencies:
14        (1) communication;
15        (2) interpersonal skills and relationship building;
16        (3) service coordination and navigation skills;
17        (4) capacity-building;
18        (5) advocacy;
19        (6) presentation and facilitation skills;
20        (7) organizational skills; cultural competency;
21        (8) public health knowledge;
22        (9) understanding of health systems and basic
23    diseases;
24        (10) behavioral health issues; and
25        (11) field experience.
26    Nothing in this definition shall be construed to authorize

 

 

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1a community health worker to provide direct care or treatment
2to any person or to perform any act or service for which a
3license issued by a professional licensing board is required.
 
4    Section 5-10. Community health worker training.
5    (a) Community health workers shall be provided with
6multi-tiered academic and community-based training
7opportunities that lead to the mastery of community health
8worker core competencies.
9    (b) For academic-based training programs, the Department
10of Public Health shall collaborate with the Illinois State
11Board of Education, the Illinois Community College Board, and
12the Illinois Board of Higher Education to adopt a process to
13certify academic-based training programs that students can
14attend to obtain individual community health worker
15certification. Certified training programs shall reflect the
16approved core competencies and roles for community health
17workers.
18    (c) For community-based training programs, the Department
19of Public Health shall collaborate with a statewide association
20representing community health workers to adopt a process to
21certify community-based programs that students can attend to
22obtain individual community health worker certification.
23    (d) Community health workers may need to undergo additional
24training, including, but not limited to, asthma, diabetes,
25maternal child health, behavioral health, and social

 

 

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1determinants of health training. Multi-tiered training
2approaches shall provide opportunities that build on each other
3and prepare community health workers for career pathways both
4within the community health worker profession and within allied
5professions.
 
6    Section 5-15. Illinois Community Health Worker
7Certification Board.
8    (a) There is created within the Department of Public
9Health, in shared leadership with a statewide association
10representing community health workers, the Illinois Community
11Health Worker Certification Board. The Board shall serve as the
12regulatory body that develops and has oversight of initial
13community health workers certification and certification
14renewals for both individuals and academic and community-based
15training programs
16    (b) A representative from the Department of Public Health,
17the Department of Financial and Professional Regulation and the
18Department of Healthcare and Family Services shall serve on the
19Board. At least one full-time professional shall be assigned to
20staff the Board with additional administrative support
21available as needed. The Board shall have balanced
22representation from the community health worker workforce,
23community health worker employers, community health worker
24training and educational organizations, and other engaged
25stakeholders.

 

 

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1    (c) The Board shall propose a certification process for and
2be authorized to approve training from community-based
3organizations, in conjunction with a statewide organization
4representing community health workers, and academic
5institutions, in consultation with the Illinois State Board of
6Education, the Illinois Community College Board and the
7Illinois Board of Higher Education. The Board shall base
8training approval on core competencies, best practices, and
9affordability. In addition, the Board shall maintain a registry
10of certification records for individually certified community
11health workers.
12    (d) All training programs that are deemed certifiable by
13the Board shall go through a renewal process, which will be
14determined by the Board once established. The Board shall
15establish criteria to grandfather in any community health
16workers who were practicing prior to the establishment of a
17certification program.
 
18    Section 5-20. Reimbursement. Community health worker
19services shall be covered under the medical assistance program
20for persons who are otherwise eligible for medical assistance.
21The Department of Healthcare and Family Services shall develop
22services, including but not limited to, care coordination and
23diagnostic-related patient education services, for which
24community health workers will be eligible for reimbursement and
25shall submit a State Plan Amendment (SPA) to the Centers for

 

 

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1Medicare and Medicaid Services (CMS) to amend the agreement
2between Illinois and the Federal government to include
3community health workers as practitioners under Medicaid.
4Certification shall not be required for reimbursement. In
5addition, the Department of Healthcare and Family Services
6shall amend its contracts with managed care entities to allow
7managed care entities to employ community health workers or
8subcontract with community-based organizations that employ
9community health workers.
 
10
Title III. Hospital Reform

 
11
Article 10.

 
12    Section 10-5. The University of Illinois Hospital Act is
13amended by adding Section 12 as follows:
 
14    (110 ILCS 330/12 new)
15    Sec. 12. Credentials and certificates. The University of
16Illinois Hospital shall require an intern, resident, or
17physician who provides medical services at the University of
18Illinois Hospital to have proper credentials and any required
19certificates for ongoing training at the time the intern,
20resident, or physician renews his or her license.
 
21    Section 10-10. The Hospital Licensing Act is amended by

 

 

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1adding Section 10.12 as follows:
 
2    (210 ILCS 85/10.12 new)
3    Sec. 10.12. Credentials and certificates. A hospital
4licensed under this Act shall require an intern, resident, or
5physician who provides medical services at the hospital to have
6proper credentials and any required certificates for ongoing
7training at the time the intern, resident, or physician renews
8his or her license.
 
9    Section 10-15. The Hospital Report Card Act is amended by
10changing Section 25 as follows:
 
11    (210 ILCS 86/25)
12    Sec. 25. Hospital reports.
13    (a) Individual hospitals shall prepare a quarterly report
14including all of the following:
15        (1) Nursing hours per patient day, average daily
16    census, and average daily hours worked for each clinical
17    service area.
18        (2) Infection-related measures for the facility for
19    the specific clinical procedures and devices determined by
20    the Department by rule under 2 or more of the following
21    categories:
22            (A) Surgical procedure outcome measures.
23            (B) Surgical procedure infection control process

 

 

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1        measures.
2            (C) Outcome or process measures related to
3        ventilator-associated pneumonia.
4            (D) Central vascular catheter-related bloodstream
5        infection rates in designated critical care units.
6        (3) Information required under paragraph (4) of
7    Section 2310-312 of the Department of Public Health Powers
8    and Duties Law of the Civil Administrative Code of
9    Illinois.
10        (4) Additional infection measures mandated by the
11    Centers for Medicare and Medicaid Services that are
12    reported by hospitals to the Centers for Disease Control
13    and Prevention's National Healthcare Safety Network
14    surveillance system, or its successor, and deemed relevant
15    to patient safety by the Department.
16        (5) Each instance of preterm birth and infant mortality
17    within the reporting period, including the racial and
18    ethnic information of the mothers of those infants.
19        (6) Each instance of maternal mortality within the
20    reporting period, including the racial and ethnic
21    information of those mothers.
22        (7) The number of female patients who have died within
23    the reporting period.
24        (8) The number of female patients who have died of a
25    preventable cause within the reporting period and the
26    number of those preventable deaths that the hospital has

 

 

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1    otherwise reported within the reporting period.
2        (9) The number of physicians, as that term is defined
3    in the Medical Practice Act of 1987, required by the
4    hospital to undergo any amount or type of retraining during
5    the reporting period.
6    The infection-related measures developed by the Department
7shall be based upon measures and methods developed by the
8Centers for Disease Control and Prevention, the Centers for
9Medicare and Medicaid Services, the Agency for Healthcare
10Research and Quality, the Joint Commission on Accreditation of
11Healthcare Organizations, or the National Quality Forum. The
12Department may align the infection-related measures with the
13measures and methods developed by the Centers for Disease
14Control and Prevention, the Centers for Medicare and Medicaid
15Services, the Agency for Healthcare Research and Quality, the
16Joint Commission on Accreditation of Healthcare Organizations,
17and the National Quality Forum by adding reporting measures
18based on national health care strategies and measures deemed
19scientifically reliable and valid for public reporting. The
20Department shall receive approval from the State Board of
21Health to retire measures deemed no longer scientifically valid
22or valuable for informing quality improvement or infection
23prevention efforts. The Department shall notify the Chairs and
24Minority Spokespersons of the House Human Services Committee
25and the Senate Public Health Committee of its intent to have
26the State Board of Health take action to retire measures no

 

 

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1later than 7 business days before the meeting of the State
2Board of Health.
3    The Department shall include interpretive guidelines for
4infection-related indicators and, when available, shall
5include relevant benchmark information published by national
6organizations.
7    The Department shall collect the information reported
8under paragraphs (5) and (6) and shall use it to illustrate the
9disparity of those occurrences across different racial and
10ethnic groups.
11    (b) Individual hospitals shall prepare annual reports
12including vacancy and turnover rates for licensed nurses per
13clinical service area.
14    (c) None of the information the Department discloses to the
15public may be made available in any form or fashion unless the
16information has been reviewed, adjusted, and validated
17according to the following process:
18        (1) The Department shall organize an advisory
19    committee, including representatives from the Department,
20    public and private hospitals, direct care nursing staff,
21    physicians, academic researchers, consumers, health
22    insurance companies, organized labor, and organizations
23    representing hospitals and physicians. The advisory
24    committee must be meaningfully involved in the development
25    of all aspects of the Department's methodology for
26    collecting, analyzing, and disclosing the information

 

 

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1    collected under this Act, including collection methods,
2    formatting, and methods and means for release and
3    dissemination.
4        (2) The entire methodology for collecting and
5    analyzing the data shall be disclosed to all relevant
6    organizations and to all hospitals that are the subject of
7    any information to be made available to the public before
8    any public disclosure of such information.
9        (3) Data collection and analytical methodologies shall
10    be used that meet accepted standards of validity and
11    reliability before any information is made available to the
12    public.
13        (4) The limitations of the data sources and analytic
14    methodologies used to develop comparative hospital
15    information shall be clearly identified and acknowledged,
16    including but not limited to the appropriate and
17    inappropriate uses of the data.
18        (5) To the greatest extent possible, comparative
19    hospital information initiatives shall use standard-based
20    norms derived from widely accepted provider-developed
21    practice guidelines.
22        (6) Comparative hospital information and other
23    information that the Department has compiled regarding
24    hospitals shall be shared with the hospitals under review
25    prior to public dissemination of such information and these
26    hospitals have 30 days to make corrections and to add

 

 

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1    helpful explanatory comments about the information before
2    the publication.
3        (7) Comparisons among hospitals shall adjust for
4    patient case mix and other relevant risk factors and
5    control for provider peer groups, when appropriate.
6        (8) Effective safeguards to protect against the
7    unauthorized use or disclosure of hospital information
8    shall be developed and implemented.
9        (9) Effective safeguards to protect against the
10    dissemination of inconsistent, incomplete, invalid,
11    inaccurate, or subjective hospital data shall be developed
12    and implemented.
13        (10) The quality and accuracy of hospital information
14    reported under this Act and its data collection, analysis,
15    and dissemination methodologies shall be evaluated
16    regularly.
17        (11) Only the most basic identifying information from
18    mandatory reports shall be used, and information
19    identifying a patient, employee, or licensed professional
20    shall not be released. None of the information the
21    Department discloses to the public under this Act may be
22    used to establish a standard of care in a private civil
23    action.
24    (d) Quarterly reports shall be submitted, in a format set
25forth in rules adopted by the Department, to the Department by
26April 30, July 31, October 31, and January 31 each year for the

 

 

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1previous quarter. Data in quarterly reports must cover a period
2ending not earlier than one month prior to submission of the
3report. Annual reports shall be submitted by December 31 in a
4format set forth in rules adopted by the Department to the
5Department. All reports shall be made available to the public
6on-site and through the Department.
7    (e) If the hospital is a division or subsidiary of another
8entity that owns or operates other hospitals or related
9organizations, the annual public disclosure report shall be for
10the specific division or subsidiary and not for the other
11entity.
12    (f) The Department shall disclose information under this
13Section in accordance with provisions for inspection and
14copying of public records required by the Freedom of
15Information Act provided that such information satisfies the
16provisions of subsection (c) of this Section.
17    (g) Notwithstanding any other provision of law, under no
18circumstances shall the Department disclose information
19obtained from a hospital that is confidential under Part 21 of
20Article VIII of the Code of Civil Procedure.
21    (h) No hospital report or Department disclosure may contain
22information identifying a patient, employee, or licensed
23professional.
24(Source: P.A. 101-446, eff. 8-23-19.)
 
25
Article 15.

 

 

 

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1    Section 15-5. The Hospital Licensing Act is amended by
2adding Section 6.30 as follows:
 
3    (210 ILCS 85/6.30 new)
4    Sec. 6.30. Posting charity care policy, financial
5counselor. A hospital that receives a property tax exemption
6under Section 15-86 of the Property Tax Code must post the
7hospital's charity care policy and the contact information of a
8financial counselor in a reasonably viewable area in the
9hospital's emergency room.
 
10
Article 20.

 
11    Section 20-5. The University of Illinois Hospital Act is
12amended by adding Section 8d as follows:
 
13    (110 ILCS 330/8d new)
14    Sec. 8d. N95 masks. The University of Illinois Hospital
15shall provide N95 masks to all physicians licensed under the
16Medical Practice Act of 1987 and registered nurses and advanced
17practice registered nurses licensed under the Nurse Licensing
18Act if the physician, registered nurse, or advanced practice
19registered nurse is employed by or providing services for
20another employer at the University of Illinois Hospital.
 

 

 

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1    Section 20-10. The Hospital Licensing Act is amended by
2adding Section 6.28 as follows:
 
3    (210 ILCS 85/6.28 new)
4    Sec. 6.28. N95 masks. A hospital licensed under this Act
5shall provide N95 masks to all physicians licensed under the
6Medical Practice Act of 1987 and registered nurses and advanced
7practice registered nurses licensed under the Nurse Licensing
8Act if the physician, registered nurse, or advanced practice
9registered nurse is employed by or providing services for
10another employer at the hospital.
 
11
Article 25.

 
12    Section 25-5. The University of Illinois Hospital Act is
13amended by adding Section 11 as follows:
 
14    (110 ILCS 330/11 new)
15    Sec. 11. Demographic data; release of individuals with
16symptoms of COVID-19. The University of Illinois Hospital shall
17report to the Department of Public Health the demographic data
18of individuals who have symptoms of COVID-19 and are released
19from, not admitted to, the University of Illinois Hospital.
 
20    Section 25-10. The Hospital Licensing Act is amended by
21adding Section 6.31 as follows:
 

 

 

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1    (210 ILCS 85/6.31 new)
2    Sec. 6.31. Demographic data; release of individuals with
3symptoms of COVID-19. A hospital licensed under this Act shall
4report to the Department the demographic data of individuals
5who have symptoms of COVID-19 and are released from, not
6admitted to, the hospital.
 
7
Article 35.

 
8    Section 35-5. The Illinois Public Aid Code is amended by
9changing Section 5-5.05 as follows:
 
10    (305 ILCS 5/5-5.05)
11    Sec. 5-5.05. Hospitals; psychiatric services.
12    (a) On and after July 1, 2008, the inpatient, per diem rate
13to be paid to a hospital for inpatient psychiatric services
14shall be $363.77.
15    (b) For purposes of this Section, "hospital" means the
16following:
17        (1) Advocate Christ Hospital, Oak Lawn, Illinois.
18        (2) Barnes-Jewish Hospital, St. Louis, Missouri.
19        (3) BroMenn Healthcare, Bloomington, Illinois.
20        (4) Jackson Park Hospital, Chicago, Illinois.
21        (5) Katherine Shaw Bethea Hospital, Dixon, Illinois.
22        (6) Lawrence County Memorial Hospital, Lawrenceville,

 

 

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1    Illinois.
2        (7) Advocate Lutheran General Hospital, Park Ridge,
3    Illinois.
4        (8) Mercy Hospital and Medical Center, Chicago,
5    Illinois.
6        (9) Methodist Medical Center of Illinois, Peoria,
7    Illinois.
8        (10) Provena United Samaritans Medical Center,
9    Danville, Illinois.
10        (11) Rockford Memorial Hospital, Rockford, Illinois.
11        (12) Sarah Bush Lincoln Health Center, Mattoon,
12    Illinois.
13        (13) Provena Covenant Medical Center, Urbana,
14    Illinois.
15        (14) Rush-Presbyterian-St. Luke's Medical Center,
16    Chicago, Illinois.
17        (15) Mt. Sinai Hospital, Chicago, Illinois.
18        (16) Gateway Regional Medical Center, Granite City,
19    Illinois.
20        (17) St. Mary of Nazareth Hospital, Chicago, Illinois.
21        (18) Provena St. Mary's Hospital, Kankakee, Illinois.
22        (19) St. Mary's Hospital, Decatur, Illinois.
23        (20) Memorial Hospital, Belleville, Illinois.
24        (21) Swedish Covenant Hospital, Chicago, Illinois.
25        (22) Trinity Medical Center, Rock Island, Illinois.
26        (23) St. Elizabeth Hospital, Chicago, Illinois.

 

 

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1        (24) Richland Memorial Hospital, Olney, Illinois.
2        (25) St. Elizabeth's Hospital, Belleville, Illinois.
3        (26) Samaritan Health System, Clinton, Iowa.
4        (27) St. John's Hospital, Springfield, Illinois.
5        (28) St. Mary's Hospital, Centralia, Illinois.
6        (29) Loretto Hospital, Chicago, Illinois.
7        (30) Kenneth Hall Regional Hospital, East St. Louis,
8    Illinois.
9        (31) Hinsdale Hospital, Hinsdale, Illinois.
10        (32) Pekin Hospital, Pekin, Illinois.
11        (33) University of Chicago Medical Center, Chicago,
12    Illinois.
13        (34) St. Anthony's Health Center, Alton, Illinois.
14        (35) OSF St. Francis Medical Center, Peoria, Illinois.
15        (36) Memorial Medical Center, Springfield, Illinois.
16        (37) A hospital with a distinct part unit for
17    psychiatric services that begins operating on or after July
18    1, 2008.
19    For purposes of this Section, "inpatient psychiatric
20services" means those services provided to patients who are in
21need of short-term acute inpatient hospitalization for active
22treatment of an emotional or mental disorder.
23    (b-5) Notwithstanding any other provision of this Section,
24the inpatient, per diem rate to be paid to all community
25safety-net hospitals for inpatient psychiatric services on and
26after January 1, 2021 shall be at least $630.

 

 

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1    (c) No rules shall be promulgated to implement this
2Section. For purposes of this Section, "rules" is given the
3meaning contained in Section 1-70 of the Illinois
4Administrative Procedure Act.
5    (d) This Section shall not be in effect during any period
6of time that the State has in place a fully operational
7hospital assessment plan that has been approved by the Centers
8for Medicare and Medicaid Services of the U.S. Department of
9Health and Human Services.
10    (e) On and after July 1, 2012, the Department shall reduce
11any rate of reimbursement for services or other payments or
12alter any methodologies authorized by this Code to reduce any
13rate of reimbursement for services or other payments in
14accordance with Section 5-5e.
15(Source: P.A. 97-689, eff. 6-14-12.)
 
16
Title IV. Medical Implicit Bias

 
17
Article 45.

 
18    Section 45-1. Findings. The General Assembly finds and
19declares all of the following:
20    (a) Implicit bias, meaning the attitudes or internalized
21stereotypes that affect our perceptions, actions, and
22decisions in an unconscious manner, exists and often
23contributes to unequal treatment of people based on race,

 

 

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1ethnicity, gender identity, sexual orientation, age,
2disability, and other characteristics.
3    (b) Implicit bias contributes to health disparities by
4affecting the behavior of physicians and surgeons, nurses,
5physician assistants, and other healing arts licensees.
6    (c) African American women are 3 to 4 times more likely
7than white women to die from pregnancy-related causes
8nationwide. African American patients often are prescribed
9less pain medication than white patients who present the same
10complaints. African American patients with signs of heart
11problems are not referred for advanced cardiovascular
12procedures as often as white patients with the same symptoms.
13    (d) Implicit gender bias also impacts treatment decisions
14and outcomes. Women are less likely to survive a heart attack
15when they are treated by a male physician and surgeon. LGBTQ
16and gender-nonconforming patients are less likely to seek
17timely medical care because they experience disrespect and
18discrimination from health care staff, with one out of 5
19transgender patients nationwide reporting that they were
20outright denied medical care due to bias.
21    (e) The General Assembly intends to reduce disparate
22outcomes and ensure that all patients receive fair treatment
23and quality health care.
 
24    Section 45-5. The Medical Practice Act of 1987 is amended
25by changing Section 20 as follows:
 

 

 

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1    (225 ILCS 60/20)  (from Ch. 111, par. 4400-20)
2    (Section scheduled to be repealed on January 1, 2022)
3    Sec. 20. Continuing education.
4    (a) The Department shall promulgate rules of continuing
5education for persons licensed under this Act that require an
6average of 50 hours of continuing education per license year.
7These rules shall be consistent with requirements of relevant
8professional associations, specialty societies, or boards. The
9rules shall also address variances in part or in whole for good
10cause, including, but not limited to, temporary illness or
11hardship. In establishing these rules, the Department shall
12consider educational requirements for medical staffs,
13requirements for specialty society board certification or for
14continuing education requirements as a condition of membership
15in societies representing the 2 categories of licensee under
16this Act. These rules shall assure that licensees are given the
17opportunity to participate in those programs sponsored by or
18through their professional associations or hospitals which are
19relevant to their practice.
20    (b) Except as otherwise provided in this subsection, the
21rules adopted under this Section shall require that, on and
22after January 1, 2022, all continuing education courses for
23persons licensed under this Act contain curriculum that
24includes the understanding of implicit bias. Beginning January
251, 2023, continuing education providers shall ensure

 

 

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1compliance with this Section. Beginning January 1, 2023, the
2Department shall audit continuing education providers at least
3once every 5 years to ensure adherence to regulatory
4requirements and shall withhold or rescind approval from any
5provider that is in violation of the requirements of this
6subsection.
7    A continuing education course dedicated solely to research
8or other issues that does not include a direct patient care
9component is not required to contain curriculum that includes
10implicit bias in the practice of medicine.
11    To satisfy the requirements of this subsection, continuing
12education courses shall address at least one of the following:
13        (1) examples of how implicit bias affects perceptions
14    and treatment decisions, leading to disparities in health
15    outcomes; or
16        (2) strategies to address how unintended biases in
17    decision making may contribute to health care disparities
18    by shaping behavior and producing differences in medical
19    treatment along lines of race, ethnicity, gender identity,
20    sexual orientation, age, socioeconomic status, or other
21    characteristics.
22    (c) Each licensee is responsible for maintaining records of
23completion of continuing education and shall be prepared to
24produce the records when requested by the Department.
25(Source: P.A. 97-622, eff. 11-23-11.)
 

 

 

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1    Section 45-10. The Nurse Practice Act is amended by
2changing Sections 55-35, 60-40, and 65-60 as follows:
 
3    (225 ILCS 65/55-35)
4    (Section scheduled to be repealed on January 1, 2028)
5    Sec. 55-35. Continuing education for LPN licensees.
6    (a) The Department may adopt rules of continuing education
7for licensed practical nurses that require 20 hours of
8continuing education per 2-year license renewal cycle. The
9rules shall address variances in part or in whole for good
10cause, including without limitation illness or hardship. The
11continuing education rules must ensure that licensees are given
12the opportunity to participate in programs sponsored by or
13through their State or national professional associations,
14hospitals, or other providers of continuing education.
15    (b) For license renewals occurring on or after January 1,
162022, all licensed practical nurses must complete at least one
17hour of implicit bias training per 2-year license renewal
18cycle. The Department may adopt rules for the implementation of
19this subsection.
20    (c) Each licensee is responsible for maintaining records of
21completion of continuing education and shall be prepared to
22produce the records when requested by the Department.
23(Source: P.A. 95-639, eff. 10-5-07.)
 
24    (225 ILCS 65/60-40)

 

 

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1    (Section scheduled to be repealed on January 1, 2028)
2    Sec. 60-40. Continuing education for RN licensees.
3    (a) The Department may adopt rules of continuing education
4for registered professional nurses licensed under this Act that
5require 20 hours of continuing education per 2-year license
6renewal cycle. The rules shall address variances in part or in
7whole for good cause, including without limitation illness or
8hardship. The continuing education rules must ensure that
9licensees are given the opportunity to participate in programs
10sponsored by or through their State or national professional
11associations, hospitals, or other providers of continuing
12education.
13    (b) For license renewals occurring on or after January 1,
142022, all registered professional nurses must complete at least
15one hour of implicit bias training per 2-year license renewal
16cycle. The Department may adopt rules for the implementation of
17this subsection.
18    (c) Each licensee is responsible for maintaining records of
19completion of continuing education and shall be prepared to
20produce the records when requested by the Department.
21(Source: P.A. 95-639, eff. 10-5-07.)
 
22    (225 ILCS 65/65-60)   (was 225 ILCS 65/15-45)
23    (Section scheduled to be repealed on January 1, 2028)
24    Sec. 65-60. Continuing education.
25    (a) The Department shall adopt rules of continuing

 

 

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1education for persons licensed under this Article as advanced
2practice registered nurses that require 80 hours of continuing
3education per 2-year license renewal cycle. Completion of the
480 hours of continuing education shall be deemed to satisfy the
5continuing education requirements for renewal of a registered
6professional nurse license as required by this Act.
7    The 80 hours of continuing education required under this
8Section shall be completed as follows:
9        (1) A minimum of 50 hours of the continuing education
10    shall be obtained in continuing education programs as
11    determined by rule that shall include no less than 20 hours
12    of pharmacotherapeutics, including 10 hours of opioid
13    prescribing or substance abuse education. Continuing
14    education programs may be conducted or endorsed by
15    educational institutions, hospitals, specialist
16    associations, facilities, or other organizations approved
17    to offer continuing education under this Act or rules and
18    shall be in the advanced practice registered nurse's
19    specialty.
20        (2) A maximum of 30 hours of credit may be obtained by
21    presentations in the advanced practice registered nurse's
22    clinical specialty, evidence-based practice, or quality
23    improvement projects, publications, research projects, or
24    preceptor hours as determined by rule.
25    The rules adopted regarding continuing education shall be
26consistent to the extent possible with requirements of relevant

 

 

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1national certifying bodies or State or national professional
2associations.
3    (b) The rules shall not be inconsistent with requirements
4of relevant national certifying bodies or State or national
5professional associations. The rules shall also address
6variances in part or in whole for good cause, including but not
7limited to illness or hardship. The continuing education rules
8shall assure that licensees are given the opportunity to
9participate in programs sponsored by or through their State or
10national professional associations, hospitals, or other
11providers of continuing education.
12    (c) For license renewals occurring on or after January 1,
132022, all advanced practice registered nurses must complete at
14least one hour of implicit bias training per 2-year license
15renewal cycle. The Department may adopt rules for the
16implementation of this subsection.
17    (d) Each licensee is responsible for maintaining records of
18completion of continuing education and shall be prepared to
19produce the records when requested by the Department.
20(Source: P.A. 100-513, eff. 1-1-18.)
 
21    Section 45-15. The Physician Assistant Practice Act of 1987
22is amended by changing Section 11.5 as follows:
 
23    (225 ILCS 95/11.5)
24    (Section scheduled to be repealed on January 1, 2028)

 

 

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1    Sec. 11.5. Continuing education.
2    (a) The Department shall adopt rules for continuing
3education for persons licensed under this Act that require 50
4hours of continuing education per 2-year license renewal cycle.
5Completion of the 50 hours of continuing education shall be
6deemed to satisfy the continuing education requirements for
7renewal of a physician assistant license as required by this
8Act. The rules shall not be inconsistent with requirements of
9relevant national certifying bodies or State or national
10professional associations. The rules shall also address
11variances in part or in whole for good cause, including, but
12not limited to, illness or hardship. The continuing education
13rules shall ensure that licensees are given the opportunity to
14participate in programs sponsored by or through their State or
15national professional associations, hospitals, or other
16providers of continuing education.
17    (b) Except as otherwise provided in this subsection, the
18rules adopted under this Section shall require that, on and
19after January 1, 2022, all continuing education courses for
20persons licensed under this Act contain curriculum that
21includes the understanding of implicit bias. Beginning January
221, 2023, continuing education providers shall ensure
23compliance with this Section. Beginning January 1, 2023, the
24Department shall audit continuing education providers at least
25once every 5 years to ensure adherence to regulatory
26requirements and shall withhold or rescind approval from any

 

 

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1provider that is in violation of the regulatory requirements.
2    A continuing education course dedicated solely to research
3or other issues that does not include a direct patient care
4component is not required to contain curriculum that includes
5implicit bias in the practice of medicine.
6    To satisfy the requirements of subsection (a) of this
7Section, continuing education courses shall address at least
8one of the following:
9        (1) examples of how implicit bias affects perceptions
10    and treatment decisions, leading to disparities in health
11    outcomes; or
12        (2) strategies to address how unintended biases in
13    decision making may contribute to health care disparities
14    by shaping behavior and producing differences in medical
15    treatment along lines of race, ethnicity, gender identity,
16    sexual orientation, age, socioeconomic status, or other
17    characteristics.
18    (c) Each licensee is responsible for maintaining records of
19completion of continuing education and shall be prepared to
20produce the records when requested by the Department.
21(Source: P.A. 100-453, eff. 8-25-17.)
 
22
Title V. Substance Abuse and Mental Health Treatment

 
23
Article 50.

 

 

 

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1    Section 50-5. The Illinois Controlled Substances Act is
2amended by changing Section 414 as follows:
 
3    (720 ILCS 570/414)
4    Sec. 414. Overdose; limited immunity from prosecution.
5    (a) For the purposes of this Section, "overdose" means a
6controlled substance-induced physiological event that results
7in a life-threatening emergency to the individual who ingested,
8inhaled, injected or otherwise bodily absorbed a controlled,
9counterfeit, or look-alike substance or a controlled substance
10analog.
11    (b) A person who, in good faith, seeks or obtains emergency
12medical assistance for someone experiencing an overdose shall
13not be arrested, charged, or prosecuted for a violation of
14Section 401 or 402 of the Illinois Controlled Substances Act,
15Section 3.5 of the Drug Paraphernalia Control Act, Section 55
16or 60 of the Methamphetamine Control and Community Protection
17Act, Section 9-3.3 of the Criminal Code of 2012, or paragraph
18(1) of subsection (g) of Section 12-3.05 of the Criminal Code
19of 2012 Class 4 felony possession of a controlled, counterfeit,
20or look-alike substance or a controlled substance analog if
21evidence for the violation Class 4 felony possession charge was
22acquired as a result of the person seeking or obtaining
23emergency medical assistance and providing the amount of
24substance recovered is within the amount identified in
25subsection (d) of this Section. The violations listed in this

 

 

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1subsection (b) must not serve as the sole basis of a violation
2of parole, mandatory supervised release, probation, or
3conditional discharge, a Department of Children and Family
4Services investigation, or any seizure of property under any
5State law authorizing civil forfeiture so long as the evidence
6for the violation was acquired as a result of the person
7seeking or obtaining emergency medical assistance in the event
8of an overdose.
9    (c) A person who is experiencing an overdose shall not be
10arrested, charged, or prosecuted for a violation of Section 401
11or 402 of the Illinois Controlled Substances Act, Section 3.5
12of the Drug Paraphernalia Control Act, Section 9-3.3 of the
13Criminal Code of 2012, or paragraph (1) of subsection (g) of
14Section 12-3.05 of the Criminal Code of 2012 Class 4 felony
15possession of a controlled, counterfeit, or look-alike
16substance or a controlled substance analog if evidence for the
17violation Class 4 felony possession charge was acquired as a
18result of the person seeking or obtaining emergency medical
19assistance and providing the amount of substance recovered is
20within the amount identified in subsection (d) of this Section.
21The violations listed in this subsection (c) must not serve as
22the sole basis of a violation of parole, mandatory supervised
23release, probation, or conditional discharge, a Department of
24Children and Family Services investigation, or any seizure of
25property under any State law authorizing civil forfeiture so
26long as the evidence for the violation was acquired as a result

 

 

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1of the person seeking or obtaining emergency medical assistance
2in the event of an overdose.
3    (d) For the purposes of subsections (b) and (c), the
4limited immunity shall only apply to a person possessing the
5following amount:
6        (1) less than 3 grams of a substance containing heroin;
7        (2) less than 3 grams of a substance containing
8    cocaine;
9        (3) less than 3 grams of a substance containing
10    morphine;
11        (4) less than 40 grams of a substance containing
12    peyote;
13        (5) less than 40 grams of a substance containing a
14    derivative of barbituric acid or any of the salts of a
15    derivative of barbituric acid;
16        (6) less than 40 grams of a substance containing
17    amphetamine or any salt of an optical isomer of
18    amphetamine;
19        (7) less than 3 grams of a substance containing
20    lysergic acid diethylamide (LSD), or an analog thereof;
21        (8) less than 6 grams of a substance containing
22    pentazocine or any of the salts, isomers and salts of
23    isomers of pentazocine, or an analog thereof;
24        (9) less than 6 grams of a substance containing
25    methaqualone or any of the salts, isomers and salts of
26    isomers of methaqualone;

 

 

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1        (10) less than 6 grams of a substance containing
2    phencyclidine or any of the salts, isomers and salts of
3    isomers of phencyclidine (PCP);
4        (11) less than 6 grams of a substance containing
5    ketamine or any of the salts, isomers and salts of isomers
6    of ketamine;
7        (12) less than 40 grams of a substance containing a
8    substance classified as a narcotic drug in Schedules I or
9    II, or an analog thereof, which is not otherwise included
10    in this subsection.
11    (e) The limited immunity described in subsections (b) and
12(c) of this Section shall not be extended if law enforcement
13has reasonable suspicion or probable cause to detain, arrest,
14or search the person described in subsection (b) or (c) of this
15Section for criminal activity and the reasonable suspicion or
16probable cause is based on information obtained prior to or
17independent of the individual described in subsection (b) or
18(c) taking action to seek or obtain emergency medical
19assistance and not obtained as a direct result of the action of
20seeking or obtaining emergency medical assistance. Nothing in
21this Section is intended to interfere with or prevent the
22investigation, arrest, or prosecution of any person for the
23delivery or distribution of cannabis, methamphetamine or other
24controlled substances, drug-induced homicide, or any other
25crime if the evidence of the violation is not acquired as a
26result of the person seeking or obtaining emergency medical

 

 

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1assistance in the event of an overdose.
2(Source: P.A. 97-678, eff. 6-1-12.)
 
3    Section 50-10. The Methamphetamine Control and Community
4Protection Act is amended by changing Section 115 as follows:
 
5    (720 ILCS 646/115)
6    Sec. 115. Overdose; limited immunity from prosecution.
7    (a) For the purposes of this Section, "overdose" means a
8methamphetamine-induced physiological event that results in a
9life-threatening emergency to the individual who ingested,
10inhaled, injected, or otherwise bodily absorbed
11methamphetamine.
12    (b) A person who, in good faith, seeks emergency medical
13assistance for someone experiencing an overdose shall not be
14arrested, charged or prosecuted for a violation of Section 55
15or 60 of this Act or Section 3.5 of the Drug Paraphernalia
16Control Act, Section 9-3.3 of the Criminal Code of 2012, or
17paragraph (1) of subsection (g) of Section 12-3.05 of the
18Criminal Code of 2012 Class 3 felony possession of
19methamphetamine if evidence for the violation Class 3 felony
20possession charge was acquired as a result of the person
21seeking or obtaining emergency medical assistance and
22providing the amount of substance recovered is less than 3
23grams one gram of methamphetamine or a substance containing
24methamphetamine. The violations listed in this subsection (b)

 

 

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1must not serve as the sole basis of a violation of parole,
2mandatory supervised release, probation, or conditional
3discharge, a Department of Children and Family Services
4investigation, or any seizure of property under any State law
5authorizing civil forfeiture so long as the evidence for the
6violation was acquired as a result of the person seeking or
7obtaining emergency medical assistance in the event of an
8overdose.
9    (c) A person who is experiencing an overdose shall not be
10arrested, charged, or prosecuted for a violation of Section 55
11or 60 of this Act or Section 3.5 of the Drug Paraphernalia
12Control Act, Section 9-3.3 of the Criminal Code of 2012, or
13paragraph (1) of subsection (g) of Section 12-3.05 of the
14Criminal Code of 2012 Class 3 felony possession of
15methamphetamine if evidence for the Class 3 felony possession
16charge was acquired as a result of the person seeking or
17obtaining emergency medical assistance and providing the
18amount of substance recovered is less than one gram of
19methamphetamine or a substance containing methamphetamine. The
20violations listed in this subsection (c) must not serve as the
21sole basis of a violation of parole, mandatory supervised
22release, probation, or conditional discharge, a Department of
23Children and Family Services investigation, or any seizure of
24property under any State law authorizing civil forfeiture so
25long as the evidence for the violation was acquired as a result
26of the person seeking or obtaining emergency medical assistance

 

 

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1in the event of an overdose.
2    (d) The limited immunity described in subsections (b) and
3(c) of this Section shall not be extended if law enforcement
4has reasonable suspicion or probable cause to detain, arrest,
5or search the person described in subsection (b) or (c) of this
6Section for criminal activity and the reasonable suspicion or
7probable cause is based on information obtained prior to or
8independent of the individual described in subsection (b) or
9(c) taking action to seek or obtain emergency medical
10assistance and not obtained as a direct result of the action of
11seeking or obtaining emergency medical assistance. Nothing in
12this Section is intended to interfere with or prevent the
13investigation, arrest, or prosecution of any person for the
14delivery or distribution of cannabis, methamphetamine or other
15controlled substances, drug-induced homicide, or any other
16crime if the evidence of the violation is not acquired as a
17result of the person seeking or obtaining emergency medical
18assistance in the event of an overdose.
19(Source: P.A. 97-678, eff. 6-1-12.)
 
20
Article 55.

 
21    Section 55-5. The Illinois Controlled Substances Act is
22amended by changing Section 316 as follows:
 
23    (720 ILCS 570/316)

 

 

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1    Sec. 316. Prescription Monitoring Program.
2    (a) The Department must provide for a Prescription
3Monitoring Program for Schedule II, III, IV, and V controlled
4substances that includes the following components and
5requirements:
6        (1) The dispenser must transmit to the central
7    repository, in a form and manner specified by the
8    Department, the following information:
9            (A) The recipient's name and address.
10            (B) The recipient's date of birth and gender.
11            (C) The national drug code number of the controlled
12        substance dispensed.
13            (D) The date the controlled substance is
14        dispensed.
15            (E) The quantity of the controlled substance
16        dispensed and days supply.
17            (F) The dispenser's United States Drug Enforcement
18        Administration registration number.
19            (G) The prescriber's United States Drug
20        Enforcement Administration registration number.
21            (H) The dates the controlled substance
22        prescription is filled.
23            (I) The payment type used to purchase the
24        controlled substance (i.e. Medicaid, cash, third party
25        insurance).
26            (J) The patient location code (i.e. home, nursing

 

 

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1        home, outpatient, etc.) for the controlled substances
2        other than those filled at a retail pharmacy.
3            (K) Any additional information that may be
4        required by the department by administrative rule,
5        including but not limited to information required for
6        compliance with the criteria for electronic reporting
7        of the American Society for Automation and Pharmacy or
8        its successor.
9        (2) The information required to be transmitted under
10    this Section must be transmitted not later than the end of
11    the next business day after the date on which a controlled
12    substance is dispensed, or at such other time as may be
13    required by the Department by administrative rule.
14        (3) A dispenser must transmit the information required
15    under this Section by:
16            (A) an electronic device compatible with the
17        receiving device of the central repository;
18            (B) a computer diskette;
19            (C) a magnetic tape; or
20            (D) a pharmacy universal claim form or Pharmacy
21        Inventory Control form.
22        (3.5) The requirements of paragraphs (1), (2), and (3)
23    of this subsection (a) also apply to opioid treatment
24    programs that prescribe Schedule II, III, IV, or V
25    controlled substances for the treatment of opioid use
26    disorder.

 

 

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1        (4) The Department may impose a civil fine of up to
2    $100 per day for willful failure to report controlled
3    substance dispensing to the Prescription Monitoring
4    Program. The fine shall be calculated on no more than the
5    number of days from the time the report was required to be
6    made until the time the problem was resolved, and shall be
7    payable to the Prescription Monitoring Program.
8    (a-5) Notwithstanding subsection (a), a licensed
9veterinarian is exempt from the reporting requirements of this
10Section. If a person who is presenting an animal for treatment
11is suspected of fraudulently obtaining any controlled
12substance or prescription for a controlled substance, the
13licensed veterinarian shall report that information to the
14local law enforcement agency.
15    (b) The Department, by rule, may include in the
16Prescription Monitoring Program certain other select drugs
17that are not included in Schedule II, III, IV, or V. The
18Prescription Monitoring Program does not apply to controlled
19substance prescriptions as exempted under Section 313.
20    (c) The collection of data on select drugs and scheduled
21substances by the Prescription Monitoring Program may be used
22as a tool for addressing oversight requirements of long-term
23care institutions as set forth by Public Act 96-1372. Long-term
24care pharmacies shall transmit patient medication profiles to
25the Prescription Monitoring Program monthly or more frequently
26as established by administrative rule.

 

 

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1    (d) The Department of Human Services shall appoint a
2full-time Clinical Director of the Prescription Monitoring
3Program.
4    (e) (Blank).
5    (f) Within one year of January 1, 2018 (the effective date
6of Public Act 100-564), the Department shall adopt rules
7requiring all Electronic Health Records Systems to interface
8with the Prescription Monitoring Program application program
9on or before January 1, 2021 to ensure that all providers have
10access to specific patient records during the treatment of
11their patients. These rules shall also address the electronic
12integration of pharmacy records with the Prescription
13Monitoring Program to allow for faster transmission of the
14information required under this Section. The Department shall
15establish actions to be taken if a prescriber's Electronic
16Health Records System does not effectively interface with the
17Prescription Monitoring Program within the required timeline.
18    (g) The Department, in consultation with the Advisory
19Committee, shall adopt rules allowing licensed prescribers or
20pharmacists who have registered to access the Prescription
21Monitoring Program to authorize a licensed or non-licensed
22designee employed in that licensed prescriber's office or a
23licensed designee in a licensed pharmacist's pharmacy who has
24received training in the federal Health Insurance Portability
25and Accountability Act to consult the Prescription Monitoring
26Program on their behalf. The rules shall include reasonable

 

 

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1parameters concerning a practitioner's authority to authorize
2a designee, and the eligibility of a person to be selected as a
3designee. In this subsection (g), "pharmacist" shall include a
4clinical pharmacist employed by and designated by a Medicaid
5Managed Care Organization providing services under Article V of
6the Illinois Public Aid Code under a contract with the
7Department of Healthcare and Family Services for the sole
8purpose of clinical review of services provided to persons
9covered by the entity under the contract to determine
10compliance with subsections (a) and (b) of Section 314.5 of
11this Act. A managed care entity pharmacist shall notify
12prescribers of review activities.
13(Source: P.A. 100-564, eff. 1-1-18; 100-861, eff. 8-14-18;
14100-1005, eff. 8-21-18; 100-1093, eff. 8-26-18; 101-81, eff.
157-12-19; 101-414, eff. 8-16-19.)
 
16
Article 60.

 
17    Section 60-5. The Adult Protective Services Act is amended
18by adding Section 3.1 as follows:
 
19    (320 ILCS 20/3.1 new)
20    Sec. 3.1. Adult protective services dementia training.
21    (a) This Section shall apply to any person who is employed
22by the Department in the Adult Protective Services division who
23works on the development and implementation of social services

 

 

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1to respond to and prevent adult abuse, neglect, or
2exploitation.
3    (b) The Department shall develop and implement a dementia
4training program that must include instruction on the
5identification of people with dementia, risks such as
6wandering, communication impairments, elder abuse, and the
7best practices for interacting with people with dementia.
8    (c) Initial training of 4 hours shall be completed at the
9start of employment with the Adult Protective Services division
10and shall cover the following:
11        (1) Dementia, psychiatric, and behavioral symptoms.
12        (2) Communication issues, including how to communicate
13    respectfully and effectively.
14        (3) Techniques for understanding and approaching
15    behavioral symptoms.
16        (4) Information on how to address specific aspects of
17    safety, for example tips to prevent wandering.
18        (5) When it is necessary to alert law enforcement
19    agencies of potential criminal behavior involving a family
20    member, caretaker, or institutional abuse; neglect or
21    exploitation of a person with dementia; and what types of
22    abuse that are most common to people with dementia.
23        (6) Identifying incidents of self-neglect for people
24    with dementia who live alone as well as neglect by a
25    caregiver.
26        (7) Protocols for connecting people living with

 

 

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1    dementia to local care resources and professionals who are
2    skilled in dementia care to encourage cross-referral and
3    reporting regarding incidents of abuse.
4    (d) Annual continuing education shall include 2 hours of
5dementia training covering the subjects described in
6subsection (c).
7    (e) This Section is designed to address gaps in current
8dementia training requirements for Adult Protective Services
9officials and improve the quality of training. If currently
10existing law or rules contain more rigorous training
11requirements for Adult Protective Service officials, those
12laws or rules shall apply. Where there is overlap between this
13Section and other laws and rules, the Department shall
14interpret this Section to avoid duplication of requirements
15while ensuring that the minimum requirements set in this
16Section are met.
17    (f) The Department may adopt rules for the administration
18of this Section.
 
19
Title VI. Access to Health Care

 
20
Article 70.

 
21    Section 70-5. The Use Tax Act is amended by changing
22Section 3-10 as follows:
 

 

 

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1    (35 ILCS 105/3-10)
2    Sec. 3-10. Rate of tax. Unless otherwise provided in this
3Section, the tax imposed by this Act is at the rate of 6.25% of
4either the selling price or the fair market value, if any, of
5the tangible personal property. In all cases where property
6functionally used or consumed is the same as the property that
7was purchased at retail, then the tax is imposed on the selling
8price of the property. In all cases where property functionally
9used or consumed is a by-product or waste product that has been
10refined, manufactured, or produced from property purchased at
11retail, then the tax is imposed on the lower of the fair market
12value, if any, of the specific property so used in this State
13or on the selling price of the property purchased at retail.
14For purposes of this Section "fair market value" means the
15price at which property would change hands between a willing
16buyer and a willing seller, neither being under any compulsion
17to buy or sell and both having reasonable knowledge of the
18relevant facts. The fair market value shall be established by
19Illinois sales by the taxpayer of the same property as that
20functionally used or consumed, or if there are no such sales by
21the taxpayer, then comparable sales or purchases of property of
22like kind and character in Illinois.
23    Beginning on July 1, 2000 and through December 31, 2000,
24with respect to motor fuel, as defined in Section 1.1 of the
25Motor Fuel Tax Law, and gasohol, as defined in Section 3-40 of
26the Use Tax Act, the tax is imposed at the rate of 1.25%.

 

 

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1    Beginning on August 6, 2010 through August 15, 2010, with
2respect to sales tax holiday items as defined in Section 3-6 of
3this Act, the tax is imposed at the rate of 1.25%.
4    With respect to gasohol, the tax imposed by this Act
5applies to (i) 70% of the proceeds of sales made on or after
6January 1, 1990, and before July 1, 2003, (ii) 80% of the
7proceeds of sales made on or after July 1, 2003 and on or
8before July 1, 2017, and (iii) 100% of the proceeds of sales
9made thereafter. If, at any time, however, the tax under this
10Act on sales of gasohol is imposed at the rate of 1.25%, then
11the tax imposed by this Act applies to 100% of the proceeds of
12sales of gasohol made during that time.
13    With respect to majority blended ethanol fuel, the tax
14imposed by this Act does not apply to the proceeds of sales
15made on or after July 1, 2003 and on or before December 31,
162023 but applies to 100% of the proceeds of sales made
17thereafter.
18    With respect to biodiesel blends with no less than 1% and
19no more than 10% biodiesel, the tax imposed by this Act applies
20to (i) 80% of the proceeds of sales made on or after July 1,
212003 and on or before December 31, 2018 and (ii) 100% of the
22proceeds of sales made thereafter. If, at any time, however,
23the tax under this Act on sales of biodiesel blends with no
24less than 1% and no more than 10% biodiesel is imposed at the
25rate of 1.25%, then the tax imposed by this Act applies to 100%
26of the proceeds of sales of biodiesel blends with no less than

 

 

10100HB5548ham002- 52 -LRB101 20617 CPF 74775 a

11% and no more than 10% biodiesel made during that time.
2    With respect to 100% biodiesel and biodiesel blends with
3more than 10% but no more than 99% biodiesel, the tax imposed
4by this Act does not apply to the proceeds of sales made on or
5after July 1, 2003 and on or before December 31, 2023 but
6applies to 100% of the proceeds of sales made thereafter.
7    With respect to food for human consumption that is to be
8consumed off the premises where it is sold (other than
9alcoholic beverages, food consisting of or infused with adult
10use cannabis, soft drinks, and food that has been prepared for
11immediate consumption) and prescription and nonprescription
12medicines, drugs, medical appliances, products classified as
13Class III medical devices by the United States Food and Drug
14Administration that are used for cancer treatment pursuant to a
15prescription, as well as any accessories and components related
16to those devices, modifications to a motor vehicle for the
17purpose of rendering it usable by a person with a disability,
18and insulin, blood sugar urine testing materials, syringes, and
19needles used by human diabetics, for human use, the tax is
20imposed at the rate of 1%. For the purposes of this Section,
21until September 1, 2009: the term "soft drinks" means any
22complete, finished, ready-to-use, non-alcoholic drink, whether
23carbonated or not, including but not limited to soda water,
24cola, fruit juice, vegetable juice, carbonated water, and all
25other preparations commonly known as soft drinks of whatever
26kind or description that are contained in any closed or sealed

 

 

10100HB5548ham002- 53 -LRB101 20617 CPF 74775 a

1bottle, can, carton, or container, regardless of size; but
2"soft drinks" does not include coffee, tea, non-carbonated
3water, infant formula, milk or milk products as defined in the
4Grade A Pasteurized Milk and Milk Products Act, or drinks
5containing 50% or more natural fruit or vegetable juice.
6    Notwithstanding any other provisions of this Act,
7beginning September 1, 2009, "soft drinks" means non-alcoholic
8beverages that contain natural or artificial sweeteners. "Soft
9drinks" do not include beverages that contain milk or milk
10products, soy, rice or similar milk substitutes, or greater
11than 50% of vegetable or fruit juice by volume.
12    Until August 1, 2009, and notwithstanding any other
13provisions of this Act, "food for human consumption that is to
14be consumed off the premises where it is sold" includes all
15food sold through a vending machine, except soft drinks and
16food products that are dispensed hot from a vending machine,
17regardless of the location of the vending machine. Beginning
18August 1, 2009, and notwithstanding any other provisions of
19this Act, "food for human consumption that is to be consumed
20off the premises where it is sold" includes all food sold
21through a vending machine, except soft drinks, candy, and food
22products that are dispensed hot from a vending machine,
23regardless of the location of the vending machine.
24    Notwithstanding any other provisions of this Act,
25beginning September 1, 2009, "food for human consumption that
26is to be consumed off the premises where it is sold" does not

 

 

10100HB5548ham002- 54 -LRB101 20617 CPF 74775 a

1include candy. For purposes of this Section, "candy" means a
2preparation of sugar, honey, or other natural or artificial
3sweeteners in combination with chocolate, fruits, nuts or other
4ingredients or flavorings in the form of bars, drops, or
5pieces. "Candy" does not include any preparation that contains
6flour or requires refrigeration.
7    Notwithstanding any other provisions of this Act,
8beginning September 1, 2009, "nonprescription medicines and
9drugs" does not include grooming and hygiene products. For
10purposes of this Section, "grooming and hygiene products"
11includes, but is not limited to, soaps and cleaning solutions,
12shampoo, toothpaste, mouthwash, antiperspirants, and sun tan
13lotions and screens, unless those products are available by
14prescription only, regardless of whether the products meet the
15definition of "over-the-counter-drugs". For the purposes of
16this paragraph, "over-the-counter-drug" means a drug for human
17use that contains a label that identifies the product as a drug
18as required by 21 C.F.R. 201.66. The "over-the-counter-drug"
19label includes:
20        (A) A "Drug Facts" panel; or
21        (B) A statement of the "active ingredient(s)" with a
22    list of those ingredients contained in the compound,
23    substance or preparation.
24    Beginning on the effective date of this amendatory Act of
25the 98th General Assembly, "prescription and nonprescription
26medicines and drugs" includes medical cannabis purchased from a

 

 

10100HB5548ham002- 55 -LRB101 20617 CPF 74775 a

1registered dispensing organization under the Compassionate Use
2of Medical Cannabis Program Act.
3    As used in this Section, "adult use cannabis" means
4cannabis subject to tax under the Cannabis Cultivation
5Privilege Tax Law and the Cannabis Purchaser Excise Tax Law and
6does not include cannabis subject to tax under the
7Compassionate Use of Medical Cannabis Program Act.
8    If the property that is purchased at retail from a retailer
9is acquired outside Illinois and used outside Illinois before
10being brought to Illinois for use here and is taxable under
11this Act, the "selling price" on which the tax is computed
12shall be reduced by an amount that represents a reasonable
13allowance for depreciation for the period of prior out-of-state
14use.
15(Source: P.A. 100-22, eff. 7-6-17; 101-363, eff. 8-9-19;
16101-593, eff. 12-4-19.)
 
17    Section 70-10. The Service Use Tax Act is amended by
18changing Section 3-10 as follows:
 
19    (35 ILCS 110/3-10)  (from Ch. 120, par. 439.33-10)
20    Sec. 3-10. Rate of tax. Unless otherwise provided in this
21Section, the tax imposed by this Act is at the rate of 6.25% of
22the selling price of tangible personal property transferred as
23an incident to the sale of service, but, for the purpose of
24computing this tax, in no event shall the selling price be less

 

 

10100HB5548ham002- 56 -LRB101 20617 CPF 74775 a

1than the cost price of the property to the serviceman.
2    Beginning on July 1, 2000 and through December 31, 2000,
3with respect to motor fuel, as defined in Section 1.1 of the
4Motor Fuel Tax Law, and gasohol, as defined in Section 3-40 of
5the Use Tax Act, the tax is imposed at the rate of 1.25%.
6    With respect to gasohol, as defined in the Use Tax Act, the
7tax imposed by this Act applies to (i) 70% of the selling price
8of property transferred as an incident to the sale of service
9on or after January 1, 1990, and before July 1, 2003, (ii) 80%
10of the selling price of property transferred as an incident to
11the sale of service on or after July 1, 2003 and on or before
12July 1, 2017, and (iii) 100% of the selling price thereafter.
13If, at any time, however, the tax under this Act on sales of
14gasohol, as defined in the Use Tax Act, is imposed at the rate
15of 1.25%, then the tax imposed by this Act applies to 100% of
16the proceeds of sales of gasohol made during that time.
17    With respect to majority blended ethanol fuel, as defined
18in the Use Tax Act, the tax imposed by this Act does not apply
19to the selling price of property transferred as an incident to
20the sale of service on or after July 1, 2003 and on or before
21December 31, 2023 but applies to 100% of the selling price
22thereafter.
23    With respect to biodiesel blends, as defined in the Use Tax
24Act, with no less than 1% and no more than 10% biodiesel, the
25tax imposed by this Act applies to (i) 80% of the selling price
26of property transferred as an incident to the sale of service

 

 

10100HB5548ham002- 57 -LRB101 20617 CPF 74775 a

1on or after July 1, 2003 and on or before December 31, 2018 and
2(ii) 100% of the proceeds of the selling price thereafter. If,
3at any time, however, the tax under this Act on sales of
4biodiesel blends, as defined in the Use Tax Act, with no less
5than 1% and no more than 10% biodiesel is imposed at the rate
6of 1.25%, then the tax imposed by this Act applies to 100% of
7the proceeds of sales of biodiesel blends with no less than 1%
8and no more than 10% biodiesel made during that time.
9    With respect to 100% biodiesel, as defined in the Use Tax
10Act, and biodiesel blends, as defined in the Use Tax Act, with
11more than 10% but no more than 99% biodiesel, the tax imposed
12by this Act does not apply to the proceeds of the selling price
13of property transferred as an incident to the sale of service
14on or after July 1, 2003 and on or before December 31, 2023 but
15applies to 100% of the selling price thereafter.
16    At the election of any registered serviceman made for each
17fiscal year, sales of service in which the aggregate annual
18cost price of tangible personal property transferred as an
19incident to the sales of service is less than 35%, or 75% in
20the case of servicemen transferring prescription drugs or
21servicemen engaged in graphic arts production, of the aggregate
22annual total gross receipts from all sales of service, the tax
23imposed by this Act shall be based on the serviceman's cost
24price of the tangible personal property transferred as an
25incident to the sale of those services.
26    The tax shall be imposed at the rate of 1% on food prepared

 

 

10100HB5548ham002- 58 -LRB101 20617 CPF 74775 a

1for immediate consumption and transferred incident to a sale of
2service subject to this Act or the Service Occupation Tax Act
3by an entity licensed under the Hospital Licensing Act, the
4Nursing Home Care Act, the ID/DD Community Care Act, the MC/DD
5Act, the Specialized Mental Health Rehabilitation Act of 2013,
6or the Child Care Act of 1969. The tax shall also be imposed at
7the rate of 1% on food for human consumption that is to be
8consumed off the premises where it is sold (other than
9alcoholic beverages, food consisting of or infused with adult
10use cannabis, soft drinks, and food that has been prepared for
11immediate consumption and is not otherwise included in this
12paragraph) and prescription and nonprescription medicines,
13drugs, medical appliances, products classified as Class III
14medical devices by the United States Food and Drug
15Administration that are used for cancer treatment pursuant to a
16prescription, as well as any accessories and components related
17to those devices, modifications to a motor vehicle for the
18purpose of rendering it usable by a person with a disability,
19and insulin, blood sugar urine testing materials, syringes, and
20needles used by human diabetics, for human use. For the
21purposes of this Section, until September 1, 2009: the term
22"soft drinks" means any complete, finished, ready-to-use,
23non-alcoholic drink, whether carbonated or not, including but
24not limited to soda water, cola, fruit juice, vegetable juice,
25carbonated water, and all other preparations commonly known as
26soft drinks of whatever kind or description that are contained

 

 

10100HB5548ham002- 59 -LRB101 20617 CPF 74775 a

1in any closed or sealed bottle, can, carton, or container,
2regardless of size; but "soft drinks" does not include coffee,
3tea, non-carbonated water, infant formula, milk or milk
4products as defined in the Grade A Pasteurized Milk and Milk
5Products Act, or drinks containing 50% or more natural fruit or
6vegetable juice.
7    Notwithstanding any other provisions of this Act,
8beginning September 1, 2009, "soft drinks" means non-alcoholic
9beverages that contain natural or artificial sweeteners. "Soft
10drinks" do not include beverages that contain milk or milk
11products, soy, rice or similar milk substitutes, or greater
12than 50% of vegetable or fruit juice by volume.
13    Until August 1, 2009, and notwithstanding any other
14provisions of this Act, "food for human consumption that is to
15be consumed off the premises where it is sold" includes all
16food sold through a vending machine, except soft drinks and
17food products that are dispensed hot from a vending machine,
18regardless of the location of the vending machine. Beginning
19August 1, 2009, and notwithstanding any other provisions of
20this Act, "food for human consumption that is to be consumed
21off the premises where it is sold" includes all food sold
22through a vending machine, except soft drinks, candy, and food
23products that are dispensed hot from a vending machine,
24regardless of the location of the vending machine.
25    Notwithstanding any other provisions of this Act,
26beginning September 1, 2009, "food for human consumption that

 

 

10100HB5548ham002- 60 -LRB101 20617 CPF 74775 a

1is to be consumed off the premises where it is sold" does not
2include candy. For purposes of this Section, "candy" means a
3preparation of sugar, honey, or other natural or artificial
4sweeteners in combination with chocolate, fruits, nuts or other
5ingredients or flavorings in the form of bars, drops, or
6pieces. "Candy" does not include any preparation that contains
7flour or requires refrigeration.
8    Notwithstanding any other provisions of this Act,
9beginning September 1, 2009, "nonprescription medicines and
10drugs" does not include grooming and hygiene products. For
11purposes of this Section, "grooming and hygiene products"
12includes, but is not limited to, soaps and cleaning solutions,
13shampoo, toothpaste, mouthwash, antiperspirants, and sun tan
14lotions and screens, unless those products are available by
15prescription only, regardless of whether the products meet the
16definition of "over-the-counter-drugs". For the purposes of
17this paragraph, "over-the-counter-drug" means a drug for human
18use that contains a label that identifies the product as a drug
19as required by 21 C.F.R. 201.66. The "over-the-counter-drug"
20label includes:
21        (A) A "Drug Facts" panel; or
22        (B) A statement of the "active ingredient(s)" with a
23    list of those ingredients contained in the compound,
24    substance or preparation.
25    Beginning on January 1, 2014 (the effective date of Public
26Act 98-122), "prescription and nonprescription medicines and

 

 

10100HB5548ham002- 61 -LRB101 20617 CPF 74775 a

1drugs" includes medical cannabis purchased from a registered
2dispensing organization under the Compassionate Use of Medical
3Cannabis Program Act.
4    As used in this Section, "adult use cannabis" means
5cannabis subject to tax under the Cannabis Cultivation
6Privilege Tax Law and the Cannabis Purchaser Excise Tax Law and
7does not include cannabis subject to tax under the
8Compassionate Use of Medical Cannabis Program Act.
9    If the property that is acquired from a serviceman is
10acquired outside Illinois and used outside Illinois before
11being brought to Illinois for use here and is taxable under
12this Act, the "selling price" on which the tax is computed
13shall be reduced by an amount that represents a reasonable
14allowance for depreciation for the period of prior out-of-state
15use.
16(Source: P.A. 100-22, eff. 7-6-17; 101-363, eff. 8-9-19;
17101-593, eff. 12-4-19.)
 
18    Section 70-15. The Service Occupation Tax Act is amended by
19changing Section 3-10 as follows:
 
20    (35 ILCS 115/3-10)  (from Ch. 120, par. 439.103-10)
21    Sec. 3-10. Rate of tax. Unless otherwise provided in this
22Section, the tax imposed by this Act is at the rate of 6.25% of
23the "selling price", as defined in Section 2 of the Service Use
24Tax Act, of the tangible personal property. For the purpose of

 

 

10100HB5548ham002- 62 -LRB101 20617 CPF 74775 a

1computing this tax, in no event shall the "selling price" be
2less than the cost price to the serviceman of the tangible
3personal property transferred. The selling price of each item
4of tangible personal property transferred as an incident of a
5sale of service may be shown as a distinct and separate item on
6the serviceman's billing to the service customer. If the
7selling price is not so shown, the selling price of the
8tangible personal property is deemed to be 50% of the
9serviceman's entire billing to the service customer. When,
10however, a serviceman contracts to design, develop, and produce
11special order machinery or equipment, the tax imposed by this
12Act shall be based on the serviceman's cost price of the
13tangible personal property transferred incident to the
14completion of the contract.
15    Beginning on July 1, 2000 and through December 31, 2000,
16with respect to motor fuel, as defined in Section 1.1 of the
17Motor Fuel Tax Law, and gasohol, as defined in Section 3-40 of
18the Use Tax Act, the tax is imposed at the rate of 1.25%.
19    With respect to gasohol, as defined in the Use Tax Act, the
20tax imposed by this Act shall apply to (i) 70% of the cost
21price of property transferred as an incident to the sale of
22service on or after January 1, 1990, and before July 1, 2003,
23(ii) 80% of the selling price of property transferred as an
24incident to the sale of service on or after July 1, 2003 and on
25or before July 1, 2017, and (iii) 100% of the cost price
26thereafter. If, at any time, however, the tax under this Act on

 

 

10100HB5548ham002- 63 -LRB101 20617 CPF 74775 a

1sales of gasohol, as defined in the Use Tax Act, is imposed at
2the rate of 1.25%, then the tax imposed by this Act applies to
3100% of the proceeds of sales of gasohol made during that time.
4    With respect to majority blended ethanol fuel, as defined
5in the Use Tax Act, the tax imposed by this Act does not apply
6to the selling price of property transferred as an incident to
7the sale of service on or after July 1, 2003 and on or before
8December 31, 2023 but applies to 100% of the selling price
9thereafter.
10    With respect to biodiesel blends, as defined in the Use Tax
11Act, with no less than 1% and no more than 10% biodiesel, the
12tax imposed by this Act applies to (i) 80% of the selling price
13of property transferred as an incident to the sale of service
14on or after July 1, 2003 and on or before December 31, 2018 and
15(ii) 100% of the proceeds of the selling price thereafter. If,
16at any time, however, the tax under this Act on sales of
17biodiesel blends, as defined in the Use Tax Act, with no less
18than 1% and no more than 10% biodiesel is imposed at the rate
19of 1.25%, then the tax imposed by this Act applies to 100% of
20the proceeds of sales of biodiesel blends with no less than 1%
21and no more than 10% biodiesel made during that time.
22    With respect to 100% biodiesel, as defined in the Use Tax
23Act, and biodiesel blends, as defined in the Use Tax Act, with
24more than 10% but no more than 99% biodiesel material, the tax
25imposed by this Act does not apply to the proceeds of the
26selling price of property transferred as an incident to the

 

 

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1sale of service on or after July 1, 2003 and on or before
2December 31, 2023 but applies to 100% of the selling price
3thereafter.
4    At the election of any registered serviceman made for each
5fiscal year, sales of service in which the aggregate annual
6cost price of tangible personal property transferred as an
7incident to the sales of service is less than 35%, or 75% in
8the case of servicemen transferring prescription drugs or
9servicemen engaged in graphic arts production, of the aggregate
10annual total gross receipts from all sales of service, the tax
11imposed by this Act shall be based on the serviceman's cost
12price of the tangible personal property transferred incident to
13the sale of those services.
14    The tax shall be imposed at the rate of 1% on food prepared
15for immediate consumption and transferred incident to a sale of
16service subject to this Act or the Service Occupation Tax Act
17by an entity licensed under the Hospital Licensing Act, the
18Nursing Home Care Act, the ID/DD Community Care Act, the MC/DD
19Act, the Specialized Mental Health Rehabilitation Act of 2013,
20or the Child Care Act of 1969. The tax shall also be imposed at
21the rate of 1% on food for human consumption that is to be
22consumed off the premises where it is sold (other than
23alcoholic beverages, food consisting of or infused with adult
24use cannabis, soft drinks, and food that has been prepared for
25immediate consumption and is not otherwise included in this
26paragraph) and prescription and nonprescription medicines,

 

 

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1drugs, medical appliances, products classified as Class III
2medical devices by the United States Food and Drug
3Administration that are used for cancer treatment pursuant to a
4prescription, as well as any accessories and components related
5to those devices, modifications to a motor vehicle for the
6purpose of rendering it usable by a person with a disability,
7and insulin, blood sugar urine testing materials, syringes, and
8needles used by human diabetics, for human use. For the
9purposes of this Section, until September 1, 2009: the term
10"soft drinks" means any complete, finished, ready-to-use,
11non-alcoholic drink, whether carbonated or not, including but
12not limited to soda water, cola, fruit juice, vegetable juice,
13carbonated water, and all other preparations commonly known as
14soft drinks of whatever kind or description that are contained
15in any closed or sealed can, carton, or container, regardless
16of size; but "soft drinks" does not include coffee, tea,
17non-carbonated water, infant formula, milk or milk products as
18defined in the Grade A Pasteurized Milk and Milk Products Act,
19or drinks containing 50% or more natural fruit or vegetable
20juice.
21    Notwithstanding any other provisions of this Act,
22beginning September 1, 2009, "soft drinks" means non-alcoholic
23beverages that contain natural or artificial sweeteners. "Soft
24drinks" do not include beverages that contain milk or milk
25products, soy, rice or similar milk substitutes, or greater
26than 50% of vegetable or fruit juice by volume.

 

 

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1    Until August 1, 2009, and notwithstanding any other
2provisions of this Act, "food for human consumption that is to
3be consumed off the premises where it is sold" includes all
4food sold through a vending machine, except soft drinks and
5food products that are dispensed hot from a vending machine,
6regardless of the location of the vending machine. Beginning
7August 1, 2009, and notwithstanding any other provisions of
8this Act, "food for human consumption that is to be consumed
9off the premises where it is sold" includes all food sold
10through a vending machine, except soft drinks, candy, and food
11products that are dispensed hot from a vending machine,
12regardless of the location of the vending machine.
13    Notwithstanding any other provisions of this Act,
14beginning September 1, 2009, "food for human consumption that
15is to be consumed off the premises where it is sold" does not
16include candy. For purposes of this Section, "candy" means a
17preparation of sugar, honey, or other natural or artificial
18sweeteners in combination with chocolate, fruits, nuts or other
19ingredients or flavorings in the form of bars, drops, or
20pieces. "Candy" does not include any preparation that contains
21flour or requires refrigeration.
22    Notwithstanding any other provisions of this Act,
23beginning September 1, 2009, "nonprescription medicines and
24drugs" does not include grooming and hygiene products. For
25purposes of this Section, "grooming and hygiene products"
26includes, but is not limited to, soaps and cleaning solutions,

 

 

10100HB5548ham002- 67 -LRB101 20617 CPF 74775 a

1shampoo, toothpaste, mouthwash, antiperspirants, and sun tan
2lotions and screens, unless those products are available by
3prescription only, regardless of whether the products meet the
4definition of "over-the-counter-drugs". For the purposes of
5this paragraph, "over-the-counter-drug" means a drug for human
6use that contains a label that identifies the product as a drug
7as required by 21 C.F.R. 201.66. The "over-the-counter-drug"
8label includes:
9        (A) A "Drug Facts" panel; or
10        (B) A statement of the "active ingredient(s)" with a
11    list of those ingredients contained in the compound,
12    substance or preparation.
13    Beginning on January 1, 2014 (the effective date of Public
14Act 98-122), "prescription and nonprescription medicines and
15drugs" includes medical cannabis purchased from a registered
16dispensing organization under the Compassionate Use of Medical
17Cannabis Program Act.
18    As used in this Section, "adult use cannabis" means
19cannabis subject to tax under the Cannabis Cultivation
20Privilege Tax Law and the Cannabis Purchaser Excise Tax Law and
21does not include cannabis subject to tax under the
22Compassionate Use of Medical Cannabis Program Act.
23(Source: P.A. 100-22, eff. 7-6-17; 101-363, eff. 8-9-19;
24101-593, eff. 12-4-19.)
 
25    Section 70-20. The Retailers' Occupation Tax Act is amended

 

 

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1by changing Section 2-10 as follows:
 
2    (35 ILCS 120/2-10)
3    Sec. 2-10. Rate of tax. Unless otherwise provided in this
4Section, the tax imposed by this Act is at the rate of 6.25% of
5gross receipts from sales of tangible personal property made in
6the course of business.
7    Beginning on July 1, 2000 and through December 31, 2000,
8with respect to motor fuel, as defined in Section 1.1 of the
9Motor Fuel Tax Law, and gasohol, as defined in Section 3-40 of
10the Use Tax Act, the tax is imposed at the rate of 1.25%.
11    Beginning on August 6, 2010 through August 15, 2010, with
12respect to sales tax holiday items as defined in Section 2-8 of
13this Act, the tax is imposed at the rate of 1.25%.
14    Within 14 days after the effective date of this amendatory
15Act of the 91st General Assembly, each retailer of motor fuel
16and gasohol shall cause the following notice to be posted in a
17prominently visible place on each retail dispensing device that
18is used to dispense motor fuel or gasohol in the State of
19Illinois: "As of July 1, 2000, the State of Illinois has
20eliminated the State's share of sales tax on motor fuel and
21gasohol through December 31, 2000. The price on this pump
22should reflect the elimination of the tax." The notice shall be
23printed in bold print on a sign that is no smaller than 4
24inches by 8 inches. The sign shall be clearly visible to
25customers. Any retailer who fails to post or maintain a

 

 

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1required sign through December 31, 2000 is guilty of a petty
2offense for which the fine shall be $500 per day per each
3retail premises where a violation occurs.
4    With respect to gasohol, as defined in the Use Tax Act, the
5tax imposed by this Act applies to (i) 70% of the proceeds of
6sales made on or after January 1, 1990, and before July 1,
72003, (ii) 80% of the proceeds of sales made on or after July
81, 2003 and on or before July 1, 2017, and (iii) 100% of the
9proceeds of sales made thereafter. If, at any time, however,
10the tax under this Act on sales of gasohol, as defined in the
11Use Tax Act, is imposed at the rate of 1.25%, then the tax
12imposed by this Act applies to 100% of the proceeds of sales of
13gasohol made during that time.
14    With respect to majority blended ethanol fuel, as defined
15in the Use Tax Act, the tax imposed by this Act does not apply
16to the proceeds of sales made on or after July 1, 2003 and on or
17before December 31, 2023 but applies to 100% of the proceeds of
18sales made thereafter.
19    With respect to biodiesel blends, as defined in the Use Tax
20Act, with no less than 1% and no more than 10% biodiesel, the
21tax imposed by this Act applies to (i) 80% of the proceeds of
22sales made on or after July 1, 2003 and on or before December
2331, 2018 and (ii) 100% of the proceeds of sales made
24thereafter. If, at any time, however, the tax under this Act on
25sales of biodiesel blends, as defined in the Use Tax Act, with
26no less than 1% and no more than 10% biodiesel is imposed at

 

 

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1the rate of 1.25%, then the tax imposed by this Act applies to
2100% of the proceeds of sales of biodiesel blends with no less
3than 1% and no more than 10% biodiesel made during that time.
4    With respect to 100% biodiesel, as defined in the Use Tax
5Act, and biodiesel blends, as defined in the Use Tax Act, with
6more than 10% but no more than 99% biodiesel, the tax imposed
7by this Act does not apply to the proceeds of sales made on or
8after July 1, 2003 and on or before December 31, 2023 but
9applies to 100% of the proceeds of sales made thereafter.
10    With respect to food for human consumption that is to be
11consumed off the premises where it is sold (other than
12alcoholic beverages, food consisting of or infused with adult
13use cannabis, soft drinks, and food that has been prepared for
14immediate consumption) and prescription and nonprescription
15medicines, drugs, medical appliances, products classified as
16Class III medical devices by the United States Food and Drug
17Administration that are used for cancer treatment pursuant to a
18prescription, as well as any accessories and components related
19to those devices, modifications to a motor vehicle for the
20purpose of rendering it usable by a person with a disability,
21and insulin, blood sugar urine testing materials, syringes, and
22needles used by human diabetics, for human use, the tax is
23imposed at the rate of 1%. For the purposes of this Section,
24until September 1, 2009: the term "soft drinks" means any
25complete, finished, ready-to-use, non-alcoholic drink, whether
26carbonated or not, including but not limited to soda water,

 

 

10100HB5548ham002- 71 -LRB101 20617 CPF 74775 a

1cola, fruit juice, vegetable juice, carbonated water, and all
2other preparations commonly known as soft drinks of whatever
3kind or description that are contained in any closed or sealed
4bottle, can, carton, or container, regardless of size; but
5"soft drinks" does not include coffee, tea, non-carbonated
6water, infant formula, milk or milk products as defined in the
7Grade A Pasteurized Milk and Milk Products Act, or drinks
8containing 50% or more natural fruit or vegetable juice.
9    Notwithstanding any other provisions of this Act,
10beginning September 1, 2009, "soft drinks" means non-alcoholic
11beverages that contain natural or artificial sweeteners. "Soft
12drinks" do not include beverages that contain milk or milk
13products, soy, rice or similar milk substitutes, or greater
14than 50% of vegetable or fruit juice by volume.
15    Until August 1, 2009, and notwithstanding any other
16provisions of this Act, "food for human consumption that is to
17be consumed off the premises where it is sold" includes all
18food sold through a vending machine, except soft drinks and
19food products that are dispensed hot from a vending machine,
20regardless of the location of the vending machine. Beginning
21August 1, 2009, and notwithstanding any other provisions of
22this Act, "food for human consumption that is to be consumed
23off the premises where it is sold" includes all food sold
24through a vending machine, except soft drinks, candy, and food
25products that are dispensed hot from a vending machine,
26regardless of the location of the vending machine.

 

 

10100HB5548ham002- 72 -LRB101 20617 CPF 74775 a

1    Notwithstanding any other provisions of this Act,
2beginning September 1, 2009, "food for human consumption that
3is to be consumed off the premises where it is sold" does not
4include candy. For purposes of this Section, "candy" means a
5preparation of sugar, honey, or other natural or artificial
6sweeteners in combination with chocolate, fruits, nuts or other
7ingredients or flavorings in the form of bars, drops, or
8pieces. "Candy" does not include any preparation that contains
9flour or requires refrigeration.
10    Notwithstanding any other provisions of this Act,
11beginning September 1, 2009, "nonprescription medicines and
12drugs" does not include grooming and hygiene products. For
13purposes of this Section, "grooming and hygiene products"
14includes, but is not limited to, soaps and cleaning solutions,
15shampoo, toothpaste, mouthwash, antiperspirants, and sun tan
16lotions and screens, unless those products are available by
17prescription only, regardless of whether the products meet the
18definition of "over-the-counter-drugs". For the purposes of
19this paragraph, "over-the-counter-drug" means a drug for human
20use that contains a label that identifies the product as a drug
21as required by 21 C.F.R. 201.66. The "over-the-counter-drug"
22label includes:
23        (A) A "Drug Facts" panel; or
24        (B) A statement of the "active ingredient(s)" with a
25    list of those ingredients contained in the compound,
26    substance or preparation.

 

 

10100HB5548ham002- 73 -LRB101 20617 CPF 74775 a

1    Beginning on the effective date of this amendatory Act of
2the 98th General Assembly, "prescription and nonprescription
3medicines and drugs" includes medical cannabis purchased from a
4registered dispensing organization under the Compassionate Use
5of Medical Cannabis Program Act.
6    As used in this Section, "adult use cannabis" means
7cannabis subject to tax under the Cannabis Cultivation
8Privilege Tax Law and the Cannabis Purchaser Excise Tax Law and
9does not include cannabis subject to tax under the
10Compassionate Use of Medical Cannabis Program Act.
11(Source: P.A. 100-22, eff. 7-6-17; 101-363, eff. 8-9-19;
12101-593, eff. 12-4-19.)
 
13
Article 75.

 
14    Section 75-5. The Illinois Public Aid Code is amended by
15changing Section 9A-11 as follows:
 
16    (305 ILCS 5/9A-11)  (from Ch. 23, par. 9A-11)
17    Sec. 9A-11. Child care.
18    (a) The General Assembly recognizes that families with
19children need child care in order to work. Child care is
20expensive and families with low incomes, including those who
21are transitioning from welfare to work, often struggle to pay
22the costs of day care. The General Assembly understands the
23importance of helping low-income working families become and

 

 

10100HB5548ham002- 74 -LRB101 20617 CPF 74775 a

1remain self-sufficient. The General Assembly also believes
2that it is the responsibility of families to share in the costs
3of child care. It is also the preference of the General
4Assembly that all working poor families should be treated
5equally, regardless of their welfare status.
6    (b) To the extent resources permit, the Illinois Department
7shall provide child care services to parents or other relatives
8as defined by rule who are working or participating in
9employment or Department approved education or training
10programs. At a minimum, the Illinois Department shall cover the
11following categories of families:
12        (1) recipients of TANF under Article IV participating
13    in work and training activities as specified in the
14    personal plan for employment and self-sufficiency;
15        (2) families transitioning from TANF to work;
16        (3) families at risk of becoming recipients of TANF;
17        (4) families with special needs as defined by rule;
18        (5) working families with very low incomes as defined
19    by rule;
20        (6) families that are not recipients of TANF and that
21    need child care assistance to participate in education and
22    training activities; and
23        (7) families with children under the age of 5 who have
24    an open intact family services case with the Department of
25    Children and Family Services. Any family that receives
26    child care assistance in accordance with this paragraph

 

 

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1    shall remain eligible for child care assistance 6 months
2    after the child's intact family services case is closed,
3    regardless of whether the child's parents or other
4    relatives as defined by rule are working or participating
5    in Department approved employment or education or training
6    programs. The Department of Human Services, in
7    consultation with the Department of Children and Family
8    Services, shall adopt rules to protect the privacy of
9    families who are the subject of an open intact family
10    services case when such families enroll in child care
11    services. Additional rules shall be adopted to offer
12    children who have an open intact family services case the
13    opportunity to receive an Early Intervention screening and
14    other services that their families may be eligible for as
15    provided by the Department of Human Services.
16    The Department shall specify by rule the conditions of
17eligibility, the application process, and the types, amounts,
18and duration of services. Eligibility for child care benefits
19and the amount of child care provided may vary based on family
20size, income, and other factors as specified by rule.
21    The Department shall update the Child Care Assistance
22Program Eligibility Calculator posted on its website to include
23a question on whether a family is applying for child care
24assistance for the first time or is applying for a
25redetermination of eligibility.
26    A family's eligibility for child care services shall be

 

 

10100HB5548ham002- 76 -LRB101 20617 CPF 74775 a

1redetermined no sooner than 12 months following the initial
2determination or most recent redetermination. During the
312-month periods, the family shall remain eligible for child
4care services regardless of (i) a change in family income,
5unless family income exceeds 85% of State median income, or
6(ii) a temporary change in the ongoing status of the parents or
7other relatives, as defined by rule, as working or attending a
8job training or educational program.
9    In determining income eligibility for child care benefits,
10the Department annually, at the beginning of each fiscal year,
11shall establish, by rule, one income threshold for each family
12size, in relation to percentage of State median income for a
13family of that size, that makes families with incomes below the
14specified threshold eligible for assistance and families with
15incomes above the specified threshold ineligible for
16assistance. Through and including fiscal year 2007, the
17specified threshold must be no less than 50% of the
18then-current State median income for each family size.
19Beginning in fiscal year 2008, the specified threshold must be
20no less than 185% of the then-current federal poverty level for
21each family size. Notwithstanding any other provision of law or
22administrative rule to the contrary, beginning in fiscal year
232019, the specified threshold for working families with very
24low incomes as defined by rule must be no less than 185% of the
25then-current federal poverty level for each family size.
26    In determining eligibility for assistance, the Department

 

 

10100HB5548ham002- 77 -LRB101 20617 CPF 74775 a

1shall not give preference to any category of recipients or give
2preference to individuals based on their receipt of benefits
3under this Code.
4    Nothing in this Section shall be construed as conferring
5entitlement status to eligible families.
6    The Illinois Department is authorized to lower income
7eligibility ceilings, raise parent co-payments, create waiting
8lists, or take such other actions during a fiscal year as are
9necessary to ensure that child care benefits paid under this
10Article do not exceed the amounts appropriated for those child
11care benefits. These changes may be accomplished by emergency
12rule under Section 5-45 of the Illinois Administrative
13Procedure Act, except that the limitation on the number of
14emergency rules that may be adopted in a 24-month period shall
15not apply.
16    The Illinois Department may contract with other State
17agencies or child care organizations for the administration of
18child care services.
19    (c) Payment shall be made for child care that otherwise
20meets the requirements of this Section and applicable standards
21of State and local law and regulation, including any
22requirements the Illinois Department promulgates by rule in
23addition to the licensure requirements promulgated by the
24Department of Children and Family Services and Fire Prevention
25and Safety requirements promulgated by the Office of the State
26Fire Marshal, and is provided in any of the following:

 

 

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1        (1) a child care center which is licensed or exempt
2    from licensure pursuant to Section 2.09 of the Child Care
3    Act of 1969;
4        (2) a licensed child care home or home exempt from
5    licensing;
6        (3) a licensed group child care home;
7        (4) other types of child care, including child care
8    provided by relatives or persons living in the same home as
9    the child, as determined by the Illinois Department by
10    rule.
11    (c-5) Solely for the purposes of coverage under the
12Illinois Public Labor Relations Act, child and day care home
13providers, including licensed and license exempt,
14participating in the Department's child care assistance
15program shall be considered to be public employees and the
16State of Illinois shall be considered to be their employer as
17of January 1, 2006 (the effective date of Public Act 94-320),
18but not before. The State shall engage in collective bargaining
19with an exclusive representative of child and day care home
20providers participating in the child care assistance program
21concerning their terms and conditions of employment that are
22within the State's control. Nothing in this subsection shall be
23understood to limit the right of families receiving services
24defined in this Section to select child and day care home
25providers or supervise them within the limits of this Section.
26The State shall not be considered to be the employer of child

 

 

10100HB5548ham002- 79 -LRB101 20617 CPF 74775 a

1and day care home providers for any purposes not specifically
2provided in Public Act 94-320, including, but not limited to,
3purposes of vicarious liability in tort and purposes of
4statutory retirement or health insurance benefits. Child and
5day care home providers shall not be covered by the State
6Employees Group Insurance Act of 1971.
7    In according child and day care home providers and their
8selected representative rights under the Illinois Public Labor
9Relations Act, the State intends that the State action
10exemption to application of federal and State antitrust laws be
11fully available to the extent that their activities are
12authorized by Public Act 94-320.
13    (d) The Illinois Department shall establish, by rule, a
14co-payment scale that provides for cost sharing by families
15that receive child care services, including parents whose only
16income is from assistance under this Code. The co-payment shall
17be based on family income and family size and may be based on
18other factors as appropriate. Co-payments may be waived for
19families whose incomes are at or below the federal poverty
20level.
21    (d-5) The Illinois Department, in consultation with its
22Child Care and Development Advisory Council, shall develop a
23plan to revise the child care assistance program's co-payment
24scale. The plan shall be completed no later than February 1,
252008, and shall include:
26        (1) findings as to the percentage of income that the

 

 

10100HB5548ham002- 80 -LRB101 20617 CPF 74775 a

1    average American family spends on child care and the
2    relative amounts that low-income families and the average
3    American family spend on other necessities of life;
4        (2) recommendations for revising the child care
5    co-payment scale to assure that families receiving child
6    care services from the Department are paying no more than
7    they can reasonably afford;
8        (3) recommendations for revising the child care
9    co-payment scale to provide at-risk children with complete
10    access to Preschool for All and Head Start; and
11        (4) recommendations for changes in child care program
12    policies that affect the affordability of child care.
13    (e) (Blank).
14    (f) The Illinois Department shall, by rule, set rates to be
15paid for the various types of child care. Child care may be
16provided through one of the following methods:
17        (1) arranging the child care through eligible
18    providers by use of purchase of service contracts or
19    vouchers;
20        (2) arranging with other agencies and community
21    volunteer groups for non-reimbursed child care;
22        (3) (blank); or
23        (4) adopting such other arrangements as the Department
24    determines appropriate.
25    (f-1) Within 30 days after June 4, 2018 (the effective date
26of Public Act 100-587), the Department of Human Services shall

 

 

10100HB5548ham002- 81 -LRB101 20617 CPF 74775 a

1establish rates for child care providers that are no less than
2the rates in effect on January 1, 2018 increased by 4.26%.
3    (f-5) (Blank).
4    (g) Families eligible for assistance under this Section
5shall be given the following options:
6        (1) receiving a child care certificate issued by the
7    Department or a subcontractor of the Department that may be
8    used by the parents as payment for child care and
9    development services only; or
10        (2) if space is available, enrolling the child with a
11    child care provider that has a purchase of service contract
12    with the Department or a subcontractor of the Department
13    for the provision of child care and development services.
14    The Department may identify particular priority
15    populations for whom they may request special
16    consideration by a provider with purchase of service
17    contracts, provided that the providers shall be permitted
18    to maintain a balance of clients in terms of household
19    incomes and families and children with special needs, as
20    defined by rule.
21(Source: P.A. 100-387, eff. 8-25-17; 100-587, eff. 6-4-18;
22100-860, eff. 2-14-19; 100-909, eff. 10-1-18; 100-916, eff.
238-17-18; 101-81, eff. 7-12-19.)
 
24
Article 80.

 

 

 

10100HB5548ham002- 82 -LRB101 20617 CPF 74775 a

1    Section 80-5. The Employee Sick Leave Act is amended by
2changing Sections 5 and 10 as follows:
 
3    (820 ILCS 191/5)
4    Sec. 5. Definitions. In this Act:
5    "Department" means the Department of Labor.
6    "Personal sick leave benefits" means any paid or unpaid
7time available to an employee as provided through an employment
8benefit plan or paid time off policy to be used as a result of
9absence from work due to personal illness, injury, or medical
10appointment or for the personal care of a parent,
11mother-in-law, father-in-law, grandparent, or stepparent. An
12employment benefit plan or paid time off policy does not
13include long term disability, short term disability, an
14insurance policy, or other comparable benefit plan or policy.
15(Source: P.A. 99-841, eff. 1-1-17; 99-921, eff. 1-13-17.)
 
16    (820 ILCS 191/10)
17    Sec. 10. Use of leave; limitations.
18    (a) An employee may use personal sick leave benefits
19provided by the employer for absences due to an illness,
20injury, or medical appointment of the employee's child,
21stepchild, spouse, domestic partner, sibling, parent,
22mother-in-law, father-in-law, grandchild, grandparent, or
23stepparent, or for the personal care of a parent,
24mother-in-law, father-in-law, grandparent, or stepparent on

 

 

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1the same terms upon which the employee is able to use personal
2sick leave benefits for the employee's own illness or injury.
3An employer may request written verification of the employee's
4absence from a health care professional if such verification is
5required under the employer's employment benefit plan or paid
6time off policy.
7    (b) An employer may limit the use of personal sick leave
8benefits provided by the employer for absences due to an
9illness, injury, or medical appointment of the employee's
10child, stepchild, spouse, domestic partner, sibling, parent,
11mother-in-law, father-in-law, grandchild, grandparent, or
12stepparent to an amount not less than the personal sick leave
13that would be earned or accrued during 6 months at the
14employee's then current rate of entitlement. For employers who
15base personal sick leave benefits on an employee's years of
16service instead of annual or monthly accrual, such employer may
17limit the amount of sick leave to be used under this Act to
18half of the employee's maximum annual grant.
19    (c) An employer who provides personal sick leave benefits
20or a paid time off policy that would otherwise provide benefits
21as required under subsections (a) and (b) shall not be required
22to modify such benefits.
23(Source: P.A. 99-841, eff. 1-1-17; 99-921, eff. 1-13-17.)
 
24
Article 90.

 

 

 

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1    Section 90-5. The Nursing Home Care Act is amended by
2adding Section 3-206.06 as follows:
 
3    (210 ILCS 45/3-206.06 new)
4    Sec. 3-206.06. Testing for Legionnaires' disease. A
5facility licensed under this Act must prove upon inspection by
6the Department that it has provided testing for Legionnaires'
7disease. The facility must also provide the results of that
8testing to the Department.
 
9    Section 90-10. The Hospital Licensing Act is amended by
10adding Section 6.29 as follows:
 
11    (210 ILCS 85/6.29 new)
12    Sec. 6.29. Testing for Legionnaires' disease. A hospital
13licensed under this Act must prove upon inspection by the
14Department that it has provided testing for Legionnaires'
15disease. The hospital must also provide the results of that
16testing to the Department.
 
17
Article 95.

 
18    Section 95-1. Short title. This Article may be cited as the
19Child Trauma Counseling Act. References in this Article to
20"this Act" mean this Article.
 

 

 

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1    Section 95-5. Definitions. As used in this Act:
2    "Day care center" has the meaning given to that term in
3Section 2.09 of the Child Care Act of 1969.
4    "School" means a public or nonpublic elementary school.
5    "Trauma counselor" means a licensed professional
6counselor, as that term is defined in Section 10 of the
7Professional Counselor and Clinical Professional Counselor
8Licensing and Practice Act, who has experience in treating
9childhood trauma or who has a certification relating to
10treating childhood trauma.
 
11    Section 95-10. Trauma counseling through fifth grade.
12    (a) Notwithstanding any other provision of law:
13        (1) a day care center shall provide the services of a
14    trauma counselor to a child, from birth through the fifth
15    grade, enrolled and attending the day care center who has
16    been identified as needing trauma counseling; and
17        (2) a school shall provide the services of a trauma
18    counselor to a child who is enrolled and attending
19    kindergarten through the fifth grade at that school and has
20    been identified as needing trauma counseling.
21    There shall be no cost for such trauma counseling to the
22parents or guardians of the child.
23    (b) A child is identified as needing trauma counseling
24under subsection (a) if the child reports trauma to a day care
25center or a school or a parent or guardian of the child or

 

 

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1employee of a day care center or a school reports that the
2child has experienced trauma.
 
3    Section 95-15. Rules.
4    (a) The Department of Children and Family Services shall
5adopt rules to implement this Act. The Department shall seek
6recommendations and advice from the State Board of Education as
7to adoption of the Department's rules as they relate to
8schools.
9    (b) The Department of Financial and Professional
10Regulation may adopt rules regarding the qualifications of
11trauma counselors working with children under this Act.
 
12    Section 95-90. The State Mandates Act is amended by adding
13Section 8.45 as follows:
 
14    (30 ILCS 805/8.45 new)
15    Sec. 8.45. Exempt mandate. Notwithstanding Sections 6 and 8
16of this Act, no reimbursement by the State is required for the
17implementation of any mandate created by the Child Trauma
18Counseling Act.
 
19
Article 100.

 
20    Section 100-1. Short title. This Article may be cited as
21the Special Commission on Gynecologic Cancers Act.
 

 

 

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1    Section 100-5. Creation; members; duties; report.    
2    (a) The Special Commission on Gynecologic Cancers is
3created. Membership of the Commission shall be as follows:
4        (1) A representative of the Illinois Comprehensive
5    Cancer Control Program, appointed by the Director of Public
6    Health;
7        (2) The Director of Insurance, or his or her designee;
8    and
9        (3) 20 members who shall be appointed as follows:
10                (A) three members appointed by the Speaker of
11        the House of Representatives, one of whom shall be a
12        survivor of ovarian cancer, one of whom shall be a
13        survivor of cervical, vaginal, vulvar, or uterine
14        cancer, and one of whom shall be a medical specialist
15        in gynecologic cancers;
16                (B) three members appointed by the Senate
17        President, one of whom shall be a survivor of ovarian
18        cancer, one of whom shall be a survivor of cervical,
19        vaginal, vulvar, or uterine cancer, and one of whom
20        shall be a medical specialist in gynecologic cancers;
21                (C) three members appointed by the House
22        Minority Leader, one of whom shall be a survivor of
23        ovarian cancer, one of whom shall be a survivor of
24        cervical, vaginal, vulvar, or uterine cancer, and one
25        of whom shall be a medical specialist in gynecologic

 

 

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1        cancers;
2                (D) three members appointed by the Senate
3        Minority Leader, one of whom shall be a survivor of
4        ovarian cancer, one of whom shall be a survivor of
5        cervical, vaginal, vulvar, or uterine cancer, and one
6        of whom shall be a medical specialist in gynecologic
7        cancers; and
8                (E) eight members appointed by the Governor,
9        one of whom shall be a caregiver of a woman diagnosed
10        with a gynecologic cancer, one of whom shall be a
11        medical specialist in gynecologic cancers, one of whom
12        shall be an individual with expertise in community
13        based health care and issues affecting underserved and
14        vulnerable populations, 2 of whom shall be individuals
15        representing gynecologic cancer awareness and support
16        groups in the State, one of whom shall be a researcher
17        specializing in gynecologic cancers, and 2 of whom
18        shall be members of the public with demonstrated
19        expertise in issues relating to the work of the
20        Commission.
21    (b) Members of the Commission shall serve without
22compensation or reimbursement from the Commission. Members
23shall select a Chair from among themselves and the Chair shall
24set the meeting schedule.
25    (c) The Illinois Department of Public Health shall provide
26administrative support to the Commission.

 

 

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1    (d) The Commission is charged with the study of the
2following:
3        (1) establishing a mechanism to ascertain the
4    prevalence of gynecologic cancers in the State and, to the
5    extent possible, to collect statistics relative to the
6    timing of diagnosis and risk factors associated with
7    gynecologic cancers;
8        (2) determining how to best effectuate early diagnosis
9    and treatment for gynecologic cancer patients;
10        (3) determining best practices for closing disparities
11    in outcomes for gynecologic cancer patients and innovative
12    approaches to reaching underserved and vulnerable
13    populations;
14        (4) determining any unmet needs of persons with
15    gynecologic cancers and those of their families; and
16        (5) providing recommendations for additional
17    legislation, support programs, and resources to meet the
18    unmet needs of persons with gynecologic cancers and their
19    families.
20    (e) The Commission shall file its final report with the
21General Assembly no later than December 31, 2021 and, upon the
22filing of its report, is dissolved.
 
23    Section 100-90. Repeal. This Article is repealed on January
241, 2023.
 

 

 

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1
Article 105.

 
2    Section 5. The Illinois Public Aid Code is amended by
3changing Section 5A-12.7 as follows:
 
4    (305 ILCS 5/5A-12.7)
5    (Section scheduled to be repealed on December 31, 2022)
6    Sec. 5A-12.7. Continuation of hospital access payments on
7and after July 1, 2020.
8    (a) To preserve and improve access to hospital services,
9for hospital services rendered on and after July 1, 2020, the
10Department shall, except for hospitals described in subsection
11(b) of Section 5A-3, make payments to hospitals or require
12capitated managed care organizations to make payments as set
13forth in this Section. Payments under this Section are not due
14and payable, however, until: (i) the methodologies described in
15this Section are approved by the federal government in an
16appropriate State Plan amendment or directed payment preprint;
17and (ii) the assessment imposed under this Article is
18determined to be a permissible tax under Title XIX of the
19Social Security Act. In determining the hospital access
20payments authorized under subsection (g) of this Section, if a
21hospital ceases to qualify for payments from the pool, the
22payments for all hospitals continuing to qualify for payments
23from such pool shall be uniformly adjusted to fully expend the
24aggregate net amount of the pool, with such adjustment being

 

 

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1effective on the first day of the second month following the
2date the hospital ceases to receive payments from such pool.
3    (b) Amounts moved into claims-based rates and distributed
4in accordance with Section 14-12 shall remain in those
5claims-based rates.
6    (c) Graduate medical education.
7        (1) The calculation of graduate medical education
8    payments shall be based on the hospital's Medicare cost
9    report ending in Calendar Year 2018, as reported in the
10    Healthcare Cost Report Information System file, release
11    date September 30, 2019. An Illinois hospital reporting
12    intern and resident cost on its Medicare cost report shall
13    be eligible for graduate medical education payments.
14        (2) Each hospital's annualized Medicaid Intern
15    Resident Cost is calculated using annualized intern and
16    resident total costs obtained from Worksheet B Part I,
17    Columns 21 and 22 the sum of Lines 30-43, 50-76, 90-93,
18    96-98, and 105-112 multiplied by the percentage that the
19    hospital's Medicaid days (Worksheet S3 Part I, Column 7,
20    Lines 2, 3, 4, 14, 16-18, and 32) comprise of the
21    hospital's total days (Worksheet S3 Part I, Column 8, Lines
22    14, 16-18, and 32).
23        (3) An annualized Medicaid indirect medical education
24    (IME) payment is calculated for each hospital using its IME
25    payments (Worksheet E Part A, Line 29, Column 1) multiplied
26    by the percentage that its Medicaid days (Worksheet S3 Part

 

 

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1    I, Column 7, Lines 2, 3, 4, 14, 16-18, and 32) comprise of
2    its Medicare days (Worksheet S3 Part I, Column 6, Lines 2,
3    3, 4, 14, and 16-18).
4        (4) For each hospital, its annualized Medicaid Intern
5    Resident Cost and its annualized Medicaid IME payment are
6    summed, and, except as capped at 120% of the average cost
7    per intern and resident for all qualifying hospitals as
8    calculated under this paragraph, is multiplied by 22.6% to
9    determine the hospital's final graduate medical education
10    payment. Each hospital's average cost per intern and
11    resident shall be calculated by summing its total
12    annualized Medicaid Intern Resident Cost plus its
13    annualized Medicaid IME payment and dividing that amount by
14    the hospital's total Full Time Equivalent Residents and
15    Interns. If the hospital's average per intern and resident
16    cost is greater than 120% of the same calculation for all
17    qualifying hospitals, the hospital's per intern and
18    resident cost shall be capped at 120% of the average cost
19    for all qualifying hospitals.
20    (d) Fee-for-service supplemental payments. Each Illinois
21hospital shall receive an annual payment equal to the amounts
22below, to be paid in 12 equal installments on or before the
23seventh State business day of each month, except that no
24payment shall be due within 30 days after the later of the date
25of notification of federal approval of the payment
26methodologies required under this Section or any waiver

 

 

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1required under 42 CFR 433.68, at which time the sum of amounts
2required under this Section prior to the date of notification
3is due and payable.
4        (1) For critical access hospitals, $385 per covered
5    inpatient day contained in paid fee-for-service claims and
6    $530 per paid fee-for-service outpatient claim for dates of
7    service in Calendar Year 2019 in the Department's
8    Enterprise Data Warehouse as of May 11, 2020.
9        (2) For safety-net hospitals, $960 per covered
10    inpatient day contained in paid fee-for-service claims and
11    $625 per paid fee-for-service outpatient claim for dates of
12    service in Calendar Year 2019 in the Department's
13    Enterprise Data Warehouse as of May 11, 2020.
14        (3) For long term acute care hospitals, $295 per
15    covered inpatient day contained in paid fee-for-service
16    claims for dates of service in Calendar Year 2019 in the
17    Department's Enterprise Data Warehouse as of May 11, 2020.
18        (4) For freestanding psychiatric hospitals, $125 per
19    covered inpatient day contained in paid fee-for-service
20    claims and $130 per paid fee-for-service outpatient claim
21    for dates of service in Calendar Year 2019 in the
22    Department's Enterprise Data Warehouse as of May 11, 2020.
23        (5) For freestanding rehabilitation hospitals, $355
24    per covered inpatient day contained in paid
25    fee-for-service claims for dates of service in Calendar
26    Year 2019 in the Department's Enterprise Data Warehouse as

 

 

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1    of May 11, 2020.
2        (6) For all general acute care hospitals and high
3    Medicaid hospitals as defined in subsection (f), $350 per
4    covered inpatient day for dates of service in Calendar Year
5    2019 contained in paid fee-for-service claims and $620 per
6    paid fee-for-service outpatient claim in the Department's
7    Enterprise Data Warehouse as of May 11, 2020.
8        (7) Alzheimer's treatment access payment. Each
9    Illinois academic medical center or teaching hospital, as
10    defined in Section 5-5e.2 of this Code, that is identified
11    as the primary hospital affiliate of one of the Regional
12    Alzheimer's Disease Assistance Centers, as designated by
13    the Alzheimer's Disease Assistance Act and identified in
14    the Department of Public Health's Alzheimer's Disease
15    State Plan dated December 2016, shall be paid an
16    Alzheimer's treatment access payment equal to the product
17    of the qualifying hospital's State Fiscal Year 2018 total
18    inpatient fee-for-service days multiplied by the
19    applicable Alzheimer's treatment rate of $226.30 for
20    hospitals located in Cook County and $116.21 for hospitals
21    located outside Cook County.
22    (e) The Department shall require managed care
23organizations (MCOs) to make directed payments and
24pass-through payments according to this Section. Each calendar
25year, the Department shall require MCOs to pay the maximum
26amount out of these funds as allowed as pass-through payments

 

 

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1under federal regulations. The Department shall require MCOs to
2make such pass-through payments as specified in this Section.
3The Department shall require the MCOs to pay the remaining
4amounts as directed Payments as specified in this Section. The
5Department shall issue payments to the Comptroller by the
6seventh business day of each month for all MCOs that are
7sufficient for MCOs to make the directed payments and
8pass-through payments according to this Section. The
9Department shall require the MCOs to make pass-through payments
10and directed payments using electronic funds transfers (EFT),
11if the hospital provides the information necessary to process
12such EFTs, in accordance with directions provided monthly by
13the Department, within 7 business days of the date the funds
14are paid to the MCOs, as indicated by the "Paid Date" on the
15website of the Office of the Comptroller if the funds are paid
16by EFT and the MCOs have received directed payment
17instructions. If funds are not paid through the Comptroller by
18EFT, payment must be made within 7 business days of the date
19actually received by the MCO. The MCO will be considered to
20have paid the pass-through payments when the payment remittance
21number is generated or the date the MCO sends the check to the
22hospital, if EFT information is not supplied. If an MCO is late
23in paying a pass-through payment or directed payment as
24required under this Section (including any extensions granted
25by the Department), it shall pay a penalty, unless waived by
26the Department for reasonable cause, to the Department equal to

 

 

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15% of the amount of the pass-through payment or directed
2payment not paid on or before the due date plus 5% of the
3portion thereof remaining unpaid on the last day of each 30-day
4period thereafter. Payments to MCOs that would be paid
5consistent with actuarial certification and enrollment in the
6absence of the increased capitation payments under this Section
7shall not be reduced as a consequence of payments made under
8this subsection. The Department shall publish and maintain on
9its website for a period of no less than 8 calendar quarters,
10the quarterly calculation of directed payments and
11pass-through payments owed to each hospital from each MCO. All
12calculations and reports shall be posted no later than the
13first day of the quarter for which the payments are to be
14issued.
15    (f)(1) For purposes of allocating the funds included in
16capitation payments to MCOs, Illinois hospitals shall be
17divided into the following classes as defined in administrative
18rules:
19        (A) Critical access hospitals.
20        (B) Safety-net hospitals, except that stand-alone
21    children's hospitals that are not specialty children's
22    hospitals will not be included.
23        (C) Long term acute care hospitals.
24        (D) Freestanding psychiatric hospitals.
25        (E) Freestanding rehabilitation hospitals.
26        (F) High Medicaid hospitals. As used in this Section,

 

 

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1    "high Medicaid hospital" means a general acute care
2    hospital that is not a safety-net hospital or critical
3    access hospital and that has a Medicaid Inpatient
4    Utilization Rate above 30% or a hospital that had over
5    35,000 inpatient Medicaid days during the applicable
6    period. For the period July 1, 2020 through December 31,
7    2020, the applicable period for the Medicaid Inpatient
8    Utilization Rate (MIUR) is the rate year 2020 MIUR and for
9    the number of inpatient days it is State fiscal year 2018.
10    Beginning in calendar year 2021, the Department shall use
11    the most recently determined MIUR, as defined in subsection
12    (h) of Section 5-5.02, and for the inpatient day threshold,
13    the State fiscal year ending 18 months prior to the
14    beginning of the calendar year. For purposes of calculating
15    MIUR under this Section, children's hospitals and
16    affiliated general acute care hospitals shall be
17    considered a single hospital.
18        (G) General acute care hospitals. As used under this
19    Section, "general acute care hospitals" means all other
20    Illinois hospitals not identified in subparagraphs (A)
21    through (F).
22    (2) Hospitals' qualification for each class shall be
23assessed prior to the beginning of each calendar year and the
24new class designation shall be effective January 1 of the next
25year. The Department shall publish by rule the process for
26establishing class determination.

 

 

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1    (g) Fixed pool directed payments. Beginning July 1, 2020,
2the Department shall issue payments to MCOs which shall be used
3to issue directed payments to qualified Illinois safety-net
4hospitals and critical access hospitals on a monthly basis in
5accordance with this subsection. Prior to the beginning of each
6Payout Quarter beginning July 1, 2020, the Department shall use
7encounter claims data from the Determination Quarter, accepted
8by the Department's Medicaid Management Information System for
9inpatient and outpatient services rendered by safety-net
10hospitals and critical access hospitals to determine a
11quarterly uniform per unit add-on for each hospital class.
12        (1) Inpatient per unit add-on. A quarterly uniform per
13    diem add-on shall be derived by dividing the quarterly
14    Inpatient Directed Payments Pool amount allocated to the
15    applicable hospital class by the total inpatient days
16    contained on all encounter claims received during the
17    Determination Quarter, for all hospitals in the class.
18            (A) Each hospital in the class shall have a
19        quarterly inpatient directed payment calculated that
20        is equal to the product of the number of inpatient days
21        attributable to the hospital used in the calculation of
22        the quarterly uniform class per diem add-on,
23        multiplied by the calculated applicable quarterly
24        uniform class per diem add-on of the hospital class.
25            (B) Each hospital shall be paid 1/3 of its
26        quarterly inpatient directed payment in each of the 3

 

 

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1        months of the Payout Quarter, in accordance with
2        directions provided to each MCO by the Department.
3        (2) Outpatient per unit add-on. A quarterly uniform per
4    claim add-on shall be derived by dividing the quarterly
5    Outpatient Directed Payments Pool amount allocated to the
6    applicable hospital class by the total outpatient
7    encounter claims received during the Determination
8    Quarter, for all hospitals in the class.
9            (A) Each hospital in the class shall have a
10        quarterly outpatient directed payment calculated that
11        is equal to the product of the number of outpatient
12        encounter claims attributable to the hospital used in
13        the calculation of the quarterly uniform class per
14        claim add-on, multiplied by the calculated applicable
15        quarterly uniform class per claim add-on of the
16        hospital class.
17            (B) Each hospital shall be paid 1/3 of its
18        quarterly outpatient directed payment in each of the 3
19        months of the Payout Quarter, in accordance with
20        directions provided to each MCO by the Department.
21        (3) Each MCO shall pay each hospital the Monthly
22    Directed Payment as identified by the Department on its
23    quarterly determination report.
24        (4) Definitions. As used in this subsection:
25            (A) "Payout Quarter" means each 3 month calendar
26        quarter, beginning July 1, 2020.

 

 

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1            (B) "Determination Quarter" means each 3 month
2        calendar quarter, which ends 3 months prior to the
3        first day of each Payout Quarter.
4        (5) For the period July 1, 2020 through December 2020,
5    the following amounts shall be allocated to the following
6    hospital class directed payment pools for the quarterly
7    development of a uniform per unit add-on:
8            (A) $2,894,500 for hospital inpatient services for
9        critical access hospitals.
10            (B) $4,294,374 for hospital outpatient services
11        for critical access hospitals.
12            (C) $29,109,330 for hospital inpatient services
13        for safety-net hospitals.
14            (D) $35,041,218 for hospital outpatient services
15        for safety-net hospitals.
16    (h) Fixed rate directed payments. Effective July 1, 2020,
17the Department shall issue payments to MCOs which shall be used
18to issue directed payments to Illinois hospitals not identified
19in paragraph (g) on a monthly basis. Prior to the beginning of
20each Payout Quarter beginning July 1, 2020, the Department
21shall use encounter claims data from the Determination Quarter,
22accepted by the Department's Medicaid Management Information
23System for inpatient and outpatient services rendered by
24hospitals in each hospital class identified in paragraph (f)
25and not identified in paragraph (g). For the period July 1,
262020 through December 2020, the Department shall direct MCOs to

 

 

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1make payments as follows:
2        (1) For general acute care hospitals an amount equal to
3    $1,750 multiplied by the hospital's category of service 20
4    case mix index for the determination quarter multiplied by
5    the hospital's total number of inpatient admissions for
6    category of service 20 for the determination quarter.
7        (2) For general acute care hospitals an amount equal to
8    $160 multiplied by the hospital's category of service 21
9    case mix index for the determination quarter multiplied by
10    the hospital's total number of inpatient admissions for
11    category of service 21 for the determination quarter.
12        (3) For general acute care hospitals an amount equal to
13    $80 multiplied by the hospital's category of service 22
14    case mix index for the determination quarter multiplied by
15    the hospital's total number of inpatient admissions for
16    category of service 22 for the determination quarter.
17        (4) For general acute care hospitals an amount equal to
18    $375 multiplied by the hospital's category of service 24
19    case mix index for the determination quarter multiplied by
20    the hospital's total number of category of service 24 paid
21    EAPG (EAPGs) for the determination quarter.
22        (5) For general acute care hospitals an amount equal to
23    $240 multiplied by the hospital's category of service 27
24    and 28 case mix index for the determination quarter
25    multiplied by the hospital's total number of category of
26    service 27 and 28 paid EAPGs for the determination quarter.

 

 

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1        (6) For general acute care hospitals an amount equal to
2    $290 multiplied by the hospital's category of service 29
3    case mix index for the determination quarter multiplied by
4    the hospital's total number of category of service 29 paid
5    EAPGs for the determination quarter.
6        (7) For high Medicaid hospitals an amount equal to
7    $1,800 multiplied by the hospital's category of service 20
8    case mix index for the determination quarter multiplied by
9    the hospital's total number of inpatient admissions for
10    category of service 20 for the determination quarter.
11        (8) For high Medicaid hospitals an amount equal to $160
12    multiplied by the hospital's category of service 21 case
13    mix index for the determination quarter multiplied by the
14    hospital's total number of inpatient admissions for
15    category of service 21 for the determination quarter.
16        (9) For high Medicaid hospitals an amount equal to $80
17    multiplied by the hospital's category of service 22 case
18    mix index for the determination quarter multiplied by the
19    hospital's total number of inpatient admissions for
20    category of service 22 for the determination quarter.
21        (10) For high Medicaid hospitals an amount equal to
22    $400 multiplied by the hospital's category of service 24
23    case mix index for the determination quarter multiplied by
24    the hospital's total number of category of service 24 paid
25    EAPG outpatient claims for the determination quarter.
26        (11) For high Medicaid hospitals an amount equal to

 

 

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1    $240 multiplied by the hospital's category of service 27
2    and 28 case mix index for the determination quarter
3    multiplied by the hospital's total number of category of
4    service 27 and 28 paid EAPGs for the determination quarter.
5        (12) For high Medicaid hospitals an amount equal to
6    $290 multiplied by the hospital's category of service 29
7    case mix index for the determination quarter multiplied by
8    the hospital's total number of category of service 29 paid
9    EAPGs for the determination quarter.
10        (13) For long term acute care hospitals the amount of
11    $495 multiplied by the hospital's total number of inpatient
12    days for the determination quarter.
13        (14) For psychiatric hospitals the amount of $210
14    multiplied by the hospital's total number of inpatient days
15    for category of service 21 for the determination quarter.
16        (15) For psychiatric hospitals the amount of $250
17    multiplied by the hospital's total number of outpatient
18    claims for category of service 27 and 28 for the
19    determination quarter.
20        (16) For rehabilitation hospitals the amount of $410
21    multiplied by the hospital's total number of inpatient days
22    for category of service 22 for the determination quarter.
23        (17) For rehabilitation hospitals the amount of $100
24    multiplied by the hospital's total number of outpatient
25    claims for category of service 29 for the determination
26    quarter.

 

 

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1        (18) Each hospital shall be paid 1/3 of their quarterly
2    inpatient and outpatient directed payment in each of the 3
3    months of the Payout Quarter, in accordance with directions
4    provided to each MCO by the Department.
5        (19) Each MCO shall pay each hospital the Monthly
6    Directed Payment amount as identified by the Department on
7    its quarterly determination report.
8    Notwithstanding any other provision of this subsection, if
9the Department determines that the actual total hospital
10utilization data that is used to calculate the fixed rate
11directed payments is substantially different than anticipated
12when the rates in this subsection were initially determined
13(for unforeseeable circumstances such as the COVID-19
14pandemic), the Department may adjust the rates specified in
15this subsection so that the total directed payments approximate
16the total spending amount anticipated when the rates were
17initially established.
18    Definitions. As used in this subsection:
19            (A) "Payout Quarter" means each calendar quarter,
20        beginning July 1, 2020.
21            (B) "Determination Quarter" means each calendar
22        quarter which ends 3 months prior to the first day of
23        each Payout Quarter.
24            (C) "Case mix index" means a hospital specific
25        calculation. For inpatient claims the case mix index is
26        calculated each quarter by summing the relative weight

 

 

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1        of all inpatient Diagnosis-Related Group (DRG) claims
2        for a category of service in the applicable
3        Determination Quarter and dividing the sum by the
4        number of sum total of all inpatient DRG admissions for
5        the category of service for the associated claims. The
6        case mix index for outpatient claims is calculated each
7        quarter by summing the relative weight of all paid
8        EAPGs in the applicable Determination Quarter and
9        dividing the sum by the sum total of paid EAPGs for the
10        associated claims.
11    (i) Beginning January 1, 2021, the rates for directed
12payments shall be recalculated in order to spend the additional
13funds for directed payments that result from reduction in the
14amount of pass-through payments allowed under federal
15regulations. The additional funds for directed payments shall
16be allocated proportionally to each class of hospitals based on
17that class' proportion of services.
18    (j) Pass-through payments.
19        (1) For the period July 1, 2020 through December 31,
20    2020, the Department shall assign quarterly pass-through
21    payments to each class of hospitals equal to one-fourth of
22    the following annual allocations:
23            (A) $390,487,095 to safety-net hospitals.
24            (B) $62,553,886 to critical access hospitals.
25            (C) $345,021,438 to high Medicaid hospitals.
26            (D) $551,429,071 to general acute care hospitals.

 

 

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1            (E) $27,283,870 to long term acute care hospitals.
2            (F) $40,825,444 to freestanding psychiatric
3        hospitals.
4            (G) $9,652,108 to freestanding rehabilitation
5        hospitals.
6        (2) The pass-through payments shall at a minimum ensure
7    hospitals receive a total amount of monthly payments under
8    this Section as received in calendar year 2019 in
9    accordance with this Article and paragraph (1) of
10    subsection (d-5) of Section 14-12, exclusive of amounts
11    received through payments referenced in subsection (b).
12        (3) For the calendar year beginning January 1, 2021,
13    and each calendar year thereafter, each hospital's
14    pass-through payment amount shall be reduced
15    proportionally to the reduction of all pass-through
16    payments required by federal regulations.
17    (k) At least 30 days prior to each calendar year, the
18Department shall notify each hospital of changes to the payment
19methodologies in this Section, including, but not limited to,
20changes in the fixed rate directed payment rates, the aggregate
21pass-through payment amount for all hospitals, and the
22hospital's pass-through payment amount for the upcoming
23calendar year.
24    (l) Notwithstanding any other provisions of this Section,
25the Department may adopt rules to change the methodology for
26directed and pass-through payments as set forth in this

 

 

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1Section, but only to the extent necessary to obtain federal
2approval of a necessary State Plan amendment or Directed
3Payment Preprint or to otherwise conform to federal law or
4federal regulation.
5    (m) As used in this subsection, "managed care organization"
6or "MCO" means an entity which contracts with the Department to
7provide services where payment for medical services is made on
8a capitated basis, excluding contracted entities for dual
9eligible or Department of Children and Family Services youth
10populations.
11    (n) In order to address the escalating infant mortality
12rates among minority communities in Illinois, the State shall,
13subject to appropriation, create a pool of funding of at least
14$50,000,000 annually to be dispersed among community
15safety-net hospitals that maintain perinatal designation from
16the Department of Public Health. The funding shall be used to
17preserve or enhance OB/GYN services or other specialty services
18at the receiving hospital.
19(Source: P.A. 101-650, eff. 7-7-20.)
 
20
Article 110.

 
21    Section 110-1. Short title. This Article may be cited as
22the Racial Impact Note Act.
 
23    Section 110-5. Racial impact note.

 

 

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1    (a) Every bill which has or could have a disparate impact
2on racial and ethnic minorities, upon the request of any
3member, shall have prepared for it, before second reading in
4the house of introduction, a brief explanatory statement or
5note that shall include a reliable estimate of the anticipated
6impact on those racial and ethnic minorities likely to be
7impacted by the bill. Each racial impact note must include, for
8racial and ethnic minorities for which data are available: (i)
9an estimate of how the proposed legislation would impact racial
10and ethnic minorities; (ii) a statement of the methodologies
11and assumptions used in preparing the estimate; (iii) an
12estimate of the racial and ethnic composition of the population
13who may be impacted by the proposed legislation, including
14those persons who may be negatively impacted and those persons
15who may benefit from the proposed legislation; and (iv) any
16other matter that a responding agency considers appropriate in
17relation to the racial and ethnic minorities likely to be
18affected by the bill.
 
19    Section 110-10. Preparation.
20    (a) The sponsor of each bill for which a request under
21Section 110-5 has been made shall present a copy of the bill
22with the request for a racial impact note to the appropriate
23responding agency or agencies under subsection (b). The
24responding agency or agencies shall prepare and submit the note
25to the sponsor of the bill within 5 calendar days, except that

 

 

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1whenever, because of the complexity of the measure, additional
2time is required for the preparation of the racial impact note,
3the responding agency or agencies may inform the sponsor of the
4bill, and the sponsor may approve an extension of the time
5within which the note is to be submitted, not to extend,
6however, beyond June 15, following the date of the request. If,
7in the opinion of the responding agency or agencies, there is
8insufficient information to prepare a reliable estimate of the
9anticipated impact, a statement to that effect can be filed and
10shall meet the requirements of this Act.
11    (b) If a bill concerns arrests, convictions, or law
12enforcement, a statement shall be prepared by the Illinois
13Criminal Justice Information Authority specifying the impact
14on racial and ethnic minorities. If a bill concerns
15corrections, sentencing, or the placement of individuals
16within the Department of Corrections, a statement shall be
17prepared by the Department of Corrections specifying the impact
18on racial and ethnic minorities. If a bill concerns local
19government, a statement shall be prepared by the Department of
20Commerce and Economic Opportunity specifying the impact on
21racial and ethnic minorities. If a bill concerns education, one
22of the following agencies shall prepare a statement specifying
23the impact on racial and ethnic minorities: (i) the Illinois
24Community College Board, if the bill affects community
25colleges; (ii) the Illinois State Board of Education, if the
26bill affects primary and secondary education; or (iii) the

 

 

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1Illinois Board of Higher Education, if the bill affects State
2universities. Any other State agency impacted or responsible
3for implementing all or part of this bill shall prepare a
4statement of the racial and ethnic impact of the bill as it
5relates to that agency.
 
6    Section 110-15. Requisites and contents. The note shall be
7factual in nature, as brief and concise as may be, and, in
8addition, it shall include both the immediate effect and, if
9determinable or reasonably foreseeable, the long range effect
10of the measure on racial and ethnic minorities. If, after
11careful investigation, it is determined that such an effect is
12not ascertainable, the note shall contain a statement to that
13effect, setting forth the reasons why no ascertainable effect
14can be given.
 
15    Section 110-20. Comment or opinion; technical or
16mechanical defects. No comment or opinion shall be included in
17the racial impact note with regard to the merits of the measure
18for which the racial impact note is prepared; however,
19technical or mechanical defects may be noted.
 
20    Section 110-25. Appearance of State officials and
21employees in support or opposition of measure. The fact that a
22racial impact note is prepared for any bill shall not preclude
23or restrict the appearance before any committee of the General

 

 

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1Assembly of any official or authorized employee of the
2responding agency or agencies, or any other impacted State
3agency, who desires to be heard in support of or in opposition
4to the measure.
 
5
Article 115.

 
6    Section 115-5. The Department of Healthcare and Family
7Services Law of the Civil Administrative Code of Illinois is
8amended by adding Section 2205-35 as follows:
 
9    (20 ILCS 2205/2205-35 new)
10    Sec. 2205-35. Increasing access to primary care in
11hospitals. The Department of Healthcare and Family Services
12shall develop a program to increase the presence of Federally
13Qualified Health Centers (FQHCs) in hospitals, including, but
14not limited to, safety-net hospitals, with the goal of
15increasing care coordination, managing chronic diseases, and
16addressing the social determinants of health on or before
17December 31, 2021. In addition, the Department shall develop a
18payment methodology to allow FQHCs to provide care coordination
19services, including, but not limited to, chronic disease
20management and behavioral health services. The Department of
21Healthcare and Family Services shall develop a payment
22methodology to allow for care coordination services in FQHCs by
23no later than December 31, 2021.
 

 

 

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1
Article 120.

 
2    Section 120-5. The Civil Administrative Code of Illinois is
3amended by changing Section 5-565 as follows:
 
4    (20 ILCS 5/5-565)  (was 20 ILCS 5/6.06)
5    Sec. 5-565. In the Department of Public Health.
6    (a) The General Assembly declares it to be the public
7policy of this State that all residents citizens of Illinois
8are entitled to lead healthy lives. Governmental public health
9has a specific responsibility to ensure that a public health
10system is in place to allow the public health mission to be
11achieved. The public health system is the collection of public,
12private, and voluntary entities as well as individuals and
13informal associations that contribute to the public's health
14within the State. To develop a public health system requires
15certain core functions to be performed by government. The State
16Board of Health is to assume the leadership role in advising
17the Director in meeting the following functions:
18        (1) Needs assessment.
19        (2) Statewide health objectives.
20        (3) Policy development.
21        (4) Assurance of access to necessary services.
22    There shall be a State Board of Health composed of 20
23persons, all of whom shall be appointed by the Governor, with

 

 

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1the advice and consent of the Senate for those appointed by the
2Governor on and after June 30, 1998, and one of whom shall be a
3senior citizen age 60 or over. Five members shall be physicians
4licensed to practice medicine in all its branches, one
5representing a medical school faculty, one who is board
6certified in preventive medicine, and one who is engaged in
7private practice. One member shall be a chiropractic physician.
8One member shall be a dentist; one an environmental health
9practitioner; one a local public health administrator; one a
10local board of health member; one a registered nurse; one a
11physical therapist; one an optometrist; one a veterinarian; one
12a public health academician; one a health care industry
13representative; one a representative of the business
14community; one a representative of the non-profit public
15interest community; and 2 shall be citizens at large.
16    The terms of Board of Health members shall be 3 years,
17except that members shall continue to serve on the Board of
18Health until a replacement is appointed. Upon the effective
19date of Public Act 93-975 (January 1, 2005) this amendatory Act
20of the 93rd General Assembly, in the appointment of the Board
21of Health members appointed to vacancies or positions with
22terms expiring on or before December 31, 2004, the Governor
23shall appoint up to 6 members to serve for terms of 3 years; up
24to 6 members to serve for terms of 2 years; and up to 5 members
25to serve for a term of one year, so that the term of no more
26than 6 members expire in the same year. All members shall be

 

 

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1legal residents of the State of Illinois. The duties of the
2Board shall include, but not be limited to, the following:
3        (1) To advise the Department of ways to encourage
4    public understanding and support of the Department's
5    programs.
6        (2) To evaluate all boards, councils, committees,
7    authorities, and bodies advisory to, or an adjunct of, the
8    Department of Public Health or its Director for the purpose
9    of recommending to the Director one or more of the
10    following:
11            (i) The elimination of bodies whose activities are
12        not consistent with goals and objectives of the
13        Department.
14            (ii) The consolidation of bodies whose activities
15        encompass compatible programmatic subjects.
16            (iii) The restructuring of the relationship
17        between the various bodies and their integration
18        within the organizational structure of the Department.
19            (iv) The establishment of new bodies deemed
20        essential to the functioning of the Department.
21        (3) To serve as an advisory group to the Director for
22    public health emergencies and control of health hazards.
23        (4) To advise the Director regarding public health
24    policy, and to make health policy recommendations
25    regarding priorities to the Governor through the Director.
26        (5) To present public health issues to the Director and

 

 

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1    to make recommendations for the resolution of those issues.
2        (6) To recommend studies to delineate public health
3    problems.
4        (7) To make recommendations to the Governor through the
5    Director regarding the coordination of State public health
6    activities with other State and local public health
7    agencies and organizations.
8        (8) To report on or before February 1 of each year on
9    the health of the residents of Illinois to the Governor,
10    the General Assembly, and the public.
11        (9) To review the final draft of all proposed
12    administrative rules, other than emergency or peremptory
13    preemptory rules and those rules that another advisory body
14    must approve or review within a statutorily defined time
15    period, of the Department after September 19, 1991 (the
16    effective date of Public Act 87-633). The Board shall
17    review the proposed rules within 90 days of submission by
18    the Department. The Department shall take into
19    consideration any comments and recommendations of the
20    Board regarding the proposed rules prior to submission to
21    the Secretary of State for initial publication. If the
22    Department disagrees with the recommendations of the
23    Board, it shall submit a written response outlining the
24    reasons for not accepting the recommendations.
25        In the case of proposed administrative rules or
26    amendments to administrative rules regarding immunization

 

 

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1    of children against preventable communicable diseases
2    designated by the Director under the Communicable Disease
3    Prevention Act, after the Immunization Advisory Committee
4    has made its recommendations, the Board shall conduct 3
5    public hearings, geographically distributed throughout the
6    State. At the conclusion of the hearings, the State Board
7    of Health shall issue a report, including its
8    recommendations, to the Director. The Director shall take
9    into consideration any comments or recommendations made by
10    the Board based on these hearings.
11        (10) To deliver to the Governor for presentation to the
12    General Assembly a State Health Assessment (SHA) and a
13    State Health Improvement Plan (SHIP). The first 5 3 such
14    plans shall be delivered to the Governor on January 1,
15    2006, January 1, 2009, and January 1, 2016, January 1,
16    2021, and June 30, 2022, and then every 5 years thereafter.
17        The State Health Assessment and State Health
18    Improvement Plan Plan shall assess and recommend
19    priorities and strategies to improve the public health
20    system, and the health status of Illinois residents, reduce
21    health disparities and inequities, and promote health
22    equity. The State Health Assessment and State Health
23    Improvement Plan development and implementation shall
24    conform to national Public Health Accreditation Board
25    Standards. The State Health Assessment and State Health
26    Improvement Plan development and implementation process

 

 

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1    shall be carried out with the administrative and
2    operational support of the Department of Public Health
3    taking into consideration national health objectives and
4    system standards as frameworks for assessment.
5        The State Health Assessment shall include
6    comprehensive, broad-based data and information from a
7    variety of sources on health status and the public health
8    system including:
9            (i) quantitative data on the demographics and
10        health status of the population, including data over
11        time on health by gender, sex, race, ethnicity, age,
12        socio-economic factors, geographic region, and other
13        indicators of disparity;
14            (ii) quantitative data on social and structural
15        issues affecting health (social and structural
16        determinants of health), including, but not limited
17        to, housing, transportation, educational attainment,
18        employment, and income inequality;
19            (iii) priorities and strategies developed at the
20        community level through the Illinois Project for Local
21        Assessment of Needs (IPLAN) and other local and
22        regional community health needs assessments;
23            (iv) qualitative data representing the
24        population's input on health concerns and well-being,
25        including the perceptions of people experiencing
26        disparities and health inequities;

 

 

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1            (v) information on health disparities and health
2        inequities; and
3            (vi) information on public health system strengths
4        and areas for improvement.
5        The Plan shall also take into consideration priorities
6    and strategies developed at the community level through the
7    Illinois Project for Local Assessment of Needs (IPLAN) and
8    any regional health improvement plans that may be
9    developed.
10        The State Health Improvement Plan Plan shall focus on
11    prevention, social determinants of health, and promoting
12    health equity as key strategies as a key strategy for
13    long-term health improvement in Illinois.
14        The State Health Improvement Plan Plan shall identify
15    priority State health issues and social issues affecting
16    health, and shall examine and make recommendations on the
17    contributions and strategies of the public and private
18    sectors for improving health status and the public health
19    system in the State. In addition to recommendations on
20    health status improvement priorities and strategies for
21    the population of the State as a whole, the State Health
22    Improvement Plan Plan shall make recommendations regarding
23    priorities and strategies for reducing and eliminating
24    health disparities and health inequities in Illinois;
25    including racial, ethnic, gender, sex, age,
26    socio-economic, and geographic disparities. The State

 

 

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1    Health Improvement Plan shall make recommendations
2    regarding social determinants of health, such as housing,
3    transportation, educational attainment, employment, and
4    income inequality.
5        The development and implementation of the State Health
6    Assessment and State Health Improvement Plan shall be a
7    collaborative public-private cross-agency effort overseen
8    by the SHA and SHIP Partnership. The Director of Public
9    Health shall consult with the Governor to ensure
10    participation by the head of State agencies with public
11    health responsibilities (or their designees) in the SHA and
12    SHIP Partnership, including, but not limited to, the
13    Department of Public Health, the Department of Human
14    Services, the Department of Healthcare and Family
15    Services, the Department of Children and Family Services,
16    the Environmental Protection Agency, the Illinois State
17    Board of Education, the Department on Aging, the Illinois
18    Housing Development Authority, the Illinois Criminal
19    Justice Information Authority, the Department of
20    Agriculture, the Department of Transportation, the
21    Department of Corrections, the Department of Commerce and
22    Economic Opportunity, and the Chair of the State Board of
23    Health to also serve on the Partnership. A member of the
24    Governors' staff shall participate in the Partnership and
25    serve as a liaison to the Governors' office.
26        The Director of the Illinois Department of Public

 

 

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1    Health shall appoint a minimum of 20 other members of the
2    SHA and SHIP Partnership representing a Planning Team that
3    includes a range of public, private, and voluntary sector
4    stakeholders and participants in the public health system.
5    For the first SHA and SHIP Partnership after the effective
6    date of this amendatory Act of the 101st General Assembly,
7    one-half of the members shall be appointed for a 3-year
8    term, and one-half of the members shall be appointed for a
9    5-year term. Subsequently, members shall be appointed to
10    5-year terms. Should any member not be able to fulfill his
11    or her term, the Director may appoint a replacement to
12    complete that term. The Director, in consultation with the
13    SHA and SHIP Partnership, may engage additional
14    individuals and organizations to serve on subcommittees
15    and ad hoc efforts to conduct the State Health Assessment
16    and develop and implement the State Health Improvement
17    Plan. Members of the SHA and SHIP Partnership shall receive
18    no compensation for serving as members, but may be
19    reimbursed for their necessary expenses.
20        The SHA and SHIP Partnership This Team shall include:
21    the directors of State agencies with public health
22    responsibilities (or their designees), including but not
23    limited to the Illinois Departments of Public Health and
24    Department of Human Services, representatives of local
25    health departments, representatives of local community
26    health partnerships, and individuals with expertise who

 

 

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1    represent an array of organizations and constituencies
2    engaged in public health improvement and prevention, such
3    as non-profit public interest groups, groups serving
4    populations that experience health disparities and health
5    inequities, groups addressing social determinants of
6    health, health issue groups, faith community groups,
7    health care providers, businesses and employers, academic
8    institutions, and community-based organizations.
9        The Director shall endeavor to make the membership of
10    the Partnership diverse and inclusive of the racial,
11    ethnic, gender, socio-economic, and geographic diversity
12    of the State. The SHA and SHIP Partnership shall be chaired
13    by the Director of Public Health or his or her designee.
14        The SHA and SHIP Partnership shall develop and
15    implement a community engagement process that facilitates
16    input into the development of the State Health Assessment
17    and State Health Improvement Plan. This engagement process
18    shall ensure that individuals with lived experience in the
19    issues addressed in the State Health Assessment and State
20    Health Improvement Plan are meaningfully engaged in the
21    development and implementation of the State Health
22    Assessment and State Health Improvement Plan.
23        The State Board of Health shall hold at least 3 public
24    hearings addressing a draft of the State Health Improvement
25    Plan drafts of the Plan in representative geographic areas
26    of the State. Members of the Planning Team shall receive no

 

 

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1    compensation for their services, but may be reimbursed for
2    their necessary expenses.
3        Upon the delivery of each State Health Improvement
4    Plan, the Governor shall appoint a SHIP Implementation
5    Coordination Council that includes a range of public,
6    private, and voluntary sector stakeholders and
7    participants in the public health system. The Council shall
8    include the directors of State agencies and entities with
9    public health system responsibilities (or their
10    designees), including but not limited to the Department of
11    Public Health, Department of Human Services, Department of
12    Healthcare and Family Services, Environmental Protection
13    Agency, Illinois State Board of Education, Department on
14    Aging, Illinois Violence Prevention Authority, Department
15    of Agriculture, Department of Insurance, Department of
16    Financial and Professional Regulation, Department of
17    Transportation, and Department of Commerce and Economic
18    Opportunity and the Chair of the State Board of Health. The
19    Council shall include representatives of local health
20    departments and individuals with expertise who represent
21    an array of organizations and constituencies engaged in
22    public health improvement and prevention, including
23    non-profit public interest groups, health issue groups,
24    faith community groups, health care providers, businesses
25    and employers, academic institutions, and community-based
26    organizations. The Governor shall endeavor to make the

 

 

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1    membership of the Council representative of the racial,
2    ethnic, gender, socio-economic, and geographic diversity
3    of the State. The Governor shall designate one State agency
4    representative and one other non-governmental member as
5    co-chairs of the Council. The Governor shall designate a
6    member of the Governor's office to serve as liaison to the
7    Council and one or more State agencies to provide or
8    arrange for support to the Council. The members of the SHIP
9    Implementation Coordination Council for each State Health
10    Improvement Plan shall serve until the delivery of the
11    subsequent State Health Improvement Plan, whereupon a new
12    Council shall be appointed. Members of the SHIP Planning
13    Team may serve on the SHIP Implementation Coordination
14    Council if so appointed by the Governor.
15        Upon the delivery of each State Health Assessment and
16    State Health Improvement Plan, the SHA and SHIP Partnership
17    The SHIP Implementation Coordination Council shall
18    coordinate the efforts and engagement of the public,
19    private, and voluntary sector stakeholders and
20    participants in the public health system to implement each
21    SHIP. The Partnership Council shall serve as a forum for
22    collaborative action; coordinate existing and new
23    initiatives; develop detailed implementation steps, with
24    mechanisms for action; implement specific projects;
25    identify public and private funding sources at the local,
26    State and federal level; promote public awareness of the

 

 

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1    SHIP; and advocate for the implementation of the SHIP. The
2    SHA and SHIP Partnership shall implement strategies to
3    ensure that individuals and communities affected by health
4    disparities and health inequities are engaged in the
5    process throughout the 5-year cycle. The SHA and SHIP
6    Partnership shall not have the authority to direct any
7    public or private entity to take specific action to
8    implement the SHIP. ; and develop an annual report to the
9    Governor, General Assembly, and public regarding the
10    status of implementation of the SHIP. The Council shall
11    not, however, have the authority to direct any public or
12    private entity to take specific action to implement the
13    SHIP.
14        The SHA and SHIP Partnership shall regularly evaluate
15    and update the State Health Assessment and track
16    implementation of the State Health Improvement Plan with
17    revisions as necessary. The State Board of Health shall
18    submit a report by January 31 of each year on the status of
19    State Health Improvement Plan implementation and community
20    engagement activities to the Governor, General Assembly,
21    and public. In the fifth year, the report may be
22    consolidated into the new State Health Assessment and State
23    Health Improvement Plan.
24        (11) Upon the request of the Governor, to recommend to
25    the Governor candidates for Director of Public Health when
26    vacancies occur in the position.

 

 

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1        (12) To adopt bylaws for the conduct of its own
2    business, including the authority to establish ad hoc
3    committees to address specific public health programs
4    requiring resolution.
5        (13) (Blank).
6    Upon appointment, the Board shall elect a chairperson from
7among its members.
8    Members of the Board shall receive compensation for their
9services at the rate of $150 per day, not to exceed $10,000 per
10year, as designated by the Director for each day required for
11transacting the business of the Board and shall be reimbursed
12for necessary expenses incurred in the performance of their
13duties. The Board shall meet from time to time at the call of
14the Department, at the call of the chairperson, or upon the
15request of 3 of its members, but shall not meet less than 4
16times per year.
17    (b) (Blank).
18    (c) An Advisory Board on Necropsy Service to Coroners,
19which shall counsel and advise with the Director on the
20administration of the Autopsy Act. The Advisory Board shall
21consist of 11 members, including a senior citizen age 60 or
22over, appointed by the Governor, one of whom shall be
23designated as chairman by a majority of the members of the
24Board. In the appointment of the first Board the Governor shall
25appoint 3 members to serve for terms of 1 year, 3 for terms of 2
26years, and 3 for terms of 3 years. The members first appointed

 

 

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1under Public Act 83-1538 shall serve for a term of 3 years. All
2members appointed thereafter shall be appointed for terms of 3
3years, except that when an appointment is made to fill a
4vacancy, the appointment shall be for the remaining term of the
5position vacant. The members of the Board shall be citizens of
6the State of Illinois. In the appointment of members of the
7Advisory Board the Governor shall appoint 3 members who shall
8be persons licensed to practice medicine and surgery in the
9State of Illinois, at least 2 of whom shall have received
10post-graduate training in the field of pathology; 3 members who
11are duly elected coroners in this State; and 5 members who
12shall have interest and abilities in the field of forensic
13medicine but who shall be neither persons licensed to practice
14any branch of medicine in this State nor coroners. In the
15appointment of medical and coroner members of the Board, the
16Governor shall invite nominations from recognized medical and
17coroners organizations in this State respectively. Board
18members, while serving on business of the Board, shall receive
19actual necessary travel and subsistence expenses while so
20serving away from their places of residence.
21(Source: P.A. 98-463, eff. 8-16-13; 99-527, eff. 1-1-17;
22revised 7-17-19.)
 
23
Article 125.

 
24    Section 125-1. Short title. This Article may be cited as

 

 

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1the Health and Human Services Task Force and Study Act.
2References in this Article to "this Act" mean this Article.
 
3    Section 125-5. Findings. The General Assembly finds that:
4        (1) The State is committed to improving the health and
5    well-being of Illinois residents and families.
6        (2) According to data collected by the Kaiser
7    Foundation, Illinois had over 905,000 uninsured residents
8    in 2019, with a total uninsured rate of 7.3%.
9        (3) Many Illinois residents and families who have
10    health insurance cannot afford to use it due to high
11    deductibles and cost sharing.
12        (4) Lack of access to affordable health care services
13    disproportionately affects minority communities throughout
14    the State, leading to poorer health outcomes among those
15    populations.
16        (5) Illinois Medicaid beneficiaries are not receiving
17    the coordinated and effective care they need to support
18    their overall health and well-being.
19        (6) Illinois has an opportunity to improve the health
20    and well-being of a historically underserved and
21    vulnerable population by providing more coordinated and
22    higher quality care to its Medicaid beneficiaries.
23        (7) The State of Illinois has a responsibility to help
24    crime victims access justice, assistance, and the support
25    they need to heal.

 

 

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1        (8) Research has shown that people who are repeatedly
2    victimized are more likely to face mental health problems
3    such as depression, anxiety, and symptoms related to
4    post-traumatic stress disorder and chronic trauma.
5        (9) Trauma-informed care has been promoted and
6    established in communities across the country on a
7    bipartisan basis, and numerous federal agencies have
8    integrated trauma-informed approaches into their programs
9    and grants, which should be leveraged by the State of
10    Illinois.
11        (10) Infants, children, and youth and their families
12    who have experienced or are at risk of experiencing trauma,
13    including those who are low-income, homeless, involved
14    with the child welfare system, involved in the juvenile or
15    adult justice system, unemployed, or not enrolled in or at
16    risk of dropping out of an educational institution and live
17    in a community that has faced acute or long-term exposure
18    to substantial discrimination, historical oppression,
19    intergenerational poverty, a high rate of violence or drug
20    overdose deaths, should have an opportunity for improved
21    outcomes; this means increasing access to greater
22    opportunities to meet educational, employment, health,
23    developmental, community reentry, permanency from foster
24    care, or other key goals.
 
25    Section 125-10. Health and Human Services Task Force. The

 

 

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1Health and Human Services Task Force is created within the
2Department of Human Services to undertake a systematic review
3of health and human service departments and programs with the
4goal of improving health and human service outcomes for
5Illinois residents.
 
6    Section 125-15. Study.
7    (1) The Task Force shall review all health and human
8service departments and programs and make recommendations for
9achieving a system that will improve interagency
10interoperability with respect to improving access to
11healthcare, healthcare disparities, workforce competency and
12diversity, social determinants of health, and data sharing and
13collection. These recommendations shall include, but are not
14limited to, the following elements:
15        (i) impact on infant and maternal mortality;
16        (ii) impact of hospital closures, including safety-net
17    hospitals, on local communities; and
18        (iii) impact on Medicaid Managed Care Organizations.
19    (2) The Task Force shall review and make recommendations on
20ways the Medicaid program can partner and cooperate with other
21agencies, including but not limited to the Department of
22Agriculture, the Department of Insurance, the Department of
23Human Services, the Department of Labor, the Environmental
24Protection Agency, and the Department of Public Health, to
25better address social determinants of public health,

 

 

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1including, but not limited to, food deserts, affordable
2housing, environmental pollutions, employment, education, and
3public support services. This shall include a review and
4recommendations on ways Medicaid and the agencies can share
5costs related to better health outcomes.
6    (3) The Task Force shall review the current partnership,
7communication, and cooperation between Federally Qualified
8Health Centers (FQHCs) and safety-net hospitals in Illinois and
9make recommendations on public policies that will improve
10interoperability and cooperations between these entities in
11order to achieve improved coordinated care and better health
12outcomes for vulnerable populations in the State.
13    (4) The Task Force shall review and examine public policies
14affecting trauma and social determinants of health, including
15trauma-informed care, and make recommendations on ways to
16improve and integrate trauma-informed approaches into programs
17and agencies in the State, including, but not limited to,
18Medicaid and other health care programs administered by the
19State, and increase awareness of trauma and its effects on
20communities across Illinois.
21    (5) The Task Force shall review and examine the connection
22between access to education and health outcomes particularly in
23African American and minority communities and make
24recommendations on public policies to address any gaps or
25deficiencies.
 

 

 

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1    Section 125-20. Membership; appointments; meetings;
2support.
3    (1) The Task Force shall include representation from both
4public and private organizations, and its membership shall
5reflect regional, racial, and cultural diversity to ensure
6representation of the needs of all Illinois citizens. Task
7Force members shall include one member appointed by the
8President of the Senate, one member appointed by the Minority
9Leader of the Senate, one member appointed by the Speaker of
10the House of Representatives, one member appointed by the
11Minority Leader of the House of Representatives, and other
12members appointed by the Governor. The Governor's appointments
13shall include, without limitation, the following:
14        (A) One member of the Senate, appointed by the Senate
15    President, who shall serve as Co-Chair;
16        (B) One member of the House of Representatives,
17    appointed by the Speaker of the House, who shall serve as
18    Co-Chair;
19        (C) Eight members of the General Assembly representing
20    each of the majority and minority caucuses of each chamber.
21        (D) The Directors or Secretaries of the following State
22    agencies or their designees:
23            (i) Department of Human Services.
24            (ii) Department of Children and Family Services.
25            (iii) Department of Healthcare and Family
26        Services.

 

 

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1            (iv) State Board of Education.
2            (v) Department on Aging.
3            (vi) Department of Public Health.
4            (vii) Department of Veterans' Affairs.
5            (viii) Department of Insurance.
6        (E) Local government stakeholders and nongovernmental
7    stakeholders with an interest in human services, including
8    representation among the following private-sector fields
9    and constituencies:
10            (i) Early childhood education and development.
11            (ii) Child care.
12            (iii) Child welfare.
13            (iv) Youth services.
14            (v) Developmental disabilities.
15            (vi) Mental health.
16            (vii) Employment and training.
17            (viii) Sexual and domestic violence.
18            (ix) Alcohol and substance abuse.
19            (x) Local community collaborations among human
20        services programs.
21            (xi) Immigrant services.
22            (xii) Affordable housing.
23            (xiii) Food and nutrition.
24            (xiv) Homelessness.
25            (xv) Older adults.
26            (xvi) Physical disabilities.

 

 

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1            (xvii) Maternal and child health.
2            (xviii) Medicaid managed care organizations.
3            (xix) Healthcare delivery.
4            (xx) Health insurance.
5    (2) Members shall serve without compensation for the
6duration of the Task Force.
7    (3) In the event of a vacancy, the appointment to fill the
8vacancy shall be made in the same manner as the original
9appointment.
10    (4) The Task Force shall convene within 60 days after the
11effective date of this Act. The initial meeting of the Task
12Force shall be convened by the co-chair selected by the
13Governor. Subsequent meetings shall convene at the call of the
14co-chairs. The Task Force shall meet on a quarterly basis, or
15more often if necessary.
16    (5) The Department of Human Services shall provide
17administrative support to the Task Force.
 
18    Section 125-25. Report. The Task Force shall report to the
19Governor and the General Assembly on the Task Force's progress
20toward its goals and objectives by June 30, 2021, and every
21June 30 thereafter.
 
22    Section 125-30. Transparency. In addition to whatever
23policies or procedures it may adopt, all operations of the Task
24Force shall be subject to the provisions of the Freedom of

 

 

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1Information Act and the Open Meetings Act. This Section shall
2not be construed so as to preclude other State laws from
3applying to the Task Force and its activities.
 
4    Section 125-40. Repeal. This Article is repealed June 30,
52023.
 
6
Article 130.

 
7    Section 130-1. Short title. This Article may be cited as
8the Anti-Racism Commission Act. References in this Article to
9"this Act" mean this Article.
 
10    Section 130-5. Findings. The General Assembly finds and
11declares all of the following:
12        (1) Public health is the science and art of preventing
13    disease, of protecting and improving the health of people,
14    entire populations, and their communities; this work is
15    achieved by promoting healthy lifestyles and choices,
16    researching disease, and preventing injury.
17        (2) Public health professionals try to prevent
18    problems from happening or recurring through implementing
19    educational programs, recommending policies, administering
20    services, and limiting health disparities through the
21    promotion of equitable and accessible healthcare.
22        (3) According to the Centers for Disease Control and

 

 

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1    Prevention, racism and segregation in the State of Illinois
2    have exacerbated a health divide, resulting in Black
3    residents having lower life expectancies than white
4    citizens of this State and being far more likely than other
5    races to die prematurely (before the age of 75) and to die
6    of heart disease or stroke; Black residents of Illinois
7    have a higher level of infant mortality, lower birth weight
8    babies, and are more likely to be overweight or obese as
9    adults, have adult diabetes, and have long-term
10    complications from diabetes that exacerbate other
11    conditions, including the susceptibility to COVID-19.
12        (4) Black and Brown people are more likely to
13    experience poor health outcomes as a consequence of their
14    social determinants of health, health inequities stemming
15    from economic instability, education, physical
16    environment, food, and access to health care systems.
17        (5) Black residents in Illinois are more likely than
18    white residents to experience violence-related trauma as a
19    result of socioeconomic conditions resulting from systemic
20    racism.
21        (6) Racism is a social system with multiple dimensions
22    in which individual racism is internalized or
23    interpersonal and systemic racism is institutional or
24    structural and is a system of structuring opportunity and
25    assigning value based on the social interpretation of how
26    one looks; this unfairly disadvantages specific

 

 

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1    individuals and communities, while unfairly giving
2    advantages to other individuals and communities; it saps
3    the strength of the whole society through the waste of
4    human resources.
5        (7) Racism causes persistent racial discrimination
6    that influences many areas of life, including housing,
7    education, employment, and criminal justice; an emerging
8    body of research demonstrates that racism itself is a
9    social determinant of health.
10        (8) More than 100 studies have linked racism to worse
11    health outcomes.
12        (9) The American Public Health Association launched a
13    National Campaign against Racism.
14        (10) Public health's responsibilities to address
15    racism include reshaping our discourse and agenda so that
16    we all actively engage in racial justice work.
 
17    Section 130-10. Anti-Racism Commission.
18    (a) The Anti-Racism Commission is hereby created to
19identify and propose statewide policies to eliminate systemic
20racism and advance equitable solutions for Black and Brown
21people in Illinois.
22    (b) The Anti-Racism Commission shall consist of the
23following members, who shall serve without compensation:
24        (1) one member of the House of Representatives,
25    appointed by the Speaker of the House of Representatives,

 

 

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1    who shall serve as co-chair;
2        (2) one member of the Senate, appointed by the Senate
3    President, who shall serve as co-chair;
4        (3) one member of the House of Representatives,
5    appointed by the Minority Leader of the House of
6    Representatives;
7        (4) one member of the Senate, appointed by the Minority
8    Leader of the Senate;
9        (5) the Director of Public Health, or his or her
10    designee;
11        (6) the Chair of the House Black Caucus;
12        (7) the Chair of the Senate Black Caucus;
13        (8) the Chair of the Joint Legislative Black Caucus;
14        (9) the director of a statewide association
15    representing public health departments, appointed by the
16    Speaker of the House of Representatives;
17        (10) the Chair of the House Latino Caucus;
18        (11) the Chair of the Senate Latino Caucus;
19        (12) one community member appointed by the House Black
20    Caucus Chair;
21        (13) one community member appointed by the Senate Black
22    Caucus Chair;
23        (14) one community member appointed by the House Latino
24    Caucus Chair; and
25        (15) one community member appointed by the Senate
26    Latino Caucus Chair.

 

 

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1    (c) The Department of Public Health shall provide
2administrative support for the Commission.
3    (d) The Commission is charged with, but not limited to, the
4following tasks:
5        (1) Working to create an equity and justice-oriented
6    State government.
7        (2) Assessing the policy and procedures of all State
8    agencies to ensure racial equity is a core element of State
9    government.
10        (3) Developing and incorporating into the
11    organizational structure of State government a plan for
12    educational efforts to understand, address, and dismantle
13    systemic racism in government actions.
14        (4) Recommending and advocating for policies that
15    improve health in Black and Brown people and support local,
16    State, regional, and federal initiatives that advance
17    efforts to dismantle systemic racism.
18        (5) Working to build alliances and partnerships with
19    organizations that are confronting racism and encouraging
20    other local, State, regional, and national entities to
21    recognize racism as a public health crisis.
22        (6) Promoting community engagement, actively engaging
23    citizens on issues of racism and assisting in providing
24    tools to engage actively and authentically with Black and
25    Brown people.
26        (7) Reviewing all portions of codified State laws

 

 

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1    through the lens of racial equity.
2        (8) Working with the Department of Central Management
3    Services to update policies that encourage diversity in
4    human resources, including hiring, board appointments, and
5    vendor selection by agencies, and to review all grant
6    management activities with an eye toward equity and
7    workforce development.
8        (9) Recommending policies that promote racially
9    equitable economic and workforce development practices.
10        (10) Promoting and supporting all policies that
11    prioritize the health of all people, especially people of
12    color, by mitigating exposure to adverse childhood
13    experiences and trauma in childhood and ensuring
14    implementation of health and equity in all policies.
15        (11) Encouraging community partners and stakeholders
16    in the education, employment, housing, criminal justice,
17    and safety arenas to recognize racism as a public health
18    crisis and to implement policy recommendations.
19        (12) Identifying clear goals and objectives, including
20    specific benchmarks, to assess progress.
21        (13) Holding public hearings across Illinois to
22    continue to explore and to recommend needed action by the
23    General Assembly.
24        (14) Working with the Governor and the General Assembly
25    to identify the necessary funds to support the Anti-Racism
26    Commission and its endeavors.

 

 

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1        (15) Identifying resources to allocate to Black and
2    Brown communities on an annual basis.
3        (16) Encouraging corporate investment in anti-racism
4    policies in Black and Brown communities.
5    (e) The Commission shall submit its final report to the
6Governor and the General Assembly no later than December 31,
72021. The Commission is dissolved upon the filing of its
8report.
 
9    Section 130-15. Repeal. This Article is repealed on January
101, 2023.
 
11
Article 131.

 
12    Section 131-1. Short title. This Article may be cited as
13the Sickle Cell Prevention, Care, and Treatment Program Act.
14References in this Article to "this Act" mean this Article.
 
15    Section 131-5. Definitions. As used in this Act:
16    "Department" means the Department of Public Health.
17    "Program" means the Sickle Cell Prevention, Care, and
18Treatment Program.
 
19    Section 131-10. Sickle Cell Prevention, Care, and
20Treatment Program. The Department shall establish a grant
21program for the purpose of providing for the prevention, care,

 

 

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1and treatment of sickle cell disease and for educational
2programs concerning the disease.
 
3    Section 131-15. Grants; eligibility standards.
4    (a) The Department shall do the following:
5        (1)(A) Develop application criteria and standards of
6    eligibility for groups or organizations who apply for funds
7    under the program.
8        (B) Make available grants to groups and organizations
9    who meet the eligibility standards set by the Department.
10    However:
11            (i) the highest priority for grants shall be
12        accorded to established sickle cell disease
13        community-based organizations throughout Illinois; and
14            (ii) priority shall also be given to ensuring the
15        establishment of sickle cell disease centers in
16        underserved areas that have a higher population of
17        sickle cell disease patients.
18        (2) Determine the maximum amount available for each
19    grant provided under subparagraph (B) of paragraph (1).
20        (3) Determine policies for the expiration and renewal
21    of grants provided under subparagraph (B) of paragraph (1).
22        (4) Require that all grant funds be used for the
23    purpose of prevention, care, and treatment of sickle cell
24    disease or for educational programs concerning the
25    disease. Grant funds shall be used for one or more of the

 

 

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1    following purposes:
2            (A) Assisting in the development and expansion of
3        care for the treatment of individuals with sickle cell
4        disease, particularly for adults, including the
5        following types of care:
6                (i) Self-administered care.
7                (ii) Preventive care.
8                (iii) Home care.
9                (iv) Other evidence-based medical procedures
10            and techniques designed to provide maximum control
11            over sickling episodes typical of occurring to an
12            individual with the disease.
13            (B) Increasing access to health care for
14        individuals with sickle cell disease.
15            (C) Establishing additional sickle cell disease
16        infusion centers.
17            (D) Increasing access to mental health resources
18        and pain management therapies for individuals with
19        sickle cell disease.
20            (E) Providing counseling to any individual, at no
21        cost, concerning sickle cell disease and sickle cell
22        trait, and the characteristics, symptoms, and
23        treatment of the disease.
24                (i) The counseling described in this
25            subparagraph (E) may consist of any of the
26            following:

 

 

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1                    (I) Genetic counseling for an individual
2                who tests positive for the sickle cell trait.
3                    (II) Psychosocial counseling for an
4                individual who tests positive for sickle cell
5                disease, including any of the following:
6                        (aa) Social service counseling.
7                        (bb) Psychological counseling.
8                        (cc) Psychiatric counseling.
9        (5) Develop a sickle cell disease educational outreach
10    program that includes the dissemination of educational
11    materials to the following concerning sickle cell disease
12    and sickle cell trait:
13            (A) Medical residents.
14            (B) Immigrants.
15            (C) Schools and universities.
16        (6) Adopt any rules necessary to implement the
17    provisions of this Act.
18    (b) The Department may contract with an entity to implement
19the sickle cell disease educational outreach program described
20in paragraph (5) of subsection (a).
 
21    Section 131-20. Sickle Cell Chronic Disease Fund.
22    (a) The Sickle Cell Chronic Disease Fund is created as a
23special fund in the State treasury for the purpose of carrying
24out the provisions of this Act and for no other purpose. The
25Fund shall be administered by the Department.

 

 

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1    (b) The Fund shall consist of:
2        (1) Any moneys appropriated to the Department for the
3    Sickle Cell Prevention, Care, and Treatment Program.
4        (2) Gifts, bequests, and other sources of funding.
5        (3) All interest earned on moneys in the Fund.
 
6    Section 131-25. Study.
7    (a) Before July 1, 2022, and on a biennial basis
8thereafter, the Department, with the assistance of:
9        (1) the Center for Minority Health Services;
10        (2) health care providers that treat individuals with
11    sickle cell disease;
12        (3) individuals diagnosed with sickle cell disease;
13        (4) representatives of community-based organizations
14    that serve individuals with sickle cell disease; and
15        (5) data collected via newborn screening for sickle
16    cell disease;
17shall perform a study to determine the prevalence, impact, and
18needs of individuals with sickle cell disease and the sickle
19cell trait in Illinois.
20    (b) The study must include the following:
21        (1) The prevalence, by geographic location, of
22    individuals diagnosed with sickle cell disease in
23    Illinois.
24        (2) The prevalence, by geographic location, of
25    individuals diagnosed as sickle cell trait carriers in

 

 

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1    Illinois.
2        (3) The availability and affordability of screening
3    services in Illinois for the sickle cell trait.
4        (4) The location and capacity of the following for the
5    treatment of sickle cell disease and sickle cell trait
6    carriers:
7            (A) Treatment centers.
8            (B) Clinics.
9            (C) Community-based social service organizations.
10            (D) Medical specialists.
11        (5) The unmet medical, psychological, and social needs
12    encountered by individuals in Illinois with sickle cell
13    disease.
14        (6) The underserved areas of Illinois for the treatment
15    of sickle cell disease.
16        (7) Recommendations for actions to address any
17    shortcomings in the State identified under this Section.
18    (c) The Department shall submit a report on the study
19performed under this Section to the General Assembly.
 
20    Section 131-30. Implementation subject to appropriation.
21Implementation of this Act is subject to appropriation.
 
22    Section 131-90. The State Finance Act is amended by adding
23Section 5.936 as follows:
 

 

 

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1    (30 ILCS 105/5.936 new)
2    Sec. 5.936. The Sickle Cell Chronic Disease Fund.
 
3
Article 132.

 
4    Section 132-5. The School Code is amended by adding Section
534-18.67 as follows:
 
6    (105 ILCS 5/34-18.67 new)
7    Sec. 34-18.67. School nurse pilot program. The board shall
8establish a school nurse pilot program. Under the program, the
9board shall require the top 20% of the lowest performing
10schools in the district, as determined by the board, to employ
11a school nurse in conformance with Section 10-22.23 of this
12Code. The board shall implement this program beginning with the
132021-2022 school year.
 
14
Article 133.

 
15    Section 133-1. Short title. This Article may be cited as
16the Health Care for All Illinois Act. References in this
17Article to "this Act" mean this Article.
 
18    Section 133-5. Purposes. It is the purpose of this Act to
19provide universal access to health care for all individuals
20within the State, to promote and improve the health of all its

 

 

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1citizens, to stress the importance of good public health
2through treatment and prevention of diseases, and to contain
3costs to make the delivery of this care affordable. Should
4legislation of this kind be enacted on a federal level, it is
5the intent of this Act to become a part of a nationwide system.
 
6    Section 133-10. Definitions. In this Act:
7    "Board" means the Illinois Health Services Governing
8Board.
9    "Program" means the Illinois Health Services Program.
 
10    Section 133-15. Eligibility; registration. All individuals
11residing in this State are covered under the Illinois Health
12Services Program for health insurance and shall receive a card
13with a unique number in the mail. An individual's social
14security number shall not be used for purposes of registration
15under this Section. Individuals and families shall receive an
16Illinois Health Services Insurance Card in the mail after
17filling out a program application form at a health care
18provider. Such application form shall be no more than 2 pages
19long. Individuals who present themselves for covered services
20from a participating provider shall be presumed to be eligible
21for benefits under this Act, but shall complete an application
22for benefits in order to receive an Illinois Health Services
23Insurance Card and have payment made for such benefits.
 

 

 

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1    Section 133-20. Benefits and portability.
2    (a) The health coverage benefits under this Act shall cover
3all medically necessary services, including:
4        (1) primary care and prevention;
5        (2) specialty care (other than what is deemed elective
6    cosmetic);
7        (3) inpatient care;
8        (4) outpatient care;
9        (5) emergency care;
10        (6) prescription drugs;
11        (7) durable medical equipment;
12        (8) long-term care;
13        (9) mental health services;
14        (10) the full scope of dental services (other than
15    elective cosmetic dentistry);
16        (11) substance abuse treatment services;
17        (12) chiropractic services; and
18        (13) basic vision care and vision correction.
19    (b) Health coverage benefits under this Act are available
20through any licensed health care provider anywhere in the State
21that is legally qualified to provide such benefits and for
22emergency care anywhere in the United States.
23    (c) No deductibles, copayments, coinsurance, or other cost
24sharing shall be imposed with respect to covered benefits
25except for those goods or services that exceed basic covered
26benefits, as defined by the Board.
 

 

 

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1    Section 133-25. Qualification of participating providers.
2    (a) Health care delivery facilities must meet regional and
3State quality and licensing guidelines as a condition of
4participation under the program, including guidelines
5regarding safe staffing and quality of care.
6    (b) A participating health care provider must be licensed
7by the State. No health care provider whose license is under
8suspension or has been revoked may participate in the program.
9    (c) Only nonprofit health maintenance organizations that
10actually deliver care in their own facilities and directly
11employ clinicians may participate in the program.
12    (d) Patients shall have free choice of participating
13eligible providers, hospitals, and inpatient care facilities.
 
14    Section 133-30. Provider reimbursement.
15    (a) The program shall pay all health care providers
16according to the following standards:
17        (1) Physicians and other practitioners can choose to be
18    paid fee-for-service, salaried by institutions receiving
19    global budgets, or salaried by group practices or health
20    maintenance organizations receiving capitation payments.
21    Investor-owned health maintenance organizations and group
22    practices shall be converted to not-for-profit status.
23    Only institutions that deliver care shall be eligible for
24    program payments.

 

 

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1        (2) The program will pay each hospital and providing
2    institution a monthly lump sum (global budget) to cover all
3    operating expenses. The hospital and program will
4    negotiate the amount of this payment annually based on past
5    budgets, clinical performance, projected changes in demand
6    for services and input costs, and proposed new programs.
7    Hospitals shall not bill patients for services covered by
8    the program, and cannot use any of their operating budgets
9    for expansion, profit, excessive executive income,
10    marketing, or major capital purchases or leases.
11        (3) The program budget will fund major capital
12    expenditures, including the construction of new health
13    facilities and the purchase of expensive equipment. The
14    regional health planning districts shall allocate these
15    capital funds and oversee capital projects funded from
16    private donations.
17    (b) The program shall reimburse physicians choosing to be
18paid fee-for-service according to a fee schedule negotiated
19between physician representatives and the program on at least
20an annual basis.
21    (c) Hospitals, nursing homes, community health centers,
22nonprofit staff model health maintenance organizations, and
23home health care agencies will receive a global budget to cover
24operating expenses, negotiated annually with the program based
25on past expenditures, past budgets, clinical performance,
26projected changes in demand for services and input costs, and

 

 

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1proposed new programs. Expansions and other substantive
2capital investments will be funded separately.
3    (d) All covered prescription drugs and durable medical
4supplies will be paid for according to a fee schedule
5negotiated between manufacturers and the program on at least an
6annual basis. Price reductions shall be achieved by bulk
7purchasing whenever possible. Where therapeutically equivalent
8drugs are available, the formulary shall specify the use of the
9lowest-cost medication, with exceptions available in the case
10of medical necessity.
 
11    Section 133-35. Prohibition against duplicating coverage;
12investor-ownership of health delivery facilities.
13    (a) It is unlawful for a private health insurer to sell
14health insurance coverage that duplicates the benefits
15provided under this Act. Nothing in this Act shall be construed
16as prohibiting the sale of health insurance coverage for any
17additional benefits not covered by this Act.
18    (b) Investor-ownership of health delivery facilities,
19including hospitals, health maintenance organizations, nursing
20homes, and clinics, is unlawful. Investor-owners of health
21delivery facilities at the time of the effective date of this
22Act shall be compensated for the loss of their facilities, but
23not for loss of business opportunities or for administrative
24capacity not used by the program.
 

 

 

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1    Section 133-40. Illinois Health Services Trust.
2    (a) The State shall establish the Illinois Health Services
3Trust (IHST), the sole purpose of which shall be to provide the
4financing reserve for the purposes outlined in this Act.
5Specifically, the IHST shall provide all of the following:
6        (1) The funds for the general operating budget of the
7    program.
8        (2) Reimbursement for those benefits outlined in
9    Section 133-20 of this Act.
10        (3) Public health services.
11        (4) Capital expenditures for construction or
12    renovation of health care facilities or major equipment
13    purchases deemed necessary throughout the State and
14    approved by the Board.
15        (5) Re-education and job placement of persons who have
16    lost their jobs as a result of this transition, limited to
17    the first 5 years.
18    (b) The General Assembly or the Governor may provide funds
19to the IHST, but may not remove or borrow funds from the IHST.
20    (c) The IHST shall be administered by the Board, under the
21oversight of the General Assembly.
22    (d) Funding of the IHST shall include, but is not limited
23to, all of the following:
24        (1) Funds appropriated as outlined by the General
25    Assembly on a yearly basis.
26        (2) A progressive set of graduated income

 

 

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1    contributions; 20% paid by individuals, 20% paid by
2    businesses, and 60% paid by the government.
3        (3) All federal moneys that are designated for health
4    care, including, but not limited to, all moneys designated
5    for Medicaid. The Secretary of Human Services shall be
6    authorized to negotiate with the federal government for
7    funding of Medicare recipients.
8        (4) Grants and contributions, both public and private.
9        (5) Any other tax revenues designated by the General
10    Assembly.
11        (6) Any other funds specifically earmarked for health
12    care or health care education, such as settlements from
13    litigation.
14    (e) The total overhead and administrative portion of the
15program budget may not exceed 12% of the total operating budget
16of the program for the first 2 years that the program is in
17operation; 8% for the following 2 years; and 5% for each year
18thereafter.
19    (f) The program may be divided into regional districts for
20the purposes of local administration and oversight of programs
21that are specific to each region's needs.
22    (g) Claims billing from all providers must be submitted
23electronically and in compliance with current State and federal
24privacy laws within 5 years after the effective date of this
25Act. Electronic claims and billing must be uniform across the
26State. The Board shall create and implement a statewide uniform

 

 

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1system of electronic medical records that is in compliance with
2current State and federal privacy laws within 7 years after the
3effective date of this Act. Payments to providers must be made
4in a timely fashion as outlined under current State and federal
5law. Providers who accept payment from the program for services
6rendered may not bill any patient for covered services.
7Providers may elect either to participate fully, or not at all,
8in the program.
 
9    Section 133-45. Long-term care payment. The Board shall
10establish funding for long-term care services, including
11in-home, nursing home, and community-based care. A local public
12agency shall be established in each community to determine
13eligibility and coordinate home and nursing home long-term
14care. This agency may contract with long-term care providers
15for the full range of needed long-term care services.
 
16    Section 133-50. Mental health services. The program shall
17provide coverage for all medically necessary mental health care
18on the same basis as the coverage for other conditions. The
19program shall cover supportive residences, occupational
20therapy, and ongoing mental health and counseling services
21outside the hospital for patients with serious mental illness.
22In all cases the highest quality and most effective care shall
23be delivered, including institutional care.
 

 

 

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1    Section 133-55. Payment for prescription medications,
2medical supplies, and medically necessary assistive equipment.
3    (a) The program shall establish a single prescription drug
4formulary and list of approved durable medical goods and
5supplies. The Board shall, by itself or by a committee of
6health professionals and related individuals appointed by the
7Board and called the Pharmaceutical and Durable Medical Goods
8Committee, meet on a quarterly basis to discuss, reverse, add
9to, or remove items from the formulary according to sound
10medical practice.
11    (b) The Pharmaceutical and Durable Medical Goods Committee
12shall negotiate the prices of pharmaceuticals and durable
13medical goods with suppliers or manufacturers on an open bid
14competitive basis. Prices shall be reviewed, negotiated, or
15renegotiated on no less than an annual basis. The
16Pharmaceutical and Durable Medical Goods Committee shall
17establish a process of open forum to the public for the
18purposes of grievance and petition from suppliers, provider
19groups, and the public regarding the formulary no less than 2
20times a year.
21    (c) All pharmacy and durable medical goods vendors must be
22licensed to distribute medical goods through the regulations
23outlined by the Board.
24    (d) All decisions and determinations of the Pharmaceutical
25and Durable Medical Goods Committee must be presented to and
26approved by the Board on an annual basis.
 

 

 

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1    Section 133-60. Illinois Health Services Governing Board.
2    (a) The program shall be administered by an independent
3agency known as the Illinois Health Services Governing Board.
4The Board will consist of a Commissioner, a Chief Medical
5Officer, and public State board members. The Board is
6responsible for administration of the program, including:
7        (1) implementation of eligibility standards and
8    program enrollment;
9        (2) adoption of the benefits package;
10        (3) establishing formulas for setting health
11    expenditure budgets;
12        (4) administration of global budgets, capital
13    expenditure budgets, and prompt reimbursement of
14    providers;
15        (5) negotiations of service fee schedules and prices
16    for prescription drugs and durable medical supplies;
17        (6) recommending evidence-based changes to benefits;
18    and
19        (7) quality and planning functions, including criteria
20    for capital expansion and infrastructure development,
21    measurement and evaluation of health quality indicators,
22    and the establishment of regions for long-term care
23    integration.
24    (b) At least one-third of the members of the Board,
25including all committees dedicated to benefits design, health

 

 

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1planning, quality, and long-term care, shall be consumer
2representatives.
 
3    Section 133-65. Patients' rights. The program shall
4protect the rights and privacy of the patients that it serves
5in accordance with all current State and federal statutes. With
6the development of the electronic medical records, patients
7shall be afforded the right and option of keeping any portion
8of their medical records separate from the electronic medical
9records. Patients have the right to access their medical
10records upon demand.
 
11    Section 133-70. Compensation. The Commissioner, the Chief
12Medical Officer, public State board members, and employees of
13the program shall be compensated in accordance with the current
14pay scale for State employees and as deemed professionally
15appropriate by the General Assembly and reviewed in accordance
16with all other State employees.
 
17
Title VII. Hospital Closure

 
18
Article 135.

 
19    Section 135-5. The Illinois Health Facilities Planning Act
20is amended by changing Sections 4 and 8.7 and by adding Section
215.5 as follows:
 

 

 

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1    (20 ILCS 3960/4)  (from Ch. 111 1/2, par. 1154)
2    (Section scheduled to be repealed on December 31, 2029)
3    Sec. 4. Health Facilities and Services Review Board;
4membership; appointment; term; compensation; quorum.
5    (a) There is created the Health Facilities and Services
6Review Board, which shall perform the functions described in
7this Act. The Department shall provide operational support to
8the Board as necessary, including the provision of office
9space, supplies, and clerical, financial, and accounting
10services. The Board may contract for functions or operational
11support as needed. The Board may also contract with experts
12related to specific health services or facilities and create
13technical advisory panels to assist in the development of
14criteria, standards, and procedures used in the evaluation of
15applications for permit and exemption.
16    (b) The State Board shall consist of 11 9 voting members.
17All members shall be residents of Illinois and at least 4 shall
18reside outside the Chicago Metropolitan Statistical Area.
19Consideration shall be given to potential appointees who
20reflect the ethnic and cultural diversity of the State. Neither
21Board members nor Board staff shall be convicted felons or have
22pled guilty to a felony.
23    Each member shall have a reasonable knowledge of the
24practice, procedures and principles of the health care delivery
25system in Illinois, including at least 5 members who shall be

 

 

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1knowledgeable about health care delivery systems, health
2systems planning, finance, or the management of health care
3facilities currently regulated under the Act. One member shall
4be a representative of a non-profit health care consumer
5advocacy organization. Two members shall be representatives
6from the community with experience on the effects of
7discontinuing health care services or the closure of health
8care facilities on the surrounding community. A spouse, parent,
9sibling, or child of a Board member cannot be an employee,
10agent, or under contract with services or facilities subject to
11the Act. Prior to appointment and in the course of service on
12the Board, members of the Board shall disclose the employment
13or other financial interest of any other relative of the
14member, if known, in service or facilities subject to the Act.
15Members of the Board shall declare any conflict of interest
16that may exist with respect to the status of those relatives
17and recuse themselves from voting on any issue for which a
18conflict of interest is declared. No person shall be appointed
19or continue to serve as a member of the State Board who is, or
20whose spouse, parent, sibling, or child is, a member of the
21Board of Directors of, has a financial interest in, or has a
22business relationship with a health care facility.
23    Notwithstanding any provision of this Section to the
24contrary, the term of office of each member of the State Board
25serving on the day before the effective date of this amendatory
26Act of the 96th General Assembly is abolished on the date upon

 

 

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1which members of the 9-member Board, as established by this
2amendatory Act of the 96th General Assembly, have been
3appointed and can begin to take action as a Board.
4    (c) The State Board shall be appointed by the Governor,
5with the advice and consent of the Senate. Not more than 5 of
6the appointments shall be of the same political party at the
7time of the appointment.
8    The Secretary of Human Services, the Director of Healthcare
9and Family Services, and the Director of Public Health, or
10their designated representatives, shall serve as ex-officio,
11non-voting members of the State Board.
12    (d) Of those 9 members initially appointed by the Governor
13following the effective date of this amendatory Act of the 96th
14General Assembly, 3 shall serve for terms expiring July 1,
152011, 3 shall serve for terms expiring July 1, 2012, and 3
16shall serve for terms expiring July 1, 2013. Thereafter, each
17appointed member shall hold office for a term of 3 years,
18provided that any member appointed to fill a vacancy occurring
19prior to the expiration of the term for which his or her
20predecessor was appointed shall be appointed for the remainder
21of such term and the term of office of each successor shall
22commence on July 1 of the year in which his predecessor's term
23expires. Each member shall hold office until his or her
24successor is appointed and qualified. The Governor may
25reappoint a member for additional terms, but no member shall
26serve more than 3 terms, subject to review and re-approval

 

 

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1every 3 years.
2    (e) State Board members, while serving on business of the
3State Board, shall receive actual and necessary travel and
4subsistence expenses while so serving away from their places of
5residence. Until March 1, 2010, a member of the State Board who
6experiences a significant financial hardship due to the loss of
7income on days of attendance at meetings or while otherwise
8engaged in the business of the State Board may be paid a
9hardship allowance, as determined by and subject to the
10approval of the Governor's Travel Control Board.
11    (f) The Governor shall designate one of the members to
12serve as the Chairman of the Board, who shall be a person with
13expertise in health care delivery system planning, finance or
14management of health care facilities that are regulated under
15the Act. The Chairman shall annually review Board member
16performance and shall report the attendance record of each
17Board member to the General Assembly.
18    (g) The State Board, through the Chairman, shall prepare a
19separate and distinct budget approved by the General Assembly
20and shall hire and supervise its own professional staff
21responsible for carrying out the responsibilities of the Board.
22    (h) The State Board shall meet at least every 45 days, or
23as often as the Chairman of the State Board deems necessary, or
24upon the request of a majority of the members.
25    (i) Five members of the State Board shall constitute a
26quorum. The affirmative vote of 5 of the members of the State

 

 

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1Board shall be necessary for any action requiring a vote to be
2taken by the State Board. A vacancy in the membership of the
3State Board shall not impair the right of a quorum to exercise
4all the rights and perform all the duties of the State Board as
5provided by this Act.
6    (j) A State Board member shall disqualify himself or
7herself from the consideration of any application for a permit
8or exemption in which the State Board member or the State Board
9member's spouse, parent, sibling, or child: (i) has an economic
10interest in the matter; or (ii) is employed by, serves as a
11consultant for, or is a member of the governing board of the
12applicant or a party opposing the application.
13    (k) The Chairman, Board members, and Board staff must
14comply with the Illinois Governmental Ethics Act.
15(Source: P.A. 99-527, eff. 1-1-17; 100-681, eff. 8-3-18.)
 
16    (20 ILCS 3960/5.5 new)
17    Sec. 5.5. Moratorium on hospital closures.    
18Notwithstanding any law or rule to the contrary, due to the
19COVID-19 pandemic, the State shall institute a moratorium on
20the closure of hospitals until December 31, 2023. As such, no
21hospital shall close or reduce capacity below the hospital's
22capacity as of January 1, 2020 before the end of such
23moratorium.
24    (b) This Section is repealed on January 1, 2024.
 

 

 

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1    (20 ILCS 3960/8.7)
2    (Section scheduled to be repealed on December 31, 2029)
3    Sec. 8.7. Application for permit for discontinuation of a
4health care facility or category of service; public notice and
5public hearing.
6    (a) Upon a finding that an application to close a health
7care facility or discontinue a category of service is complete,
8the State Board shall publish a legal notice on 3 consecutive
9days in a newspaper of general circulation in the area or
10community to be affected and afford the public an opportunity
11to request a hearing. If the application is for a facility
12located in a Metropolitan Statistical Area, an additional legal
13notice shall be published in a newspaper of limited
14circulation, if one exists, in the area in which the facility
15is located. If the newspaper of limited circulation is
16published on a daily basis, the additional legal notice shall
17be published on 3 consecutive days. The legal notice shall also
18be posted on the Health Facilities and Services Review Board's
19website and sent to the State Representative and State Senator
20of the district in which the health care facility is located.
21In addition, the health care facility shall provide notice of
22closure to the local media that the health care facility would
23routinely notify about facility events.
24    Upon the completion of an application to close a health
25care facility or discontinue a category of service, the State
26Board shall conduct a racial equity impact assessment to

 

 

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1determine the effect of the closure or discontinuation of
2service on racial and ethnic minorities. The results of the
3racial equity impact assessment shall be made available to the
4public.
5    An application to close a health care facility shall only
6be deemed complete if it includes evidence that the health care
7facility provided written notice at least 30 days prior to
8filing the application of its intent to do so to the
9municipality in which it is located, the State Representative
10and State Senator of the district in which the health care
11facility is located, the State Board, the Director of Public
12Health, and the Director of Healthcare and Family Services. The
13changes made to this subsection by this amendatory Act of the
14101st General Assembly shall apply to all applications
15submitted after the effective date of this amendatory Act of
16the 101st General Assembly.
17    (b) No later than 30 days after issuance of a permit to
18close a health care facility or discontinue a category of
19service, the permit holder shall give written notice of the
20closure or discontinuation to the State Senator and State
21Representative serving the legislative district in which the
22health care facility is located.
23    (c) If there is a pending lawsuit that challenges an
24application to discontinue a health care facility that either
25names the Board as a party or alleges fraud in the filing of
26the application, the Board may defer action on the application

 

 

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1for up to 6 months after the date of the initial deferral of
2the application.
3    (d) The changes made to this Section by this amendatory Act
4of the 101st General Assembly shall apply to all applications
5submitted after the effective date of this amendatory Act of
6the 101st General Assembly.
7(Source: P.A. 101-83, eff. 7-15-19; 101-650, eff. 7-7-20.)
 
8
Title VIII. Managed Care Organization Reform

 
9
Article 145.

 
10    Section 145-5. The Illinois Public Aid Code is amended by
11changing Section 5-30.1 as follows:
 
12    (305 ILCS 5/5-30.1)
13    Sec. 5-30.1. Managed care protections.
14    (a) As used in this Section:
15    "Managed care organization" or "MCO" means any entity which
16contracts with the Department to provide services where payment
17for medical services is made on a capitated basis.
18    "Emergency services" include:
19        (1) emergency services, as defined by Section 10 of the
20    Managed Care Reform and Patient Rights Act;
21        (2) emergency medical screening examinations, as
22    defined by Section 10 of the Managed Care Reform and

 

 

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1    Patient Rights Act;
2        (3) post-stabilization medical services, as defined by
3    Section 10 of the Managed Care Reform and Patient Rights
4    Act; and
5        (4) emergency medical conditions, as defined by
6    Section 10 of the Managed Care Reform and Patient Rights
7    Act.
8    (b) As provided by Section 5-16.12, managed care
9organizations are subject to the provisions of the Managed Care
10Reform and Patient Rights Act.
11    (c) An MCO shall pay any provider of emergency services
12that does not have in effect a contract with the contracted
13Medicaid MCO. The default rate of reimbursement shall be the
14rate paid under Illinois Medicaid fee-for-service program
15methodology, including all policy adjusters, including but not
16limited to Medicaid High Volume Adjustments, Medicaid
17Percentage Adjustments, Outpatient High Volume Adjustments,
18and all outlier add-on adjustments to the extent such
19adjustments are incorporated in the development of the
20applicable MCO capitated rates.
21    (d) An MCO shall pay for all post-stabilization services as
22a covered service in any of the following situations:
23        (1) the MCO authorized such services;
24        (2) such services were administered to maintain the
25    enrollee's stabilized condition within one hour after a
26    request to the MCO for authorization of further

 

 

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1    post-stabilization services;
2        (3) the MCO did not respond to a request to authorize
3    such services within one hour;
4        (4) the MCO could not be contacted; or
5        (5) the MCO and the treating provider, if the treating
6    provider is a non-affiliated provider, could not reach an
7    agreement concerning the enrollee's care and an affiliated
8    provider was unavailable for a consultation, in which case
9    the MCO must pay for such services rendered by the treating
10    non-affiliated provider until an affiliated provider was
11    reached and either concurred with the treating
12    non-affiliated provider's plan of care or assumed
13    responsibility for the enrollee's care. Such payment shall
14    be made at the default rate of reimbursement paid under
15    Illinois Medicaid fee-for-service program methodology,
16    including all policy adjusters, including but not limited
17    to Medicaid High Volume Adjustments, Medicaid Percentage
18    Adjustments, Outpatient High Volume Adjustments and all
19    outlier add-on adjustments to the extent that such
20    adjustments are incorporated in the development of the
21    applicable MCO capitated rates.
22    (e) The following requirements apply to MCOs in determining
23payment for all emergency services:
24        (1) MCOs shall not impose any requirements for prior
25    approval of emergency services.
26        (2) The MCO shall cover emergency services provided to

 

 

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1    enrollees who are temporarily away from their residence and
2    outside the contracting area to the extent that the
3    enrollees would be entitled to the emergency services if
4    they still were within the contracting area.
5        (3) The MCO shall have no obligation to cover medical
6    services provided on an emergency basis that are not
7    covered services under the contract.
8        (4) The MCO shall not condition coverage for emergency
9    services on the treating provider notifying the MCO of the
10    enrollee's screening and treatment within 10 days after
11    presentation for emergency services.
12        (5) The determination of the attending emergency
13    physician, or the provider actually treating the enrollee,
14    of whether an enrollee is sufficiently stabilized for
15    discharge or transfer to another facility, shall be binding
16    on the MCO. The MCO shall cover emergency services for all
17    enrollees whether the emergency services are provided by an
18    affiliated or non-affiliated provider.
19        (6) The MCO's financial responsibility for
20    post-stabilization care services it has not pre-approved
21    ends when:
22            (A) a plan physician with privileges at the
23        treating hospital assumes responsibility for the
24        enrollee's care;
25            (B) a plan physician assumes responsibility for
26        the enrollee's care through transfer;

 

 

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1            (C) a contracting entity representative and the
2        treating physician reach an agreement concerning the
3        enrollee's care; or
4            (D) the enrollee is discharged.
5    (f) Network adequacy and transparency.
6        (1) The Department shall:
7            (A) ensure that an adequate provider network is in
8        place, taking into consideration health professional
9        shortage areas and medically underserved areas;
10            (B) publicly release an explanation of its process
11        for analyzing network adequacy;
12            (C) periodically ensure that an MCO continues to
13        have an adequate network in place; and
14            (D) require MCOs, including Medicaid Managed Care
15        Entities as defined in Section 5-30.2, to meet provider
16        directory requirements under Section 5-30.3.
17        (2) Each MCO shall confirm its receipt of information
18    submitted specific to physician or dentist additions or
19    physician or dentist deletions from the MCO's provider
20    network within 3 days after receiving all required
21    information from contracted physicians or dentists, and
22    electronic physician and dental directories must be
23    updated consistent with current rules as published by the
24    Centers for Medicare and Medicaid Services or its successor
25    agency.
26    (g) Timely payment of claims.

 

 

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1        (1) The MCO shall pay a claim within 30 days of
2    receiving a claim that contains all the essential
3    information needed to adjudicate the claim.
4        (2) The MCO shall notify the billing party of its
5    inability to adjudicate a claim within 30 days of receiving
6    that claim.
7        (3) The MCO shall pay a penalty that is at least equal
8    to the timely payment interest penalty imposed under
9    Section 368a of the Illinois Insurance Code for any claims
10    not timely paid.
11            (A) When an MCO is required to pay a timely payment
12        interest penalty to a provider, the MCO must calculate
13        and pay the timely payment interest penalty that is due
14        to the provider within 30 days after the payment of the
15        claim. In no event shall a provider be required to
16        request or apply for payment of any owed timely payment
17        interest penalties.
18            (B) Such payments shall be reported separately
19        from the claim payment for services rendered to the
20        MCO's enrollee and clearly identified as interest
21        payments.
22        (4)(A) The Department shall require MCOs to expedite
23    payments to providers identified on the Department's
24    expedited provider list, determined in accordance with 89
25    Ill. Adm. Code 140.71(b), on a schedule at least as
26    frequently as the providers are paid under the Department's

 

 

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1    fee-for-service expedited provider schedule.
2        (B) Compliance with the expedited provider requirement
3    may be satisfied by an MCO through the use of a Periodic
4    Interim Payment (PIP) program that has been mutually agreed
5    to and documented between the MCO and the provider, and the
6    PIP program ensures that any expedited provider receives
7    regular and periodic payments based on prior period payment
8    experience from that MCO. Total payments under the PIP
9    program may be reconciled against future PIP payments on a
10    schedule mutually agreed to between the MCO and the
11    provider.
12        (C) The Department shall share at least monthly its
13    expedited provider list and the frequency with which it
14    pays providers on the expedited list.
15    (g-5) Recognizing that the rapid transformation of the
16Illinois Medicaid program may have unintended operational
17challenges for both payers and providers:
18        (1) in no instance shall a medically necessary covered
19    service rendered in good faith, based upon eligibility
20    information documented by the provider, be denied coverage
21    or diminished in payment amount if the eligibility or
22    coverage information available at the time the service was
23    rendered is later found to be inaccurate in the assignment
24    of coverage responsibility between MCOs or the
25    fee-for-service system, except for instances when an
26    individual is deemed to have not been eligible for coverage

 

 

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1    under the Illinois Medicaid program; and
2        (2) the Department shall, by December 31, 2016, adopt
3    rules establishing policies that shall be included in the
4    Medicaid managed care policy and procedures manual
5    addressing payment resolutions in situations in which a
6    provider renders services based upon information obtained
7    after verifying a patient's eligibility and coverage plan
8    through either the Department's current enrollment system
9    or a system operated by the coverage plan identified by the
10    patient presenting for services:
11            (A) such medically necessary covered services
12        shall be considered rendered in good faith;
13            (B) such policies and procedures shall be
14        developed in consultation with industry
15        representatives of the Medicaid managed care health
16        plans and representatives of provider associations
17        representing the majority of providers within the
18        identified provider industry; and
19            (C) such rules shall be published for a review and
20        comment period of no less than 30 days on the
21        Department's website with final rules remaining
22        available on the Department's website.
23    The rules on payment resolutions shall include, but not be
24limited to:
25        (A) the extension of the timely filing period;
26        (B) retroactive prior authorizations; and

 

 

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1        (C) guaranteed minimum payment rate of no less than the
2    current, as of the date of service, fee-for-service rate,
3    plus all applicable add-ons, when the resulting service
4    relationship is out of network.
5    The rules shall be applicable for both MCO coverage and
6fee-for-service coverage.
7    If the fee-for-service system is ultimately determined to
8have been responsible for coverage on the date of service, the
9Department shall provide for an extended period for claims
10submission outside the standard timely filing requirements.
11    (g-6) MCO Performance Metrics Report.
12        (1) The Department shall publish, on at least a
13    quarterly basis, each MCO's operational performance,
14    including, but not limited to, the following categories of
15    metrics:
16            (A) claims payment, including timeliness and
17        accuracy;
18            (B) prior authorizations;
19            (C) grievance and appeals;
20            (D) utilization statistics;
21            (E) provider disputes;
22            (F) provider credentialing; and
23            (G) member and provider customer service.
24        (2) The Department shall ensure that the metrics report
25    is accessible to providers online by January 1, 2017.
26        (3) The metrics shall be developed in consultation with

 

 

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1    industry representatives of the Medicaid managed care
2    health plans and representatives of associations
3    representing the majority of providers within the
4    identified industry.
5        (4) Metrics shall be defined and incorporated into the
6    applicable Managed Care Policy Manual issued by the
7    Department.
8    (g-7) MCO claims processing and performance analysis. In
9order to monitor MCO payments to hospital providers, pursuant
10to this amendatory Act of the 100th General Assembly, the
11Department shall post an analysis of MCO claims processing and
12payment performance on its website every 6 months. Such
13analysis shall include a review and evaluation of a
14representative sample of hospital claims that are rejected and
15denied for clean and unclean claims and the top 5 reasons for
16such actions and timeliness of claims adjudication, which
17identifies the percentage of claims adjudicated within 30, 60,
1890, and over 90 days, and the dollar amounts associated with
19those claims. The Department shall post the contracted claims
20report required by HealthChoice Illinois on its website every 3
21months.
22    (g-8) Dispute resolution process. The Department shall
23maintain a provider complaint portal through which a provider
24can submit to the Department unresolved disputes with an MCO.
25An unresolved dispute means an MCO's decision that denies in
26whole or in part a claim for reimbursement to a provider for

 

 

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1health care services rendered by the provider to an enrollee of
2the MCO with which the provider disagrees. Disputes shall not
3be submitted to the portal until the provider has availed
4itself of the MCO's internal dispute resolution process.
5Disputes that are submitted to the MCO internal dispute
6resolution process may be submitted to the Department of
7Healthcare and Family Services' complaint portal no sooner than
830 days after submitting to the MCO's internal process and not
9later than 30 days after the unsatisfactory resolution of the
10internal MCO process or 60 days after submitting the dispute to
11the MCO internal process. Multiple claim disputes involving the
12same MCO may be submitted in one complaint, regardless of
13whether the claims are for different enrollees, when the
14specific reason for non-payment of the claims involves a common
15question of fact or policy. Within 10 business days of receipt
16of a complaint, the Department shall present such disputes to
17the appropriate MCO, which shall then have 30 days to issue its
18written proposal to resolve the dispute. The Department may
19grant one 30-day extension of this time frame to one of the
20parties to resolve the dispute. If the dispute remains
21unresolved at the end of this time frame or the provider is not
22satisfied with the MCO's written proposal to resolve the
23dispute, the provider may, within 30 days, request the
24Department to review the dispute and make a final
25determination. Within 30 days of the request for Department
26review of the dispute, both the provider and the MCO shall

 

 

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1present all relevant information to the Department for
2resolution and make individuals with knowledge of the issues
3available to the Department for further inquiry if needed.
4Within 30 days of receiving the relevant information on the
5dispute, or the lapse of the period for submitting such
6information, the Department shall issue a written decision on
7the dispute based on contractual terms between the provider and
8the MCO, contractual terms between the MCO and the Department
9of Healthcare and Family Services and applicable Medicaid
10policy. The decision of the Department shall be final. By
11January 1, 2020, the Department shall establish by rule further
12details of this dispute resolution process. Disputes between
13MCOs and providers presented to the Department for resolution
14are not contested cases, as defined in Section 1-30 of the
15Illinois Administrative Procedure Act, conferring any right to
16an administrative hearing.
17    (g-9)(1) The Department shall publish annually on its
18website a report on the calculation of each managed care
19organization's medical loss ratio showing the following:
20        (A) Premium revenue, with appropriate adjustments.
21        (B) Benefit expense, setting forth the aggregate
22    amount spent for the following:
23            (i) Direct paid claims.
24            (ii) Subcapitation payments.
25            (iii) Other claim payments.
26            (iv) Direct reserves.

 

 

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1            (v) Gross recoveries.
2            (vi) Expenses for activities that improve health
3        care quality as allowed by the Department.
4    (2) The medical loss ratio shall be calculated consistent
5with federal law and regulation following a claims runout
6period determined by the Department.
7    (g-10)(1) "Liability effective date" means the date on
8which an MCO becomes responsible for payment for medically
9necessary and covered services rendered by a provider to one of
10its enrollees in accordance with the contract terms between the
11MCO and the provider. The liability effective date shall be the
12later of:
13        (A) The execution date of a network participation
14    contract agreement.
15        (B) The date the provider or its representative submits
16    to the MCO the complete and accurate standardized roster
17    form for the provider in the format approved by the
18    Department.
19        (C) The provider effective date contained within the
20    Department's provider enrollment subsystem within the
21    Illinois Medicaid Program Advanced Cloud Technology
22    (IMPACT) System.
23    (2) The standardized roster form may be submitted to the
24MCO at the same time that the provider submits an enrollment
25application to the Department through IMPACT.
26    (3) By October 1, 2019, the Department shall require all

 

 

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1MCOs to update their provider directory with information for
2new practitioners of existing contracted providers within 30
3days of receipt of a complete and accurate standardized roster
4template in the format approved by the Department provided that
5the provider is effective in the Department's provider
6enrollment subsystem within the IMPACT system. Such provider
7directory shall be readily accessible for purposes of selecting
8an approved health care provider and comply with all other
9federal and State requirements.
10    (g-11) The Department shall work with relevant
11stakeholders on the development of operational guidelines to
12enhance and improve operational performance of Illinois'
13Medicaid managed care program, including, but not limited to,
14improving provider billing practices, reducing claim
15rejections and inappropriate payment denials, and
16standardizing processes, procedures, definitions, and response
17timelines, with the goal of reducing provider and MCO
18administrative burdens and conflict. The Department shall
19include a report on the progress of these program improvements
20and other topics in its Fiscal Year 2020 annual report to the
21General Assembly.
22    (h) The Department shall not expand mandatory MCO
23enrollment into new counties beyond those counties already
24designated by the Department as of June 1, 2014 for the
25individuals whose eligibility for medical assistance is not the
26seniors or people with disabilities population until the

 

 

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1Department provides an opportunity for accountable care
2entities and MCOs to participate in such newly designated
3counties.
4    (h-5) MCOs shall be required to publish, at least quarterly
5for the preceding quarter, on their websites:
6        (1) the total number of claims received by the MCO;
7        (2) the number and monetary amount of claims payments
8    made to a service provider as defined in Section 2-16 of
9    this Code;
10        (3) the dates of services rendered for the claims
11    payments made under paragraph (2);
12        (4) the dates the claims were received by the MCO for
13    the claims payments made under paragraph (2); and
14        (5) the dates on which claims payments under paragraph
15    (2) were released.
16    (i) The requirements of this Section apply to contracts
17with accountable care entities and MCOs entered into, amended,
18or renewed after June 16, 2014 (the effective date of Public
19Act 98-651).
20    (j) Health care information released to managed care
21organizations. A health care provider shall release to a
22Medicaid managed care organization, upon request, and subject
23to the Health Insurance Portability and Accountability Act of
241996 and any other law applicable to the release of health
25information, the health care information of the MCO's enrollee,
26if the enrollee has completed and signed a general release form

 

 

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1that grants to the health care provider permission to release
2the recipient's health care information to the recipient's
3insurance carrier.
4(Source: P.A. 100-201, eff. 8-18-17; 100-580, eff. 3-12-18;
5100-587, eff. 6-4-18; 101-209, eff. 8-5-19.)
 
6
Article 150.

 
7    Section 150-5. The Illinois Public Aid Code is amended by
8changing Section 5-30.1 and by adding Section 5-30.15 as
9follows:
 
10    (305 ILCS 5/5-30.1)
11    Sec. 5-30.1. Managed care protections.
12    (a) As used in this Section:
13    "Managed care organization" or "MCO" means any entity which
14contracts with the Department to provide services where payment
15for medical services is made on a capitated basis.
16    "Emergency services" include:
17        (1) emergency services, as defined by Section 10 of the
18    Managed Care Reform and Patient Rights Act;
19        (2) emergency medical screening examinations, as
20    defined by Section 10 of the Managed Care Reform and
21    Patient Rights Act;
22        (3) post-stabilization medical services, as defined by
23    Section 10 of the Managed Care Reform and Patient Rights

 

 

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1    Act; and
2        (4) emergency medical conditions, as defined by
3    Section 10 of the Managed Care Reform and Patient Rights
4    Act.
5    (b) As provided by Section 5-16.12, managed care
6organizations are subject to the provisions of the Managed Care
7Reform and Patient Rights Act.
8    (c) An MCO shall pay any provider of emergency services
9that does not have in effect a contract with the contracted
10Medicaid MCO. The default rate of reimbursement shall be the
11rate paid under Illinois Medicaid fee-for-service program
12methodology, including all policy adjusters, including but not
13limited to Medicaid High Volume Adjustments, Medicaid
14Percentage Adjustments, Outpatient High Volume Adjustments,
15and all outlier add-on adjustments to the extent such
16adjustments are incorporated in the development of the
17applicable MCO capitated rates.
18    (d) An MCO shall pay for all post-stabilization services as
19a covered service in any of the following situations:
20        (1) the MCO authorized such services;
21        (2) such services were administered to maintain the
22    enrollee's stabilized condition within one hour after a
23    request to the MCO for authorization of further
24    post-stabilization services;
25        (3) the MCO did not respond to a request to authorize
26    such services within one hour;

 

 

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1        (4) the MCO could not be contacted; or
2        (5) the MCO and the treating provider, if the treating
3    provider is a non-affiliated provider, could not reach an
4    agreement concerning the enrollee's care and an affiliated
5    provider was unavailable for a consultation, in which case
6    the MCO must pay for such services rendered by the treating
7    non-affiliated provider until an affiliated provider was
8    reached and either concurred with the treating
9    non-affiliated provider's plan of care or assumed
10    responsibility for the enrollee's care. Such payment shall
11    be made at the default rate of reimbursement paid under
12    Illinois Medicaid fee-for-service program methodology,
13    including all policy adjusters, including but not limited
14    to Medicaid High Volume Adjustments, Medicaid Percentage
15    Adjustments, Outpatient High Volume Adjustments and all
16    outlier add-on adjustments to the extent that such
17    adjustments are incorporated in the development of the
18    applicable MCO capitated rates.
19    (e) The following requirements apply to MCOs in determining
20payment for all emergency services:
21        (1) MCOs shall not impose any requirements for prior
22    approval of emergency services.
23        (2) The MCO shall cover emergency services provided to
24    enrollees who are temporarily away from their residence and
25    outside the contracting area to the extent that the
26    enrollees would be entitled to the emergency services if

 

 

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1    they still were within the contracting area.
2        (3) The MCO shall have no obligation to cover medical
3    services provided on an emergency basis that are not
4    covered services under the contract.
5        (4) The MCO shall not condition coverage for emergency
6    services on the treating provider notifying the MCO of the
7    enrollee's screening and treatment within 10 days after
8    presentation for emergency services.
9        (5) The determination of the attending emergency
10    physician, or the provider actually treating the enrollee,
11    of whether an enrollee is sufficiently stabilized for
12    discharge or transfer to another facility, shall be binding
13    on the MCO. The MCO shall cover emergency services for all
14    enrollees whether the emergency services are provided by an
15    affiliated or non-affiliated provider.
16        (6) The MCO's financial responsibility for
17    post-stabilization care services it has not pre-approved
18    ends when:
19            (A) a plan physician with privileges at the
20        treating hospital assumes responsibility for the
21        enrollee's care;
22            (B) a plan physician assumes responsibility for
23        the enrollee's care through transfer;
24            (C) a contracting entity representative and the
25        treating physician reach an agreement concerning the
26        enrollee's care; or

 

 

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1            (D) the enrollee is discharged.
2    (f) Network adequacy and transparency.
3        (1) The Department shall:
4            (A) ensure that an adequate provider network is in
5        place, taking into consideration health professional
6        shortage areas and medically underserved areas;
7            (B) publicly release an explanation of its process
8        for analyzing network adequacy;
9            (C) periodically ensure that an MCO continues to
10        have an adequate network in place; and
11            (D) require MCOs, including Medicaid Managed Care
12        Entities as defined in Section 5-30.2, to meet provider
13        directory requirements under Section 5-30.3; and .
14            (E) require MCOs to: (i) ensure that any provider
15        under contract with an MCO on the date of service is
16        paid for any medically necessary service rendered to
17        any of the MCO's enrollees, regardless of inclusion on
18        the MCO's published and publicly available roster of
19        available providers; and (ii) ensure that all
20        contracted providers are listed on an updated roster
21        within 7 days of entering into a contract with the MCO
22        and that such roster is readily accessible to all
23        medical assistance enrollees for purposes of selecting
24        an approved healthcare provider.
25        (2) Each MCO shall confirm its receipt of information
26    submitted specific to physician or dentist additions or

 

 

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1    physician or dentist deletions from the MCO's provider
2    network within 3 days after receiving all required
3    information from contracted physicians or dentists, and
4    electronic physician and dental directories must be
5    updated consistent with current rules as published by the
6    Centers for Medicare and Medicaid Services or its successor
7    agency.
8    (g) Timely payment of claims.
9        (1) The MCO shall pay a claim within 30 days of
10    receiving a claim that contains all the essential
11    information needed to adjudicate the claim.
12        (2) The MCO shall notify the billing party of its
13    inability to adjudicate a claim within 30 days of receiving
14    that claim.
15        (3) The MCO shall pay a penalty that is at least equal
16    to the timely payment interest penalty imposed under
17    Section 368a of the Illinois Insurance Code for any claims
18    not timely paid.
19            (A) When an MCO is required to pay a timely payment
20        interest penalty to a provider, the MCO must calculate
21        and pay the timely payment interest penalty that is due
22        to the provider within 30 days after the payment of the
23        claim. In no event shall a provider be required to
24        request or apply for payment of any owed timely payment
25        interest penalties.
26            (B) Such payments shall be reported separately

 

 

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1        from the claim payment for services rendered to the
2        MCO's enrollee and clearly identified as interest
3        payments.
4        (4)(A) The Department shall require MCOs to expedite
5    payments to providers based on criteria that include, but
6    are not limited to:
7            (A) At a minimum, each MCO shall ensure that
8        providers identified on the Department's expedited
9        provider list, determined in accordance with 89 Ill.
10        Adm. Code 140.71(b), are paid by the MCO on a schedule
11        at least as frequently as the providers are paid under
12        the Department's fee-for-service expedited provider
13        schedule.
14            (B) Compliance with the expedited provider
15        requirement may be satisfied by an MCO through the use
16        of a Periodic Interim Payment (PIP) program that has
17        been mutually agreed to and documented between the MCO
18        and the provider, if and the PIP program ensures that
19        any expedited provider receives regular and periodic
20        payments based on prior period payment experience from
21        that MCO. Total payments under the PIP program may be
22        reconciled against future PIP payments on a schedule
23        mutually agreed to between the MCO and the provider.
24            (C) The Department shall share at least monthly its
25        expedited provider list and the frequency with which it
26        pays providers on the expedited list.

 

 

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1    (g-5) Recognizing that the rapid transformation of the
2Illinois Medicaid program may have unintended operational
3challenges for both payers and providers:
4        (1) in no instance shall a medically necessary covered
5    service rendered in good faith, based upon eligibility
6    information documented by the provider, be denied coverage
7    or diminished in payment amount if the eligibility or
8    coverage information available at the time the service was
9    rendered is later found to be inaccurate in the assignment
10    of coverage responsibility between MCOs or the
11    fee-for-service system, except for instances when an
12    individual is deemed to have not been eligible for coverage
13    under the Illinois Medicaid program; and
14        (2) the Department shall, by December 31, 2016, adopt
15    rules establishing policies that shall be included in the
16    Medicaid managed care policy and procedures manual
17    addressing payment resolutions in situations in which a
18    provider renders services based upon information obtained
19    after verifying a patient's eligibility and coverage plan
20    through either the Department's current enrollment system
21    or a system operated by the coverage plan identified by the
22    patient presenting for services:
23            (A) such medically necessary covered services
24        shall be considered rendered in good faith;
25            (B) such policies and procedures shall be
26        developed in consultation with industry

 

 

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1        representatives of the Medicaid managed care health
2        plans and representatives of provider associations
3        representing the majority of providers within the
4        identified provider industry; and
5            (C) such rules shall be published for a review and
6        comment period of no less than 30 days on the
7        Department's website with final rules remaining
8        available on the Department's website.
9    The rules on payment resolutions shall include, but not be
10limited to:
11        (A) the extension of the timely filing period;
12        (B) retroactive prior authorizations; and
13        (C) guaranteed minimum payment rate of no less than the
14    current, as of the date of service, fee-for-service rate,
15    plus all applicable add-ons, when the resulting service
16    relationship is out of network.
17    The rules shall be applicable for both MCO coverage and
18fee-for-service coverage.
19    If the fee-for-service system is ultimately determined to
20have been responsible for coverage on the date of service, the
21Department shall provide for an extended period for claims
22submission outside the standard timely filing requirements.
23    (g-6) MCO Performance Metrics Report.
24        (1) The Department shall publish, on at least a
25    quarterly basis, each MCO's operational performance,
26    including, but not limited to, the following categories of

 

 

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1    metrics:
2            (A) claims payment, including timeliness and
3        accuracy;
4            (B) prior authorizations;
5            (C) grievance and appeals;
6            (D) utilization statistics;
7            (E) provider disputes;
8            (F) provider credentialing; and
9            (G) member and provider customer service.
10        (2) The Department shall ensure that the metrics report
11    is accessible to providers online by January 1, 2017.
12        (3) The metrics shall be developed in consultation with
13    industry representatives of the Medicaid managed care
14    health plans and representatives of associations
15    representing the majority of providers within the
16    identified industry.
17        (4) Metrics shall be defined and incorporated into the
18    applicable Managed Care Policy Manual issued by the
19    Department.
20    (g-7) MCO claims processing and performance analysis. In
21order to monitor MCO payments to hospital providers, pursuant
22to this amendatory Act of the 100th General Assembly, the
23Department shall post an analysis of MCO claims processing and
24payment performance on its website every 6 months. Such
25analysis shall include a review and evaluation of a
26representative sample of hospital claims that are rejected and

 

 

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1denied for clean and unclean claims and the top 5 reasons for
2such actions and timeliness of claims adjudication, which
3identifies the percentage of claims adjudicated within 30, 60,
490, and over 90 days, and the dollar amounts associated with
5those claims. The Department shall post the contracted claims
6report required by HealthChoice Illinois on its website every 3
7months.
8    (g-8) Dispute resolution process. The Department shall
9maintain a provider complaint portal through which a provider
10can submit to the Department unresolved disputes with an MCO.
11An unresolved dispute means an MCO's decision that denies in
12whole or in part a claim for reimbursement to a provider for
13health care services rendered by the provider to an enrollee of
14the MCO with which the provider disagrees. Disputes shall not
15be submitted to the portal until the provider has availed
16itself of the MCO's internal dispute resolution process.
17Disputes that are submitted to the MCO internal dispute
18resolution process may be submitted to the Department of
19Healthcare and Family Services' complaint portal no sooner than
2030 days after submitting to the MCO's internal process and not
21later than 30 days after the unsatisfactory resolution of the
22internal MCO process or 60 days after submitting the dispute to
23the MCO internal process. Multiple claim disputes involving the
24same MCO may be submitted in one complaint, regardless of
25whether the claims are for different enrollees, when the
26specific reason for non-payment of the claims involves a common

 

 

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1question of fact or policy. Within 10 business days of receipt
2of a complaint, the Department shall present such disputes to
3the appropriate MCO, which shall then have 30 days to issue its
4written proposal to resolve the dispute. The Department may
5grant one 30-day extension of this time frame to one of the
6parties to resolve the dispute. If the dispute remains
7unresolved at the end of this time frame or the provider is not
8satisfied with the MCO's written proposal to resolve the
9dispute, the provider may, within 30 days, request the
10Department to review the dispute and make a final
11determination. Within 30 days of the request for Department
12review of the dispute, both the provider and the MCO shall
13present all relevant information to the Department for
14resolution and make individuals with knowledge of the issues
15available to the Department for further inquiry if needed.
16Within 30 days of receiving the relevant information on the
17dispute, or the lapse of the period for submitting such
18information, the Department shall issue a written decision on
19the dispute based on contractual terms between the provider and
20the MCO, contractual terms between the MCO and the Department
21of Healthcare and Family Services and applicable Medicaid
22policy. The decision of the Department shall be final. By
23January 1, 2020, the Department shall establish by rule further
24details of this dispute resolution process. Disputes between
25MCOs and providers presented to the Department for resolution
26are not contested cases, as defined in Section 1-30 of the

 

 

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1Illinois Administrative Procedure Act, conferring any right to
2an administrative hearing.
3    (g-9)(1) The Department shall publish annually on its
4website a report on the calculation of each managed care
5organization's medical loss ratio showing the following:
6        (A) Premium revenue, with appropriate adjustments.
7        (B) Benefit expense, setting forth the aggregate
8    amount spent for the following:
9            (i) Direct paid claims.
10            (ii) Subcapitation payments.
11            (iii) Other claim payments.
12            (iv) Direct reserves.
13            (v) Gross recoveries.
14            (vi) Expenses for activities that improve health
15        care quality as allowed by the Department.
16    (2) The medical loss ratio shall be calculated consistent
17with federal law and regulation following a claims runout
18period determined by the Department.
19    (g-10)(1) "Liability effective date" means the date on
20which an MCO becomes responsible for payment for medically
21necessary and covered services rendered by a provider to one of
22its enrollees in accordance with the contract terms between the
23MCO and the provider. The liability effective date shall be the
24later of:
25        (A) The execution date of a network participation
26    contract agreement.

 

 

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1        (B) The date the provider or its representative submits
2    to the MCO the complete and accurate standardized roster
3    form for the provider in the format approved by the
4    Department.
5        (C) The provider effective date contained within the
6    Department's provider enrollment subsystem within the
7    Illinois Medicaid Program Advanced Cloud Technology
8    (IMPACT) System.
9    (2) The standardized roster form may be submitted to the
10MCO at the same time that the provider submits an enrollment
11application to the Department through IMPACT.
12    (3) By October 1, 2019, the Department shall require all
13MCOs to update their provider directory with information for
14new practitioners of existing contracted providers within 30
15days of receipt of a complete and accurate standardized roster
16template in the format approved by the Department provided that
17the provider is effective in the Department's provider
18enrollment subsystem within the IMPACT system. Such provider
19directory shall be readily accessible for purposes of selecting
20an approved health care provider and comply with all other
21federal and State requirements.
22    (g-11) The Department shall work with relevant
23stakeholders on the development of operational guidelines to
24enhance and improve operational performance of Illinois'
25Medicaid managed care program, including, but not limited to,
26improving provider billing practices, reducing claim

 

 

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1rejections and inappropriate payment denials, and
2standardizing processes, procedures, definitions, and response
3timelines, with the goal of reducing provider and MCO
4administrative burdens and conflict. The Department shall
5include a report on the progress of these program improvements
6and other topics in its Fiscal Year 2020 annual report to the
7General Assembly.
8    (g-12) Notwithstanding any other provision of law, if the
9Department or an MCO requires submission of a claim for payment
10in a non-electronic format, a provider shall always be afforded
11a period of no less than 90 business days, as a correction
12period, following any notification of rejection by either the
13Department or the MCO to correct errors or omissions in the
14original submission.
15    Under no circumstances, either by an MCO or under the
16State's fee-for-service system, shall a provider be denied
17payment for failure to comply with any timely claims submission
18requirements under this Code or under any existing contract,
19unless the non-electronic format claim submission occurs after
20the initial 180 days following the latest date of service on
21the claim, or after the 90 business days correction period
22following notification to the provider of rejection or denial
23of payment.
24    (h) The Department shall not expand mandatory MCO
25enrollment into new counties beyond those counties already
26designated by the Department as of June 1, 2014 for the

 

 

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1individuals whose eligibility for medical assistance is not the
2seniors or people with disabilities population until the
3Department provides an opportunity for accountable care
4entities and MCOs to participate in such newly designated
5counties.
6    (h-5) MCOs shall be required to publish, at least quarterly
7for the preceding quarter, on their websites:
8        (1) the total number of claims received by the MCO;
9        (2) the number and monetary amount of claims payments
10    made to a service provider as defined in Section 2-16 of
11    this Code;
12        (3) the dates of services rendered for the claims
13    payments made under paragraph (2);
14        (4) the dates the claims were received by the MCO for
15    the claims payments made under paragraph (2); and
16        (5) the dates on which claims payments under paragraph
17    (2) were released.
18    (i) The requirements of this Section apply to contracts
19with accountable care entities and MCOs entered into, amended,
20or renewed after June 16, 2014 (the effective date of Public
21Act 98-651).
22    (j) Health care information released to managed care
23organizations. A health care provider shall release to a
24Medicaid managed care organization, upon request, and subject
25to the Health Insurance Portability and Accountability Act of
261996 and any other law applicable to the release of health

 

 

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1information, the health care information of the MCO's enrollee,
2if the enrollee has completed and signed a general release form
3that grants to the health care provider permission to release
4the recipient's health care information to the recipient's
5insurance carrier.
6    (k) The requirements of this Section added by this
7amendatory Act of the 101st General Assembly shall apply to
8services provided on or after the first day of the month that
9begins 60 days after the effective date of this amendatory Act
10of the 101st General Assembly.
11(Source: P.A. 100-201, eff. 8-18-17; 100-580, eff. 3-12-18;
12100-587, eff. 6-4-18; 101-209, eff. 8-5-19.)
 
13    (305 ILCS 5/5-30.15 new)
14    Sec. 5-30.15. Discharge notification and facility
15placement of individuals; managed care. Whenever a hospital
16provides notice to a managed care organization (MCO) that an
17individual covered under the State's medical assistance
18program has received a discharge order from the attending
19physician and is ready for discharge from an inpatient hospital
20stay to another level of care, the MCO shall secure the
21individual's placement in or transfer to another facility
22within 24 hours of receiving the hospital's notification, or
23shall pay the hospital a daily rate equal to the hospital's
24daily rate associated with the stay ending, including all
25applicable add-on adjustment payments.
 

 

 

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1
Article 155.

 
2    Section 155-5. The Illinois Public Aid Code is amended by
3adding Section 5-30.17 as follows:
 
4    (305 ILCS 5/5-30.17 new)
5    Sec. 5-30.17. Medicaid Managed Care Oversight Commission.
6    (a) The Medicaid Managed Care Oversight Commission is
7created within the Department of Healthcare and Family Services
8to evaluate the effectiveness of Illinois' managed care
9program.
10    (b) The Commission shall consist of the following members:
11        (1) One member of the Senate, appointed by the Senate
12    President, who shall serve as co-chair.
13        (2) One member of the House of Representatives,
14    appointed by the Speaker of the House of Representatives,
15    who shall serve as co-chair.
16        (3) One member of the House of Representatives,
17    appointed by the Minority Leader of the House of
18    Representatives.
19        (4) One member of the Senate, appointed by the Senate
20    Minority Leader.
21        (5) One member representing the Department of
22    Healthcare and Family Services, appointed by the Governor.
23        (6) One member representing the Department of Public

 

 

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1    Health, appointed by the Governor.
2        (7) One member representing the Department of Human
3    Services, appointed by the Governor.
4        (8) One member representing the Department of Children
5    and Family Services, appointed by the Governor.
6        (9) One member of a statewide association representing
7    Medicaid managed care plans.
8        (10) One member of a statewide association
9    representing hospitals.
10        (11) Two academic experts on Medicaid managed care
11    programs.
12        (12) One member of a statewide association
13    representing primary care providers.
14        (13) One member of a statewide association
15    representing behavioral health providers.
16    (c) The Director of Healthcare and Family Services and
17chief of staff, or their designees, shall serve as the
18Commission's executive administrators in providing
19administrative support, research support, and other
20administrative tasks requested by the Commission's co-chairs.
21Any expenses, including, but not limited to, travel and
22housing, shall be paid for by the Department's existing budget.
23    (d) The members of the Commission shall receive no
24compensation for their services as members of the Commission.
25    (e) The Commission shall meet quarterly beginning as soon
26as is practicable after the effective date of this amendatory

 

 

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1Act of the 101st General Assembly.
2    (f) The Commission shall:
3        (1) review data on health outcomes of Medicaid managed
4    care members;
5        (2) review current care coordination and case
6    management efforts and make recommendations on expanding
7    care coordination to additional populations with a focus on
8    the social determinants of health;
9        (3) review and assess the appropriateness of metrics
10    used in the Pay-for-Performance programs;
11        (4) review the Department's prior authorization and
12    utilization management requirements and recommend
13    adaptations for the Medicaid population;
14        (5) review managed care performance in meeting
15    diversity contracting goals and the use of funds dedicated
16    to meeting such goals, including, but not limited to,
17    contracting requirements set forth in the Business
18    Enterprise for Minorities, Women, and Persons with
19    Disabilities Act; recommend strategies to increase
20    compliance with diversity contracting goals in
21    collaboration with the Chief Procurement Officer for
22    General Services and the Business Enterprise Council for
23    Minorities, Women, and Persons with Disabilities; and
24    recoup any misappropriated funds for diversity
25    contracting;
26        (6) review data on the effectiveness of claims

 

 

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1    processing to medical providers;
2        (7) review the adequacy of the Medicaid managed care
3    network and member access to health care services,
4    including specialty care services;
5        (8) review value-based and other alternative payment
6    methodologies to enhance program efficiency and improve
7    health outcomes;
8        (9) review the compliance of all managed care entities
9    in State contracts and recommend reasonable financial
10    penalties for any noncompliance; and
11        (10) produce an annual report detailing the
12    Commission's findings based upon its review of research
13    conducted under this Section, including specific
14    recommendations, if any, and any other information the
15    Commission may deem proper in furtherance of its duties
16    under this Section.
17    (g) The Department of Healthcare and Family Services shall
18impose financial penalties on any managed care entity that is
19found to not be in compliance with any provision of a State
20contract. In addition to any financial penalties imposed under
21this subsection, the Department shall recoup any
22misappropriated funds identified by the Commission for the
23purpose of meeting the Business Enterprise Program
24requirements set forth in contracts with managed care entities.
25Any financial penalty imposed or funds recouped in accordance
26with this Section shall be deposited into the Managed Care

 

 

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1Oversight Fund.
2    When recommending reasonable financial penalties upon a
3finding of noncompliance under this subsection, the Commission
4shall consider the scope and nature of the noncompliance and
5whether or not it was intentional or unreasonable. In imposing
6a financial penalty on any managed care entity that is found to
7not be in compliance, the Department of Healthcare and Family
8Services shall consider the recommendations of the Commission.
9    Upon conclusion by the Department of Healthcare and Family
10Services that any managed care entity is not in compliance with
11its contract with the State based on the findings of the
12Commission, it shall issue the managed care entity a written
13notification of noncompliance. The written notice shall
14specify any financial penalty to be imposed and whether this
15penalty is consistent with the recommendation of the
16Commission. If the specified financial penalty differs from the
17Commission's recommendation, the Department of Healthcare and
18Family Services shall specify why the Department did not impose
19the recommended penalty and how the Department arrived at its
20determination of the reasonableness of the financial penalty
21imposed.
22    Within 14 calendar days after receipt of the notification
23of noncompliance, the managed care entity shall submit a
24written response to the Department of Healthcare and Family
25Services. The response shall indicate whether the managed care
26entity: (i) disputes the determination of noncompliance,

 

 

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1including any facts or conduct to show compliance; (ii) agrees
2to the determination of noncompliance and any financial penalty
3imposed; or (iii) agrees to the determination of noncompliance
4but disputes the financial penalty imposed.
5    Failure to respond to the notification of noncompliance
6shall be deemed acceptance of the Department of Healthcare and
7Family Services' determination of noncompliance.
8    If a managed care entity disputes any part of the
9Department of Healthcare and Family Services' determination of
10noncompliance, within 30 calendar days of receipt of the
11managed care entity's response the Department shall respond in
12writing whether it (i) agrees to review its determination of
13noncompliance or (ii) disagrees with the entity's disputation.
14    The Department of Healthcare and Family Services shall
15issue a written notice to the Commission of the dispute and its
16chosen response at the same time notice is made to the managed
17care entity.
18    Nothing in this Section limits or alters a person or
19entity's existing rights or protections under State or federal
20law.
21    (h) A decision of the Department of Healthcare and Family
22Services to impose a financial penalty on a managed care entity
23for noncompliance under subsection (g) is subject to judicial
24review under the Administrative Review Law.
25    (i) The Department shall issue quarterly reports to the
26Governor and the General Assembly indicating: (i) the number of

 

 

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1determinations of noncompliance since the last quarter; (ii)
2the number of financial penalties imposed; and (iii) the
3outcome or status of each determination.
4    (j) Beginning January 1, 2022, and for each year
5thereafter, the Commission shall submit a report of its
6findings and recommendations to the General Assembly. The
7report to the General Assembly shall be filed with the Clerk of
8the House of Representatives and the Secretary of the Senate in
9electronic form only, in the manner that the Clerk and the
10Secretary shall direct.
 
11
Article 160.

 
12    Section 160-5. The State Finance Act is amended by adding
13Sections 5.935 and 6z-124 as follows:
 
14    (30 ILCS 105/5.935 new)
15    Sec. 5.935. The Managed Care Oversight Fund.
 
16    (30 ILCS 105/6z-124 new)
17    Sec. 6z-124. Managed Care Oversight Fund. The Managed Care
18Oversight Fund is created as a special fund in the State
19treasury. Subject to appropriation, available annual moneys in
20the Fund shall be used by the Department of Healthcare and
21Family Services to support emergency procurement and sole
22source contracting with women and minority-owned businesses as

 

 

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1part of the Department's Business Enterprise Program
2requirements. The Department shall prioritize contracts for
3care coordination services in allocating funds. Funds may not
4be used for institutional overhead costs, indirect costs, or
5other organizational levies.
 
6
Article 165.

 
7    Section 165-5. The Illinois Public Aid Code is amended by
8adding Section 5-45 as follows:
 
9    (305 ILCS 5/5-45 new)
10    Sec. 5-45. Termination of managed care. The Department of
11Healthcare and Family Services shall not renew, re-enter,
12renegotiate, change orders, or amend any contract or agreement
13it entered with a managed care organization, as defined in
14Section 5-30.1, that was solicited under the State of Illinois
15Medicaid Managed Care Organization Request for Proposals
16(2018-24-001). Any care health plan administered by a managed
17care organization that entered a contract with the Department
18under the State of Illinois Medicaid Managed Care Organization
19Request for Proposals 2018-24-001) shall be transitioned to the
20State's fee-for-service medical assistance program upon the
21expiration of the managed care organization's contract with the
22Department until such time the Department enters a new contract
23in accordance with Section 5-30.6. Any new contract entered

 

 

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1into by the Department with a Managed Care Organization in
2accordance with Section 5-30.6 shall specify the patient
3diseases that require care planning and assessment, including,
4but not limited to, social determinants of health as determined
5by the Centers for Disease Control and Prevention.
 
6
Article 170.

 
7    Section 170-5. The Illinois Public Aid Code is amended by
8adding Section 5-30.16 as follows:
 
9    (305 ILCS 5/5-30.16 new)
10    Sec. 5-30.16. Managed care organizations; subcontracting
11diversity requirements.
12    (a) In this Section, "managed care organization" has the
13meaning given to that term in Section 5-30.1.
14    (b) The Illinois Department shall require each managed care
15organization participating in the medical assistance program
16established under this Article to satisfy any minority-owned or
17women-owned business subcontracting requirements to which the
18managed care organization is subject under the contract.
19    (c) The Illinois Department shall terminate its contract
20with any managed care organization that does not meet the
21minority-owned or women-owned business subcontracting
22requirements under its contract with the State. The Illinois
23Department shall terminate the contract no later than 60 days

 

 

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1after receiving a contractually required report indicating
2that the managed care organization has not met the
3subcontracting goals. To ensure there is no disruption of care
4to Medicaid recipients who are enrolled with a managed care
5organization whose contract is terminated as provided under
6this subsection, the Illinois Department shall reassign to
7another managed care plan any Medicaid recipient who will lose
8healthcare coverage as a result of the Illinois Department's
9decision to terminate its contract with the managed care
10organization.
 
11
Title IX. Maternal and Infant Mortality

 
12
Article 175.

 
13    Section 175-5. The Illinois Public Aid Code is amended by
14adding Section 5-18.5 as follows:
 
15    (305 ILCS 5/5-18.5 new)
16    Sec. 5-18.5. Perinatal doula and evidence-based home
17visiting services.
18    (a) As used in this Section:
19    "Home visiting" means a voluntary, evidence-based strategy
20used to support pregnant people, infants, and young children
21and their caregivers to promote infant, child, and maternal
22health, to foster educational development and school

 

 

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1readiness, and to help prevent child abuse and neglect. Home
2visitors are trained professionals whose visits and activities
3focus on promoting strong parent-child attachment to foster
4healthy child development.
5    "Perinatal doula" means a trained provider who provides
6regular, voluntary physical, emotional, and educational
7support, but not medical or midwife care, to pregnant and
8birthing persons before, during, and after childbirth,
9otherwise known as the perinatal period.
10    "Perinatal doula training" means any doula training that
11focuses on providing support throughout the prenatal, labor and
12delivery, or postpartum period, and reflects the type of doula
13care that the doula seeks to provide.
14    (b) Notwithstanding any other provision of this Article,
15perinatal doula services and evidence-based home visiting
16services shall be covered under the medical assistance program
17for persons who are otherwise eligible for medical assistance
18under this Article. Perinatal doula services include regular
19visits beginning in the prenatal period and continuing into the
20postnatal period, inclusive of continuous support during labor
21and delivery, that support healthy pregnancies and positive
22birth outcomes. Perinatal doula services may be embedded in an
23existing program, such as evidence-based home visiting.
24Perinatal doula services provided during the prenatal period
25may be provided weekly, services provided during the labor and
26delivery period may be provided for the entire duration of

 

 

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1labor and the time immediately following birth, and services
2provided during the postpartum period may be provided up to 12
3months postpartum.
4    (c) The Department of Healthcare and Family Services shall
5adopt rules to administer this Section. In this rulemaking, the
6Department shall consider the expertise of and consult with
7doula program experts, doula training providers, practicing
8doulas, and home visiting experts, along with State agencies
9implementing perinatal doula services and relevant bodies
10under the Illinois Early Learning Council. This body of experts
11shall inform the Department on the credentials necessary for
12perinatal doula and home visiting services to be eligible for
13Medicaid reimbursement and the rate of reimbursement for home
14visiting and perinatal doula services in the prenatal, labor
15and delivery, and postpartum periods. Every 2 years, the
16Department shall assess the rates of reimbursement for
17perinatal doula and home visiting services and adjust rates
18accordingly.
19    {d) The Department shall seek such State plan amendments or
20waivers as may be necessary to implement this Section and shall
21secure federal financial participation for expenditures made
22by the Department in accordance with this Section.
 
23
Title X. Miscellaneous

 
24
Article 999.

 

 

 

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1    Section 999-99. Effective date. This Act takes effect upon
2becoming law, except that Article 133 takes effect January 1,
32023.".