|The ISMS Legislative Action Hub tracks issues, ISMS actions, and recent votes in the Illinois General Assembly of importance to Illinois physicians. If you require additional information on an issue below or on one of the numerous bills in Illinois that impact medicine, please contact State Legislative Affairs Staff at 800-782-4767.
Please visit our Frequently Asked Questions to learn more about the ISMS Hub and the legislative process.
For a look at federal advocacy efforts, visit the AMA Current Topics in Advocacy page.
Support Oppose Neutral
From the ISMS House of Delegates ISMS Initiative
A summary of ISMS' legislative activities during 2013 is now available.
View/download the 2013 End of Session Legislative Report.
LEGAL SETTLEMENT RULES – Senate Bill 1912 (Sen. Raoul), an initiative of the Illinois Trial Lawyers Association, imposes new and unprecedented rules for legal settlements. ISMS opposed SB 1912 and sought amendments removing onerous provisions.
Despite opposition from ISMS, business and insurance groups, Senate Bill 1912 passed both houses and has been signed into law.
Medicaid Expansion – Senate Bill 26 (Sen. Steans/Rep. Feigenholtz) will extend Medicaid coverage to adults ages 19 through 64 who earn less than $16,000 per year. The state would provide health care to 342,000 more Illinoisans who currently don’t qualify for coverage because of income level or health condition. The federal government will pay 100 percent of the cost of coverage for the new Medicaid population for the first three years, then tapering between 2017 and 2020, until it reaches 90 percent.
The bill makes other changes to the Medicaid program including "fixing" some of the SMART Act Medicaid cuts, such as partially restoring dental care to pregnant women. The bill also allows for a new category of mental health facilities for short term crises.
ISMS remained neutral on the bill. Physicians remain concerned about the low reimbursement rate paid to all physicians in Illinois, and that the two year increase paid to primary care physicians will not be made permanent.
Senate Bill 26 passed both houses and was signed by the governor.
PHYSICIAN LICENSURE FEE INCREASES – 2013 began with intense negotiations with the Illinois Department of Financial and Professional Regulation (IDFPR) regarding physician licensure fee increases and how best to replace the $8 million that had been swept from the fund and transferred to the General Revenue Fund (GRF). This money has never been paid back and because of this, the Medical Disciplinary Fund experienced a shortage of funds.
To address the immediate funding crisis in the Medical Disciplinary Fund, ISMS introduced House Bill 1001 (Rep. Hays) and Senate Bill 1494 (Sen. Martinez) to transfer $9.6 million from the General Revenue Fund (GRF) to the Medical Disciplinary Fund. To ensure long term stability in the fund, the bills would have increased physician initial licensure and renewal fees 67% to $500. The bills also provided for a 10 year extension of the Medical Practice Act.
Unfortunately due to strong opposition from the Governor’s office and concern among legislators about the lack of state revenue in GRF and the poor fiscal condition in the state, neither S.B. 1494 nor H.B. 1001 were called for a vote.
In early February, Speaker Michael Madigan introduced House Bill 193, a bill to require physicians to restore money to the Medical Disciplinary Fund that was diverted to pay for other state programs. To make up this diversion, HB 193 would have raised initial and renewal fees for physician licenses to $750 and sharply raise other physician licensure fees as well. The licensure fees would have remained at $750 even after the money would have been paid back, creating a surplus of revenue in the Medical Disciplinary Fund, making it ripe for future sweeps.
An alternative to H.B. 193 was introduced in the Senate and passed on February 14.
Senate Bill 622 authorized the transfer of money into the Medical Disciplinary Fund and then beginning in 2014, and over two licensure cycles, require that the revenue to be paid back. Fees for initial and renewal fees would be increased from $300 to $700. After the temporary appropriation would be paid back, those licensure fees would be brought down to a reasonable level of $500.
Efforts to amend S.B. 622 in the Illinois House so that the bill would closely mirror H.B. 193 were averted due to ISMS opposition. The House approved an unamended version of S.B. 622 on March 7 and it was signed into law on March 8.
Although ISMS would have preferred restoration of previously swept funds from general revenues, it is good news that the licensure crisis is over.
MEDICAL PRACTICE ACT EXTENSION – During the November veto session, the Illinois General Assembly passed legislation to extend the Medical Practice Act with several new provisions. Amendment #3 to S.B. 1496 was sent to Govern Quinn for approval and awaits his signature.
FULL FUNDING FOR STATE HEALTH PROGRAMS – The state’s budget crisis continues to create significant payment delays for Medicaid and the state employees’ group health plan. ISMS will continue to advocate for increased funding for these programs so that past due bills are paid and future payment cycles are considerably shortened.
HOME HEALTH SERVICES BY OUT-OF-STATE PHYSICIANS – House Bill 2760 (Rep. Sosnowski/Sen. LaHood) is an initiative of ISMS and addresses home health care services ordered by an out-of-state physician. Current law does not expressly allow for home health care services to be ordered by an out-of-state physician, so this bill ensures that Illinois law allows for such orders and then provides a reasonable time frame for the patient to find an Illinois physician to order home health services.
As originally drafted, patients have 90 days to transition to an Illinois physician. An amendment was added to provide for a transition period of 180 days for those patients where home health services are needed to care for two or more medical conditions requiring intensive management by two or more physicians.
HB 2760 passed out of both houses and has been signed into law.
Concealed Carry -- House Bill 183 (Rep. Phelps/Sen. Forby) creates the Firearm Concealed Carry Act and allows residents and non-residents who meet specified qualifications to apply for a license to carry a concealed firearm in this State. Part of this bill amends the Mental Health and Developmental Disabilities Code and requires health care professionals providing mental health services to report patients with certain developmental disabilities or those who present a clear and present danger within 24 hours of the determination to the Department of Human Services.
ISMS worked with interested parties to ensure that health care professionals who are required to report have immunity from civil, criminal and professional liability.
ISMS was neutral on House Bill 183, which passed both houses. Governor Quinn amendatorily vetoed the bill, making a number of changes opposed by the gun-right advocates. The General Assembly voted to override the governor’s changes on 7/9/13 and the bill, as originally passed, is now law.
SEXUAL HEALTH EDUCATION – House Bill 2675 (Rep. Lilly/Sen. Steans) and Senate Bill 2354 create a standard for existing sexual health education courses, ensuring that only medically accurate, age-appropriate, and complete information is taught as part of public school sex education curricula. This would include information on reducing unintended pregnancies, STDs and STIs, and would stress abstinence. This proposal applies to grades six through 12, ensuring that whenever public schools choose to teach sex education, their programs must be medically accurate and developmentally and age appropriate.
Pursuant to ISMS House of Delegates policy, ISMS supported the bill. House Bill 2675 passed both houses and has been signed into law.
– Senate Bill 73 (Sen. Steans) and House Bill 1052 (Rep. Bradley), as originally introduced, would allow all types of advanced practice nurses, including certified nurse anesthetists, to provide medical care completely independent of physicians. Current Illinois law emphasizes a team approach in patient care, requiring physician input and collaboration.
ADVANCED PRACTICE NURSES
Senate Bill 73 was never called for a vote in the Senate Licensed Activities Committee. ISMS successfully amended HB 1052 with language retaining the collaborative agreement between a physician and an APN. The amendment instead eases some of the current restrictions in collaborative agreements.
Specifically, the ISMS language clarifies that a written collaborative agreement outside of an employment arrangement may not restrict APNs from contracting with Medicaid, Medicare or other health plans, nor limit geographic practice locations. It further clarifies that the agreement may include services the collaborating physician may provide, but chooses not to. And finally, the amendment provides that, notwithstanding the collaborative agreement, an APN may provide primary health care services such as health screenings, histories and physicals, women’s health exams and school physicals as part of their routine practice or on a volunteer basis.
There are no changes to prescribing or to anesthesia services included the bill as amended. House Bill 1052, as amended, passed out of both houses and has been signed into law.
PRESCRIPTIVE AUTHORITY FOR PSYCHOLOGISTS – Senate Bill 2187 (Sen. Harmon/Rep. Bradley) and House Bill 3074 (Rep. Bradley) would have granted clinical psychologists who have their doctorate in psychology and complete a master’s program in psychopharmacology the authority to prescribe and dispense drugs used in the treatment of mental, emotional, and psychological disorders.
The bills also would have required prescribing psychologists to maintain a collaborative agreement with any type of physician.
ISMS is strongly opposed to these bills. Simply requiring minimal instruction in pharmacology, neuroscience and physiology independent of a professional’s overall education and training is far from adequate and does not prepare a person to treat a patient as a medical doctor would. The collaborative agreement language is misleading and fails to require that any collaboration be with an Illinois physician licensed to practice medicine in all of its branches who provides mental health services.
House Bill 3074 was never assigned to a standing committee. Senate Bill 2187 passed the Senate and was assigned to the House Executive Committee. It was amended to remove all substantive and objectionable language. The bill, as amended, was re-referred to the House Rules Committee.
DENTISTS – Senate Bill 1217 (Sen. Haine/Rep. McAuliffe) would have allowed dentists to administer vaccinations after they complete “appropriate training” on how to address contraindications and adverse reactions. ISMS strongly opposed this legislation. The requirement for additional training is inadequate and will not protect patients, especially those who suffer from chronic illnesses, experience allergic reactions and/or those who are on other drugs that may negatively interact with an immunization.
There is also concern about dentists’ ability to actually implement a program for which they have little to no experience, including the vaccine schedule, its administration, handling and storage. ISMS questioned the Illinois State Dental Society on how dentists will retain documentation and communicate with the patient’s primary care provider, and how they intend to bill for these services. General dentists do not enroll in Medicare, nor do they participate in most health plans.
Because of ISMS’ opposition, the language permitting dentists to provide immunizations was removed and replaced with language making minor changes to the Dental Practice Act. ISMS is neutral on the bill as amended, which passed both houses and awaits further action by the governor.
DIRECT-ENTRY MIDWIVES – House Bill 2685 (Rep. Morrison) and House Bill 1194 (Rep. Berrios) would have created the Home Birth Safety Act and provided for the licensure of “certified professional midwives” (CPMs) by the Department of Financial and Professional Regulation. These midwives are significantly different from certified nurse midwives. CPMs have little to no medical education, yet want to be able to provide medical treatment to pregnant women.
House Bill 3636 (Rep. Berrios) would have created the Certified Professional Midwife Licensure Act to provide for licensure of direct entry midwives.
ISMS opposed all of these bills. House Bill 2685 failed in the House Health Care Licenses Committee and House Bill 1194 was never assigned to committee. House Bill 3636 was introduced during the last week of the spring legislative session and it remains in the House Rules Committee.
LICENSURE OF NATUROPATHIC PHYSICIANS – Senate Bill 1168 (Sen. Martinez) would have created the Naturopathic Medical Practice Act and provided for the regulation of naturopathic physicians through licensure by the Illinois Department of Financial and Professional Regulation.
Naturopaths hope to offer the public a form of “alternative treatment” that includes the use of nutrition, herbal therapy, homeopathy and behavioral modification.
In the view of ISMS, naturopaths are neither trained nor capable of diagnosing and treating physical ailments. ISMS opposed this legislation, which was never called for a vote in the Senate Licensed Activities Committee.
BILLING FOR ANATOMICAL PATHOLOGY SERVICES – Senate Bill 1630 (Sen. Haine), as originally drafted, would have amended the Medical Practice Act to prohibit any clinical laboratory or other physician from charging, billing, or otherwise soliciting payment for anatomic pathology services unless the services were rendered personally by the clinical laboratory or physician, or under the clinical laboratory's or physician's direct supervision.
Senate Amendment 2, which was adopted in committee, would allow a referring physician who takes a patient specimen to charge a patient or a payer an acquisition or processing charge when (i) the charge is limited to actual costs incurred for specimen collection and transportation, and (ii) the charge is separately coded or denoted as a service distinct from the performance of the anatomic pathology service.
ISMS is monitoring and reviewing this legislation, which passed out of the Senate Insurance Committee but was never called for a vote on the Senate floor and was re-referred to the Committee on Assignments.
MEDICAL LIABILITY REFORM – Senate Bill 2160 (Sen. Barickman) is ISMS legislation and would have reenacted many of the provisions from Public Act 94-677 (the medical liability reform law of 2005), with the exception of caps on awards for non-economic damages and the Sorry Works! program. Specifically, Senate Bill 2160:
1) Strengthened the affidavit of merit by requiring the disclosure of the consulting physician’s name and that the physician be an expert in the area of medicine that is the subject of the lawsuit;
2) Limited 90-day extensions for filing the affidavit and written report to situations where the affiant was unable to obtain consultation because the consultation could not be obtained before the statute of limitations expired;
3) Allowed the use of annuities for the payment of portions of the award for medical costs;
4) Increased the standards for expert witnesses by requiring them to be board certified or board eligible in the same specialty as the defendant. The expert would also have to devote a majority of time to the practice of medicine, teaching or research. Retired experts would have to be current with continuing education requirements;
5) Extended Good Samaritan immunity to retired physicians providing free care;
6) Allowed a free medical clinic to receive reimbursement from the Department of Healthcare and Family Services, provided the reimbursements would only be used to pay overhead expense of operating the clinic and not to provide compensation to the health care professional receiving civil immunity;
7) Provided that the interest rate on judgments would be automatically increased or decreased by a percentage equal to the percentage change in the consumer price index during the preceding 12 months (currently, the 9% interest rate is not annually indexed); and
8) Delayed the accrual of interest in certain cases where a federal Medicare lien may exist against the judgment by providing that in such cases, the interest would be computed from the day after the federal Medicare program provides confirmation of any lien against the judgment, rather than from the day the judgment is entered.
Because of strong opposition from the Illinois Trial Lawyers Association, Senate Bill 2160 did not advance.
ADVANCE DIRECTIVES; SIMPLIFIED HEALTH CARE POWER OF ATTORNEY – An ISMS initiative, House Bill 2373 (Rep. Williams) would create a more patient-friendly power of attorney for health care. One of the main goals of this legislation would provide a notice and form in simpler language that will be more easily understood by the general public. This form would be designed with the intent to increase the use of these instruments and encourage individuals to designate a person to make health care decisions for them when they can no longer do so themselves. The legislation would preserve the individual right to use any other “non-statutory” form, but specify for the first time the minimum requirements for an alternate form to be considered acceptable under the Illinois Power of Attorney Act.
Because there was a comprehensive rewrite of the Power of Attorney Act last year, this bill was held in the House Rules Committee. ISMS intends to continue to advocate for these changes next year.
EASING OF FOUR-DRUG LIMIT FOR MEDICAID PATIENTS – Last year the Illinois General Assembly instituted a limit of four drugs that would be covered as a Medicaid benefit for many patients. This limitation has caused great concern among physicians and patients alike, as many patients have gone without essential medications. While the Department of Health and Family Services has attempted to minimize some of the difficulties caused by this legislation, physicians believe more should be done to address physician and patient concerns.
House Bill 2352 (Rep. Cassidy) was introduced at the request of ISMS to require the Department, in consultation with statewide organizations representing prescribers, to develop a protocol that expedites review and approval of prescriptions for psychiatric conditions and chronic conditions such as asthma, hypertension and diabetes. The bill would also allow the Department to exempt prescriptions for antibiotics and other categories of drugs simply by using its rulemaking authority.
House Bill 2352 was one of many bills introduced that attempted to expand the number of drugs a Medicaid patient could have, but because of concerns the Department had about cost, this bill and all other bills did not advance.