SB 466, which passed the Senate and House unanimously, will close the insurance gap for women to receive life‐saving 3‐D mammography (digital breast tomosynthesis). Breast tomosynthesis was FDA approved in 2011 as clinically superior to traditional digital mammography. Clinical data in more than 150 peer reviewed publications continues to show an increase is cancer detection up to 41% and a decrease in recalls by 40%. 

After Medicare’s coverage decision (effective January 1, 2015), and the passage of SB 54 last year, Medicaid, Blue Cross & Blue Shield, and Health Alliance have all made decisions to cover this preventive service, but the other commercial carriers have not. This bill will close the gap on the 27% of Illinois women who still must pay out of pocket.

• Bill Status of SB 466

The federal Affordable Care Act led to the creation of a marketplace where individuals and small businesses in Illinois can obtain health insurance policies, often with subsidies to offset the cost of the premiums. Since its rollout in 2013, issues with health insurance policies sold on the marketplace have arisen, particularly with changes in some policies' networks of physicians and hospitals. Many consumers have a difficult time verifying whether their preferred physician or hospital is actually contracted with a specific health plan before deciding whether or not to enroll in that plan. For physicians, the lack of transparency in these networks makes it difficult to refer a patient to an in-network physician for necessary specialty care.

Additionally, the creation of "narrow networks," or plans only offering care with very few providers, limits patient choice and may prevent patients from choosing plans that include their preferred physician and their preferred hospital. Limiting patients to narrower networks and only very specific providers could hinder patient access to a broad range of health care services, particularly specialty care. Too often, narrow networks do not contract with an adequate number of specialists. ISMS continues to monitor this issue closely and supported the introduction of bi-partisan legislation in May. HB 6562, the Network Adequacy and Transparency Act, remains under negotiation. ISMS continues to work with lawmakers, the Illinois Department of Insurance, insurers, physician specialty groups and patient advocates. We expect these negotiations to continue into the summer and possibly the fall.  

• Bill Status of HB 6562
• News Release
• ISMS Summary on Network Adequacy

Senator Pamela J. Althoff (R-McHenry) filed Senate Bill 2899, a bill that contains several substantive changes to the Optometric Practice Act. The bill includes highly controversial changes to the scope of practice for optometrists. Specifically, the bill would allow optometrists to perform some surgical procedures and give injections around the eye. ISMS and the Illinois Society of Eye Physicians and Eye Surgeons are opposed to SB 2899. Optometrists are not physicians. They do not attend medical school, nor have they completed a residency in medicine and surgery. Expanding the procedures that may be performed by optometrists is troubling because optometric training is in no way comparable to that of an ophthalmologist. On May 12 SB 2899 passed in the Illinois Senate, but ISMS secured a commitment from leading members of the General Assembly that this initiative will not pass unless there is an agreement between the optometrists and ISMS.  

• Bill status of SB 2899
• SB 2899 Position Paper
• View ISMS Call to Action

The Medical Practice Act is scheduled to sunset on December 31, 2016. All professional licensure acts in Illinois contain a "sunset date" to allow the legislature to periodically revisit and revise licensure acts. Senate Bill 2377, filed by Senator Iris Martinez (D-Chicago) and House Bill 4481, filed by Representative Michael Zalewski (D-Riverside) are both ISMS initiatives to extend the Medical Practice Act for ten years, from December 31, 2016, to January 1, 2027.

• Bill Status of SB 2377
• Bill Status of HB 4481

Fiscal Year 2016 is coming to a close without a budget. Physicians throughout Illinois are owed millions of dollars in claims under the State Employee Group Insurance Program. If the delay in reimbursing physicians for the care they provide to State employees, dependents, and retirees is not addressed, this failure to reimburse will create severe access-to-care issues. Many Illinois practices and large clinics have taken out substantial loans to keep their medical practices viable while they wait for reimbursement from the State of Illinois.

As of June, our current budget situation has left a 17-month and $3 billion backlog of payments owed to physicians and health insurers who treat state government workers and retirees covered in the State Employees Group Insurance Program (SEGIP).

ISMS, along with CIGNA, successfully advocated that the Rauner Administration use available funds from the Health Insurance Reserve Fund (HIRF) to begin to pay physicians and insurers a small portion of what is owed to them. The HIRF is a fund into which premiums paid by State employees are deposited and can only be used to pay the costs associated with health insurance. ISMS, along with Cigna, advocated for the release of these funds to provide for some short term relief. Comptroller Leslie Munger very recently began releasing those funds. ISMS can also help facilitate meetings with those struggling with debts and members of the Administration

While a state budget for fiscal year 2016 has not been enacted, the Governor’s office has relayed it willingness to advocate for any health care professional currently in financial distress. Representatives from the Governor’s Office indicated that for unpaid claims from the state’s self-insured plan, they will work with those who are being adversely affected by the lack of appropriation to SEGIP to provide some financial relief through the Vendor Support Program or by certifying accounts receivable for various vendors/providers that can be used to access individual lines of credit. Professionals and facilities should also review the following link detailing the State’s vendor assistance program at www.vendorassistance.com/Program/Illinois/Home/Home.

ISMS will also provide assistance to facilitate this process. Contact ISMS at 800-782-4767 for individual assistance relating to the backlog.

Resolution to the budget impasse is key to moving forward and ISMS continues to advocate for full funding for the State Employee Group Insurance program going forward, and strongly advocates that immediate action be taken to pay for care that has been provided.

Senate Bill 2379, filed by Senator Bill Haine (D-Alton), is an ISMS initiative that prohibits insurers from using extrapolation or any other form of statistical sampling methodology to recoup payments from physicians. Instead, it provides that any request for recoupment shall be in writing and include specific information.  

• Bill Status of SB 2379

Representative Robyn Gabel (D-Evanston) filed House Bill 4634 to create a new profession of "certified midwives." ISMS and several other medical specialty groups oppose HB 4634. The bill's education and licensure requirements for certified midwives are noticeably absent and even if specified would fall well below the standards for certified nurse midwives. Besides the lack of training, this legislation would allow midwives to perform a wide range of medical services at home without the support of medical technology or other qualified professionals. Because of the significant risks that come with home birth, ISMS, along with groups serving mothers, opposes the creation of a new license that does not require essential training and authorizes the provision of medical services to women and children by unqualified individuals.

• Bill Status of HB 4364
• HB 4364 Position Paper

The Compassionate Use of Medical Cannabis Pilot Program Act passed in 2013 is now implemented in Illinois as a four-year pilot program. Senator Bill Haine (D-Alton) introduced Senate Bill 2378, an ISMS initiative that seeks to improve the information provided to recipients of medical cannabis and integrate medical cannabis dispensing information with the current Illinois Prescription Monitoring Program (PMP).

During the last days of the Spring legislative session, another bill (Senate Bill 10) was amended to include the PMP expansion among other changes.

Under SB 10 certifications will be reported to the Prescription Monitoring Program (PMP), and physicians will no longer be in the position of “recommending” medical cannabis, instead physicians can certify the patient has one of the qualifying conditions defined in the law.

SB 10 passed both houses and was signed by Governor Rauner on June 30.

• Bill Status of SB 2378
• Status of SB 10

Senator Jason Barickman (R-Bloomington) filed Senate Bill 2382, an ISMS-initiated comprehensive bill to reform Illinois’ medical liability climate. The legislation will prevent administrative payment guidelines from being introduced as the standard of care in medical liability suits; ensure that the amounts of medical bills actually paid are presented in medical liability cases rather than the amounts charged; remove the ability to file a medical liability case without a Certificate of Merit; and restore the right to a 12-member jury in civil cases. 

• Bill Status of SB 2382

Representative Ron Sandack (R-Downers Grove) filed House Bill 4473 at ISMS' request to restore the right to a 12-member jury in civil cases, which was removed by Public Act 98-1132 (Senate Bill 3075) last year. A Cook county circuit court ruled this provision unconstitutional based on a reading that the 1970 State Constitution preserved the right to a 12- person jury trial, and any law that restricts that right would on its face violate the constitution. ISMS believes that reducing jury size will have a negative impact on the civil justice system in Illinois, likely resulting in less representation and less-diverse juries, in addition to ushering in a dramatic departure in United State jurisprudence without any thoughtful study or documented complaints about the prior jury system. That ruling will now be appealed to the Illinois Supreme Court.

• Bill Status of HB 4473

Representative Michelle Mussman (D-Schaumburg) filed House Bill 5809 to allow pharmacists to prescribe and dispense contraceptive drugs. ISMS opposes HB 5809. Pharmacists are not trained to diagnose and treat conditions, diseases and other maladies of the human body, and allowing them to prescribe drugs exposes patients to risk. Moreover, this prescriptive authority would promote episodic care and diminish the physician-patient relationship.

Hormonal birth control medication require a prescription from a physician for a reason. Until the FDA determines that these drugs are safe enough to be sold over the counter, ISMS does not believe it is good public policy to circumvent the processes that are in place to protect patients.

• Bill Status of HB 5809
• HB 5809 Position Paper

State government has previously "swept" monies from dedicated professional licensure funds, including the Medical Disciplinary Fund, and used those moneys to fund other government programs. These sweeps have created extreme shortfalls in the fund, which, by state law, is meant to pay for the physician licensure and disciplinary process in Illinois. In early 2013, the state's medical licensure process temporarily shut down, and a loan was made to reinstate the program. Legislative proposals are surfacing to authorize additional fund sweeps to meet immediate financial demands. ISMS opposes further sweeping of moneys from the Medical Disciplinary Fund, as those resources are needed to ensure that physician licensing activities are not interrupted. 

The Medical Studies Act has long been relied upon by hospitals and medical staffs to protect peer review meetings and related documents from disclosure. The purpose of the Act is not to shield hospitals or physicians from liability, but to ensure that physicians will engage in effective examination of their peers in order to advance the quality of healthcare.

Once again, the Illinois Trial Lawyers Association have introduced another bill to repeal the Medical Studies Act, Senate Bill 2744, filed by Senator Don Harmon (D-Oak Park).  This bill is identical to Senate Bill 1700 from last session. ISMS advocacy efforts have highlighted how the repeal of this act would not only dramatically increase lawsuits against physicians and hospitals, but also severely impede the improvement of patient care. By filing this legislation again, it is clear that the Illinois Trial Lawyers Association will not stop in their efforts to repeal this important protection for the delivery of health care services by physicians in Illinois.

• Bill Status of SB 2744

In 2011, the General Assembly passed a workers' compensation reform bill that subjected physicians who treat injured workers to a 30% reduction to their fees. The bill did nothing to improve the long payment delays and additional administrative burdens of treating workers' compensation patients.  

Reforming Illinois' worker's compensation system remains a priority for Governor Rauner's Administration. Organizations representing employers continue to advocate for further reductions to the medical fee schedule, which ISMS remains strongly opposed to.

While the legislative leaders and representatives from the governor's office continue to meet over these and other issues, it is unknown at this time what, if anything will be agreed to. 

Stakeholder Position Paper