2022 Legislative Report
In one of the shortest, yet busiest legislative sessions in memory, the Illinois General Assembly adjourned early on Saturday, April 9, 2022, with the Senate adjourning at 3:00 a.m. and the House following at 6:00 a.m. This concluded a 20-hour day in which both chambers addressed the most controversial legislation introduced this session. In addition to passing a budget, legislators approved legislation aimed at providing residents relief from inflation and property taxes; cracking down on crimes, including carjacking and smash-and-grabs at retail stores; authorizing more expressway cameras; reforming the hospital assessment; reforming nursing home rates; banning “ghost guns”; and establishing a multi-year safe gun storage campaign.
In addition, ISMS was successful in helping shepherd through rules to fully implement and enforce the Network Adequacy and Transparency Act passed in 2017.
Equally important are the bills that ISMS successfully pushed back on, such as bills expanding other health care professionals’ scope of practice and bills that would establish onerous mandates on physicians.
ISMS’ work to effectuate positive changes for our practices and our patients continues as we prepare for the fall veto session and the 2023 spring legislative session.
On behalf of the Board of Trustees, I would like to thank every physician member who makes ISMS’ advocacy efforts possible.
Clarence W. Brown Jr., M.D., J.D.
President, Illinois State Medical Society
FY2023 BUDGET & MEDICAID
For the second straight year, Illinois’ finances look much better than expected going into Fiscal Year 2023, due to higher-than-expected post-COVID incoming revenues and federal COVID relief. Incoming state revenues are $4.6 billion higher for the current fiscal year than previously projected, mainly because spending on goods, which Illinois taxes rather than services, grew during the pandemic, and because the budget was bolstered with federal stimulus funds. Additionally, because funds are still available from the federal American Rescue Plan Act (ARPA), the Democratic leaders had a surplus of state funds to allocate this year, compared to previous budgets that required cuts. The FY23 state budget has been signed into law as Public Act 102-698.
The total revenue number for the FY23 state budget is $45.6 billion. Highlights of the budget include:
- Suspending the 1 percent sales tax on groceries for one year, beginning July 1, 2022 (saves consumers $400 million; local governments will still receive revenue).
- Freezing the Motor Fuel Tax at 39 cents/gallon until January 1, 2023; the tax will then increase by 2.2 cents in 2023. This saves consumers $70 million; retailers also need to place a sign on each gas pump highlighting the tax relief.
- Increasing the state Earned Income Tax Credit to 20% of the federal credit, up from 18% (at a cost of $100 million per year), and expanding eligibility to persons 18-25 and 65 or older.
- Sending $50 checks per individual directly to taxpayers this fall for households earning less than $200,000 individually or $400,000 jointly, and $100 per child up to three children (these checks will be sent to 90% of Illinois families).
- Suspending the state sales tax on back-to-school supplies and clothing from August 5-14, 2022 (saving consumers $50 million).
- Providing $236 million for public safety ($124 million for law enforcement grants; $48 million for carjacking prevention; $50 million for domestic violence programs; and $12 million for the witness protection program and anonymous tip line).
- Deposits $1 billion in the rainy-day fund; and
- Pays another $200 million into pension deficit in addition to the required $9.6 billion payment.
- Allow Nursing Education Scholarships to be awarded to students at approved institutions that are not required to meet the definition of “institution of higher learning”;
- Increase Medicaid rates for specialized mental health rehabilitation facilities by 5% to incentivize reduced room occupancy; Medicaid rates for supportive living services must be 54.3% of the average total nursing services per diem rate for geographic areas;
- Increase reimbursements for substance use disorder treatment providers and facilities;
- Reimburse for medical forensic services to sexual assault survivors;
- Waive licensure fees for healthcare workers for FY 22-24, but allows individuals to benefit from waiver only once;
- Use COVID Relief Funds to increase pay for front-line workers at nursing home facilities and ground ambulance service providers;
- Mandate that the Department of Health and Family Services (DHFS) create a Managed Primary Care Demonstration Project to provide primary care services for preventative care in underserved communities with a health care organization; and
- Create a Statewide 988 Trust Fund for a suicide prevention and mental health crisis system.
The BIMP has been signed into law by Governor Pritzker as Public Act 102-699.
The Medicaid Working Group is a bi-partisan/bi-cameral working group of legislators established to provide a thorough review of Medicaid legislation, rules, and policy. This year the Medicaid Working Group introduced an omnibus bill (HB 4343, Rep. Harris/Sen. Gillespie) that provides funding for wellness checks for mental health in schools; Medicaid payments for midwifery and acupuncture; increases in Medicaid payments for behavioral and maternal health services and dental services; Medicaid coverage for peer recovery support services; certified nursing assistant internship programs; and an increase in rates for non-emergency ground ambulance services. The Illinois Department of Healthcare and Family Services (HFS) will also investigate how to align Medicare Part D and the Medicare Savings Program. The bill also allows emergency rulemaking for providing coverage to noncitizens ages 42 to 54. HB 4343 is currently awaiting the Governor’s signature.
Medicaid Expansion Feasibility Study
The Medicaid Working Group met over the summer to discuss HFS’ feasibility study on supporting the uninsured and underinsured in Illinois. The study looked at several options, including a single-payer plan, Medicaid expansion, and creating a state-based exchange. This session, HB 5142 (Rep. Harris) and HB 4343 (Rep. Harris) were introduced to focus on enrolling those who qualify for Medicaid plans but are currently not enrolled. Even though a public option bill was not considered this spring, Governor Pritzker, who campaigned on bringing a public option to Illinois in his first gubernatorial run, said he is still interested in allowing residents to buy into Medicaid. His administration is observing how other states have implemented the policy.
ETHICS/CAMPAIGN FINANCE REFORM
In terms of ethics reform and judicial campaigns, the legislature approved a measure (House Bill 716) that changes how the campaigns of state Supreme Court justices are financed. First, the bill creates a task force to study the feasibility of implementing public financing of campaigns.
The bill also caps contributions from individuals if a judicial candidate is self-funded. Currently, there is a $6,000 limit on donations from individuals, though if a candidate gives his or her own campaign more than $100,000, then contribution limits from individuals are lifted. The bill changes that, capping donations from individuals in these judicial races at $500,000.
The $500,000 limit is also extended to independent expenditure committees seeking to make contributions to judicial candidates. Currently, these organizations have no restrictions on their contributions. Governor Pritzker signed the bill into law (Public Act 102-0909), which has an immediate effective date, so it will affect this year’s elections.
HEALTH INSURANCE REFORM
Coverage for Victims of Domestic Violence
House Bill 4337 (Rep. Cassidy), ISMS legislation, would require insurance coverage for treatment of physical and mental trauma for victims of domestic violence. The bill did not advance due to opposition from the insurance industry.
Network Adequacy and Transparency
During calendar year 2021, Springfield Clinic and Blue Cross Blue Shield (BCBS) began negotiations regarding the continued utilization of Springfield Clinic’s physician network by BCBS, with the hope of an agreement prior to the 2022 coverage year commencing. Negotiations became very contentious and public as BCBS made it very clear that Springfield Clinic must accept its payment demands to continue being served by the BCBS network. Springfield Clinic was being forced to accept thousands of additional patients without any type of rate increase or reconciliation. By the time employer benefit choice periods began last fall, BCBS decided to drop Springfield Clinic from its central Illinois networks leaving over 100,000 area patients without access to their usual network of physicians and care providers. Further, it was later determined that BCBS did not follow through on proper notification procedures to inform the Illinois Department of Insurance (DOI) that it had dropped Springfield Clinic, causing a great disruption in care. Horror stories of patients not being able to access critical care or being charged high co-pays to continue care gained media attention that has caused a grassroots campaign seeking to bring BCBS back to the table.
In March, DOI determined that BCBS did not adequately adhere to Illinois’ Network Adequacy and Transparency Act, which passed and was signed into law in 2017. This important patient protection initiative was championed by ISMS. ISMS has pushed hard for the enforcement of the Network Adequacy and Transparency Act by DOI for the last five years. Enforcement rules were finally issued while the impasse between Springfield Clinic and BCBS continued. Representative Sue Scherer (D-Decatur) filed House Bill 5729 to add further restrictions and mandates on the Network Adequacy and Transparency Act in response to the ongoing network contract negotiations between BCBS and the physicians in Springfield Clinic. The bill would require insurers to audit their entire provider directory every 90 days, mandate specific information on providers’ location and contact information, establish minimum ratios of providers to beneficiaries for network plans, and authorize the DOI to adopt emergency rules implementing federal standards for provider ratios, time and distance, or appointment wait times. The language was added to HB 1463; however, the bill failed in the House. Neither bill moved forward this spring.
On April 8, DOI formally filed rules to support compliance with and enforcement of the NAT Act. ISMS has encouraged DOI to develop rules to ensure the provisions in the Act are implemented consistent with their legislative intent, requests that have taken on new urgency in light of recent problems arising from the ongoing contract dispute between BCBS and Springfield Clinic. In particular, we have stressed the importance of using the rulemaking process to strengthen protections related to provider ratio and time and distance standards; plan reporting of network changes; assuring continuity of care for patients during network transitions; and maintaining the accuracy of provider directories.
The proposed rules reflect recent conversations with and input from ISMS. Specifically, the rules:
- Specify that time and distance standards are those established in the 2023 Letter to Insurers in Federally-Facilitated Marketplaces, issued by the Centers for Medicare and Medicaid Services, and clarify how distance and time are to estimated (i.e., “as the crow flies” and Google Maps time estimates for noon travel during a normal weekday, respectively).
- Codify specific provider ratios for all provider types listed in the NAT Act.
- Require material changes to be submitted via a revised version of the complete network adequacy filing, including the changes indicated for each document that was revised from the previous version of the filing.
- Require plans to file annual reports describing the verification process established to ensure accuracy of provider directories. In addition, plans are required to audit their print and online directories every 90 days, and to submit these audits as an attachment to the annual filing describing the verification process.
- Require plans to submit to DOI sample correspondence to beneficiaries and providers re. network changes. Specifies information that must be included in letters to patients, including the availability of transitional services; a description of who qualifies for transitional services; and the insurer’s formal procedure for a beneficiary to request transitional services.
These provisions will help clarify and further strengthen the provisions in the NAT Act. ISMS will be providing comments on the rule, specifically supporting these provisions while also highlighting the need for additional work, including on developing provisions clarifying the extent to which telehealth providers count toward network adequacy standards. We understand that DOI plans to wait for additional information and guidance from CMS, as they are currently soliciting stakeholder input about the use of telehealth providers in the context of network adequacy.
House Bill 4703 (Rep. Morgan/Rep. Gillespie) makes changes to Illinois’ No Surprises Act to track with the federal law by including many of the patient protections and broadening language about when balance billing is prohibited for out-of-network professionals delivering care at in-network facilities.
It does not change the state’s current arbitration system.
The changes include requiring plans to pay some initial reimbursement or issue a denial within 30 days. Illinois law previously did not require any initial payment or deadlines; the payment dispute could have been ongoing without any interim payment.
These payment changes are used for determining patient cost sharing in surprise billing situations and cannot be used in a manner in determining payment that would tip the scales toward insurers during the arbitration process.
In the changes to Illinois’ law, the Illinois Department of Insurance retains the authority to enforce the requirements of this section, which means that their authority would extend not only to state-regulated plans, but to all plans operating in the state. ISMS supported the bill, which has been signed into law as Public Act 102-0901.
Additional changes will likely be introduced next year, including some proposed by ISMS, as issues at the federal level change.
LICENSURE BILLS/SCOPE OF PRACTICE
APRN Use of Fluoroscopy
Senate Bill 3196 (Sen. Feigenholtz) would allow advanced practice registered nurses (APRNs) to independently administer radiation using fluoroscopy. The use of fluoroscopy and radiation applications are sensitive and should not be used independently of physicians. ISMS opposed this legislation and the bill did not advance.
Certified Registered Nurse Anesthetists (CRNAs) Independent Practice
Senate Bill 2566 (Sen. Bush) would grant certified registered nurse anesthetists (CRNAs) more independent practice by eliminating important patient safety requirements, including having a written anesthesia plan with an anesthesiologist, and physician availability to treat medical emergencies when nurse anesthetists provide care. ISMS opposed this legislation and it remains in the Senate Assignments Committee.
Numerous bills were introduced relating to the current licensure of dietitians and nutritionists. Bills originally introduced by the advocates would have expanded their scope of practice to include the authority to prescribe nutritional therapy, make nutritional diagnoses and change the dosage of prescription drugs or otherwise issue discontinuation orders. ISMS opposed this language and was successful in removing it. ISMS was neutral on the final bill, HB 4665 (Rep. Mah/Sen. Jones), which has been signed into law as Public Act 102-0945.
Licensure of Naturopaths
Senate Bill 3025/House Bill 4294 (Sen. Bush/Rep. Gabel) would license naturopaths in Illinois and allow them to provide a full range of naturopathic “medicine” to patients including providing pediatric care; treating and managing chronic conditions, such as diabetes and cancer; and providing specialty care, such as gynecological services. ISMS opposed these bills and they did not advance.
Optometrists Vaccination Authority
House Bill 4929 (Rep. Mah/Sen. Murphy) as introduced would have allowed optometrists to provide the influenza vaccine, the COVID-19 vaccine and the shingles vaccine. As amended the bill would allow optometrists to provide only the COVID-19 vaccine, as currently allowed under Governor Pritzker’s executive orders. ISMS was neutral on the bill as amended, which has been signed into law as Public Act 102-0788.
Physician Title Protection
Senate Bill 3491 (Sen. Crowe), ISMS legislation, would add stronger physician title protections by amending the Medical Practice Act to prohibit the use of “anesthesiologist” and “dermatologist” by anyone other than a physician. The bill did not advance due to concerns expressed by the Illinois Department of Financial and Professional Regulation (IDFPR).
House Bill 4706 (Rep. Stoneback) would require hospitals to record and internally report, every six months, the NTSV caesarean birth rate for each obstetrician-gynecologist who works at the hospital. The bill would require hospitals to submit a copy of this report to the Illinois Department of Public Health (IDPH) with the names of the physicians redacted. Hospitals would also be required to publicly record and report their cumulative NTSV caesarean birth rates on their websites every six months. ISMS opposed the bill and attempted to work with the sponsor on alternative language to remove any requirement to report information related to individual physicians and patients. While the sponsor indicated she would like to find an agreement with ISMS, she moved the bill out of the House. ISMS opposed the bill and it failed to advance in the Senate.
CME Mandate on Human Trafficking
Senate Bill 3824 (Sen. Bennett) would create the Health Care Services Human Trafficking Recognition Training Act and would require Illinois healthcare professionals to undergo training in the recognition of human trafficking and protocols for reporting observed human trafficking to the appropriate law enforcement agency as part of their CME. ISMS opposed this bill and the bill did not advance.
CME Mandate on Cultural Competency
House Bill 4654 (Rep. Avelar) would require that Illinois healthcare professionals take courses on cultural competency as part of their CME. ISMS opposed this bill and the bill did not advance.
Expansion of Prescription Monitoring Program (PMP)
Senate Bill 3920 (Sen. Bush) would expand the PMP by requiring pharmacists to list all prescriptions dispensed to a patient, and require that each corresponding diagnosis be noted on the prescription by the physician and uploaded by the pharmacist into the PMP. ISMS opposed this legislation and the bill did not advance.
Senate Bill 2535 (Sen. Bush/Rep. Conroy) would have required prescribers to offer a prescription for naloxone to a patient when one or more of the following conditions are present: (1) the prescription dosage for the patient is 50 or more morphine milligram equivalents of an opioid medication per day; (2) an opioid medication is prescribed concurrently with a prescription for a benzodiazepine; or (3) the patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant. The bill would have also required that prescribers not only counsel the patient on the addictive nature of the opioid being prescribed and the benefits of naloxone, but a designee of the patient as well. ISMS opposed this legislation and worked closely with the sponsors to develop an alternative pathway forward as it relates to increasing access to naloxone for those who need it, as well as ways to educate patients about the dangers of opioid abuse. ISMS successfully amended the bill. When prescribing an opioid, prescribers will have to let patients know the risk and benefits of the prescription and that naloxone is available. It will require pharmacists, who can currently dispense naloxone without a prescription, to offer naloxone to patients who are being dispensed an opioid. This bill, as amended, was signed into law as Public Act 102-1040.
MEDICAL LIABILITY/WRONGFUL DEATH
House Bill 4968 (Rep. Ford) would allow for the recovery of punitive damages in wrongful death cases. This was an initiative of victims of recent plane crashes due to malfunctions in planes manufactured by Boeing. This bill, however, was not limited solely to product liability. For that reason, ISMS opposed the bill, which failed to advance out of subcommittee.
Protect Health Records from Ransomware
Senate Bill 3440 (Sen. Bennett), ISMS legislation, would amend the Illinois Criminal Code to classify ransomware attacks against healthcare providers and facilities as a felony. The bill did not advance due to concerns from legislators who are opposed to adding new penalties to the Criminal Code.
Senate Resolution 792 (Sen. Koehler) directs the Auditor General to conduct an audit of all Medicaid MCOs. ISMS supported this resolution, which was adopted by the Senate.
Banning Flavored Tobacco
Senate Bill 3854 (Sen. Morrison), ISMS legislation, would ban flavored tobacco, including menthol, but did not advance due to opposition from tobacco manufacturers and retailers.
Drug Take Back Program
House Bill 1780 (Rep. Gong Gershowitz/Sen. Fine) will make it easier for people to dispose of pharmaceutical drugs and increase safe and convenient drug take back locations by creating a sustainable source of funding to be provided by drug manufacturers. ISMS did not take a position on this bill, which passed both chambers and is headed to the governor.
Limiting THC Levels
House Bill 4709 (Rep. Batnick), ISMS legislation, would limit THC levels to 10% in cannabis sold for recreational use, but did not advance due to strong opposition from proponents and advocates for legalization of recreational cannabis
Medical Forensic Exams
Senate Bill 3023 (Sen. Morrison/Rep. Cassidy) provides the option to opt out of using private insurance when receiving a sexual assault forensic exam and increases the variety of locations where individuals can obtain medical forensic exams. This, along with increases in reimbursement rates for providing the exams, is an initiative of Vituity, an ISMS group member. ISMS supported Senate Bill 3023, which passed both chambers and awaits further action by the governor.
Senate Bill 3024 (Sen. Bush/Rep. Willis) is an initiative of the Northern Illinois Health Consortium and as originally introduced would have required that the IDPH share with local county health departments information from the state’s PMP. ISMS expressed concerns about the bill as it failed to provide any confidentiality of the data shared, and that it included a very broad purpose as to how the information could be used. ISMS offered an amendment that prohibits information identifying individual prescribers and dispensers from being reported, and establishes that the data can only be used by county health departments for educational purposes and analysis of prescribing trends to help with naloxone distribution and other public health programs. ISMS supported this bill as amended, which was signed into law as Public Act 102- 0751.
Protect Smoke Free Illinois
House Joint Resolution 75 (Rep. Lily/Sen. Morrison) celebrates the 15th anniversary of the landmark vote to pass the Smoke Free Illinois Act. ISMS supported this resolution, which was adopted by both chambers.
Use of Fentanyl Test Strips
House Bill 4556 (Rep. Guzzardi/Sen. Peters) expands access for health care professionals to distribute fentanyl testing strips to help reduce overdoses. The testing strips can detect fentanyl in counterfeit pills and other illicit drugs. ISMS was neutral on this legislation, which was signed into law as Public Act 102-1039.