2023 Legislative Report
The 2023 Illinois spring legislative session was the first full session since the COVID public health emergency was declared in early 2020.
The 2023 Illinois spring legislative session was the first full session since the COVID public health emergency was declared in early 2020. The ISMS Governmental Affairs team not only pushed back on scope of practice bills, additional continuing medical education (CME) mandates, a plaintiff’s bar initiative, efforts to target and criminalize mandated reporters of child abuse, but also managed to change Illinois’ surprise billing law to better assist physicians and medical groups, advocate for changes in our CME timelines, secure exemptions to the e-prescribing mandate and increase Medicaid reimbursements paid to physicians.
In addition, ISMS was successful in shepherding through rules to fully implement and enforce the Network Adequacy and Transparency Act passed in 2017.
We also saw an unprecedented number of ISMS members contact their state legislators on issues important to the practice of medicine and patient safety. This effective grassroots effort helped secure our success this spring session, particularly in pushing back against physician assistants in their efforts to expand their scope of practice without required physician support.
ISMS’ work to effect positive changes for our practices and our patients continues as we prepare for the fall veto session and the 2024 spring legislative session.
On behalf of the Board of Trustees, I would like to thank every physician member who continues to make ISMS’ advocacy efforts possible.
Rodney S. Alford, M.D., M.B.A.
President, Illinois State Medical Society
FY2024 BUDGET & MEDICAID
In presenting his FY24 Budget to the Illinois General Assembly, Governor Pritzker lauded the state’s ability to eliminate the $8 billion bill backlog, pay off interfund borrowing liabilities, establish a $1.9 billion rainy day fund, obtain seven credit upgrades, and pay off the $4 billion in Unemployment Insurance Trust Fund liabilities.
However, once April revenues were collected, the strong economy finally showed the expected signs of weakness with receipts coming in $1.8 billion less than last April, due to losses of personal income taxes from capital gains. In addition, the state experienced unprecedented budget pressures, including the loss of federal pandemic funding previously used to bolster the budget, across the board demands for rate increases in the Medicaid program, and a significant $800 million underestimate of the cost for providing healthcare to undocumented immigrants.
The FY24 state budget will take effect on July 1, 2023; the total revenue number of which is $50.7 billion and anticipated spending coming out to $50.6 billion, resulting in a $100 million surplus.
Highlights of the budget include:
- $550 million to cover the health benefits for undocumented immigrant adults;
- $250 million to fund the Smart Start early childhood plan;
- $100 million more in Monetary Award Program (MAP) funding for lower-income college students;
- $80.5 million for public universities and $19.4 million for community colleges;
- $400 million for incentives for economic development; and
- A boost of $350 million for evidence-based funding for K-12 education.
Budget pressures will continue through FY24, with a cushion of just $100 million between estimated incoming revenue for the year and total state spending. The budget passed along partisan lines and has been signed by the governor.
Medicaid reimbursement rates were the focus of healthcare budget discussions with all provider and professional groups requesting increases.
ISMS Secures Physician Rate Increase
The FY24 budget contains over $250 million in overall Medicaid rate increases. Through ISMS advocacy, $25 million will be designated specifically for physician rate increases to begin on January 1, 2024. Keep in mind that converting this amount into a full year’s rate will total $50 million.
ISMS will be working with Health and Family Services (HFS) and the members of the General Assembly to implement this overdue budget victory over the next couple of months. In late summer, HFS is expected to issue notice with the exact timeframes for these increases to take effect.
HEALTH INSURANCE REFORM
Adequate Networks and Hospital-Based Specialists
House Bill 2580 (Rep. Hauter), ISMS legislation, would amend the Network Adequacy and Transparency Act (NAT Act) to include pathologists, anesthesiologists, emergency medicine, radiologists, and neonatologists in the list of physician specialties that must be considered by the Department of Insurance (DOI) when assessing the adequacy of a health care plan’s network of health care professionals. The insurance industry strongly opposed this bill. HB 2580 remains in the House.
Coverage for Victims of Domestic Violence
House Bill 1384 (Public Act 103-0123) (Rep. Cassidy/Sen. Loughran Cappel), ISMS legislation, would require insurance coverage for treatment of physical trauma for victims of violence. The bill passed both chambers and was signed into law in June as Public Act 103-0123.
Health Coverage and Deductible Year
Senate Bill 92 (Sen. Fine), an ISMS initiative, would require DOI to issue rules establishing specific standards to align an accident and health insurance policy's coverage year and deductible year for the purpose of determining patient out-of-pocket cost-sharing limits. The insurance industry opposed SB 92, which remains in the Senate.
Network Adequacy and Transparency Rules
On March 21, 2023, the Joint Committee on Administrative Rules (JCAR) approved DOI’s final rule to support compliance with, and enforcement of, the NAT Act. ISMS had encouraged DOI to develop rules to ensure the provisions in the Act are implemented consistently with their legislative intent. ISMS stressed the importance of using the rulemaking process to strengthen protections related to provider ratio as well as time and distance standards; the reporting of insurance plan network changes; assuring continuity of care for patients during network transitions and maintaining the accuracy of provider directories.
The approved rules reflect extensive 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 (CMS), and clarifies how distance and time are to be estimated.
- The law requires DOI, in consultation with the Illinois Department of Public Health (IDPH), to establish time and distance standards annually, based on CMS guidance. The rules specifically tie the time and distance standards to the published 2023 CMS guidance to Marketplace issuers. DOI has indicated that it intends to issue updated rules annually, which will reaffirm or revise the basis for the time and distance standards, including considering the latest published guidance from CMS. Also, the rules specify that these time and distance standards must be demonstrated for each county in a plan’s service area.
- Specify that plans seeking an exception to the time and distance standards submit specific information to DOI via a Network Adequacy Exception Form, to be available on the DOI website. The underlying law allows for an exceptions process for plans that “are not able to comply” with the time and distance standards. Potential reasons for an exception include a lack of physicians that meet the specific parameters, in which case the plan can document availability of the “next closest” group, or that patterns of care of the service area do not support the inclusion of certain physician types. The rules specify that, in the case of plans requesting to rely on the “next closest” providers, plans “shall state whether there are any providers or facilities that would satisfy the time and distance standards if they were contracted for use with the network plan and shall identify any such providers or facilities.”
- Codify specific physician ratios for most specialties listed in the NAT Act. The law gives DOI discretion in selecting specialties for which it will establish ratios, and discretion in setting those ratios. The rules establish specific ratios for all but six of the 28 specialties listed in the law as ones for DOI to consider.
- Require material changes to be submitted via a revised version of the most recent network adequacy filing, indicating the changes for each document that was revised from the previous version of the filing. The law requires plans to submit material changes to DOI but does not specify how the notification should be made or what details need to be included. The approved rules formalize and increase transparency of this notification requirement by requiring plans to submit the revisions via an updated network adequacy filing, with relevant changes highlighted.
- Require plans to file annual reports describing the verification process established to ensure accuracy of provider directories. In addition, plans are required to audit each of their print and online directories for each network plan no less than twice per year, and to submit these audits as an attachment to the annual filing describing the verification process. The law requires plans to maintain updated directories and to conduct their own audits “periodically,” the results of which should be submitted to DOI upon request. The rules require plans to file reports with DOI annually, and to attach copies of self-audits.
- Require plans to submit to DOI sample correspondence to beneficiaries and providers regarding network changes. Specified information that must be included in letters to patients includes the availability of transitional services; a description of who qualifies for transitional service; and the insurer’s formal procedure for a beneficiary to request transitional services. The law requires plans to notify providers and beneficiaries of non-renewal or termination of a provider at least 60 days before the end date. The law also requires plans to provide for a 90-day transition of care for certain patients being served by providers who leave the network. The rules define the information that must be included in the non-renewal/termination notice, including detailed information about a patient’s potential transitional care rights under the law.
In February 2023, DOI established a Network Adequacy Unit with staff specifically dedicated to network adequacy and transparency issues, which will significantly increase DOI’s capacity to respond to complaints, review filings and devise efficient regulatory processes under the NAT Act. The new unit will also continually monitor the efficiency and effectiveness of network adequacy regulations, and may recommend appropriate adjustments via future rulemakings, which DOI plans to undertake annually.
House Bill 2581 (Rep. Hauter), ISMS legislation, requires that, for any bill submitted to arbitration, the health insurance issuer shall pay the physicians or facility at least the current Medicare reimbursement rate pending the resolution of the arbitration. The insurance industry opposed this bill. The bill did not advance and remains in the House.
House Bill 579 (Public Act 103-0103) (Rep. Gabel/Sen. Harmon) will create a state-controlled health care exchange for consumers to purchase health care insurance. Individual Illinoisans seeking to purchase health insurance as required under the federal Affordable Care Act, can do so on Get Covered Illinois, our state’s health insurance exchange. Currently, Illinois uses a partnership exchange with the federal government, and enrollments are completed via the federal HealthCare.gov platform. HB 579 will create a state-controlled exchange program, citing hopes of saving money and gaining more control over marketplace functions that affect Illinoisans.
The enabling legislation creates an advisory committee of stakeholders whose purpose will be to make recommendations to the Marketplace Director of the Illinois Health Benefits Exchange concerning the operation of the exchange. ISMS will be appointed as a stakeholder on the advisory committee. Participation at the early stages of the exchange is important because once it is created and approved by the federal government no additional legislation is necessary, and health plans, including potential new products, like a Medicaid buy-in or a public option, can be created through the state’s rulemaking process, which is much harder to influence.
HB 579 passed both chambers and was signed into law, by the Governor,as Public Act 103-0103.
Surprise Billing/Bundling of Claims
House Bill 3030 (Public Act 103-0440) (Rep. Morgan/Sen. Morrison) allows out-of-network physicians to batch claims when seeking arbitration for underpayment of services. Currently, physicians seeking arbitration can only do so on a per-claim basis, which is cost prohibitive. HB 3030 passed both chambers and was signed into law this summer as Public Act 103-0440.
LICENSURE BILLS/SCOPE OF PRACTICE
Advanced Practice Registered Nurses Independent Practice
Senate Bill 199 (Public Act 103-0060) (Sen. Feigenholtz) would allow full practice authority advanced practice registered nurses (APRNs) to practice independently by removing the requirement that full practice authority APRNs enter into consultation agreements with consulting physicians to prescribe Schedule II opioids and benzodiazepines. Currently, there are APRNs with full practice authority treating patients who abuse benzodiazepines. ISMS opposed the original language but came to an agreement on an amendment that will allow APRNS with full practice authority to prescribe a limited number of benzodiazepines. If the patient does not demonstrate any improvement, then the full practice authority APRN must consult a physician. The bill,was signed into law this summer as Public Act 103-0060.
Certified Registered Nurse Anesthetists (CRNAs) Independent Practice
House Bill 2895 (Rep. Moeller) 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 on the premises to treat medical emergencies when nurse anesthetists provide care. ISMS joined the Illinois Society of Anesthesiologists in opposing this legislation which remains in the House Rules Committee.
Licensure of Certified Anesthesiologist Assistants
Senate Bill 2214 (Sen. Castro) would license certified anesthesiologist assistants (CAAs), who would work as part of the anesthesia care team led by an anesthesiologist. CAAs would help balance and supplement the perioperative workforce and actively contribute to increased quality, decreased costs, and improved service line expansion efforts in patient care. ISMS joined the Illinois Society of Anesthesiologists in support of this legislation. The Association representing the certified nurse anesthetists strongly opposed the bill, asserting that they would only remove their opposition if their bill for more independent practice advanced. Senate Bill 2214 did not advance and remains in the Senate Committee on Assignments.
Licensure of Naturopaths
House Bill 3721 (Rep. Costa Howard) 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 this bill, which did not advance.
Physician Assistant Independent Practice
Senate Bill 218 (Public Act 103-0065) (Sen. Gillespie/Rep. Collins), as introduced, would have granted physician assistants independent practice. ISMS strongly opposed the language and successively amended the bill to change how APRNs and PAs are supervised in Federally Qualified Health Centers (FQHC). ISMS was neutral on the bill as amended. SB 218, as amended, was signed into law as Public Act 103-0065.
Psychologists Expanded Prescribing Authority
Senate Bill 1586 (Sen. Cunningham) would expand the prescriptive authority of prescribing psychologists by allowing them to prescribe medications to patients who are less than 17 years of age or over 65 years of age. The bill would also allow the prescription of non-opioid Schedule II drugs. ISMS opposed the bill and remains the Senate Assignments Committee.
Child Abuse Pediatricians
Senate Bill 376 (Sen. Lightford) would limit the effectiveness of child abuse pediatricians in Illinois. The legislation would require physicians to follow a specific, limited script as they do medical evaluations on children who are suspected of being abused or neglected. ISMS, along with the Illinois Chapter of the American Academy of Pediatrics, opposed the bill, which remains in the Senate.
CME Mandate on Lyme Disease
Senate Bill 2044 (Sen. Sally Turner) would have created the Tick-Borne Disease Prevention and Protection Act and added within that act a requirement that physicians take additional CME in chronic Lyme disease. ISMS opposed the CME mandate, and the bill was re-referred to the Senate Assignments Committee.
CME Mandate on Cultural Competency
House Bill 2280 (Rep. Avelar) and Senate Bill 2427 (Sen. Villivalam) would require that Illinois health care professionals take courses on cultural competency as part of their CME. ISMS opposed these bills, which did not advance as stand-alone mandates. See House Bill 2450.
Regulation of CME Mandated Topics
The proposed mandate on cultural competency training had strong support in the State Senate. As a compromise, ISMS and groups representing other licensed health care professionals agreed to create a pathway providing individual professionals more time to take mandated topics.
Specifically, as amended, HB 2450 (Public Act 103-0531) (Sen. Villivalam/Rep. Avelar) does the following:
- For those professionals who receive the one-time opioid training at the federal level, reduces the state mandated hours from three hours to one hour.
- Adds one hour of health care cultural competency training.
- Provides health care professionals two licensure cycles to take mandated hours on opioids, Alzheimer’s, and cultural competency.
- Adds a trigger mechanism that, if any more mandates are added, then the time in which health care professionals must complete all the statutory mandates will be extended to three licensure cycles for physicians and dentists, and four licensure cycles for other health care professionals.
- Maintains that implicit bias and sexual harassment be taken every licensure cycle.
The Alzheimer’s Association and AARP of Illinois opposed the changes in Amendment 3, and clarifying language was added to Amendment 4 to require new professionals to take the Alzheimer’s training during their first renewal cycle. HB 2450, as amended, provides much-needed flexibility and scheduling relief for thousands of health care professionals. ISMS supported HB 2450 as amended, and the bill was signed into law this summer as Public Act 103-0531.
MEDICAL LIABILITY/WRONGFUL DEATH
Punitive Damages in Wrongful Death Cases
House Bill 219 (Public Act 103-0514) (Rep. Hoffman/President Harmon) allows for the recovery of punitive damages in wrongful death cases. This was an initiative of the plaintiff’s bar. ISMS was successful in clarifying that this would not apply to cases involving medical malpractice. For that reason, ISMS was neutral on the bill, and it was signed into law as Public Act 103-0514.
MEDICAL PRACTICE & RECORDS
Senate Bill 1445 (Sen. Glowiak) is an ISMS initiative that would require coroners to provide one copy of the deceased's autopsy report without charge to the deceased's physician after the physician attests to the physician-patient relationship in writing on a form provided by the coroner. The Illinois Coroners and Medical Examiner’s Association opposed the bill, stating that a coroner is often charged for medical records by the physician, and asked for an amendment requiring physicians to provide free copies of medical records. Members of the ISMS Governmental Affairs Council decided that this should be opposed, as medical records for the deceased can be quite lengthy and could end up costing the physician more money. The bill did not advance.
House Bill 2046 (Rep. Cassidy), an ISMS initiative, is intended to help patients suffering from chronic pain to access appropriate treatments, including the prescription of opioids, without interference, and protect physicians treating chronic pain from inappropriate investigations. The language amends the Illinois Controlled Substances Act and provides that all decisions regarding the treatment of patients experiencing pain, including chronic pain, shall be made by the prescriber and the patient. It also requires that ordering, prescribing, or paying for controlled substances, including opioids, shall not in any way be predetermined by specific morphine milligram equivalent guidelines. Finally, the bill attempts to tighten criteria used to determine who can have access to the state’ Prescription Monitoring Program. HFS and the Illinois Department of Human Services (DHS) are strongly opposed to the bill. HB 2046 is currently being held in the House.
Exemptions/Waivers to E-Prescribing Mandate
All healthcare professionals who write prescriptions for controlled substances must, on January 1, 2024, provide those prescriptions electronically. ISMS successfully advocated for the following exemptions/waivers within House Bill 2077 (Public Act 103-0425) (Rep. Vella/Sen. McClure):
- The underlying law exempted prescribers issuing 25 prescriptions or less annually. ISMS increased the number so now prescribers issuing 150 prescriptions or less annually are exempt from the mandate until January 1, 2029. After that, anyone annually issuing 50 prescriptions or less are exempt.
- Prior to 2026, waivers will be granted to prescribers who demonstrate a financial hardship. After January 1, 2026, prescribers who offer proof of receiving a waiver from the federal CMS e-prescribing mandate will be waived from the state mandate.
- Temporary technological or electric failures that prevent a prescription from being transmitted electronically.
- The prescription is for a drug that the prescriber determines would be impracticable for the patient to obtain in a timely manner and the delay would impact the patient’s health.
- The prescription is a drug under research protocol.
- The prescription is non-patient-specific, such as a drug that is dispensed under a standing order, approved protocol for drug therapy, collaborative drug management, comprehensive medication management, or in response to a public health emergency or other circumstance in which the prescriber may issue a non-patient specific prescription.
- The prescription is issued when the prescriber and dispenser are the same person or entity.
- The prescription is issued for a compounded prescription; or
- The prescription is for a patient who:
- Resides in a nursing home or assisted living facility;
- Receiving hospice or palliative care;
- Receiving care at a renal dialysis facility and the prescription is related to the care;
- Receiving care through the U.S. Dept. of Veterans Affairs; or
- Is incarcerated, detained, or confined in a correctional facility.
HB 2077 also includes language that ensures pharmacists will not be charged with enforcing parts of this law. ISMS supported this bill, and it was signed into law as Public Act 103-0425.
Health Data Management
Hospital and Medical Group Mergers
House Bill 2222 (Public Act 103-0526) (Rep. Gong Gershowitz/Sen. Gillespie) is an initiative of the Illinois Attorney General’s Office, and, as introduced, would have required hospitals, Ambulatory Surgical Treatment Center (ASTC)s and all physician offices with seven or more physicians to provide advance notice of mergers to the Attorney General of 30 days prior to a merger. The bill also convoluted what type of medical facility is subject to the Certificate of Need process. ISMS opposed this language. ISMS was able to negotiate the amendment so that it now only applies to mergers between healthcare facilities and large provider organizations, and clarifies that physician owned practices are not subject to the Certificate of Need process. The Senate also added a sunset date of January 1, 2027. HB 2222, as amended, was signed into law, by the Governor, as Public Act 103-0526.
Medical Records for Representatives of a Patient
House Bill 3153 (Rep. Stava-Murray) would provide that, in cases involving a guardian ad litem, no fee shall be charged by a health care facility or health care professional for any copy of a patient's records if the records are requested by the patient or a person, entity, attorney, registered representative, guardian ad litem, or organization presenting a valid authorization for the release of records signed by the patient or the patient's legally authorized representative, who has provided documentation of authority to act for the patient, or by such other requester as is authorized by statute if the patient is deceased. ISMS opposed this bill, which did not advance.
Senate Bill 1561 (Public Act 103-0551) (Sen. Villanueva/Rep. Cassidy) mandates coverage for a variety of health care services and creates avenues for visiting medical residents to secure parts of their post-graduate residency training in Illinois. While this applies to all medical residents, it is intended to assist medical residents specializing in obstetrics and gynecology in securing training in abortion care. Securing this training in states that have outlawed abortion has become problematic for many ob/gyn medical residents. The bill passed both chambers and was signed into law as Public Act 103-0551.
Senate Bill 1909 (Public Act 103-0270) (Sen. Villanueva/Rep. Costa Howard) is an initiative of the Illinois Attorney General’s Office and prohibits a limited services pregnancy center from engaging in unfair methods of competition or unfair or deceptive acts or practices: (1) to interfere with or prevent an individual from seeking to gain entry or access to a provider of abortion or emergency contraception; (2) to induce an individual to enter or access the limited services pregnancy center; (3) in advertising, soliciting, or otherwise offering pregnancy-related services; or (4) in conducting, providing, or performing pregnancy-related services. This initiative is supported by the Illinois Chapter of the American Congress of Obstetricians and Gynecologists (ACOG).
As originally drafted, the bill was very broad, and ISMS expressed concerns that it could apply to individual health care professionals who oppose providing abortions and exercise their right to oppose through the Health Care Right of Conscience Act. ISMS successfully secured language exempting out individual health care professionals and secured language in the discussion of the bill clarifying that this bill does not create a loophole in the Health Care Right of Conscience Act.
The bill, as amended, was signed into law, by the Governor, as Public Act 103-0270.
Reporting of Child Abuse
House Bill 1468 (Rep. Ford) is an initiative of an ISMS member and supported by ISMS, the Illinois Society of Addiction Medicine, and other medical groups. As amended, HB 1468 would create a formal pathway for Illinois to design a system for the implementation of Family Recovery Plans (Plans of Safe Care) using a statewide multidisciplinary task force, which has been proven successful in other states. It would also lift existing punitive policies affecting families with substance use disorders by removing positive toxicology at birth from the definition of as a finding of unfitness for purposes of terminating parental rights as well as removing a provision requiring the Department of Children and Family Services (DCFS) to report substance exposed infants to law enforcement. The purpose of HB 1468 is to ensure the safety of mother, infants and children, while improving maternal mortality in Illinois. While the bill did not advance this spring, it will be introduced next year.
House Bill 1540 (Public Act 103-0272 ) (Rep. Lilly/Sen. Morrison) amends the Illinois Smoke Free Act and adds to the definition of “smoking,” the use of electronic cigarettes. ISMS supported this legislation, which passed both chambers and was signed into law as Public Act 103-0272.
House Bill 3516 (Public Act 103-0450) (Rep. Syed/Sen. Villivalam) is intended to increase organs available for donation. HB 3516 allows full-time employees working for employers who employ at least 51 employees to take up to 10 days of leave in any 12-month period to serve as an organ donor. ISMS supported this bill, and it was signed into law as Public Act 103-0450.