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.

Senate Amendment 4 re-wrote the entire bill to amend the Medical Patient Rights Act to prohibit the markup of anatomic pathology services.  It requires that a physician who orders, but does not supervise or perform, an anatomic pathology service to disclose in a bill to the patient the name and address of the physician or laboratory that provides the pathology service and the amount paid or to be paid for each pathology service.  The amendment does not prohibit a referring physician from charging a specimen acquisition or processing charge under certain circumstances.  ISMS took a neutral position on this legislation as amended.

Senate Bill 1630, as amended, passed both houses and was sent to the Governor. On August 5, the Governor used his amendatory veto power to include two new sections into the proposed law.  His first change ensures that under the proposed  bill physicians will not be prevented from sending a patient's specimen to any laboratory providing anatomic pathology services.  The second change gives the Department of Financial and Professional Regulation the right to discipline any physician found to be in violation of the bill.  ISMS remains neutral on the SB 1630 and the amendatory veto changes proposed by the Governor.

• Current Bill Status - SB 1630  
• Governor's Message  

ISMS is advocating for House Bill 5309 (Rep. Fine), legislation to require health insurance plans to provide coverage for foreign language interpretation services and sign language interpreter services within the context of the provision of health care. Currently, physicians must pay for these services, which can cost a hundreds of dollars per patient.

Due to concern that HB 5309 might conflict with federal rules, this measure failed to advance.

•   Bill Status of HB 5309

The Illinois State Dental Society has proposed legislation, Senate Bill 3409 (Sen. Manar) and House Bill 5574 (Rep. Fine), that would allow dentists to provide immunizations to patients 10 years of age and older, including immunizations for flu, shingles, tetanus, diphtheria, pertussis, hepatitis B, and the human papilloma virus.

As advocates for a public health system that encourages patients to have access to a medical home, we are extremely concerned that this legislation will take people away from their medical home and hinder care coordination.

We are also concerned 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. The HPV vaccine, for example, has to be given in a series of three shots over a six month period. We also have questions on how they will retain documentation and communicate with the patient's primary care provider.

As introduced, this bill will not increase access to immunizations. Medicaid no longer covers adult dental care. Medicare does not cover dental services, except under certain circumstances. Very few health care plans cover services provided by dentists, and dental plans to our knowledge do not include coverage for immunizations. This will cause a payment and billing nightmare for patients as dentists will have to collect payment from the patient on the day the service is provided.

Given that health insurance payers follow the policies of the Centers for Medicare and Medicaid Services, it is highly unlikely that individual or group health coverage will consider dentists as credentialed and qualified to provide immunizations. This will most likely create a cash business for dentists as patients will be paying out of pocket for the vaccines, instead of having it a covered service under their health care plan when they seek treatment from their physician.

Because of ISMS' concerns, the bill was drastically changed to limit dentists to only providing the influenza vaccine to adults, and require that dentists administering the vaccine be enrolled and credentialed by the patient's health plan.  The bill, as amended, passed both houses and was signed into law.

• Bill Status of HB 5574
• ISMS Position Paper on HB 5574
• Bill Status of SB 3409
• Position Paper on SB 3409, Amendment 2 
• Position Paper on SB 3409, Amendment 3
• Senate Roll Call

The Medical Practice Act will sunset Dec. 31, 2014. House Bill 4389 (Rep. Zalewski) and Senate Bill 2812 (Sen. Martinez), both ISMS initiatives, call for a 10-year extension of the Medical Practice Act, setting a sunset date of Dec. 31, 2024.

We expect that the Act will be extended during the fall veto session, which begins November 19, 2014.

Bill Status of HB 4389

• Bill Status of SB 2812

Physicians and health care facilities are owed tens of millions of dollars in payments under the Illinois' State Employee Group Health Plan. Springfield Clinic, for example, is owed over $40 million by the state employee health program. That doesn't include the millions they are also owed by Medicaid and workers compensation. Most physicians are waiting as long as a year to be reimbursed for treating state employees. If not addressed, this failure to reimburse physicians and other professionals and providers for these services will create severe access issues. ISMS supports full funding for this program going forward, and strongly advocates that immediate action be taken to pay for care that has been provided.  

The Illinois Poison Center is committed to providing physicians with trusted information and treatment advice on potentially harmful substances. The IPC is an important medical resource that allows physicians to focus on patients who have more advanced medical needs, and also saves hospital valuable resources during these trying economic times.

The IPC faces an imminent funding shortfall and could close as soon as June 30, 2014.  HB 4230/SB 2674 had been introduced to keep the IPC open. The bill creates a dedicated and sustainable funding source for the IPC.  Unfortunately due to strong opposition from municipalities and other groups, neither bill advanced.  The legislature did, however, provide $2 million in funding for the Center in SB 741, which passed both houses and was signed into law.

• Bill Status of HB 4230
• Position Paper
• Contact your lawmakers

ISMS is working with the Illinois Bar Association to advocate for Senate Bill 3228 (Sen. Haine), legislation to amend the Power of Attorney Act to simplify the language of the current power of attorney health care form so more people can understand it. The form has recently been assessed to be written in college-level English. Simplifying the form will encourage more individuals to plan for health care emergencies.

SB 3228 passed both houses and was signed into law.

• Bill Status of SB 3228

To help maintain and expand access to underserved areas, House Bill 4593 (Rep. Zalewski), an ISMS initiative, will allow retired health care professionals to apply for a category of license allowing for limited practice for uncompensated care. Specifically, the legislation:

• Allows the Illinois Department of Financial and Professional Regulation (IDFPR) to grant volunteer licenses to all health care professionals who meet the requirements of licensure under their applicable licensing act and who practice at a free clinic or public health clinic;
• Prohibits the licensed professional from practicing for compensation outside of a free clinic or public health clinic; and
• Requires the license be issued without fee. 

HB 4593 passed both houses and was signed into law.

• Bill Status of HB 4593

Currently, individuals who want to practice midwifery in Illinois can become APNs certified as nurse midwives, and work under a collaborative agreement with a physician or be credentialed by the medical staff of a hospital.

Illinois does not license “certified professional midwives” (CPMs). House Bills 1194 (Rep. Berrios), 2685 (Rep. Morrison), and 3636 (Rep. Berrios) were introduced in the Illinois legislature to license these midwives to provide prenatal, delivery, post-partum, and pediatric care – including the administration of prescription drugs and the performance of surgical procedures like episiotomies – without requiring the education and training required of certified nurse midwives.

The education requirements for licensed advanced practice nurse midwives, which far exceed those required of certified midwives, protect patient safety. The education and training for CPMs falls short of the level which, even with collaborative agreement with a physician, would ensure proper patient care and safety.

Physicians believe that licensure of “certified professional midwives” is a step backward in patient safety as it would allow the least-trained individuals to provide one of the most critical services to women in Illinois.

Due to ISMS' strong opposition, none of these bills were called this session. 

• Bill Status of HB 1194
• Bill Status of HB 2685
• Bill Status of HB 3636
• ISMS Position Paper

House Bill 3645 (Rep. Osmond) would license naturopaths as “naturopathic physicians.”

This bill would license naturopaths under the same provision of the Medical Practice Act that licenses chiropractors, who are allowed to treat human ailments without the use of drugs or operative surgery. Previous bills in Illinois and in other states, however, would have allowed naturopaths to prescribe drugs, provide obstetrical care and perform “minor office procedures.”

ISMS strongly opposes naturopath licensure, and the Illinois General Assembly has repeatedly rejected proposals to license naturopaths in Illinois.However, they continue to push for licensure through IDFPR. There is no comparison between the training of a physician and that of a naturopath.

Due to ISMS' strong opposition, this bill failed to advance out of committee. 

• Bill Status of HB 3645
• ISMS Position Paper

ISMS has long been interested in legislation affecting the Illinois Health Care Services Lien Act and is cooperating with other groups representing health care professionals and facilities to shape this law in ways that we consider fair to all parties. For that reason, ISMS has introduced House Bill 5656 (Rep. Schmitz) to require the following:

• That health care professionals treating the injured party must be notified of their right to file a lien by either the plaintiff or the plaintiff's attorney.
• That the statutory percentage of a judgment, award or verdict (set at 40 percent by existing law) is paid to health professionals or providers from the gross amount prior to any reduction. 
• That lien holders shall be notified either by the plaintiff or plaintiff's attorney in writing when a case is dismissed or a judgment is entered.  

HB 5656 was not assigned to a substantive committee and therefore remains in the House. 

• Bill Status of HB 5656

ISMS is working closely with the Illinois Hospital Association, the Illinois Psychiatric Society, and other groups to require Illinois insurers to cover services for telehealth. 

House Bill 5313 (Rep. Feigenholtz) and Senate Bill 3319 (Sen. Harmon) are initiatives providing for telehealth coverage that will increase access to medical care for patients in rural and other underserved areas.

Neither HB 5313 nor SB 3319 were called for a vote in committee.  Instead ISMS, along with IHA, successfully negotiated a compromise that will increase access to teleheath by prohibiting health insurance plans which provide coverage for telehealth services from creating barriers to accessing telehealth. The bill also ensures that co-payments and deductibles for telehealth services shall not exceed those charged for the same services delivered through in-person consultation.  SB 647 passed both houses and was signed into law.

• Bill Status of HB 5313
• Bill Status of SB 3319

Beginning in 2014, it is expected that Illinois will see a significant increase in new Medicaid enrollees.

ISMS is hopeful that the state will closely monitor what kind of demands this expansion will put on our health care system. Physicians remain concerned about low reimbursements that are often delayed for an extended period of time. Given these inadequate rates and the anticipated increase in Medicaid clients, physician offices could face significant financial strains.

Adequate Medicaid funding for physician services is essential to access to care for Medicaid clients. Currently, Illinois ranks in the bottom 10 states for Medicaid reimbursement to physicians. An across-the-board fee increase has not occurred since 1999, when fees were increased 5 percent. While there were increases to a dozen primary care services in 2006 as a result of a lawsuit claiming that low reimbursement caused inadequate access to care, rates still do not come close to covering the cost of providing care. Coupled with decreasing reimbursement from Medicare and private payers that has put increased financial pressure on physicians, it should not be surprising that most physicians limit the number of Medicaid patients in their practices. Obviously, any cuts to physician reimbursement will worsen access to care for Medicaid patients.

While primary care physicians will get an increase in rates paid for by the federal government for two years, many physicians fear that the state won't pick those costs up and retain the increase after two years. It is our hope that the state acknowledges the correlation between the increase in rates and the improvement in access, and is diligently working on ways to retain that increase.

To ensure adequate access to all aspects of care, reimbursements to all physicians participating in Medicaid need to be increased.

Physicians also remain very concerned about last year's "reform" that limits Medicaid patients to four drugs a month. ISMS introduced legislation last year to require the Department of Health and Family Services, 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.

Unfortunately, due to cost, the bill failed to advance. ISMS will monitor this issue carefully and keep stakeholders updated as to how the limit impacts care.

Another Medicaid bill did pass this session and was signed into law by Governor Quinn. SB 741restores some services that were cut under the 2013 Medicaid reform law. Some exclusions are now allowed for the four-drug prescription medication prior authorization limit.

• Bill Status of SB 741

House Bill 4484 (Rep. Reboletti), an ISMS initiative, seeks to protect a patient's continuity of care during a transition between health care facilities by requiring the Illinois Department of Public Health to develop and implement a uniform bi-directional patient transfer form for use by all hospitals, nursing homes and assisted living facilities. This form will include important patient information that will enhance quality of care.

HB 4484 was not called for a vote in committee and remains in the House. 

• Bill Status of HB 4484

ISMS has joined a number of specialty physician societies in opposing Senate Bill 3277 (Sen. Althoff), legislation that would allow pharmacists to vaccinate patients between the ages of 10 to 13 with the meningococcal vaccine.

At age 11, most children in Illinois need their 6th grade physical, with their Tdap, meningococcal, and HPV vaccines. Often, parents claim that their children have had their vaccines but do not have documentation indicating when the vaccines were administered. This makes it difficult, if not impossible, for the physician to determine whether the appropriate vaccinations were given.

The Affordable Care Act requires quality and outcome measurements of all physicians, clinics and offices. Pharmacies are not held to these same outcome measurements. This bill makes it difficult for physicians providing care to children to maintain accurate records, and thus negatively impacts their measurements.

Furthermore, this initiative takes a piecemeal approach to medical care and will take more children out of the medical home. This is a disservice to children, who need comprehensive assessments and screenings.

Due to ISMS' opposition, the bill was not called for a vote in committee and remains in the Senate.

• Bill Status of SB 3277
• ISMS Postition Paper

ISMS believes that patients prefer and are best served in a patient-centered medical home where they are cared for by a physician-led team of professionals.  We have published a joint statement with the Illinois Academy of Family Physicians (IAFP) in support of physician-led medical homes, outlining their benefits and key characteristics.

• ISMS-IAFP Joint Statement on Medical Homes

Two bills have been introduced that would grant prescriptive authority to psychologists without requiring the biomedical and clinical training required of advanced practice nurses (APNs) or physician assistants (PAs) (Senate Bill 2187, Sen. Harmon/Rep. Bradley and House Bill 3074, Rep. Bradley).

Physicians, advanced practice nurses (either working under a collaborative agreement with a physician or in a hospital under the direction of the medical staff), and physician assistants (working under a supervisory agreement with a physician) can prescribe medication to treat mental illness. All of these professionals receive appropriate biomedical and clinical training before they are permitted to prescribe drugs.

ISMS is part of a coalition including mental health patient advocacy groups, physician organizations, and other health care groups that are opposed to this legislation based upon the risks posed to patients.

ISMS, along with the Illinois Psychiatric Society and other physician specialty groups, forced a compromise that significantly increases the biomedical education and clinical training requirements for prescribing psychologists, making it similar to what physician assistants must complete. The compromise also requires a written collaborative agreement with a practicing physician who treats mental illness, and prevents psychologists from prescribing to minors, the elderly, pregnant women, or disabled individuals.  Psychologists are also prohibited from prescribing benzodiazepines, narcotics or any Schedule II controlled substances.

Due to significant changes to SB 2187 through ammendment, ISMS switched to a neutral postion on the bill.  Amended SB 2187 passed both houses. The amended bill was signed into law.

• ISMS Statement on Amended SB 2187
• Coaltion for Patient Safety Statement on Amended SB 2187
• Bill Status of SB 2187
• Bill Status of HB 3074
• Coalition Against Psychologists Prescribing
• ISMS Position Paper
• Prescribers Should Be Trained in Medicine
• Put patients first, oppose RxP bill in Illinois

Senate Bill 3076 (Sen. Mulroe), an ISMS initiative, seeks to improve the Physician Order for Life Sustaining Treatment (POLST) form. The current form fails to meet the national requirements set by the National POLST Initiative due to the potential confusion between the state POLST form and a do-not-resuscitate order. Specifically, our changes remove the "do not resuscitate" and "advance directive" language in the title and border of the form.

The bill would also permit APNs and PAs to sign the Illinois Department of Public Health Uniform DNR Advance Directive if delegated by their collaborative or supervising physician. A licensed medical resident who has completed one year of residency training and has been assigned primary responsibility for treatment and care of the patient may also sign the form if this legislation is enacted. If enacted, the legislation will change the form name to the Practitioner Order for Life Sustaining Treatment.

SB 3076 passed both houses and was signed into law.

• Bill Status of SB 3076
• ISMS Position Paper

Senate Bill 3149 (Sen. Hunter), an ISMS initiative, has been introduced to ensure that diabetics are able to inject insulin in public without fear of prosecution.

SB 3149 passed both Houses and was signed into law.

• Bill Status of SB 3149

Senate Bill 3077 (Sen. Mulroe), an ISMS initiative, makes a technical change to the Illinois Clinical Laboratory and Blood Bank Act by updating the reference to PAs from practicing under written guidelines to practicing with a written supervision agreement as is specified in the Physician Assistants Licensing Act.

SB 3077 passed both houses and was signed into law.

Bill Status of SB 3077