2024 Legislative Report

FY2025 BUDGET & MEDICAID

SB 251 (Sims/Gordon Booth) contains the FY25 state budget totaling $53.1 billion. Much of the Governor’s budget proposal remains in place; however, the final budget includes an approximately $400 million spending increase. The FY25 state budget also reduced spending in several areas from the proposed budget by $73 million. The FY25 state budget is set to take effect on July 1, 2024, would increase spending by 5 percent from last year’s enacted budget.

Final revenue generators:

• The proposed $200 million increase in the sports betting tax (15% to 35%) was converted to a graduated tax ranging from 20 to 40% plus 1% tax increase on video gaming for $35 million.
• $101 million from reducing retailer discount for collecting sales tax.
• $526 million by continuing the limit on the corporate net operating loss deductions but increasing the allowable loss cap; and
• $25 million from applying the existing hotel operator’s room occupation tax to third-party entities that resell large blocks of hotel rooms.

The budget eliminates the 1% sales tax on groceries on January 1, 2026. The revenues generated by this grocery tax was distributed to municipal governments, but local governments will receive other revenues to offset this loss in income.

Other highlights in the budget:

• Health insurance spending for undocumented immigrants matches Governor Pritzker’s proposed budget of $629 million including $440 million in state general revenue funds.
• The FY25 Medicaid liability is estimated to be $26.7 billion.
• The FY25 State Employee Group Insurance Program is funded at $6.9 billion.
• Safety net hospitals will receive $155 million, which is $100 million over the governor’s request.
• Department of Insurance (DoI) will receive $20.1 million, and the Department of Healthcare and Family Services (HFS) will receive $7.5 million to assist with the rollout of the State Based Marketplace.
• A total of $2.8 million is appropriated to DoI for costs associated with the administration and operations of the governor’s Healthcare Protection Act.
• K-12 education spending increase by $350 million.
• Another $200 million for Smart Start Illinois (universal preschool).
• $14 million to create the new Department of Early Childhood agency.
• $3.5 billion for capital projects.
• $50 million for child tax credit for qualifying families with children under age 12
• Transferring $150 million from the Road Fund to pay for public transit expenses.
• Agencies are allowed to transfer up to 4% of line items for certain operational and lump sum spending.
• $10 million to relieve medical debt for more than 300,000 Illinoisans.
• $500 million to boost quantum computing by a building a quantum campus with the University of Illinois and University of Chicago, a cryogenic facility for computers, and infrastructure for the technology hub.
• $711 million for Monetary Award Program grants (146,000 students

Regarding Medicaid, the Illinois Hospital Association introduced a package of bills at the beginning of session, including gold-carding provisions for prior authorization exemptions and payment for out-of-network emergency services during in-patient stabilization periods. These provisions were included in the omnibus Medicaid bill. The provisions will:

HEALTH INSURANCE REFORM

Adequate Networks and Hospital-Based Specialists

Senate Bill 2641 (Sen. Holmes/Rep. Manley) is an initiative of the College of American Pathologists and amends the Illinois Network Adequacy and Transparency Act (NAT Act) to include hospital-based specialties, including pathologists, anesthesiologists, emergency medicine, and radiologists. ISMS supported this bill, which has been signed into law as Public Act 103-906.

Coverage for Continuous Glucose Monitors

Senate Bill 3414 (Sen. Morrison/Rep. Ladisch Douglass requires that health insurance provide coverage for medically necessary continuous glucose monitors for individuals who are diagnosed with any form of diabetes mellitus (instead of type 1 or type 2 diabetes) and require insulin for the management of their diabetes. It also provides that an individual who is diagnosed with diabetes and meets the specified requirements shall not be required to obtain prior authorization for coverage for 12 months once prior authorization has already been given. The bill passed both chambers and has been signed into law as Public Act 103-0639.

Coverage for Wigs 

Senate Bill 2573 (Sen. Harris/Rep. Morris) requires state regulated group or individual plans of accident and health insurance or managed care plans to provide coverage for, no less than once every 12 months, one wig or other scalp prosthesis worn for hair loss caused by alopecia, chemotherapy, or radiation treatment for cancer or other conditions. SB 2573 passed both chambers and has been signed into law as Public Act 103-0753.

Elimination of Short-Term Limited Durability (STLD) Health Plans

House Bill 2499 (Sen. Fine/Rep) will ban short-term limited plans in Illinois. This bill is part of the governor’s health care package. Often consumers may mistakenly buy these plans with the belief that essential benefits are covered. STLD plans do not have the same consumer protection safeguards as ACA plans. Instead, consumers can be left with medical debt if they need even basic care while covered by an STLD plan. HB 2499 has been signed into law as Public Act 103-0649.

Governor Pritzker’s Healthcare Protection Act

House Bill 5395 (Rep. Moeller/Sen. Peters) does the following:

• Prohibits insurance companies and MCOs from making up their own clinical criteria and require them to use accepted standards of care when deciding whether to cover a treatment recommended by a doctor.
• Bans prior authorization for in-patient hospital-setting mental health treatment for private insurance and Medicaid consumers.
• Bans step therapy for state regulated private insurance, Medicaid, and state group health so patients can get medically necessary healthcare and prescriptions without requiring them to fail first on less-effective drugs.
• Requires insurers to publicly post any treatments that require prior authorization.

In 2017, ISMS caused the passage of the Illinois Network Adequacy and Transparency Act. Under that Act, insurers are required to ensure that their networks are adequate to serve the healthcare needs of consumers. Unfortunately, those requirements are too often ignored and what are issued instead are “ghost networks,”— provider directories that include doctors who do not exist, are not in network, or are not accepting new patients.

To protect against this, House Bill 5395 will:

• Create an avenue for consumer complaints to the Department of Insurance when they receive care from providers incorrectly listed as in-network.
• Require insurance companies to pay consumers the difference between the in-network and out-of-network cost of the provider if the Department of Insurance finds that a provider was incorrectly listed as in-network.
• Require insurance companies to conduct 90-day self-audits to ensure their provider directories reflect the reality of health care that is available to consumers in that network and report the findings to the Department.
• Requires providers to inform insurance companies in a timely manner when they are no longer accepting new patients. The Act will create a working group of professionals, including physicians, to develop a uniform form that professionals will use to alert payers of changes to their practice

HB 5395 has been signed into law as Public Act 103-0650

Reducing Prior Authorization Requirements

ISMS caused to be introduced two bills that eliminate prior authorization for certain patient groups. Senate Bill 3741 (Sen. Morrison/Rep. Morgan) removes prior authorization for prescriptions of higher doses of buprenorphine. Senate Bill 3732 (Sen. Castro) seeks to ban prior authorization for patients who have been diagnosed with one of the following chronic diseases and have been on a stable and successful prescribed treatment of at least one year: multiple sclerosis, rheumatoid arthritis, lupus, prediabetes, and diabetes types I and II.

Senate Bill 3741 has been signed into law as Public Act 103-1040.

Senate Bill 3732 is currently being held. We are hopeful that SB 3732 will be considered during the fall veto session or the lame duck session of the 103rd General Assembly.

LICENSURE BILLS/SCOPE OF PRACTICE

Certified Registered Nurse Anesthetists (CRNAs) Independent Practice

Senate Bill 3653 (Sen. Collins) would grant CRNAs independent practice in ambulatory surgical treatment centers. The bill would also allow CRNAs with clinical privileges to perform acts of advanced assessment and diagnosis and practice without a collaborative agreement pursuant to certain criteria. ISMS joined the Illinois Society of Anesthesiologists in their opposition to the bill, which remained in the Senate Committee on Assignments.

Hair Laser Removal

House Bill 4357 (Rep. Croake/Sen.Villa) as originally introduced would have removed physician examination and supervision in hair laser clinics. ISMS negotiated with the advocates and amended the bill to provide that an on-site physician examination prior to the performance of a non-ablative laser procedure shall not be required when: (1) the laser hair removal facility follows a physician delegation protocol, which shall be made available to the Department of Financial and Professional Regulation upon request; (2) the examination is performed by an advanced practice registered nurse; (3) the procedure is delegated by a physician and performed by a registered nurse or licensed practical nurse who has received appropriate, documented training and education in the safe and effective use of each system; and (4) a physician is available by telephone or other electronic means to respond promptly to any questions or complications that may occur. ISMS was neutral on the language as amended, which has been signed into law as Public Act 103-0814.

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. The bill passed out of the House Health Care Licenses Committee, but due to ISMS’ opposition, the bill did not advance.

Certified “Medical” Esthetician

House Bill 4281 (Rep. Weaver) would have allowed the IDFPR to certify medical estheticians and grant them the authority to perform microdermabrasion, dermaplaning, microneedling, and radio frequency treatment without the supervision of a physician. ISMS, working with the Illinois Dermatological Society, opposed this bill, which did not advance.

Pharmacists Test and Treat

House Bill 4822 (Rep. Manley) and SB 3336 (Sen. Morrison) would allow pharmacists to independently prescribe drugs to treat the flu. House Bill 4562 (Rep. Moeller) would allow pharmacists to test and treat for strep, RSV, skin conditions and any other conditions that the Illinois Department of Public Health deems a public health emergency. The bill also granted pharmacists the ability to change prescriptions, including the prescribed dosage, if he or she determines it is in the best interest of the patient. Due to ISMS opposition, the bills as standalone measures did not move. During the last the days of session, however, Governor Pritzker cut a last-minute deal with the Illinois Retail Merchants Association to include test and treat in the Medicaid omnibus bill (SB 3268) as condition of their neutrality on another provision which reduces the amount of sales tax transaction fees retained by businesses, which will increase state revenue. ISMS fought to remove it from the budget package of bills up until its passage. ISMS was not successful. It is the intention of ISMS, collaborating with other physician specialties, to introduce to mitigate some of the more egregious language in the 2024 fall veto or the 2025 spring session.

Physician Assistant Independent Practice

House Bill 4637 (Rep. Crespo) and Senate Bill 3114 (Sen. Cervantes) would have granted physician assistants independent practice. ISMS strongly opposed the language. Neither bill advanced.

MANDATES

Adoptee Medical Testing

Senate Bill 2759 (Sen. Hunter) would require medical intake forms for services provided by health care professionals and facilities to include questions concerning the patient's adoption status and, if adopted, whether the patient has access to the patient's biological medical history. The bill would have required that, if a patient has indicated on the medical intake form that the patient is adopted and does not have access to the patient's biological medical history, then, upon request by the patient or patient's parent or guardian, the health care professional shall provide no-cost, baseline testing with minimized time-bound restrictions for genetically predisposed conditions or diseases. Referrals would be required in instances where the health care professional does not have staff qualified to perform the testing. The sponsor did not move the legislation due to opposition, including that from ISMS. ISMS has committed to working with Senator Hunter on alternative language.

Child Abuse Pediatricians

Senate Bill 378 (Sen. Lightford/Rep. Buckner) 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. The bill passed the Senate but was held in the House due to physician opposition.

Expansion of Mandate to Check the Prescription Monitoring Program (PMP)

Senate Bill 3701 (Sen. Ellman) would have expanded the mandate required of prescribers to check the Prescription Monitoring Program from Schedule II opioids to all controlled substances. The bill would also make registering and maintaining an individual account for the program a prerequisite of licensure. ISMS opposed this bill, which did not advance and remains in the Senate Assignments Committee.

Regulation of CME Mandated Topics

House Bill 4436 (Rep. Huynh) would mandate that continuing medical education include simulation training. The sponsor agreed not to move the bill due to ISMS’ opposition.

MEDICAL PRACTICE & RECORDS

Advanced Directives

Senate Bill 2644 (Sen. Morrison/Sen. Delgado) Requires the Secretary of State to establish an electronic registry, by January 1, 2027, to be known as the Advance Directive Registry, through which residents of the State of Illinois may deposit, with the Secretary of State, a completed Department of Public Health Uniform POLST form. Specifies that information in the Advance Directive Registry shall be made available to hospitals licensed under the Hospital Licensing Act and hospitals organized under the University of Illinois Hospital Act, and emergency medical services personnel. Authorizes hospitals to rely on information obtained from the Advance Directive Registry as an accurate copy of the documents filed with the Advance Directive Registry. ISMS supported this bill, which has been signed into law as 103-0908.

Chronic Pain

House Bill 5373 (Rep. Cassidy/Sen. Fine) and Senate 3491, ISMS initiatives, would help patients suffering from chronic pain access appropriate treatments, including the prescription of opioids, without interference, and protect physicians treating chronic 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 bills attempt to tighten criteria used to determine who can have access to the state’s Prescription Monitoring Program. SB 3491 was held in the Senate. HB 5373 passed the House but was held in the Senate.

Emergency Medical Treatment and Labor Act (EMTALA)

House Bill 581 (Rep. Avelar/Sen. Villanueva) is an initiative of Governor Pritzker’s office and codifies at the state level President Biden’s interpretation of EMTALA, which considers abortions part of the stabilizing care that EMTALA requires facilities to provide. ISMS raised concerns with the language originally introduced. The initial draft defined abortion as emergency services, which could conflict with Illinois’ Health Care Right of Conscience Act. It also included a private right of action. ISMS successfully amended the bill to remove the private right of action and define “stabilizing treatment” as one that may include abortion. ISMS was neutral on the language as amended. HB 581 has been signed into law as Public Act 103-0784.

Exemptions/Waivers to E-Prescribing Mandate

Pharmacists throughout Illinois are failing Illinois patients by ignoring the exemptions that ISMS secured in 2023 to the mandate requiring that controlled substances be prescribing electronically. In response, ISMS introduced House Bill 4874 (Rep. Avelar/Sen. Glowiak), which prohibits pharmacists from denying a prescription for a controlled substance solely due to the fact it was not prescribed electronically. HB 4874 has been signed into law as Public Act 103-0732.

Medical Records for Representatives of a Patient

House Bill 5074 (Rep. Chung) would prohibit a health care facility and/or a health care professional from charging a handling fee for providing medical records to a patient or patient's representative if they are electronic records retrieved from a scanning, digital imaging, electronic information, or other digital format in an electronic document. The bill also repeals the annual adjustment for the handling fee for inflation. The sponsor agreed not to move the bill due to ISMS opposition.

Prescription Treatment for Pain

House Bill 5355 (Rep. Yang Rohr/Sen. Villa), is an initiative of a drug company that manufacturers a non-addictive alternative to opioids. As introduced, the bill would have mandated that health care professionals who prescribe opioid drugs to provide certain information to the patient, discuss certain topics, and document the reasons for the prescription. The Illinois Department of Public Health would have been charged with developing a nonopioid directive form for patients and required health care professionals to use the form when discussing treatments for pain. ISMS opposed the bill as introduced. The advocates agreed to amend and add language limiting the bill to only mandate insurance coverage. ISMS supported the amended version, which passed the House, but stalled in the Senate.

PUBLIC HEALTH

Family Recovery Plans

Senate Bill 3136 (Sen. Castro/Rep. Canty), a bill that ISMS caused to be introduced, will create a statewide, multidisciplinary task force to design family recovery plans to help pregnant women who have been diagnosed with substance use disorder. These plans are required by federal law, which has been a requirement since 2003. The task force will develop recommendations for the creation, implementation, and management of these plans. The leading cause of maternal mortality in Illinois is substance use disorder. A Family Recovery Plan sets up medical treatment, recovery services and referrals to community agencies/resources for identified infant and caregiver(s). The bill also makes two minor changes to how a positive toxicology test of a newborn is managed by DCFS. The bill passed both chambers and will be sent to the governor for further action.

Legalization of Psilocybin

Senate Bill 2695 (Sen. Ventura) would have created the Illinois Psilocybin Advisory Board within the Department of Financial and Professional Regulation (IDFPR) for the purpose of advising and making recommendations to IDPFR regarding the provision of psilocybin and psilocybin services. The bill would have allowed the IDPFR to receive applications for the licensing of persons to manufacture or test psilocybin products, operate service centers, or facilitate psilocybin services. The bill would remove psilocybin and psilocin from the list of Schedule I controlled substances. ISMS opposed this bill, which did not advance.