The Illinois House of Representatives and Senate are projected to be in session every day until the end of session, which is scheduled to adjourn on May 31. With less than a week of session remaining, legislative redistricting and the Fiscal Year (FY) 2022 state budget are major issues of focus for the legislature.
102nd Illinois General Assembly: Key Legislative Issues
Redistricting will undoubtedly remain a major focus considered for the remainder of the legislative session. Every decade, legislative districts are re-drawn to accommodate changes in population shifts following a national census survey. Illinois Democrats released their re-drawn legislative map last week. In the Illinois House, twenty-two republican districts are being consolidated, meaning that each of those legislators, if they decide to run again at their current residence, will face a primary election race against a current colleague of their own party.
The re-drawn legislative map must be passed no later than June 30 in each year following a decennial census (2020). If no legislation is passed by this date, a bipartisan legislative commission is composed for the purpose of drawing the map.
There will be four public hearings to discuss the map prior to voting: two on Tuesday, May 25 and two on Wednesday, May 26. The Democratic proposal will likely pass before the end of the legislative session as they have majority control of the General Assembly and the Governor’s Office.
Illinois Governor J.B. Pritzker and Democratic leaders agreed to expend state general revenue funds to retire the debt associated with a federal loan, taken during the pandemic, which totaled $3.1 billion. Paying the debt in its entirety will save the state $100 million in interest payments. Legislators intended to use federal American Rescue Plan (ARP) funds for these purposes.
As shared in last month’s Illinois Update, the legislative “budgeteers” are still working to close a $1.3 billion gap in the proposed FY 2022 budget, which begins July 1, 2021. Illinois House and Senate budgeteers are considering potential spending cuts and/or new revenue through “closing corporate loopholes” to eliminate the gap between revenues and expenses.
An agreement has been reached between the Illinois Coalition to Protect Telehealth and Illinois health insurance companies on comprehensive telehealth legislation that will be passed by May 31. Per the Illinois Health and Hospital Association, key provisions of the agreed legislation, House Bill 3308, Special Committee Amendment 1, are as follows:
- Reimbursement Parity: Insurers must reimburse in-network health care professionals and facilities, including those in tiered networks, on the same basis, in the same manner, and at the same reimbursement rate that would apply to in-person services.
- The Reimbursement Mandate:
- Applies to those telehealth services that meet the same criteria required to bill in-person care.
- Does not preclude insurers and providers from voluntarily negotiating alternate reimbursement rates for telehealth services, as long as any agreed upon rates account for ongoing provider investments in telehealth platforms;
- Includes a 5-year sunset clause (mental health and substance use disorder telehealth services are excluded from the sunset); and
- Requires the Illinois Department of Insurance and the Illinois Department of Public Health to commission an in-state medical college to carry out a study on the efficacy of the coverage and reimbursement parity mandates before the sunset date.
- Coverage Mandate: Insurers must cover clinically appropriate, medically necessary telehealth services (real-time audio or audio/video interactions), e-visits (patient portal communications) and virtual check-ins (5-10-minute “live” conversations to prevent an in-person visit) in the same manner as any other benefits covered under the policy.
- Patient and Provider Protections: Existing patient and provider protections in the Illinois Insurance Code for telehealth services were clarified and broadened. Specifically, insurers are prohibited from:
- Requiring in-person contact to occur between a healthcare professional and a patient prior to the provision of a telehealth service;
- Requiring patients or providers to demonstrate or document a hardship or access barrier to an in-person consultation;
- Requiring use of telehealth services when a patient’s provider has determined it is not appropriate or when a patient chooses an in-person care;
- Requiring a healthcare professional to be physically present in the same room as a patient receiving the telehealth service, unless deemed medically necessary by the professional delivering the service;
- Creating geographic or facility restrictions for telehealth services;
- Requiring patients to use a separate panel of health care professionals or facilities for telehealth services;
- Imposing utilization review requirements that are unnecessary, duplicative or unwarranted, or imposing treatment limitations, prior authorization, documentation, or recordkeeping requirements that are more stringent than those for in-person services; and
- Imposing deductibles, copayments/co-insurance, or any other cost-sharing that exceed those required for in-person services.
Save Medicaid Access and Resources Together (SMART) Act
In 2012, the Illinois General Assembly passed the SMART Act, resulting in a 3.5% Medicaid rate reduction to hospitals. Following continued improvements of the State’s revenue since the bill was enacted, UnityPoint Health is working collaboratively with the Illinois Health and Hospital Association to restore these funds, which will help support care and services provided by Illinois hospitals to the state’s Medicaid population.
For more information on State of Illinois advocacy, legislative, policy and regulatory issues of impact to UnityPoint Health, please contact Ashley Thompson, director of government & external affairs for UnityPoint Health.