December 13, 2018

The Healthcare Bills of 2018

To do in November: Override SB 1737 veto - checked!The new year will bring with it Public Act 100-1118, which protects Illinois consumers by imposing strict limitations on so-called “short term health insurance plans.”

Enacted in a veto override last month, it was perhaps the most dramatic of several important legislative achievements the now-outgoing 100th Legislature.

The Short-Term, Limited-Duration Health Insurance Coverage Act – The bill was developed with help from Protect our Care Illinois, in response to the Trump Administration’s proposed regulations to extend short-term insurance terms and make them renewable.These plans, which are essentially a form of junk insurance, are not bound by ACA consumer protections and can deny coverage for pre-existing conditions; analysts warned that extending their duration would undermine risk pools and cause Marketplace premiums to soar. Under an October executive order,” short term plans” can be extended for up to three years. (See details in our recent post.) The bill, initially drafted to limit these plans to 90 days, was modified to six months to obtain broader support. It requires such plans to be regulated by the Department of Insurance, bans issuers from discriminating against people with pre-existing conditions, and requires warnings that the plan may not provide all needed coverage. Gov. Rauner vetoed vetoed the bill in July, along with other consumer protection measures. The bill’s provisions were incorporated in SB 1737, and strong bipartisan support made it a prime candidate for veto override. (HB 2624; enacted as HB 1737 Sponsor: Sen. Heather Steans. Public Act 100-1118)

Ensuring Patient Continuity of Care – This act lets Medicaid managed care patients remain with their primary care provider if he/she is no longer contracted with the patient’s managed care organization. Currently, in such cases, patients are assigned a new PCP, often without the patient’s knowledge or input with the effect of drastically disrupting continuity of care. This very popular measure, which got only one “nay” in the legislature, was signed into law by the governor on August 19 and went into effect immediately. (HB 4383 sponsors: Rep. Sara Feigenholtz and Sen. Heather Steans. Public Act 100-0950)

Emergency Opioid and Addiction Treatment Access Act – This act amends the Illinois Insurance Code to permit treatment for inpatient and outpatient mental health along with substance abuse disorder treatment for the first 180 days per plan year when deemed medically necessary by the person’s health care provider and without the need for prior authorization. The insurer or MCO must allow the patient to seek treatment out of network within 24 hours if no in-network provider is immediately available. The bill was developed with input from the Illinois Association for Behavioral Health. (HB 5464; enacted as SB 682. Sponsors: Rep. Sara Feigenholtz and Sen. John Mulroe. Public Act 100-1023)

Mental Health Parity Act – Although a federal mental health parity law has been in effect for 10 years, insurers had often denied payment nased on the need for pre-authorization or seen as not medically necessary. This bill, drafted with input from the Kennedy Forum and the Illinois Association for Behavioral Health, strenghtens the existing state parity law and arms the Department of Insurance with clear enforcement powers as well by expanding access to addiction treatment and increasing health plan transparency. Along with SB 682, it was part of a package of bills enacted to combat the opioid epidemic. See details in our recent post (“A Strong, New Mental Health Parity Law”) (SB 1707 Sponsor: Rep. Lou Lang. Public Act 100-1024)

Left to deal with in 2019

State senators representatives of varied political stripes and statuses – reelected, defeated, retiring – came together to craft bills that were capable of securing enactment, and mustered the votes for a veto override with only one day left of Illinois’ 100th Legislature.

Some other bills were not so fortunate. Our newly elected legislators are sworn in as the 101st Legislature early in January, and may take up some of these issues in the coming year. Advocates working to see other measures reintroduced, remember to use the 100th Legislature bill lookup.

The Do No Harm Healthcare Act – The act would have prohibited the State from applying for any federal waiver that would reduce or eliminate any ACA-mandated protection or coverage that was in effect on January 1, 2017. The Rauner Administration opposed the bill, which became entangled early on in a budget tug-of-war. Having passed by only 67-48 in the House and 35-20 in the Senate, support was insufficient to attempt to override the total veto. (HB 4165 Sponsor: Rep. Greg Harris)

Medicaid single drug formulary – The bill would amend the Public Aid Code to require that the State’s preferred drug formulary would only serve as a minimum standard, not a restrictive list, thus allowing MCOs the ability to provide stronger drug coverage if they chose to. HFS had included language in its most recent managed care contract requiring all plans to adhere to a single formulary authorized by the department in an attempt to achieve a standardized drug formulary (or “preferred drug list”) to be used by Medicaid managed care organizations. The contract further stated that MCOs shall not deviate from the PDL, even if they choose to offer more-generous coverage options. This single PDL – which the bill sponsor called a form of rationing –creates barriers to care for a large number of Medicaid recipients living with chronic illnesses such as HIV/AIDS. The bill had passed 70-37 in the House and 47-9 in the Senate; the governor’s total veto stands. (HB 4096 Rep. Greg Harris)

Banning subminimum wage for people with disabilities – This bill would have phased out the practice of people with disabilities being paid less than minimum wage. More than 11,000 people with disabilities work in Illinois’ 124 “sheltered workshops,” one of four types of employers that are allowed to pay less than minimum to certain categories of workers. People with disabilities make up 95% of such workers. The bill would require the Illinois Department of Human Services to lead a four-year effort to move the state away from the practice. New Hampshire was the first state to ban the practice, and several others, such as Alaska, have followed. Mother Jones recently did a roundup of subminimum wage and recent challenges to it. The bill stalled in committee. The Illinois Network of Centers for Independent Living, which helped draft the bill, reports sponsors are working on compromise language possibly base on the very successful Maryland model. (HB 1592 Sponsor: Rep. Theresa Mah)

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