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  • June 8, 2018

  • Triumphant Year in Springfield – ALL ISMS-Priority Bills Clear Both Chambers!

    As the Illinois Senate and House of Representatives wrapped up the spring session last week, all of ISMS' priority bills cleared the General Assembly and will soon land on the governor's desk.

    ISMS' legislative team worked hard in Springfield to achieve this stellar year of advocating on behalf of members.

    Following is a compilation of our priority bills that cleared the General Assembly: 

    • Workers’ comp

    ISMS delivered a big win for physicians on workers' comp payments! Thank you to all the physicians who contacted state legislators and advocated to help pass this historic bill.

    An ISMS-developed initiative, Senate Bill 904, passed both the House (105-11) and Senate (38-7, with 4 senators voting "present"). This bill would make three important changes to the Illinois Workers' Compensation Act:

    • Allow physicians to collect 1 percent interest on late medical claims. This interest penalty is allowed under current law, but there is no enforcement mechanism. Under the new law, physicians would be able to seek remedy for unpaid interest through the circuit court.

    • Require workers' compensation insurance companies to send an Explanation of Benefits to medical offices explaining why they have denied the authorization of medical care, or what additional information insurers need to make a decision on that care.

    • Prevent workers' compensation insurers from ignoring the law that requires them to use electronic billing for workers' compensation claims. 

    Call to Action: But our work is not done yet - Senate Bill 904 will now be sent to the governor's desk for consideration. Please call the governor's Chicago office and urge him to sign Senate Bill 904 into law:

    Governor Bruce Rauner

    • Drug coverage protection for patients with stage IV advanced, metastatic cancer

    Illinois House Bill 4821 would protect patients with stage IV advanced, metastatic cancer and would preclude any state-licensed health benefit plan that covers treatment for stage IV cancer from excluding drug coverage. The legislation includes health plans that cover the patient directly, such as an insurer, and indirectly, such as a pharmacy benefit manager.

    Patients with stage IV cancer are in compromised and fragile health, with little fortitude to "fail first" on a prioritized drug or time to wait for an authorization before receiving the doctor's choice of treatment.

    • Tobacco 21 – legislation to increase legal age for buying tobacco

    Tobacco 21 is a national effort to raise the legal age to purchase tobacco products from 18 to 21.

    ISMS supports Illinois' Tobacco 21 legislation ( Senate Bill 2332), as nearly all adult smokers started as kids. Imposing a barrier to access tobacco products at an early age will prevent more young people from starting to smoke, which means a reduction in future deaths, disease and health care costs.

    Earlier this year, then-ISMS President Nestor A. Ramirez, MD, MPH, was one of the speakers advocating for this legislation.

    Senate Bill 2332 covers all tobacco and nicotine products, including e-cigarettes. 

    • Supporting mental health conditions and addiction treatment for Illinois' youth

    Senate Bill 2951 would require Illinois to seek federal approval for a pilot program that extends Medicaid coverage for:

    • A youth-focused, team-based treatment model for serious mental health conditions.
    • Assertive community outreach and clinical treatment for substance abuse delivered outside of clinic settings.

    • Addressing Illinois' unpaid bill backlog

    Illinois' pile of unpaid bills has grown so large that interest payments owed for the debt are now a significant contributor to the growing debt. Essentially, the state owes compounding interest for unpaid interest penalties that have already accrued. Senate Bill 2858 includes a two-fold strategy to reduce the debt and interest amount owed. If the governor signs this measure, the state treasurer would have new abilities to prioritize payments on the underlying principal debt, thereby reducing the amount of interest that can accrue.

    • Ratio change for physicians collaborating with PAs

    Amended Senate Bill 2904 passed in the final week of the legislative session. This legislation increases the current ratio of physician assistants (PAs) to physicians from 5:1 to 7:1, and provides for a supervisory ratio exemption for certain areas of the state where there is a determined shortage of primary care professionals.

    This legislation is an initiative of the Illinois Academy of Physician Assistants. As originally introduced, Senate Bill 2904 would have removed the current five PA to one physician ratio in its entirety. While ISMS opposed the original bill, a significant number of physicians and medical groups supported removing the ratio. Despite our opposition, the original bill passed out of the Senate Licensed Activities Committee. A resolution removing the ratio was introduced and debated at the ISMS House of Delegates. The resolution was sent to the ISMS Board of Trustees for decision. The ISMS governmental affairs team was given direction to negotiate a compromise.

    ISMS successfully included important disciplinary protections in both the Medical Practice Act and the Physician Assistant Practice Act for professionals who maintain too many collaborative agreements and thus fail to provide appropriate care to their patients.  

    • Stopping insurance companies from modifying an enrollee's coverage for a drug

    House Bill 4146 would prevent insurance companies from modifying an enrollee's drug formulary coverage after the enrollee is already locked into a health plan for the year.

    Specifically, the bill would prevent these actions, which often comes with:

    • Increasing out-of-pocket costs for a covered drug.
    • The movement of a prescription drug to a more restrictive tier.
    • The loss of prescription drugs from a formulary.
    • Refills for non-controlled substances  

    ISMS-backed Senate Bill 3170 would extend the time a patient can refill a prescription for a non-controlled substance from 12 months to 15 months.  

    • Allowing ambulatory surgical treatment facilities to file liens

    ISMS-backed House Bill 4911 would amend the Health Care Services Lien Act to allow ambulatory surgical treatment facilities (ASTFs) to file liens.

    Under current law, only health care professionals and licensed medical institutions (hospitals, home health agencies, and ambulatory surgical treatment centers [ASTCs]) are able to file liens. ASTFs are typically physician-owned facilities that do not qualify for state licensure because of their size, but are nationally accredited.

    • Limited direct access for physical therapists

    Prior to any negotiations, House Bill 4643 would have allowed physical therapists unfettered direct access with no physician involvement. ISMS successfully negotiated with the physical therapists to provide limited direct access and retain physician involvement, referral and medical diagnosis with regard to physical therapy services. 

    • Fertility preservation

    House Bill 2617 would guarantee insurance coverage in Illinois for fertility preservation for Iatrogenic infertility (usually cancer patients who are facing fertility-threatening treatments). Currently, insurance does not cover in-vitro-fertilization (IVF) for patients facing a necessary medical treatment to proceed with egg/embryo/sperm banking because they do not meet the medical definition of "infertile."  If they proceed with their course of treatment and then later pursue fertility treatment, it is often too late to use their own eggs/sperm.

    This bill was initiated by the Illinois Chapter of the American College of Obstetricians and Gynecologists.

    • ACA protection

    • House Bill 4165 would require the Illinois General Assembly's authorization for the state to apply for any federal waivers to reduce access or eliminate expanded Medicaid coverage authorized under the Affordable Care Act.  

    As these bills head to the governor's desk for signature, ISMS will keep you informed with Physician Advocate and the Legislative Action Hub.

    Questions? Please contact ISMS Vice President of Legislative Affairs Erin O'Brien at 312-580-6488.

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