Senate Bill 2807, the Right to Shop Act, would require insurance companies to establish “incentive” programs. Patients would receive financial rewards solely for choosing the lowest cost health professionals and care settings – completely disregarding quality of care, care coordination or patient experience. Incentivizing patients to choose based on the least expensive care is a flawed way to achieve the goals of increased price transparency and lower health care costs.

While strategies are needed to help patients receive better information about health care costs in general, and individual out-of-pockets costs in particular, most health plans include cost estimators on their websites. Their covered patients can obtain estimates of what their care would cost with specific health professionals and health delivery settings, as well as what their out-of-pocket obligation would be. The scheme under Senate Bill 2807 misleads patients into thinking that health care services can be selected on the basis of cost alone, essentially creating a tiered network structure whereby physicians, other health care professionals and hospitals are placed in a tier exclusively on the basis of cost.

• Bill Status of SB 2807

Tobacco 21 is a national effort to raise the legal age to purchase tobacco products from 18 to 21. Several states have already enacted this legislation and numerous cities and jurisdictions have imposed local ordinances.

ISMS supports this bill, 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. Senate Bill 2332 covers all tobacco products, including e-cigarettes.

Tobacco 21 legislation (Senate Bill 2332) cleared the Illinois Senate this past week. This legislation is now before the Illinois House.

• Bill Status of SB 2332

HB 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 facilities (hospitals, home health agencies, and ambulatory surgical treatment centers [ASTCs]) are able to file liens. This bill has cleared the Illinois House and is now under consideration in the Senate.

• Bill Status of HB 4911
• ISMS Position Paper
  

Illinois HB 4821 would protect patients with stage IV advanced, metastatic cancer. The bill 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 manger.

Stage IV refers to cancer that has spread from the original site to nearby tissues, lymph nodes, or other areas of the body. 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.

HB 4821 would preclude health plans from requiring the patient to fail first on a preferred medication or wait for a prior authorization. Further, the covered drugs must be:

• Approved by the FDA.
• Consistent with best practices for treating stage IV cancer.
• Supported by peer-reviewed medical literature.

HB 4821 passed the House unanimously and is now under consideration in the Senate.

• Bill Status of HB 4821

HB 5238 (Rep. Pritchard) is legislation establishing a hospital-based employed physician’s bill of rights. The legislation states that every physician employed by a hospital or hospital affiliate has the right: 

1. To compensation based on the totality of the physician’s activities for the hospital or affiliate, including but not limited to education endeavors and preparation, committee participation, student and resident activities, and administrative responsibilities;
   
   
2. To academic freedom, without censorship in clinical research or academic pursuits;
   
   
3. To not be solely responsible for data entry, coding, management of the use or electronic medical records system;
   
   
4. To evaluation of clinical activity through the peer review process and to be judged only by clinicians and not corporate executives; 
   
   
5. To perform activities outside of defined employed time boundaries solely at the prerogative of the individual and not the hospital or affiliate employing the physician, unless the activities directly conflict with or increase risk for the hospital or affiliate;
   
   
6. To have conflict of interest disclosures limited to the physician’s activities that directly affect the hospital or affiliate, and the disclosures should only be made to entities that directly reimburse the physician during his or her period of employment;
   
   
7. To have resources appropriately allocated by the hospital or affiliate for CME; and
   
   
8. To be legally empowered to be a patient advocate and to be allowed to adhere to the spirit of the Hippocratic Oath allowing patient privacy, confidentially, and continuity of a patient’s health care.
   
   

• Bill Status of HB 5238

SB 3184 would amend the Illinois Controlled Substances Act to prohibit requests for or possession of a prescriber's Illinois controlled substance license number or Drug Enforcement Administration (DEA) registration number for purposes other than those for which these numbers are intended.

• Bill Status of SB 3184

SB 2858 is legislation to address Illinois growing backlog of unpaid bills. Illinois’ pile of unpaid bills has grown so large that interest payments owed for the growing debt are now a significant contributor to the debt itself. Essentially, the state owes compounding interest for unpaid interest penalties that have already accrued. This legislation includes a two-fold strategy to reduce the debt and interest amount owed. If it passes, the State Treasurer will have new abilities to prioritize payments on the underlying principal debt, thereby reducing the amount of interest that can accrue. The legislation also reduces the interest rate paid as penalty for delayed payment. SB 2858 passed in the Illinois Senate and is now under consideration in the House.

• Bill Status of HB 2858

SB 3491 is a technical follow-up to the Network Adequacy and Transparency Act (NAT Act), which was enacted in 2017. This “trailer bill” would clarify that the tenets of the NAT Act do not apply to dental and vision plans, as requested by the Illinois Department of Insurance. The legislation will also clarify, in the provision regarding the accuracy of provider directories, that the network plans will be held harmless when the information submitted by the provider is inaccurate or incomplete.  

• Bill Status for SB 3491
• Bill Status for HB 311 – Network Adequacy and Transparency Act
• Full Text of Network Adequacy and Transparency Act (Public Act 100-0502)
• ISMS Notes on SB 3491

ISMS has successfully negotiated a compromise with the physical therapists for HB 4643 that would provide limited direct access and retain physician involvement, referral and diagnosis with regard to physical therapy services. The amended bill is likely to pass the House yet this week. 

• Bill Status of HB 4643

Democratic and Republican legislators, state government agencies, and the Governor's office continue to express serious concerns over the opioid crisis in Illinois and the current state of prescribing controlled substances. Physicians have typically helped develop policy and engaged in advocacy efforts to protect the public health of the citizens of Illinois. Despite these efforts, many policymakers support efforts that would limit the amount of opioids physicians can prescribe. Other mandates, such as mandated CME on how to prescribe opioids, also continue to be discussed. ISMS firmly believes any legislation to address opioids must be comprehensive and include support for treating addiction.

• Bill Status of SB 2332
• ISMS Responds to Opioid Epidemic

SB 3018 would prohibit the Illinois Department of Financial and Professional Regulation from publicly disclosing an individual’s medical license number, as a means to thwart identity theft and fraud.

• Bill Status of SB 3018

Illinois HB 4821 protects patients with Stage 4, advanced, metastatic cancer. The bill precludes any state-licensed health benefit plan that covers treatment for Stage 4 cancer from excluding drug coverage for a Stage 4 patient.  These are plans that cover the patient directly, like an insurer and indirectly, like a pharmacy benefit manger. Stage 4 is defined as cancer that has spread from the original site to nearby tissues, lymph nodes, or other areas of the body.  Less than 18% of cancer patients are diagnosed with Stage 4 and the average course of treatment is only four months.  Stage 4 cancer patients 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. The bill precludes health plans from requiring the patient to fail first on a preferred medication or wait for a prior authorization. Covered drugs must be approved by the FDA, must be consistent with best practices for treating Stage 4 cancer and must be supported by peer reviewed medical literature.

HB 4821 passed the House unanimously and is now under consideration in the Senate.

• Bill Status of HB 4821

HB 4820 seeks to limit a payer’s ability to recoup payment to 60 days, as opposed to the current 18 months. 

• Bill Status of SB 4820

SB 3170 would extend the time a patient can refill a prescription for a non-controlled substance from 12 months to 15 months. This legislation has cleared the Illinois Senate and is under consideration in the House.

• Bill Status of SB 3170
• ISMS Position Paper

HB 4146 continues to pick up co-sponsors and is still under consideration in the Illinois House. This legislation 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 cause hikes in out-of-pocket costs for drugs:

• Increasing out-of-pocket costs for a covered drug.
• Moving a prescription drug to a more restrictive tier.
• Removing a prescription drug from a formulary.

• Bill Status of HB 4146

This legislation would require Illinois to seek federal approval for Medicaid coverage for:

1. A youth-focused, team-based treatment model for the early treatment of serious mental health conditions.
2. Assertive outreach and clinical treatment delivered beyond the four walls of a clinic for substance use treatment

Senate Bill 2951 passed in the Illinois Senate on Wednesday with an overwhelming bi-partisan vote of 55-1. The bill now goes before the House.

• Bill Status of SB 2951

House Amendment 2 to Senate Bill 904 makes three changes to the Illinois Workers’ Compensation Act to address a growing crisis of unpaid workers’ compensation medical bills.

It would:

• Allow medical professionals to collect interest on late medical claims by filing a claim for this interest in circuit court, and increase that late payment penalty from 1 percent to 2 percent. While this interest provision has been in the law since 2005, medical professionals currently have no means to collect this interest.
• Require workers' compensation insurance companies to send an Explanation of Benefits to medical professionals explaining why they have denied the authorization of medical care or what additional information they need to make a decision on that care.
• Prevent workers' compensation insurers from ignoring the law requiring them to use electronic billing for workers' compensation claims. This has been the law for seven years, yet workers' compensation insurers still refuse to use standardized electronic billing systems that are used throughout the rest of the healthcare world.

More and more doctors, hospitals, and other medical professionals are finding it difficult to provide care to injured workers under the current situation. Any reduction in access to medical care will increase the time that injured workers are off of work and increase the long-term effects of their injuries – both of which could actually increase costs for employers, in addition to the negative effects on workers.

• Bill Status of SB 904
• ISMS Position Paper