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. 

This ISMS-backed legislation passed through both chambers with super-majorities. Unfortunately, on August 28 Governor Rauner issued an amendatory veto to the bill removing key protections. Thankfully, Illinois’s General Assembly acted to overturn the Governor’s veto in November and this important legislation is now law!

SB 904 Resources:

• Bill Status of SB 904
• ISMS Position Paper
• Alert: Contact Governor Rauner
• Letter to Governor Rauner
• Second letter to Governor Rauner
• Statement of ISMS President-Elect Paul E. Pedersen, M.D. on Governor Rauner's amendatory veto
• Statement from ISMS President Katherine M. Tynus, M.D., on the override of SB 904 veto
  

 This legislation will 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 will 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.

The bill has been signed into law as Public Act 100 - 1052. 

• Bill Status of HB 4146

House Bill 4383 (Rep. Feigenholtz/Sen. Steans) will give Medicaid managed care enrollees the option to stay with their primary care physician if the contract between their physician and health plan is terminated. ISMS supported HB 4383. This bill has been signed into law as Public Act 100-0950. 

• Bill Status of HB 4383
• Letter to Governor

SB 3170 will extend the time a patient can refill a prescription for a non-controlled substance from 12 months to 15 months. This ISMS-backed legislation was signed into law as Public Act 100-0804. 

• Bill Status of SB 3170
• ISMS Position Paper
• Letter to Governor

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.
   

Due to strong opposition this bill failed to advance.

• Bill Status of HB 5238
  

HB 4820 would have limited a payer’s ability to recoup payment to 60 days, as opposed to the current 18 months. Due to strong opposition from the insurance industry, this bill did not advance.

• Bill Status of SB 4820

SB 3018 would have prohibited 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. Due to strong opposition from the Secretary of State’s Office (SOS) and from IDPFR, the bill failed to advance.

• Bill Status of SB 3018

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 will 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. SB 2777 passed in both chambers and includes new opioid education coursework requirements for prescribers that hold controlled substance licenses. The bill has been signed into law as Public Act 100-1106.

• Bill Status of SB 2777
• ISMS Responds to Opioid Epidemic

ISMS has successfully negotiated a compromise with the physical therapists for HB 4643 that will provide limited direct access and retain physician involvement, referral and diagnosis with regard to physical therapy services. The bill has been signed into law as Public Act 100-0897. 

• Bill Status of HB 4643

SB 3491 is a technical follow-up to the Network Adequacy and Transparency Act (NAT Act), which was enacted in 2017. This “trailer bill” will 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 also clarifies, 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. This bill has been signed into law as Public Act 100-0601.

• 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

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. 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. This bill has been signed into law as Public Act 100-1107.

• Bill Status of HB 2858

SB 3184 will 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. Legislative staff in the Senate expressed concerns that this bill is duplicative of current law. ISMS will reintroduce language to the House.

• Bill Status of SB 3184

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

This bill has been signed into law as Public Act 100-1057.

• Bill Status of HB 4821

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 both chambers and was vetoed by Governor Rauner.

• Bill Status of SB 2332
• Letter to Governor

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 been signed into law as Public Act 100-0653

• Bill Status of HB 4911
• ISMS Position Paper
• Letter to Governor

Senate Bill 2904 (Sen. Steans/ Rep. Feigenholtz) as originally introduced would have removed the physician-physician assistant (PA) ratio in its entirety. The physician assistants argued that the current five-to-one ratio hurts access in rural and underserved areas and creates barriers to employment.  

The Illinois Academy of Physician Assistants secured key physician support, including among ISMS members. After extensive debate on an ISMS resolution, the ISMS House of Delegates voted to refer the issue of removing the ratio to the ISMS Board for decision.  The ISMS governmental affairs team was directed to negotiate a compromise that included increasing the ratio from five to one to seven to one, and providing some relief to physicians practicing in certain rural and underserved areas should they want to collaborate with more than seven PAs.  

The amended bill provides that a physician licensed to practice medicine in all its branches may not collaborate with more than seven (rather than five) full-time equivalent physician assistants. It specifies that entering into an excessive number of written collaborative agreements with licensed physician assistants, resulting in an inability to adequately collaborate and repeated failure to adequately collaborate with a physician assistant, constitutes grounds for disciplinary action.

The bill also provides that a physician licensed to practice medicine in all its branches may collaborate with more than seven physician assistants when the services are provided in a federal primary care health professional shortage area with a Health Professional Shortage Area score greater than or equal to 12. This will assist rural areas in need of access.  ISMS was neutral on the bill as amended. SB 2904 (Public Act 100-0605) was signed by the Governor in July and is now law.

• Bill Status of SB 2904

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. It received similar support in the House and will not go to the Governor for his signature.

• Bill Status of SB 2951

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. This legislation did not clear the General Assembly this session.

• Bill Status of SB 2807