Overview
Illinois was one of the first states to protect patients from surprise bills for services they receive unintentionally from out-of-network providers with the Fair Patient Billing Act. More recently, the legislature considered a proposal to create the Right to Shop Act, which would require health insurance carriers to develop a benefit plan with financial incentives for patients who receive services voluntarily from providers that charge below the average in-network rates. The state also enacted laws promoting price transparency in drug pricing, requiring that a pharmacy benefit manager may not prohibit a pharmacy or pharmacist from providing a consumer a more affordable alternative when one is available.
The state explored the creation of an all-payer claims database (APCD) as a result of Executive Order 14-01, signed by former Governor Pat Quinn in 2014. The order established the Governor’s Office of Health Innovation and Transformation to direct the state’s participation in the Center for Medicare and Medicaid Innovation’s State Innovation Model Program. Illinois was awarded up to $2,088,530 to develop its plan, dubbed the Illinois Alliance for Health Innovation Plan. The plan calls for building the APCD to ultimately collect data on commercial plans, Medicare, Medicaid, and the uninsured. However, the state does not yet have an operational APCD.
Illinois has a strong certificate of need program, which requires a health care facility to obtain a certificate of need in several circumstances, including any transfer of ownership, sale, consolidation, construction, modification, creation, or conversion of facilities. The state does not otherwise require notice or approval of hospital or provider mergers. Nonetheless, Illinois was the site of two antitrust cases involving hospital mergers: one private antitrust action and one case brought by the FTC. In FTC v. Advocate Health Care Network, the district court granted an injunction in March 2017, and the parties abandoned their merger plans.
In telehealth, Illinois statute provides cost-sharing parity, which prohibits deductibles, co-payments, and coinsurance for telehealth services from exceeding those required for in-person services. The state does not require coverage or reimbursement parity for telehealth services.
See below for an overview of existing Illinois state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/11/2023 - 1/9/2024 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 1007 – Illinois
Introduced: 2023 Status: In Process
Amends the Pharmacy Practice Act. Requires that at least one registered pharmacy technician be on duty whenever the practice of pharmacy is conducted. Requires that a pharmacy set a prescription filing limit of not more …
HB 1029 – Illinois
Introduced: 2023 Status: In Process
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall transition pharmacy services for managed care enrollees from the State’s managed care medical assistance …
HB 1034 – Illinois
Introduced: 2023 Status: In Process
Amends the Illinois Food, Drug and Cosmetic Act. Provides that the amendatory provisions apply to any manufacturer of a prescription drug that is purchased or reimbursed by specified parties. Provides that a manufacturer of a …
HB 1054 – Illinois
Introduced: 2023 Status: In Process
Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance amended, delivered, issued, or renewed on or after January 1, 2024 that provides coverage for prescription drugs shall …
HB 1094 – Illinois
Introduced: 2023 Status: In Process
Creates the Health Care for All Illinois Act. Provides that all individuals residing in this State are covered under the Illinois Health Services Program for health insurance. Sets forth requirements and qualifications of participating health …
20 Ill. Comp. Stat. § 1305/1-40. Substance Use Disorders; Mental Health; provider payments: Department of Human Services Act – Illinois
Introduced: Status: Enacted
For authorized Medicaid services to enrolled individuals, Division of Substance Use Prevention and Recovery and Division of Mental Health providers shall receive payments for such authorized services, with payment occurring no later than in the …
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20 Ill. Comp. Stat. § 1705/15.3. Quality assurance for community mental health services: Mental Health and Developmental Disabilities Administrative Act – Illinois
Introduced: Status: Enacted
When the Department of Healthcare and Family Services or the Department of Human Services pays the cost, directly or indirectly, in whole or in part, for community mental health services and programs under the Medicaid …
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20 Ill. Comp. Stat. § 1705/54. Establishment of rates for purchase of service: Mental Health and Developmental Disabilities Administrative Act – Illinois
Introduced: Status: Enacted
Statute establishes procedures for the development, calculation, and communication of rates promulgated by the Department for the purchase of services for persons with a developmental disability and persons with mental illness. Statute requires that rates …
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20 Ill. Comp. Stat. § 1705/7. Care and treatment: Mental Health and Developmental Disabilities Administrative Act – Illinois
Introduced: Status: Enacted
The Department is required to adopt a model protocol and forms for recording all patient diagnosis, care and treatment at each State-operated facility for the mentally ill and for persons with developmental disabilities under the …
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20 Ill. Comp. Stat. § 1705/71a. Community Behavioral Health Care: Mental Health and Developmental Disabilities Administrative Act – Illinois
Introduced: Status: Enacted
The Department shall strive to guarantee that persons, including children, suffering from mental illness, substance abuse, and other behavioral disorders have access to locally accessible behavioral health care providers who have the ability to treat …
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In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In re: EPIPEN (Epinephrine Injection, USP) Marketing, Sales Practices, and Antitrust Litigtion – Illinois, Kansas, New Jersey, Washington
District Court: District of Kansas Status: Pending
The plaintiffs in the case allege Mylan N.V. created and exploited an EpiPen monopoly by providing aggressive rebates and incentives to pharmacy benefit managers to …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
LEGISLATION/REGULATION
Legislative Calendar
Illinois’ current legislative session runs from 1/9/2019 – 1/7/2020. Bills from 2019 will carry over to 2020 as part of the 2019-2020 legislative term.
STATE BUDGET
Illinois operates on an annual budget cycle. The governor submits the proposed budget in February, and the General Assembly passes the budget in May. The fiscal year begins on July 1 and ends on June 30 the following year.
REGULATION & ENFORCEMENT
Illinois was one of 16 states to file an amicus brief supporting the FTC’s winning position in the Ninth Circuit appeal of St. Luke’s Health Care Sys. v. FTC, No. 14-35173 (March 7, 2014), decided February 10, 2015. The States’ brief stated that the acceleration of health care costs due to the growth of large health care provider systems had become a matter of grave concern for the states.
KEY RESOURCES