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 1465 – Illinois
Introduced: 2021 Status: Inactive / Dead
Replaces everything after the enacting clause. Creates the Health Insurance Coverage Premium Misalignment Study Act. Sets forth provisions concerning the purpose of the Act and findings. Provides that the Department of Insurance shall oversee a …
HB 1536 – Illinois
Introduced: 2023 Status: In Process
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides the no appropriation may be expended to a managed care organization under contract with the Department of Healthcare and Family Services unless the …
HB 1546 – Illinois
Introduced: 2023 Status: In Process
Amends the Workers’ Compensation Act. Provides that the Illinois Workers’ Compensation Commission, upon consultation with the Workers’ Compensation Medical Fee Advisory Board, shall adopt an evidence-based drug formulary. Requires prescriptions in workers’ compensation cases to …
HB 156 – Illinois
Introduced: 2019 Status: Enacted
BIOLOGICAL PRODUCTS-DRUG PRICE. Creates the Prescription Drug Pricing Transparency Act. Requires health insurers to disclose certain rate and spending information concerning prescription drugs and certain prescription drug pricing information to the Department of Public Health. Requires …
HB 1638 – Illinois
Introduced: 2019 Status: Inactive / Dead
MEDICAID-AMBULANCE SERVICES. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to receive the approval of the General Assembly prior to applying for any waiver to …
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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Federal Trade Commission and State of Illinois v. Advocate Health Care and NorthShore University HealthSystem – Illinois
District Court: Northern District of Illinois Eastern Division Status: Decided
The FTC successfully blocked the merger of Chicago-are Advocate Health Care and NorthShore University HealthSystems after winning its appeal to put the proposed merger on …
In re: Evanston Northwestern Healthcare Corp. Antitrust Litigation – Illinois
District Court: N.D. Illinois, Eastern Division Status: Pending
In this putative class action, end-payors who purchased inpatient or outpatient healthcare services accused Evanston Northwestern Healthcare, now known as NorthShore University System, of violating …
Marion Healthcare v. Southern Illinois Healthcare – Illinois
District Court: S.D. Illinois Status: Pending
Marion Healthcare brought suit against Southern Illinois Healthcare in August 2012 alleging that SIH secured unlawfully exclusive contracts that severely discourage competition in the local …
Methodist Health Services v. OSF Healthcare dba St. Francis Medical Center – Illinois
District Court: C.D. Illinois, Peoria Division Status: Decided
In 2015, Methodist Hospital brought a $300 million antitrust suit against rival hospital system St. Francis Medical Center. In September 2016, a federal district court granted …
Federal Trade Commission and State of Idaho v. St. Luke’s Health System, Ltd and Saltzer Medical Group, P.A. – California, Connecticut, Delaware, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Mississippi, Montana, Nevada, New Mexico, Oregon, Pennsylvania, Tennessee, Washington
District Court: District of Idaho Status: Decided
In March 2013, the FTC and the Idaho Attorney General filed a joint complaint challenging the merger betweenSt. Luke’s Health System, Idaho’s largest health system, …
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