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. §§ 3860/1 through 3860/10: Illinois Health Information Exchange and Technology Act – Illinois
Introduced: Status: Enacted
The Illinois Health Information Exchange Authority exists to to serve as a State-level electronic medical records exchange providing for the transfer of health information, medical records, and other health data in a secure environment for …
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20 Ill. Comp. Stat. §§ 3934/1 through 3934/15: Electronic Health Records Taskforce Act – Illinois
Introduced: Status: Enacted
Statute creates an Electronic Health Records Taskforce to create a plan for development and utilization of electronic health records in order to improve the quality of patient care, increase the efficiency of health care practice, …
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20 Ill. Comp. Stat. §§ 3960/1 through 3960/5.3: Illinois Health Facilities Planning Act – Illinois
Introduced: Status: Enacted
The purpose of this act is to establish a procedure that promotes the orderly and economic development of health care facilities in the state of Illinois that avoids unnecessary duplication of such facilities and promotes …
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210 Ill. Comp. Stat. § 50/3.55. Scope of practice: Emergency Medical Services Systems Act – Illinois
Introduced: Status: Enacted
Statute provides emergency and non-emergency medical services that any person licensed as an EMR, EMT, EMT-I, A-EMT, PHRN, PHAPRN, PHPA, or Paramedic may perform.
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210 Ill. Comp. Stat. §§ 155/1 through 155/45: Long Term Acute Care Hospital Quality Improvement Transfer Program Act – Illinois
Introduced: Status: Enacted
Act created as a method to improve health care outcomes of patients, which results in a more efficient use of resources needed to provide care. It is estimated this Act could save $10,000,000 annually. Statutes …
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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