2021 End of Session Report

Of the concentrated set of initiatives prioritized by legislators at the end of May 2021, several included issues important to the Illinois Academy of Family Physicians (IAFP), which are detailed further below and internally linked to each section in the following list:


  • Healthcare Equity
  • Prior Authorization
  • Telehealth Expansion
  • Increased Medicaid Funding
  • Increased Primary Care Funding


Several other additional topics relevant to family physician practices were passed during the 2021 legislative session:


  • Vaping & Electronic Cigarettes – Senate Bill 512 creates the Preventing Youth Vaping Act, expanding 21 year old tobacco prohibitions to electronic cigarettes
    • Doula Coverage – House Bill 354 was integrated into the Illinois Legislative Black Caucus Healthcare Equity legislation to allow for Medicaid reimbursement of doula services, see Fact Sheet.
    • Vaccination Access Expansion – Senate Bill 2017 authorizes pharmacist vaccinations to CDC and FDA approved vaccines pursuant to a valid physician prescription or standing order consistent with AAFP’s national survey, see SB 2017 pg. 535, ln. 2 through pg. 549, ln. 26
    • Mental Health Coverage – House Bill 2595 mandates coverage for mental, emotional, nervous, or substance use disorders or conditions as part of the Health is Health campaign
    • Practitioner Orders for Life Sustaining Treatment – Senate Bill 109 aligns Illinois state law with national standards by removing the witness signature on POLST forms, see Fact Sheet.
    • HIV Decriminalization – House Bill 1063 decriminalizes HIV transmission consistent with AAFP Policy, see Fact Sheet


There were also several other issues introduced at the beginning of session that were not able to move through the process by the end of session, but are likely to return next year:


  • Immunization Tracking & Reimbursement – HB 347 (with Senate Amendment 1) to improve immunization data and reimbursement rates for children in Illinois. Link to a fact sheet here.
    • Prescription Monitoring Program – Senate Bill 1842 authorizes access to controlled substances for the treatment of opioid use disorders and reduces trigger for issuance of unsolicited reports
    • Pharmacy Benefit Manager Reforms – Senate Bill 2008 authorizes generic equivalent drugs and drug formulary changes in addition to limitations on pharmacy benefit manager mandates
    • Midwife Authorization – House Bill 3401 creates the Licensed Certified Professional Midwife Practice Act, which provides optional collaboration with limitations on vicarious liability



(see also IAFP Overview of Issues in the General Assembly)


***Healthcare Equity***


In the summer of 2020, the Illinois Legislative Black Caucus (ILBC) initiated hearings for the purpose of developing comprehensive legislative pillars involving equity in healthcare, criminal justice, education and workforce development, and economic opportunity. (click here for a review of 2020 Legislative Black Caucus healthcare committee hearings)


During a one week legislative session in January 2021, the ILBC sought passage of their healthcare pillar, which included numerous areas of focus:


  • Access to Healthcare
  • Hospital Closures
  • Hospital Reform
  • Managed Care Organization (MCO) Reforms
  • Community Health Workers
  • Maternal & Infant Mortality
  • Mental & Substance Abuse Treatment
  • Medical Implicit Bias


Although no version of the ILBC healthcare legislation passed during the short January 2021 session, legislation was re-initiated and moved through the 102nd General Assembly as House Bill 158.


ILBC Healthcare Legislative Review Executive Summary

In initial versions of the amendment filings in January 2021, there were two provisions highlighted for specific language review and possible input, which were similarly included in legislation reintroduced and passed in the 102nd General Assembly, see House Bill 158:


  • Regarding implicit bias, compromise language was negotiated to limit the education mandate from being required in all patient-related continuing education to one hour of continuing education during a renewal period (note: IAFP maintains a position consistent with American Academy of Family Physicians' CME policies recommending implicit bias education, click here);


  • Regarding doula services, the language is consistent with House Committee Amendment No.2 to House Bill 4 from the 101st General Assembly, which includes language for evidence-based standards and qualifying criteria that was supported by IAFP.


There were also several provisions in the January 2021 that were particularly relevant for targeted membership groups within IAFP, most of which remained part of 102nd General Assembly legislative compromises:


  • Department on Aging implementation of a dementia training program
    • Creation of a Behavioral Health Workforce Education Center of Illinois (note: the Synchronicity Report showcasing the Mental Health Collaborative Care Model)
    • Federally Qualified Health Centers (FQHCs) coordination with hospitals and related payment methodology and care coordination (note: AAFP Backgrounder: Teaching Health Centers - goal of a physician workforce that serves its community includes increasing care coordination, managing chronic diseases, and addressing the social determinants of health)
    • Requiring State Board of Health to complete a State Health Assessment in addition to a State Health Improvement Plan
    • Moratorium on the closure of hospitals until the end of the COVID-19 disaster proclamation
    • Creation of the Medicaid Managed Care Oversight Commission



Provisions that were part of the ILBC healthcare package in the 101st General Assembly but not included in the 102nd General Assembly initiative include:


  • A Prescription Monitoring Program applying to opioid treatment programs that prescribe Schedule II, III, IV, or V controlled substances for the treatment of opioid use disorder was removed in the final House amendment before passage in the House
  • Creation of the Child Trauma Counseling Act was not included in the 102nd General Assembly initiative as introduced


***Prior Authorization***


House Bill 711 creates a system to reduce long term health care costs by eliminating or reducing inefficiencies and by keeping people healthy on the front end. Our important initiative does the following:


  • Increases transparency. The bills will require payers to maintain and publicly post a list of services for which prior authorization is required. Finding out what treatments require prior authorization is often a challenge in itself, and often is not known until after the treatment is prescribed, exacerbating delays in care.
    • Establishes important maximum timelines for urgent and non-urgent prior authorization requests. Currently there are no standard timelines, forcing patients to wait an excessive amount of time, often weeks, before care can be initiated. Illinois oncologists, for example, note that their patients often have to wait 30 days before cancer treatments are approved and can be scheduled to begin.
    • Defines qualifications of individuals designated to review and make prior authorization determinations. Too often treatment plans are reviewed and determined by individuals who are not trained in the area of medicine they are reviewing. Setting forth specific qualifications required of these individuals will streamline the process with quicker, educated decisions.
    • Ensures that if prior authorization is requested and approved for a given procedure, reasonably related supplies or services are considered to have also received authorization. Surgeons are registering complaints that while a surgery is approved, a separate prior authorization is required for the anesthesia and has not come through, delaying the surgery.
    • Provides for continuity of care for patients with long-term or chronic conditions by requiring that prior authorization approvals remain in effect for the lesser of 12 months or the course of treatment as recommended by the patient’s health care professional or provider. Approvals would generally remain in effect for 6 months for treatments for non-chronic conditions.
    • Ensures that a prior authorization determination confirms medical necessity requirements and requirements for payment for the delivery of the health care service. All too often a physician spends hours dealing with payers to get a treatment approved, only to experience non- payments after the care is rendered.



For more information, click here.




House Bill 3308 establishes the following telehealth protections:


  • Bars insurers from requiring patients to prove a hardship or access barrier in order to receive healthcare services through telehealth.
    • Prohibits geographic or facility restrictions on telehealth services, allowing patients to be treated via telehealth in their home.
    • Protects patient preference by establishing that a patient cannot be required to use telehealth services.
    • Ensures patients will not be required to use a separate panel of providers or professionals to receive telehealth services.
    • Aligns telehealth practice with privacy laws for in-person practice, while giving healthcare professionals the latitude to determine the appropriateness of specific sites and technology platforms for telehealth services.
    • Aligns telehealth coverage and payment with in-person care, making appropriate patient access to care the priority and removing harmful barriers that shift costs to the patient and healthcare professional.



On March 19, 2020, the Governor issued Executive Order 2020-9 to expand telehealth access in response to COVID-19. Illinois Academy of Family Physicians focused on several priorities when advocating for possible legislative codification of telehealth Executive Order 2020-9, which were ultimately codified in some way in House Bill 3308:


  • Reimbursement parity to in-person services
  • Coverage regardless of patient or service provider location
  • Application to the same range of insurance policies as EO 20-9
  • Application to the same range of services as EO 20-9
  • Prior authorization prohibitions
  • Cost sharing prohibitions


Payment Parity Analysis

While HB3308, SCA1 recognizes telehealth as a modality for delivering otherwise in-person healthcare services, there will still be more work necessary to (1) justify telehealth costs for those seeking payment parity from private carriers and (2) preserve Medicaid telehealth payment parity beyond the current pandemic related administrative rules.


  • 215 ILCS 5/356z.22(d)(new): recognizes telehealth payment parity as a concept for private carriers through December 2027 (note: mental health and substance abuse services are not subject to the sunset);
  • 215 ILCS 5/356z.22(e)(new): authorizes a study on the effectiveness of telehealth, subject to appropriation, and by January 2027;
  • 215 ILCS 5/356z.22(f)(new): subjects telehealth payment parity to conditions that provide for negotiated rates and cost justifications


Commercial Carrier Payment Parity

Telehealth payment parity under commercial health insurance policies is mandated through December 2027, but subject to conditional negotiated rates.


More specifically, insurance carriers and medical providers may "voluntarily negotiate alternate reimbursement rates for telehealth services” that "shall take into consideration the ongoing investment necessary to ensure these telehealth platforms may be continuously maintained, seamlessly updated, and integrated with a patient's electronic medical records.”


Subject to state funding, a study is to be conducted and due by January 2027 that reviews whether telehealth polices "improve access to care, reduce health disparities, promote health equity, have an impact on utilization and cost-avoidance, including direct or indirect cost savings to the patient, and to provide any recommendations for telehealth access expansion in the future."


Medicaid Payment Parity

Medicaid telehealth payment parity will continue through at least this summer and is expected to continue during the Pritzker administration.


More specifically, a 2020 emergency rule provided for Medicaid telehealth payment parity (DHFS Medicaid Rule-Ill. Register, Vol. 44 Issue 14, pages 5772-5774) and was subsequently passed through regular rule making, see 89 Ill. Adm. Cd. 140.403(e). This Medicaid telehealth payment parity is authorized "to protect the public health in connection with a public health emergency” (e.g. COVID-19), and may continue "until the Department determines any or all of the services or flexibilities permitted under this subsection (e) are no longer necessary.” The Secretary of DHFS has committed to continuing Medicaid payment parity in the near term, but further discussion will occur this summer with possible legislation needed during the fall legislative session.


With Medicaid telehealth payment parity reliant on continued state agency regulations, tracking implementation of 2020 regulations will be necessary:


·        DHFS Provider Notice (03/20/20)

  • confirmed that "Reimbursement for telehealth services will continue to be made at the same rate paid for face-to-face services provided on-site."
  • confirmed that providers will "reimburse medically necessary and clinically appropriate telehealth services with dates of service on or after March 9, 2020 until the public health emergency no longer exists, that meet the following requirements [synchronous telehealth service sufficiently meeting key components of face-to-face interactions]"
  • DHFS Provider Notice (03/30/20) provides additional guidance for facility fee billing, including a

$25.00 originating site facility fee


  • DHFS Medicaid Rule (04/03/20) similarly confirms reimbursement for "face-to-face services" dating back to March 9th through the COVID-19 disaster period, see Ill. Register, Vol. 44 Issue 14, pages 5772-5774
  • DHFS Provider Notice (05/20/20) provides clarification of billing instructions to Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and Encounter Rate Clinics (ERCs) for fee-for-service (FFS) reimbursement of Long-Acting Reversible Contraceptives (LARCs), FFS reimbursement of virtual check-in and e-visit services billable during the COVID-19 public health emergency, and telehealth services. These instructions do not apply to claims for participants covered under HealthChoice Illinois managed care plans and the Medicare/Medicaid Alignment Initiative (MMAI) plans
  • DHFS Updated FAQ for Illinois Medicaid Virtual Healthcare Expansion/Telehealth Emergency Rules


Additional Resources:


  • Joint Principles for Telehealth Policy that the AAFP developed in partnership with the American Academy of Pediatrics and the American College of Physicians.
  • AAFP Testimony from Dr. Davis to Senate Finance Committee - May 21, 2021
  • AAFPP Opinion: These Four Telehealth Changes Should Stay, Evan After the Pandemic
  • AAFP Backgrounder: Telehealth: Preserving Access to Telehealth Beyond COVID-19
  • Agency for Healthcare Research and Quality – Telehealth One-Pager - Google Docs
  • JAMA Viewpoint– Ensuring Quality When Providing Virtual Care
  • JAMA Viewpoint – Post-Pandemic Telehealth Payment


***Medicaid & Behavioral Health***


Senate Bill 2294


As noted by Health News Illinois, the Department of Healthcare and Family Services (DHFS), in collaboration with the Department of Human Services and other stakeholders, is required to develop a behavioral health and substance abuse strategy focused on reducing the administrative burden for patients and providers by July 2022.


HFS shall ensure inpatient coverage for Medicaid patients experiencing an opioid-related overdose or withdrawal. And, starting next year, Medicaid must reimburse at the prevailing fee schedule for long- acting injectable medications administered for mental health or substance use disorder in the hospital inpatient setting. HFS, working with managed care organizations and hospital groups, shall implement rules regarding reimbursement policy and prior authorization criteria.


HFS must also submit an application to the federal government no later than the end of 2022 to provide community-based, risk-based, and capitated long-term care services as optional services under the Illinois Title XIX State Plan and under contracts between the Centers for Medicare and Medicaid Services, HFS and PACE. All PACE organizations selected by HFS shall begin operations no later than June 30, 2024.


Included in the Medicaid omnibus bill, was a key component of House Bill 347, which increases the Vaccines for Children (VFC) reimbursement rate to 70% of the maximum allowable charge ($23.87) by


the Centers for Medicaid and Medicare Services. It would raise the fee from current rate of $6.40 to

$16.71. The language ties the rate to the Federal rate so that increases continue automatically.


IAFP helped organize a letter to DHFS in May 2021 in collaboration with the Illinois Chapter of American Academy of Pediatrics and the Illinois Hospital Association requesting that the agency assign a reasonable reimbursement to CPT codes 99492, 99493, 99494, and G0512 to comply with Public Act 101-0574 that took effect in 2020, providing targeted payments for behavioral health care in the collaborative call model.


***Budget Support for Public Health and Primary Care ***


In addition to maintaining budget appropriation increases from the last fiscal year, an additional

$350 million was appropriated this session for public health response, pandemic assistance to health care industry and behavioral health investments.