HFS Files Emergency Rules on Medicaid MCO Standardization, Transparency
After several months of intense negotiations with the Illinois Dept. of Healthcare and Family Services (HFS), the Medicaid managed care organizations (MCOs), and the Illinois Association of Medicaid Health Plans (IAMHP), HFS has filed emergency administrative rules, effective July 1, 2025, to implement the standardization and transparency provisions of the Medicaid MCO prior authorization reforms under Public Act (PA) 103-0593. To view the emergency rules, click here. An IHA memo detailing the provisions was sent to membership today.
PA 103-0593 was a significant IHA advocacy initiative passed during the spring 2024 legislative session to hold MCOs accountable for their egregious prior authorization tactics. The Act required HFS to adopt rules by July 1, 2025. The most recent Medicaid omnibus package passed by the General Assembly last month permitted HFS to file emergency rules to meet the July 1 implementation date.
While HFS has issued emergency rules effective July 1, 2025, they are required to adopt permanent rules by Oct. 1, 2025. Members will have the opportunity to submit comments once the permanent rules are published by the Joint Committee on Administrative Rules (JCAR). With regard to next steps, IHA will soon provide guidance on how to submit comments and feedback to HFS.
Staff contact: Jordan Powell
ADVOCACY ALERT: Urge U.S. House to Mitigate Harmful Senate Legislation
Yesterday, the U.S. Senate passed H.R. 1 by a 51-50 vote. The legislation now returns to the House for consideration. It is imperative that we raise awareness of the impact the Senate bill would have on Illinois patients, hospitals and communities and urge the House to VOTE NO on the Senate version and send the bill to Conference Committee to mitigate the harmful provisions of the bill. Due to the House’s self-imposed deadline of July 4th, it is critical to engage in this effort today. Please click here to access a pre-populated action alert that you can use and share with your colleagues as soon as possible. Please share this alert with your staff and encourage them to also send a message to their U.S. House member.
Staff contact: Jennifer Koehler
Upcoming: First EMTALA Compliance Webinar July 9
Federal EMTALA requirements for emergency care and patient transfers continue to evolve – bringing new compliance expectations along the way. IHA's first session of its three-part Emergency Medical Treatment and Labor Act (EMTALA) webinar series begins Wednesday, July 9 and offers an in-depth look at core EMTALA principles, recent Centers for Medicare & Medicaid Services (CMS) updates, and new federal requirements for emergency and obstetrical services.
At the end of the first webinar, you'll be able to:
- Describe basic EMTALA requirements;
- Identify why EMTALA requirements are among the most-frequently cited deficiencies in Illinois acute care hospitals;
- Outline 2024 civil monetary penalties levied against acute and critical access hospitals for EMTALA violations;
- Explain updated Conditions of Participation requirements for equipment and transfer requirements; and
- Review how hospitals can keep current on regulatory changes.
The webinar will take place from 9:30 to 11:30 a.m., followed by additional sessions on July 23 and August 6.
Registration for IHA member hospitals is $195 per webinar. Nurse continuing education credit is available. Click here to register for this informative series and stay ahead of compliance challenges.
Staff contact: Bridget McCarte
IDPH Adds More ZIP Codes to Lead Testing List
The Illinois Dept. of Public Health (IDPH) announced an expansion of its list of ZIP codes where lead exposure testing is required for children who live within those areas. Added to the list this year are 180 new zip codes, representing parts of 47 Illinois counties, bringing the total of high-risk ZIP codes to more than 1,350. By this time next year, all remaining ZIP codes in the state will be included, implementing universal childhood lead testing statewide.
Under Illinois law, any child residing in a high-risk ZIP code is to be tested automatically at 12 and 24 months. High-risk ZIP codes are determined through an algorithm that considers several different risk factors. The department has been expanding that list of ZIP codes gradually. The new expanded list, which took effect on July 1 can be found here.
