State Legislation

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As a service to our clients, CorVel is providing links to information related to the COVID-19 pandemic provided by the states.

IWCC Chairman released a statement in response to the COVID-19 outbreak.

Legislature Status: Session suspended indefinitely.

• Illinois Department of Public Health coronavirus resource page.
• April 14, 2020 – The Illinois Emergency Management Agency (IEMA) and the Illinois Department of Public Health launched a new public service campaign to remind Illinois residents to continue to follow the Stay at Home order enacted by the governor’s executive order.

Legislation

• HB 128  Amends Illinois code relating to insurance premium oversight and workers’ compensation.
  This measure is applicable to health insurers and workers’ compensation.
• HB 3558 Amends the Illinois Workers’ Compensation Act relating to an evidence-based drug formulary.
• HB 5607  Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code. Requires the Department of Public Health to conduct a study, subject to appropriations, of the state’s disease response preparedness, in particular studying the state’s preparedness against the coronavirus. At the request of the Department, requires other state agencies, in particular the Emergency Management Agency, to support the Department’s efforts. Pending.
• HB 1957 amends Illinois Insurance Code relating to group workers’ compensation pools and insurance
  producer licensing. Enacted.
• SB 1993 Transfers the powers and responsibilities of the Insurance Compliance Division to the Department of
  Insurance. Enacted.
• HB 3662 Amends the Workers’ Compensation Act to provides that, with respect to firefighters and emergency medical technicians, a contagious staph infection, including methicillin-resistant staphylococcus aureus (MRSA), is rebuttably presumed to arise out of and in the course of employment. Enacted.

 

COVID-19 Related Policies

Illinois Workers’ Compensation Commission emergency rule effective 4/16/2020: Essential Front-Line Workers

Issues: Workers’ Compensation Coverage

Summary:

The Commission has adopted emergency amendments that impact workers’ compensation and essential front-line workers. The emergency rule establishes that cases before the Commission where front-line workers or first responders are exposed to COVID-19 during the State of Emergency, will be rebuttably presumed that the individual’s exposure arises out of and in the course of their COVID-19 first responder or front-line worker employment and rebuttably presumed to be causally connected to their employment.

The rule focuses on only those workers that are first responders or essential front-line workers. Additionally, the emergency rule does not guarantee that an award of benefits to any individual who suspects he or she has contracted COVID-19 or self-isolates due to an alleged or suspected exposure to COVID-19, but instead creates a reasonable rebuttable presumption that a first responder or front-line worker’s exposure to the virus is connected to their employment. The rule specifically adds the language above under the rules of evidence requirements that apply to all proceedings before the Commission, either upon Arbitration or Review, except in cases of conflict with the Workers’ Occupational Disease Act or the Rules Governing Practice Before the Workers’ Compensation Commission.

Most Recent Update: Notice of the emergency rule was released for review. The emergency rule is effective 4/16/2020 and will expired after 150 days, unless readopted.

Illinois Regulatory Updates 06/07/2023

HB 4079 – Workers Comp-Various

Issues: Workers’ Compensation, Workers’ Compensation (General)

Summary:

This measure establishes geographic regions for workers’ compensation fee schedules. It establishes 4 regions for non-hospital fees and 14 regions for hospital fees. It sets the fees according to CPT and DRG code relative to percentages of the Medicare fee schedule, though allows for petitioning by providers if the fee is insufficient. Fees are to be set administratively within bands relative to the Medicare rate. This takes effect September 1, 2024.
It also requires development of an evidence-based workers’ compensation formulary. It allows custom compound medications for no more than 7 days unless the compound meets certain qualifications, including no commercial equivalent and a demonstration of clinical appropriateness. It bases reimbursement for these compounds on national average wholesale price, according to proportion of the component within the compound. This section takes effect September 1, 2023.

Most Recent Update:

05/10/2023 – Introduced

HB 4087 – Workers Comp-Compound Drugs 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 Be Limited to the Drugs on the Formulary. Provides That By September 1, 2023, the Commission, In Consultation With the Workers’ Compensation Medical Fee Advisory Board, Shall Adopt By Rule an Evidence-Based Drug Formulary and any Rules Necessary For Its Administration. Provides That Prescriptions Prescribed For Workers’ Compensation Cases Shall Be Limited to the Prescription Drugs and Doses on the Closed Formulary. Provides That a Custom Compound Medication For Longer Than the One Time 7-Day Supply Shall Be Approved For Payment Only If the Compound Meets Specified Standards. Provides For Charges For Custom Compound Medications. Effective Immediately. 

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure requires administrative development of an evidence-based drug formulary under the workers’ compensation system. It also sets limits on compounded drugs. It allows custom compounds in excess of 7-day amounts only if there is no readily available commercial equivalent and the components are all approved for use and have a National Drug Code number. It also outlines allowable cost, according to proportion of components within the compound. Finally, it allows dispensing fees based on actual cost. It takes effect upon enactment.

Most Recent Update:

05/11/2023 – Introduced

Illinois Regulatory Updates 3/3/2023

SB 1305 – Workers Comp-Repetitive Injury Amends the Workers’ Compensation Act. Provides That an Accidental Injury That Results from Repetitive or Cumulative Trauma and Occurs Within 6 Months After the Employee Begins Employment Shall Not Be Considered By a Workers’ Compensation Insurer In Setting Rates. Provides For Contribution By Prior Employers With Respect to Awards For Repetitive or Cumulative Injuries. Amends the Illinois Administrative Procedure Act to Authorize Emergency Rulemaking.

Issues: Workers’ Compensation, Workers’ Compensation (General)

Summary:

This measure excludes injuries from repetitive or cumulative trauma experienced in the first 6 months of employment from being considered in workers’ compensation insurance premiums. It also entitles employers to recover costs from previous employers in the event of a repetitive or cumulative injury award where a previous employer contributed to it according to their share. This is allowed for two years after the payment is made.

Most Recent Update:

2/14/2023 This measure was introduced for the 2023 legislative session. This measure has been referred to the Senate Assignments Committee. The sponsor serves on the committee of referral.    This measure is eligible for consideration in the committee of referral

HB 2145 – Dfpr-Work Comp Requirements Amends the Civil Administrative Code of Illinois (Department of Professional Regulation Law). Provides That the Department of Financial and Professional Regulation Shall Refuse the Issuance or Renewal of a License To, or Suspend or Revoke the License Of, any Individual, Corporation, Partnership, or Other Business Entity That Has Been Found By the Workers’ Compensation Commission or the Department of Insurance to Have Failed to Secure Workers’ Compensation Obligations In the Manner Required By the Workers’ Compensation Act, to Pay In Full a Fine or Penalty Imposed Due to a Failure to Secure Workers’ Compensation Obligations In the Manner Required By the Workers’ Compensation Act, or to Fulfill All Obligations Assumed Pursuant to a Settlement Reached With the Workers’ Compensation Commission or the Department of Insurance Relating to a Failure to Secure Workers’ Compensation Obligations In the Manner Required By the Workers’ Compensation Act. Provides No Initial or Renewal License Shall Be Issued, and No Suspended License Shall Be Reinstated, Until the Department Is Notified By the Workers’ Compensation Commission or the Department of Insurance That the Licensee’s or Applicant’s Failure to Comply With the Workers’ Compensation Act Has Been Corrected or Otherwise Resolved to the Satisfaction of the Workers’ Compensation Commission or the Department of Insurance. Provides That an Application to Make Disciplinary Records Confidential Shall Also Be Considered By the Department For an Offense or Action Relating To: Failure to Comply With Workers’ Compensation Requirements or Reprimand of a Licensee. Makes Corresponding Changes to the Asbestos Abatement Act, the Lead Poisoning Prevention Act, and the Illinois Plumbing License Law. Effective January 1, 2024.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure allows revocation of licenses from any business, individual, corporation, etc that fails to meet workers’ compensation obligations, including fees and settlements. It takes effect January 1, 2024.

Most Recent Update:

2/14/2023 This measure was introduced for the 2023 legislative session. This measure is eligible for committee referral.

HB 2345 – Workers Comp-Spinal Injury Amends the Workers’ Compensation Act. Provides That For Purposes of Computing Compensation For an Employee Who Had a Prior Compensated Injury to the Spine, the Prior Compensation Shall Be Deducted from Compensation Awarded For a Subsequent Injury to the Same Part of the Spine. Effective Immediately.

Issues: Workers’ Compensation (General)

Summary:

This measure provides that compensation for an employee who had a prior compensated spine injury, the prior compensation shall be deducted from compensation awarded for a subsequent injury to the same part of the spine. It takes effect upon enactment.

Most Recent Update:

03/01/2023 – This measure is scheduled for a hearing on March 1 in the House Labor and Commerce Committee.The Illinois legislature is meeting in-person for the 2023 legislative session. Anyone wishing to testify may do so in-person or virtually by submitting written testimony to the committee email. Testimony must be submitted in advance of the hearing. A vote may occur at the discretion of the Chair. The measure may be referred to multiple committees.

HB 3501 – Work Comp-Disability Benefits Amends the Workers’ Compensation Act. Provides That an Employee Who Has Been Employed For at Least 4 Weeks By an Employer and Becomes Physically or Mentally Incapacitated to Perform the Duties of His or Her Position Shall Receive a Temporary Disability Benefit, Provided That Proper Proof Is Received from One or More Licensed Health Care Professionals Designated By the Illinois Workers’ Compensation Commission Certifying That the Employee Is Mentally or Physically Incapacitated. Provides That the Temporary Disability Benefit Shall Be 50% of the Employee’s Final Average Compensation at the Date of Disability. Provides That the Commission Shall Adopt Rules Governing the Filing of Claims For Temporary Disability Benefits, and the Investigation, Control, and Supervision of Those Claims.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure provides that an employee who has been employed for at least 4 weeks by an employer and becomes physically or mentally incapacitated to perform the duties of his or her position will receive a temporary disability benefit. To receive this benefit, the incapacitated employee must provide proper proof from one or more licensed health care professionals. The temporary benefit will be 50% of the employee’s final average compensation at the date of disability. This measure will go into effect January 1 / June 1 following enactment before / after May 31 respectively.

Most Recent Update:

2/21/2023 This measure was introduced for the 2023 legislative session. This measure is eligible for committee referral.

HB 3408 – Workers Comp-Review-Collateral Amends the Workers’ Compensation Act. Provides That, When a Bond Is Required Because a Party Against Whom the Illinois Workers’ Compensation Commission Rendered an Award For the Payment of Money Seeks Judicial Review of the Award, the Bond Requirement May Be Satisfied By Posting Collateral or Guarantee of Payment, Which May Include an Insurance Policy, a Certificate of Self-Insurance, or Funds In an Escrow Account. Effective Immediately.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure requires the appealing party in a workers’ compensation case to post collateral or guarantee of payment of the award if the review is not successfully prosecuted. It takes effect upon enactment.

Most Recent Update:

2/28/2023 On February 17, this measure was introduced to the House chamber. This measure is eligible for committee referral and consideration in the House chamber.

Illinois Regulatory Updates 2/3/2022

HB 4630 – Workers Comp-Presumption Amends the Workers’ Compensation Act. Provides That the Rebuttable Presumption Concerning Specified Conditions or Impairments of Health of an Employee Employed As a Firefighter, Emergency Medical Technician, Emergency Medical Technician-Intermediate, Advanced Emergency Medical Technician, or Paramedic Is Intended to Shift the Burden of Proof to the Employing Entity and any Party Attacking the Presumption Must Establish By Clear and Convincing Evidence an Independent and Non-Work Related Cause For the Condition or Disability and Prove That No Aspect of the Employment Contributed to the Condition. Provides That the Rebuttable  Presumption Relating to Hearing Loss Cannot Be Overcome With Evidence Allegedly Showing That the Injured Employee Did Not Meet Specified Exposure Thresholds.

Issues: Workers’ Compensation (Medical Coverage and Reimbursement), Workers’ Compensation (General)

Summary:

This measure amends the Workers’ Compensation Law to shift the burden of proof from certain emergency personnel to the employer. This measure amends the Workers’ Compensation Law. to shift the burden of proof from firefighters, emergency medical technicians, emergency medical technicians, or paramedics to the employer. The employer, and any party attacking the presumption, must prove that an independent and non-work-related injury cause caused the condition and not the employment itself. Hearing loss cannot be overcome with evidence showing that the injured employee did not meet the specified exposure thresholds. This measure is effective January 1, 2023, if enacted before June 1, 2022. This measure is effective June 1, 2023, if enacted after May 31, 2022.

Most Recent Update:

1/21/2022 This measure has been referred to the House Committee on Rules, where Representative Greg Harris (D) serves as Chair. The sponsor does not serve on the committee of referral. This measure awaits consideration from the Committee of referral.

Illinois Regulatory Updates 10/4/2021

HB 3662 – Worker Comp MRSA Presumption Amends the Workers’ Compensation Act. Provides That, With Respect to Firefighters and Emergency Medical Technicians, a Contagious Staph Infection, Including Methicillin-Resistant Staphylococcus Aureus (MRSA), Is Rebuttably Presumed to  Arise Out of and In the Course of Employment.

Issues: Workers’ Compensation (General)

Summary:

This measure amends Illinois Insurance Code relating to group workers’ compensation pools and insurance producer licensing. This measure changes the filing due date applicable to actuarial opinions as to the sufficiency of the loss and loss adjustment expense reserves for group workers’ compensation pools from  June 1 to March 1 of each year. Additionally, this measure provides that an insurer must ensure that it has complied with the financial requirements and treatment limitations applicable to mental, emotional, nervous, or substance use disorder or condition benefits prior to policy issuance. The measure also provides that pre-licensing course of study hours required to be completed in a classroom setting in order to obtain an insurance producer license may also be completed in a webinar setting. This measure goes into effect on July 23.

Most Recent Update:

7/23/2021 This measure was signed by Governor JB Pritzker (D). This measure became effective immediately.

Illinois Regulatory Updates 9/1/2021

HB 1957 – Ins-Various Amends the Illinois Insurance Code

Issues: Workers’ Compensation (General)

Summary:

This measure amends Illinois Insurance Code relating to group workers’ compensation pools and insurance producer licensing. This measure changes the filing due date applicable to actuarial opinions as to the sufficiency of the loss and loss adjustment expense reserves for group workers’ compensation pools from June 1 to March 1 of each year. Additionally, this measure provides that an insurer must ensure that it has complied with the financial requirements and treatment limitations applicable to mental, emotional, nervous, or substance use disorder or condition benefits prior to policy issuance. The measure also  provides that pre-licensing course of study hours required to be completed in a classroom setting in order to obtain an insurance producer license may also be completed in a webinar setting. This measure goes into effect on July 23.

Most Recent Update:

7/23/2021 This measure was signed by Governor JB Pritzker (D). This measure became effective immediately.

SB 1993 – Insurance Compliance Division Amends the Department of Insurance Law of the Civil Administrative Code of Illinois By Transferring All Powers, Duties, Rights, Responsibilities, Personnel, Books, Records, Papers, Documents, Property (Real and Personal), Contracts, Causes of  Action, and Pending Business of the Insurance Compliance Division Within the Illinois Workers’ Compensation Commission to the Department of Insurance. Provides That, When Reports or Notices Are to Be Made or Given or Papers or Documents Furnished or Served By any Person to or Upon the Insurance Compliance Division, They Shall Be Made, Given, Furnished, or Served In the Same Manner to or Upon the Department of Insurance. Provides That the Amendatory Act Does Not Affect any Act Done, Ratified, or Canceled, any Right Occurring or Established, or any Action or Proceeding Had or Commenced In an Administrative, Civil, or Criminal Cause By the Insurance Compliance Division Before the Amendatory Act Takes Effect. Makes Other Changes. Amends the Workers’ Compensation Act. Replaces References to the Insurance  Compliance Division With References to the Department of Insurance. In Provisions Concerning Department of Insurance Oversight, Changes the Date Before Which Insurers Licensed to Write Workers Compensation Coverage In the State Must Record and Report Specified Information Concerning Claims from March 1 to June 1 of Each Year. Deletes a Provision Stating That the Fraud and Insurance Non-Compliance Unit Shall Procure and Implement a System Using Advanced Analytics For the Detection and Prevention of Fraud, Waste, and Abuse. Effective July 1, 2021.

Issues: Workers’ Compensation (General)

Summary:

This measure amends Illinois Insurance Code relating to group workers’ compensation pools and insurance producer licensing. This measure changes the filing due date applicable to actuarial opinions as to the sufficiency of the loss and loss adjustment expense reserves for group workers’ compensation pools from June 1 to March 1 of each year. Additionally, this measure provides that an insurer must ensure that it has complied with the financial requirements and treatment limitations applicable to mental, emotional, nervous, or substance use disorder or condition benefits prior to policy issuance. The measure also  provides that pre-licensing course of study hours required to be completed in a classroom setting in order to obtain an insurance producer license may also be completed in a webinar setting. This measure goes into effect on July 23.

Most Recent Update:

6/25/2021 : This measure was signed by Governor JB Pritzker (D). This measure became effective on July 1, 2021.

Illinois Regulatory Updates 8/5/2021

HB 128 

Issues: Workers’ Compensation (Prescription Drug Formulary), Workers’ Compensation (General)

Summary:

This measure amends Illinois code relating to insurance premium oversight and workers’ compensation. This measure is applicable to health insurers and workers’ compensation. See Update 2/2/2021 for full summary.

Most Recent Update:

6/1/2021 This measure has been carried over to the 2022 Legislative Session. In Illinois, all bills and resolutions introduced in odd numbered years are automatically carried over to the next legislative session. All bills will retain their chamber status but will have to be re-referred to committee and go through the committee process again.

HB 3558 – Worker Comp-Drug Formulary Amends the Workers’ Compensation Act.

Issues: Workers’ Compensation (Prescription Drug Formulary), Workers’ Compensation (General)

Summary:

This measure amends the Illinois Workers’ Compensation Act relating to an evidence-based drug formulary. See Update 6/3/2021 for full summary.

Most Recent Update: 

6/1/2021 This measure has been carried over to the 2022 Legislative Session. In Illinois, all bills and resolutions introduced in odd numbered years are automatically carried over to the next legislative session. All bills will retain their chamber status but will have to be re-referred to committee and go through the committee process again.

HB 3560 – Workers Comp-Compound Drugs Amends the Workers’ Compensation Act In Relation to Custom Compound Medications.

Issues: Workers’ Compensation (Compounded Drug Limits), Workers’ Compensation (General)

Summary:

This measure amends statute to modify workers’ compensation for compounded drugs. See Update 6/3/2021 for full summary.

Most Recent Update: 

6/1/2021 This measure has been carried over to the 2022 Legislative Session. In Illinois, all bills and resolutions introduced in odd numbered years are automatically carried over to the next legislative session. All bills will retain their chamber status but will have to be re-referred to committee and go through the committee process again.

Illinois Regulatory Updates 6/3/2021

HB 3558 – Worker Comp-Drug Formulary Amends the Workers’ Compensation Act.

Issues: Workers’ Compensation (Prescription Drug Formulary), Workers’ Compensation (General)

Summary:

This measure amends the Illinois Workers’ Compensation Act relating to an evidence-based drug formulary. This measure applies to workers’ compensation. This measure provides that by September 1, 2022, the Illinois Workers’ Compensation Commission, in consultation with the Workers’ Compensation Medical Fee Advisory Board, is required to promulgate an evidence-based drug formulary. Prescriptions prescribed for workers’ compensation cases must be limited to the prescription drugs and doses on the closed formulary.

Most Recent Update: 

3/26/2021 This measure was heard in the House Labor and Commerce Committee, chaired by Representative Evans (D). No action was reported from the hearing. This measure awaits further consideration in the committee of referral.

HB 3560 – Workers Comp-Compound Drugs Amends the Workers’ Compensation Act In Relation to Custom Compound Medications.

Issues: Workers’ Compensation (Compounded Drug Limits), Workers’ Compensation (General)

Summary:

This measure amends statute to modify workers’ compensation for compounded drugs. This measure is applicable to workers’ compensation. This measure provides that charges must be based upon the specific amount of each compounded drug and its original manufacturer’s National Drug Code number. A provider may prescribe a one-time 7-day supply unless a prescription for more than 7 days is preauthorized by the employer. This measure takes effect upon enactment.

Most Recent Update: 

3/26/2021 This measure was heard in the House Labor and Commerce Committee, chaired by Representative Evans (D). No action was reported from the hearing. This measure awaits further consideration in the committee of referral.

Illinois Regulatory Updates 4/2/2021

HB 3558 – Worker Comp-Drug Formulary Amends the Workers’ Compensation Act.

Issues: Workers’ Compensation (Prescription Drug Formulary), Workers’ Compensation (General)

Summary:

This measure amends the Illinois Workers’ Compensation Act relating to an evidence-based drug formulary. This measure applies to workers’ compensation. This measure provides that by September 1, 2022, the Illinois Workers’ Compensation Commission, in consultation with the Workers’ Compensation Medical Fee Advisory Board, is required to promulgate an evidence-based drug formulary. Prescriptions prescribed for workers’ compensation cases must be limited to the prescription drugs and doses on the closed formulary.

Most Recent Update: 

3/26/2021 This measure is scheduled to be heard on March 26 in the House Labor and Commerce Committee, chaired by Representative Evans (D). Committee meetings are not open to the public, but testimony and attendance may be done through zoom. Witness slips with position can be submitted through https://my.ilga.gov/ until the end of the meeting. A vote may occur at the hearing. A measure may be referred to more than one committee.

HB 3560 – Workers Comp-Compound Drugs Amends the Workers’ Compensation Act In Relation to Custom Compound Medications.

Issues: Workers’ Compensation (Compounded Drug Limits), Workers’ Compensation (General)

Summary:

This measure amends statute to modify workers’ compensation for compounded drugs. This measure is applicable to workers’ compensation. This measure provides that charges must be based upon the specific amount of each compounded drug and its original manufacturer’s National Drug Code number. A provider may prescribe a one-time 7-day supply unless a prescription for more than 7 days is preauthorized by the employer. This measure takes effect upon enactment.

Most Recent Update: 

3/26/2021 This measure is scheduled to be heard on March 26 in the House Labor and Commerce Committee, chaired by Representative Evans (D). Committee meetings are not open to the public, but testimony and attendance may be done through zoom. Witness slips with position can be submitted through https://my.ilga.gov/ until the end of the meeting. A vote may occur at the hearing. A measure may be referred to more than one committee.

Illinois Regulatory Updates 2/2/2021

HB 128 

Issues: Workers’ Compensation (Prescription Drug Formulary), Workers’ Compensation (General)

Summary:

This measure amends Illinois code relating to insurance premium oversight and workers’ compensation. This measure is applicable to health insurers and workers’ compensation.

Insurance  Premiums:
This measure provides that premiums cannot be excessive. An excessive premium is one that is likely to produce a profit that is unreasonably high for the insurance provided, or if expenses are unreasonably high for the coverage or services rendered. This measure allows enrollees to file a request for a review of a premium with the Director of Insurance. The Director has the power to deem premiums as no longer effective if they do not meet the standards of this measure. An insurer whose premium has been denied will be given a hearing upon a written request within 30 days. The Director has the authority to order an adjustment to the premium, and the insurer must refund the enrollee the amount found to be excessive.

Workers’ Compensation:
This measure provides that accidental injuries sustained while traveling to or from work do not arise out of and in the course of employment. The exception to this is when an employee is required to travel away from the premise of employment in order to perform their job, or when the conduct in which he or she was engaged in at the time of injury is reasonable and may have been anticipated or foreseen by the  employer.

This measure also establishes safety programs and return to work programs. This measure provides that any accidental injury which results from repetitive or cumulative trauma within 3 months of employment, will not be considered by a workers’ compensation insurer in setting the premium rate for the employer. This measure also establishes an evidence-based drug formulary. Prescriptions prescribed for workers’ compensation claims are required to be limited to those prescriptions and non-prescription drugs and doses on the closed formulary.

Additionally, the Commission is required to submit an annual report to the Governor and General Assembly on the details of the state of self-insurance for workers’ compensation. This measure establishes a Workers’ Compensation Premium Rates Task Force. If enacted, this measure will take immediate effect.

Most Recent Update:

1/20/2021 A motion has been filed by the sponsor to table this measure. This measure awaits further consideration before the House.

Illinois Regulatory Updates 07/01/2020

SB 3433 – Work Comp Impairment Standard Amends the Workers’ Compensation Act

Issues: Workers’ Compensation (Medical Marijuana), Workers’ Compensation (Medical Coverage And Reimbursement)

Summary:

The measure stipulates that the presence of 5 nanograms of tetrahydrocannabinol in the blood or 10 nanograms of tetrahydrocannabinol in other bodily substances shall create a rebuttable presumption that intoxication is the proximate cause of the injury.

Authorized use may be evidenced only by written consent by the employer to the employee, which consent willl not be unreasonably withheld.

This measure will be effective upon enactment.

Most Recent Update: On June 24, this measure was referred to the Senate Assignments Committee per Senate Rule 3-9(b). This measure is eligible for committee consideration.

 

Illinois Regulatory Updates 05/01/2020

HB 2480 – WORKER COMP-MRSA/HEARING LOSS

Issues: Workers’ Compensation (Medical Coverage And Reimbursement)

Summary:

This measure provides that all managed care plans shall ensure that all claims and indemnities concerning health care services shall be paid within 30 days after receipt of a claim that has provided specified information on a CMS-1500 Health Insurance Claim Form or a UB-04 (CMS-1450) form.

This measure provides that certain health care providers shall be notified of any known failure of the claim and provide detailed information on how the claim may be satisfied to receive payment within 30 days after receipt. This measure provides that any undisputed portions of a claim must be reimbursed by the managed care plan within 30 days after receipt.

This measure grants the Department of Insurance specific authority to issue a cease and desist order, fine, or otherwise penalize managed care plans that violate provisions concerning timely payment for health care services. This measure provides that a policy issued or delivered to the Department of Healthcare and Family Services that provides coverage to certain persons is subject to the provisions concerning timely payment for health care services.

Most Recent Update: House Floor Amendment No. 2 was heard on March 4 in the House Labor & Commerce Committee, where it was recommended for adoption by a vote of 30-0. This measure and amendment are eligible for consideration in the House.

 

Illinois Regulatory Updates 03/01/2020

SB 2530 – Workers’ Comp-Pstd-Ems-Police Amends the Workers’ Compensation Act.

Issues: Workers’ Compensation (Medical Coverage And Reimbursement)

Summary:

This measure provides for workers’ compensation coverage for PTSD in certain public safety employees.

This measure stipulates that any emergency services personnel, public safety personnel, or individuals licensed as emergency medical services personnel under the Emergency Medical Services (EMS) Systems Act who has been diagnosed by a licensed psychiatrist with post-traumatic stress disorder is entitled to benefits under the Workers’ Compensation Act.

The measure also requires the Illinois Workers’ Compensation Commission to ensure that services provided under the amendatory Act comply with all applicable federal parity regulations including, but not limited to, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

Under the measure, “post-traumatic stress disorder” or “PTSD” means a disorder that meets the diagnostic criteria for PTSD specified by the American Psychiatric Association in its most recent edition of the Diagnostic and Statistical Manual of Mental Disorders adopted by the Illinois Workers’ Compensation Commission and that is caused by an event occurring in the course and scope of one’s employment.

Most Recent Update: On February 4, 2020, this measure was assigned to the Senate Judiciary Committee. This measure awaits committee consideration at the discretion of the Chair.

 

Illinois Regulatory Updates 01/02/2020

HB 2587 – An act concerning employment.

Issues: Workers’ Compensation (Opioid Limits), Workers’ Compensation (Prescription Drug Formulary)

Summary:

This measure requires a recipient of certain pain management medication to sign a written agreement with the prescribing physician agreeing to comply with the conditions of the prescription.

This measure prohibits additional prescriptions while the recipient is noncompliant. This measure limits the applicability of the lack of pain management as a consideration in awarding benefits. This measure provides for the disclosure of violations of the agreement upon request by the employer. This measure requires a prescribing physician to file quarterly reports to obtain payment.

Most Recent Update: This measure is eligible to be carried over to the 2020 Legislative Session. In Illinois, the Legislature’s rules allow for measures to be carried over from regular sessions in odd-numbered years to regular sessions in even-numbered years. All bills and resolutions are referred to either the House Rules Committee or the Senate Assignments Committee.

The status of each measure and resolution will be the same at the beginning of the next regular session as it was immediately before the adjournment of the previous regular session. The Illinois Legislature is expected to convene for the 2020 Legislative Session in January.\

HB 2635 – AN ACT concerning employment.

Issues: Workers’ Compensation (General), Workers’ Compensation (Medical Coverage And Reimbursement)

Summary:

This measure relates to workers’ compensation.

This measure removes language requiring employers to make payments on annual adjustments to the compensation rate in awards for permanent total disability for every accident occurring on or after July 20, 2005 but before November 11, 2005.

This measure directs the Workers’ Compensation Medical Fee Advisory Board to develop a fee payment schedule for procedures, treatments, and services covered under the Act based upon fees for such procedures, treatments, and services authorized under Medicare.

Most Recent Update: This measure is eligible to be carried over to the 2020 Legislative Session.

In Illinois, the Legislature’s rules allow for measures to be carried over from regular sessions in odd-numbered years to regular sessions in even-numbered years. All bills and resolutions are referred to either the House Rules Committee or the Senate Assignments Committee. The status of each measure and resolution will be the same at the beginning of the next regular session as it was immediately before the adjournment of the previous regular session. The Illinois Legislature is expected to convene for the 2020 Legislative Session in January.

HB 2792 – WORKERS COMP-FEE SCHEDULE

Issues: Workers’ Compensation (Pharmacy Fee Schedule), Workers’ Compensation (General)

Summary:

This measure makes existing medical fee schedules inoperative after August 31, 2020 and stipulates that the Illinois Workers’ Compensation Commission must establish new medical fee schedules applicable on and after September 1, 2020 in accordance with specified criteria.

This measure provides for non-hospital fee schedules and hospital fee schedules applicable to different geographic areas of the State.

The measure sets forth a procedure for petitioning the Commission if a maximum fee causes a significant limitation on access to quality health care in either a specific field of health care services or a specific geographic limitation on access to health care.

Most Recent Update: This measure is eligible to be carried over to the 2020 Legislative Session.

In Illinois, the Legislature’s rules allow for measures to be carried over from regular sessions in odd-numbered years to regular sessions in even-numbered years. All bills and resolutions are referred to either the House Rules Committee or the Senate Assignments Committee. The status of each measure and resolution will be the same at the beginning of the next regular session as it was immediately before the adjournment of the previous regular session. The Illinois Legislature is expected to convene for the 2020 Legislative Session in January.

HB 2794 – AN ACT concerning employment.

Issues: Workers’ Compensation (Compounded Drug Limits), Workers’ Compensation (Prescription Drug Formulary)

Summary:

This measure relates to compounded medication within the workers’ compensation program.

This measure stipulates a custom compound medication for longer than the one-time 7-day supply described in must be approved for payment only if the compound meets all of the following standards:

(1) there is no readily available commercially manufactured equivalent product;

(2) no other Food and Drug Administration approved alternative drug is appropriate for the patient;

(3) the active ingredients of the compound each have a National Drug Code number, are components of drugs approved by the Food and Drug Administration, and the active ingredients in the custom compound medication are being used for diagnosis or conditions approved use by the Food and Drug Administration and not being used for off-label use;

(4) the drug has not been withdrawn or removed from the market for safety reasons; and

(5) the prescriber is able to demonstrate to the payer that the compound medication is clinically appropriate for the intended use.

Custom compound medications must be charged using the specific amount of each component drug and its original manufacturer’s National Drug Code number included in the compound. Charges must be based on a maximum charge of the AWP based upon the original manufacturer’s National Drug Code number, as published by Red Book or Medi-Span and prorated for each component amount used. If the National Drug Code for the compound ingredient is a repackaged drug, the maximum allowable fee for the repackaged drug must be determined by the National Drug Code and the average wholesale price of the underlying original manufacturer. Components without National Drug Code numbers must not be charged.

A single dispensing fee for a custom compound medication as determined by the Commission based on the actual costs of preparing and dispensing the custom compound medication must be paid. The dispensing fee for a compound prescription must be billed with code WC 700-C. The provider may prescribe a one-time 7-day supply. Any custom compound medication prescriptions for more than 7 days must be preauthorized by the employer. Under all circumstances, if the compound medication meets the requirements in a 7-day supply must be covered.

Most Recent Update: This measure is eligible to be carried over to the 2020 Legislative Session. In Illinois, the Legislature’s rules allow for measures to be carried over from regular sessions in odd-numbered years to regular sessions in even-numbered years. All bills and resolutions are referred to either the House Rules Committee or the Senate Assignments Committee. The status of each measure and resolution will be the same at the beginning of the next regular session as it was immediately before the adjournment of the previous regular session. The Illinois Legislature is expected to convene for the 2020 Legislative Session in January.

 

HB 2795 – AN ACT concerning employment.

Issues: Workers’ Compensation (Prescription Drug Formulary), Workers’ Compensation (General)

Summary:

This measure addresses a prescription drug formulary within the workers’ compensation program.

This measure stipulates, by September 1, 2020, the Workers’ Compensation Commission, in consultation with the Workers’ Compensation Medical Fee Advisory Board, must promulgate by rule an evidence-based drug formulary and any rules necessary for its administration. Prescriptions prescribed for workers’ compensation cases shall be limited to the prescription drugs and doses on the closed formulary.

Most Recent Update:

This measure is eligible to be carried over to the 2020 Legislative Session. In Illinois, the Legislature’s rules allow for measures to be carried over from regular sessions in odd-numbered years to regular sessions in even-numbered years. All bills and resolutions are referred to either the House Rules Committee or the Senate Assignments Committee.

The status of each measure and resolution will be the same at the beginning of the next regular session as it was immediately before the adjournment of the previous regular session. The Illinois Legislature is expected to convene for the 2020 Legislative Session in January.

SB 1596 – WORKERS’ COMPENSATION REPOSE

Issues: Workers’ Compensation (Medical Coverage And Reimbursement), Workers’ Compensation (General)

Summary:

This measure provides that sections limiting recovery do not apply to injuries or death resulting from an occupational

disease.

This measure provides that sections limiting recovery do not apply to injuries or death resulting from an occupational disease as to which the recovery of compensation benefits would be precluded due to the operation of any period of repose or repose provision. This measure provides that, as to any such injury occupational disease, the employee, the employee’s heirs, and any person having the standing under law to bring a civil action at law has the nonwaivable right to bring such an action against any employer or employers.

Most Recent Update: This measure has been signed by Governor J. B. Pritzker (D).

This measure is effective immediately.

 

Illinois Regulatory Updates 08/01/2019

HB 269 – Relating to workers’ compensation and the ability to pay

Issues: Workers’ Compensation (Medical Coverage And Reimbursement), Workers’ Compensation (General)

Summary:

This measure amends the Workers’ Compensation Act.

Specifically, this measure permits a single commissioner to approve of enforcement actions under provisions of the Act concerning insuring an employer’s ability to pay compensation, replacing the current requirement of a panel of 3 commissioners. This measure permits the Illinois Workers’ Compensation Commission to, if an employer’s business is declared to be extra hazardous, issue a work-stop order while awaiting a ruling from the Commission or while awaiting proof of insurance by the employer. This measure provides that investigative actions must be acted upon within 90 days of the issuance of a complaint. Raises the maximum allowable penalty for noncompliance with certain insurance requirements from $2,000 to $10,000. Doubles the maximum allowable penalties, to $1,000 per day, with a minimum penalty of $20,000, for employers found to be in noncompliance more than once. This measure provides that an employer with 2 or more violations may no longer self-insure or purchase an insurance policy from a private broker for one year or until all penalties are paid, during which time the employer must purchase insurance from the Assigned Risk Pool through the National Council on Compensation Insurance.

Most Recent Update: This measure has been signed by Governor J.B. Pritzker (D). This measure is effective January 1, 2020.

 

Illinois Regulatory Updates 07/01/2019

HB 13 – Relating to prescription data privacy.

Issues: Workers’ Compensation (Utilization Review And Appeals)

Summary:

This measure prohibits the licensure, transference, use, or sale of any records relative to prescription information except in certain circumstances.

This measure prohibits the licensure, transference, use, or sale of any records relative to prescription information containing patient-identifiable or prescriber-identifiable data by an licensee or registrant for commercial purposes, except in certain instances. These purposes include:

1) Pharmacy reimbursement

2) Formulary compliance

3) Care management

4) Utilization review by a health care provider, the patient’s insurance provider, or the agent of either

5) Health care research

6) Any other purpose provided by the law

Most Recent Update: This measure failed to meet the applicable deadline and was re-referred to the Senate Assignments Committee pursuant to Rule 3-9(a). This measure is unlikely to receive further consideration this session, unless the Chair of the Senate Assignments Committee re-refers the measure to a policy committee. This measure may be brought up again in next year’s session.

 

Illinois Regulatory Updates 6/3/2019

SB 1596 – WORKERS’ COMPENSATION REPOSE

Issues: Workers’ Compensation (General), Workers’ Compensation (Medical Coverage And Reimbursement)

Summary:

This measure provides that sections limiting recovery do not apply to injuries or death resulting from an occupational disease.

This measure provides that sections limiting recovery do not apply to injuries or death resulting from an occupational disease as to which the recovery of compensation benefits would be precluded due to the operation of any period of repose or repose provision. This measure provides that, as to any such injury occupational disease, the employee, the employee’s heirs, and any person having the standing under law to bring a civil action at law has the nonwaivable right to bring such an action against any employer or employers.

Most Recent Update: This measure has been signed by Governor J. B. Pritzker (D).

This measure is effective immediately.

 

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