Illinois 2023-2024 Regular Session

Illinois Senate Bill SB3781 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3781 Introduced 2/9/2024, by Sen. Karina Villa SYNOPSIS AS INTRODUCED: New Act215 ILCS 5/370c.3 new305 ILCS 5/5-55 new Creates the Nonopioid Alternatives for Pain Act. Requires the Department of Public Health to develop and publish an educational pamphlet regarding the use of nonopioid alternatives for pain treatment. Provides that a health care practitioner shall exercise professional judgment in selecting appropriate treatment modalities for pain in accordance with specified Centers for Disease Control and Prevention guidelines, including the use of nonopioid alternatives whenever nonopioid alternatives exist. Requires a health care practitioner who prescribes an opioid drug to provide certain information to the patient, discuss certain topics, and document the reasons for the prescription. Requires the Department to develop a nonopioid directive form for patients. Sets forth provisions concerning exceptions, execution of a nonopioid directive, opioid administration to a patient with a nonopioid directive, and limitations of liability. Amends the Illinois Insurance Code. Provides that when a licensed health care practitioner prescribes a nonopioid medication for the treatment of acute pain, it shall be unlawful for a health insurance issuer to deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug or to require the patient to try an opioid prescription drug before providing coverage. Provides that in establishing and maintaining its drug formulary, a health insurance issuer shall ensure that no nonopioid drug approved by the Food and Drug Administration for the treatment or management of pain shall be disadvantaged or discouraged, with respect to coverage or cost sharing, relative to any opioid or narcotic drug for the treatment or management of pain. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that whenever a licensed health care practitioner prescribes a nonopioid medication for the treatment of acute pain, neither the Department of Healthcare and Family Services nor a managed care organization shall deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug or require a patient to try an opioid prescription drug prior to providing coverage of the nonopioid prescription drug. Makes other changes. LRB103 39079 RPS 69217 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3781 Introduced 2/9/2024, by Sen. Karina Villa SYNOPSIS AS INTRODUCED: New Act215 ILCS 5/370c.3 new305 ILCS 5/5-55 new New Act 215 ILCS 5/370c.3 new 305 ILCS 5/5-55 new Creates the Nonopioid Alternatives for Pain Act. Requires the Department of Public Health to develop and publish an educational pamphlet regarding the use of nonopioid alternatives for pain treatment. Provides that a health care practitioner shall exercise professional judgment in selecting appropriate treatment modalities for pain in accordance with specified Centers for Disease Control and Prevention guidelines, including the use of nonopioid alternatives whenever nonopioid alternatives exist. Requires a health care practitioner who prescribes an opioid drug to provide certain information to the patient, discuss certain topics, and document the reasons for the prescription. Requires the Department to develop a nonopioid directive form for patients. Sets forth provisions concerning exceptions, execution of a nonopioid directive, opioid administration to a patient with a nonopioid directive, and limitations of liability. Amends the Illinois Insurance Code. Provides that when a licensed health care practitioner prescribes a nonopioid medication for the treatment of acute pain, it shall be unlawful for a health insurance issuer to deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug or to require the patient to try an opioid prescription drug before providing coverage. Provides that in establishing and maintaining its drug formulary, a health insurance issuer shall ensure that no nonopioid drug approved by the Food and Drug Administration for the treatment or management of pain shall be disadvantaged or discouraged, with respect to coverage or cost sharing, relative to any opioid or narcotic drug for the treatment or management of pain. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that whenever a licensed health care practitioner prescribes a nonopioid medication for the treatment of acute pain, neither the Department of Healthcare and Family Services nor a managed care organization shall deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug or require a patient to try an opioid prescription drug prior to providing coverage of the nonopioid prescription drug. Makes other changes. LRB103 39079 RPS 69217 b LRB103 39079 RPS 69217 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3781 Introduced 2/9/2024, by Sen. Karina Villa SYNOPSIS AS INTRODUCED:
3	3	New Act215 ILCS 5/370c.3 new305 ILCS 5/5-55 new New Act 215 ILCS 5/370c.3 new 305 ILCS 5/5-55 new
4	4	New Act
5	5	215 ILCS 5/370c.3 new
6	6	305 ILCS 5/5-55 new
7	7	Creates the Nonopioid Alternatives for Pain Act. Requires the Department of Public Health to develop and publish an educational pamphlet regarding the use of nonopioid alternatives for pain treatment. Provides that a health care practitioner shall exercise professional judgment in selecting appropriate treatment modalities for pain in accordance with specified Centers for Disease Control and Prevention guidelines, including the use of nonopioid alternatives whenever nonopioid alternatives exist. Requires a health care practitioner who prescribes an opioid drug to provide certain information to the patient, discuss certain topics, and document the reasons for the prescription. Requires the Department to develop a nonopioid directive form for patients. Sets forth provisions concerning exceptions, execution of a nonopioid directive, opioid administration to a patient with a nonopioid directive, and limitations of liability. Amends the Illinois Insurance Code. Provides that when a licensed health care practitioner prescribes a nonopioid medication for the treatment of acute pain, it shall be unlawful for a health insurance issuer to deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug or to require the patient to try an opioid prescription drug before providing coverage. Provides that in establishing and maintaining its drug formulary, a health insurance issuer shall ensure that no nonopioid drug approved by the Food and Drug Administration for the treatment or management of pain shall be disadvantaged or discouraged, with respect to coverage or cost sharing, relative to any opioid or narcotic drug for the treatment or management of pain. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that whenever a licensed health care practitioner prescribes a nonopioid medication for the treatment of acute pain, neither the Department of Healthcare and Family Services nor a managed care organization shall deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug or require a patient to try an opioid prescription drug prior to providing coverage of the nonopioid prescription drug. Makes other changes.
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10	10	A BILL FOR
11	11	SB3781LRB103 39079 RPS 69217 b SB3781 LRB103 39079 RPS 69217 b
12	12	SB3781 LRB103 39079 RPS 69217 b
13	13	1 AN ACT concerning health.
14	14	2 Be it enacted by the People of the State of Illinois,
15	15	3 represented in the General Assembly:
16	16	4 Section 1. Short title. This Act may be cited as the
17	17	5 Nonopioid Alternatives for Pain Act.
18	18	6 Section 3. Findings. The General Assembly finds that every
19	19	7 competent adult has the fundamental right of
20	20	8 self-determination regarding decisions pertaining to that
21	21	9 adult's own health, including the right to refuse an opioid
22	22	10 drug.
23	23	11 Section 5. Definitions. As used in this Act:
24	24	12 "Department" means the Department of Public Health.
25	25	13 "Emergency medical services personnel" has the meaning
26	26	14 given to that term in Section 3.5 of the Emergency Medical
27	27	15 Services (EMS) Systems Act.
28	28	16 "Health care practitioner" means a person licensed or
29	29	17 registered by the Department of Financial and Professional
30	30	18 Regulation under the following Acts: the Medical Practice Act
31	31	19 of 1987, the Nurse Practice Act, the Clinical Psychologist
32	32	20 Licensing Act, the Illinois Optometric Practice Act of 1987,
33	33	21 the Illinois Physical Therapy Act, the Pharmacy Practice Act,
34	34	22 the Physician Assistant Practice Act of 1987, the Clinical
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38	38	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3781 Introduced 2/9/2024, by Sen. Karina Villa SYNOPSIS AS INTRODUCED:
39	39	New Act215 ILCS 5/370c.3 new305 ILCS 5/5-55 new New Act 215 ILCS 5/370c.3 new 305 ILCS 5/5-55 new
40	40	New Act
41	41	215 ILCS 5/370c.3 new
42	42	305 ILCS 5/5-55 new
43	43	Creates the Nonopioid Alternatives for Pain Act. Requires the Department of Public Health to develop and publish an educational pamphlet regarding the use of nonopioid alternatives for pain treatment. Provides that a health care practitioner shall exercise professional judgment in selecting appropriate treatment modalities for pain in accordance with specified Centers for Disease Control and Prevention guidelines, including the use of nonopioid alternatives whenever nonopioid alternatives exist. Requires a health care practitioner who prescribes an opioid drug to provide certain information to the patient, discuss certain topics, and document the reasons for the prescription. Requires the Department to develop a nonopioid directive form for patients. Sets forth provisions concerning exceptions, execution of a nonopioid directive, opioid administration to a patient with a nonopioid directive, and limitations of liability. Amends the Illinois Insurance Code. Provides that when a licensed health care practitioner prescribes a nonopioid medication for the treatment of acute pain, it shall be unlawful for a health insurance issuer to deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug or to require the patient to try an opioid prescription drug before providing coverage. Provides that in establishing and maintaining its drug formulary, a health insurance issuer shall ensure that no nonopioid drug approved by the Food and Drug Administration for the treatment or management of pain shall be disadvantaged or discouraged, with respect to coverage or cost sharing, relative to any opioid or narcotic drug for the treatment or management of pain. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that whenever a licensed health care practitioner prescribes a nonopioid medication for the treatment of acute pain, neither the Department of Healthcare and Family Services nor a managed care organization shall deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug or require a patient to try an opioid prescription drug prior to providing coverage of the nonopioid prescription drug. Makes other changes.
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45	45	LRB103 39079 RPS 69217 b
46	46	A BILL FOR
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52	52	New Act
53	53	215 ILCS 5/370c.3 new
54	54	305 ILCS 5/5-55 new
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73	73	1 Social Work and Social Work Practice Act, the Nursing Home
74	74	2 Administrators Licensing and Disciplinary Act, the Illinois
75	75	3 Occupational Therapy Practice Act, the Podiatric Medical
76	76	4 Practice Act of 1987, the Respiratory Care Practice Act, the
77	77	5 Professional Counselor and Clinical Professional Counselor
78	78	6 Licensing and Practice Act, the Illinois Speech-Language
79	79	7 Pathology and Audiology Practice Act, the Illinois Dental
80	80	8 Practice Act, the Illinois Dental Practice Act, or the
81	81	9 Behavior Analyst Licensing Act.
82	82	10 "Nonopioid directive form" means the form developed under
83	83	11 Section 20.
84	84	12 "Prescriber" has the meaning given to that term in
85	85	13 subsection (mm) of Section 102 of the Illinois Controlled
86	86	14 Substances Act.
87	87	15 Section 10. Nonopioid alternatives pamphlet. The
88	88	16 Department of Public Health shall develop and publish on its
89	89	17 website an educational pamphlet regarding the use of nonopioid
90	90	18 alternatives for the treatment of acute nonoperative, acute
91	91	19 perioperative, subacute, or chronic pain. The pamphlet shall,
92	92	20 at a minimum, conform with the most current CDC Clinical
93	93	21 Practice Guideline for Prescribing Opioids for Pain published
94	94	22 by the Centers for Disease Control and Prevention and shall
95	95	23 include:
96	96	24 (1) information on available nonopioid alternatives
97	97	25 for the treatment of pain, including available nonopioid
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108	108	1 medicinal drugs or drug products and nonpharmacological
109	109	2 therapies; and
110	110	3 (2) the advantages and disadvantages of the use of
111	111	4 nonopioid alternatives.
112	112	5 Section 15. Prescription of opioids.
113	113	6 (a) A health care practitioner shall exercise professional
114	114	7 judgment in selecting appropriate treatment modalities for
115	115	8 acute nonoperative, acute perioperative, subacute, or chronic
116	116	9 pain in accordance with the most current CDC Clinical Practice
117	117	10 Guideline for Prescribing Opioids for Pain published by the
118	118	11 Centers for Disease Control and Prevention, including the use
119	119	12 of nonopioid alternatives whenever reasonable, clinically
120	120	13 appropriate, and evidence-based alternatives exist.
121	121	14 (b) The health care practitioner shall consider
122	122	15 prescribing nonopioids as the first line of pain control in
123	123	16 patients, unless the prescription is not clinically
124	124	17 appropriate, in accordance with subsection (a).
125	125	18 (c) Except when a patient is receiving care in a hospital
126	126	19 critical care unit or emergency department or a patient is
127	127	20 receiving hospice services under Hospice Program Licensing
128	128	21 Act, before providing care requiring the administration of
129	129	22 anesthesia involving the use of an opioid drug, or prescribing
130	130	23 or ordering an opioid drug for the treatment of pain, a health
131	131	24 care practitioner who prescribes or orders an opioid drug must
132	132	25 do all of the following:
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143	143	1 (1) Inform the patient or the patient's representative
144	144	2 of available nonopioid alternatives for the treatment of
145	145	3 pain, which may include available nonopioid medicinal
146	146	4 drugs or drug products, interventional procedures or
147	147	5 treatments, acupuncture, chiropractic treatments, massage
148	148	6 therapy, physical therapy, occupational therapy, or any
149	149	7 other appropriate therapy as determined by the health care
150	150	8 practitioner.
151	151	9 (2) Discuss with the patient or the patient's
152	152	10 representative the advantages and disadvantages of the use
153	153	11 of nonopioid alternatives and whether the patient is at a
154	154	12 high risk of, or has a history of, controlled substance
155	155	13 abuse or misuse and the patient's personal preferences.
156	156	14 (3) Provide the patient or the patient's
157	157	15 representative, electronically or in printed form, with
158	158	16 the educational pamphlet described in Section 10.
159	159	17 (4) Document in the patient's record that nonopioid
160	160	18 alternatives were considered and discussed with the
161	161	19 patient or the patient's representative and, to the extent
162	162	20 that the health care practitioner prescribes or orders an
163	163	21 opioid for the treatment of pain, document the reasons for
164	164	22 such a prescription or order.
165	165	23 Section 20. Nonopioid directive form. The Department shall
166	166	24 develop a nonopioid directive form indicating to health care
167	167	25 practitioners and emergency medical services personnel that,
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178	178	1 except as otherwise provided in Section 30 or in rules adopted
179	179	2 by the Department, a patient who has executed the form or who
180	180	3 has had a form executed on the patient's behalf must not be
181	181	4 administered an opioid or offered a prescription for an
182	182	5 opioid. The Department shall include on the nonopioid
183	183	6 directive form instructions on how the form may be revoked and
184	184	7 any other information that the Department considers relevant.
185	185	8 The Department shall make the form available to the public on
186	186	9 the Department's website.
187	187	10 Section 25. Nonopioid directive form; execution. A patient
188	188	11 may execute a nonopioid directive form on his or her own
189	189	12 behalf. A guardian or patient advocate of a patient may
190	190	13 execute a nonopioid directive form on behalf of the patient.
191	191	14 If a nonopioid directive form is executed by or on behalf of a
192	192	15 patient and is presented to a health care practitioner, the
193	193	16 health care practitioner shall obtain a copy of the form and
194	194	17 include the copy in the patient's medical record. A patient
195	195	18 may revoke a nonopioid directive form executed by himself or
196	196	19 herself at any time and in any manner by which he or she is
197	197	20 able to communicate his or her intent to revoke the form. A
198	198	21 patient advocate or guardian may revoke a nonopioid directive
199	199	22 form on behalf of a patient at any time by issuing the
200	200	23 revocation in writing and providing notice of the revocation
201	201	24 to the patient's health professional or his or her delegate.
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212	212	1 Section 30. Administration of an opioid to a patient who
213	213	2 has executed a nonopioid directive form. A prescriber who
214	214	3 holds a controlled substances license or a health care
215	215	4 practitioner who is a practical nurse or registered
216	216	5 professional nurse and is acting on the order of the
217	217	6 prescriber may administer an opioid to a patient who has
218	218	7 executed a nonopioid directive form or who has had a nonopioid
219	219	8 directive form executed on his or her behalf if the patient is
220	220	9 being treated at a hospital or in a setting outside of a
221	221	10 hospital in the case of an emergency and, in the prescriber's
222	222	11 professional opinion, the administration of the opioid is
223	223	12 medically necessary to treat the patient. If an opioid is
224	224	13 administered under this Section, the prescriber shall ensure
225	225	14 that the patient is provided with information on substance use
226	226	15 disorder services.
227	227	16 Section 35. Limitation of liability. Except as otherwise
228	228	17 provided by law, the following are not subject to civil or
229	229	18 criminal liability or professional disciplinary action for
230	230	19 failing to administer, prescribe, or dispense an opioid, or
231	231	20 for the inadvertent administration of an opioid, to a patient
232	232	21 who has executed a nonopioid directive form or who has had a
233	233	22 nonopioid directive form executed on his or her behalf if the
234	234	23 failure to act or the act was done reasonably and in good
235	235	24 faith:
236	236	25 (1) A health care practitioner whose scope of practice
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247	247	1 includes the prescribing, administering, or dispensing of
248	248	2 a controlled substance.
249	249	3 (2) A health facility or agency.
250	250	4 (3) An employee of a health care practitioner.
251	251	5 (4) An employee of a health facility or agency.
252	252	6 (5) Emergency medical services personnel.
253	253	7 Section 40. Rulemaking. The Department shall adopt rules
254	254	8 to implement this Act. The rules must allow a health care
255	255	9 practitioner or health facility or agency to incorporate a
256	256	10 nonopioid directive form into an existing patient form or into
257	257	11 other documentation used by the health care practitioner or
258	258	12 health facility or agency, and the rules must include, but not
259	259	13 be limited to, all of the following:
260	260	14 (1) Procedures to record a nonopioid directive form in
261	261	15 a medical record, including an electronic medical record.
262	262	16 (2) Procedures to revoke a nonopioid directive form.
263	263	17 (3) Procedures to ensure that the recording,
264	264	18 disclosure, or distribution of data relating to a
265	265	19 nonopioid directive form or the transmission of a
266	266	20 nonopioid directive form complies with State and federal
267	267	21 confidentiality and consent laws, rules, and regulations.
268	268	22 (4) Exemptions for administering or prescribing an
269	269	23 opioid to a patient who has executed a nonopioid directive
270	270	24 form or who has had a nonopioid directive form executed on
271	271	25 his or her behalf if the opioid is administered or
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282	282	1 prescribed to treat the patient for a substance use
283	283	2 disorder.
284	284	3 (5) Exemptions for administering or prescribing an
285	285	4 opioid to a patient who has executed a nonopioid directive
286	286	5 form or who has had a nonopioid directive form executed on
287	287	6 his or her behalf if the patient is a hospice patient.
288	288	7 Section 100. The Illinois Insurance Code is amended by
289	289	8 adding Section 370c.3 as follows:
290	290	9 (215 ILCS 5/370c.3 new)
291	291	10 Sec. 370c.3. Coverage for nonopioid medications; pain
292	292	11 relief parity.
293	293	12 (a) In this Section, "health insurance issuer" has the
294	294	13 meaning set forth in Section 5 of the Illinois Health
295	295	14 Insurance Portability and Accountability Act.
296	296	15 (b) Notwithstanding any provision of law to the contrary,
297	297	16 when a licensed health care practitioner prescribes a
298	298	17 nonopioid medication for the treatment of acute pain, it shall
299	299	18 be unlawful for a health insurance issuer to deny coverage of
300	300	19 the nonopioid prescription drug in favor of an opioid
301	301	20 prescription drug or to require the patient to try an opioid
302	302	21 prescription drug prior to providing coverage of the nonopioid
303	303	22 prescription drug.
304	304	23 (c) In establishing and maintaining its drug formulary, a
305	305	24 health insurance issuer shall ensure that no nonopioid drug
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316	316	1 approved by the United States Food and Drug Administration for
317	317	2 the treatment or management of pain shall be disadvantaged or
318	318	3 discouraged, with respect to coverage or cost sharing,
319	319	4 relative to any opioid or narcotic drug for the treatment or
320	320	5 management of pain on the health insurance issuer's drug
321	321	6 formulary, where impermissible disadvantaging or
322	322	7 discouragement includes, without limitation: imposing more
323	323	8 restrictive coverage criteria on any such nonopioid drug than
324	324	9 the least restrictive coverage criteria imposed on an opioid
325	325	10 or narcotic drug; establishing more restrictive or more
326	326	11 extensive utilization controls, including, but not limited to,
327	327	12 more restrictive or more extensive prior authorization or step
328	328	13 therapy requirements, for such nonopioid drug than the least
329	329	14 restrictive or extensive utilization controls applicable to
330	330	15 any such opioid or narcotic drug; or, if the health insurance
331	331	16 issuer maintains a drug formulary grouped into tiers for the
332	332	17 purposes of determining cost sharing, placing any such
333	333	18 nonopioid drug on a tier that requires a cost-sharing
334	334	19 responsibility that exceeds the lowest cost-sharing
335	335	20 responsibility required for any opioid or narcotic drug on the
336	336	21 drug formulary.
337	337	22 This subsection applies to a nonopioid drug immediately
338	338	23 upon its approval by the United States Food and Drug
339	339	24 Administration for the treatment or management of pain.
340	340	25 Section 105. The Illinois Public Aid Code is amended by
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351	351	1 adding Section 5-55 as follows:
352	352	2 (305 ILCS 5/5-55 new)
353	353	3 Sec. 5-55. Coverage for nonopioid medications; pain relief
354	354	4 parity.
355	355	5 (a) Required coverage for nonopioid medications.
356	356	6 Notwithstanding any provision of law to the contrary, whenever
357	357	7 a licensed health care practitioner prescribes a nonopioid
358	358	8 medication for the treatment of acute pain, neither the
359	359	9 Department nor a managed care organization contracted with the
360	360	10 Department shall deny coverage of the nonopioid prescription
361	361	11 drug in favor of an opioid prescription drug or require a
362	362	12 patient to try an opioid prescription drug prior to providing
363	363	13 coverage of the nonopioid prescription drug.
364	364	14 (b) Pain relief parity. In establishing and maintaining
365	365	15 the Illinois Medicaid Preferred Drug List, the Department
366	366	16 shall ensure that no nonopioid drug approved by the U.S. Food
367	367	17 and Drug Administration for the treatment or management of
368	368	18 pain shall be disadvantaged or discouraged with respect to
369	369	19 coverage relative to any opioid or narcotic drug for the
370	370	20 treatment or management of pain on the Illinois Medicaid
371	371	21 Preferred Drug List, where impermissible disadvantaging or
372	372	22 discouragement includes, without limitation: designating any
373	373	23 such nonopioid drug as a nonpreferred drug if any opioid or
374	374	24 narcotic drug is designated as a preferred drug; or
375	375	25 establishing more restrictive or more extensive utilization
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