All Roll Calls
Yes: 379 • No: 87
IllinoisHB3019104th General Assembly (2025–2026)HouseWALLET
DENTAL PRACTICE ACT EXTENSION
Sponsored By: Lindsey LaPointe (Democratic)
Became Law
health care licensesassignmentsexecutive
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Bill Overview
Analyzed Economic Effects
17 provisions identified: 11 benefits, 0 costs, 6 mixed.
Stronger pregnancy and postpartum coverage
If your policy was issued or renewed on or after October 8, 2021, it must cover pregnancy and newborn care. Policies must also cover home visits by lactation consultants, breast pumps, and needed supplies. Postpartum services are covered for 12 months after pregnancy. High‑risk pregnancies get a single qualified case manager to coordinate care. Pregnancy‑ and postpartum‑related mental health and substance use care must be covered, with limits on prior authorization. If an insurer says continued pregnancy/postpartum treatment is not medically necessary, it must give written notice in 24 hours, decide a fast appeal in 24 hours (72 hours for outside review), pay through the next day, and not discharge you until appeals end.
Doula and midwife care covered, with limits
Plans must cover services by perinatal doulas and licensed certified professional midwives, including home births and needed equipment. This applies to people who are pregnant or postpartum, and to those who had a miscarriage or stillbirth. For doula home visits (not the home birth), coverage may be limited to 16 visits before and 16 after birth and capped at $8,000 per pregnancy.
Lower costs for pregnancy and newborn care
Beginning January 1, 2026, any policy amended, issued, delivered, or renewed must cover postpartum care. Most pregnancy, postpartum, and newborn services are covered with no cost-sharing. The no-cost rule does not apply to home birth services, inpatient or residential mental health care, or substance use care at Level 3.1 and above. High-deductible plans keep Health Savings Account eligibility, so some cost-sharing can still apply there.
Cap on hospital pre-approval penalties
If your plan charges a penalty for not getting pre-approval for an inpatient hospital stay, that penalty is capped at $1,000 per occurrence. You still owe your normal deductible, copays, or coinsurance.
Clear network info and 24/7 access
Insurers must keep a current website and toll‑free phone line with accurate provider lists and plan details. Beginning January 1, 2026, they must file maps showing provider locations and service areas, expected enrollment, and how care is accessible (including provider‑to‑patient ratios and travel standards). They must also file policies on adding providers, referrals, and providing 24/7 access to primary care, emergency care, and women’s OB/GYN care. Plans cannot gag your provider from discussing options or speaking for you during appeals.
Emergency care costs same in or out of network
Starting January 1, 2026, emergency care is covered the same whether the provider is in-network or not. You do not pay more for emergency care because of network status.
Faster access to mental health care
Beginning January 1, 2026, plans must meet time and distance limits for mental health and substance use care. In Cook, DuPage, Kane, Lake, McHenry, and Will counties, outpatient care must be within 30 minutes or 30 miles, with first visits in 10 business days and follow‑ups in 20 business days. In other counties, outpatient travel can be up to 60 minutes or 60 miles with the same wait times. Inpatient or residential behavioral care must be within 60 minutes or 60 miles statewide. If no in‑network provider meets these rules, your plan must allow care at in‑network costs with an exception.
Keep insurer reports and rebates
Insurers must file yearly reports showing how premium dollars are spent, and the state posts them online. If federal rules are weakened after January 15, 2025, Illinois still requires extra reports or extra rebate payments so enrollees get the same information and rebates as before.
Protections when in-network care unavailable
Starting January 1, 2026, if you try the directory, call the plan, and call providers but cannot find an in‑network option, your plan must grant a network exception and charge you no more than in‑network costs. Special HMO rules apply for notice and reimbursement. Emergency care is always covered at in‑network benefit levels. If your plan has a penalty for not getting pre‑approval for inpatient hospital care, it cannot be more than $1,000 per occurrence, plus normal cost‑sharing.
Quicker approval for postpartum mental health care
For pregnancy or postpartum behavioral health care, plans cannot review medical necessity for the first 48 hours of inpatient, detox/withdrawal, or partial hospitalization. Your provider decides medical necessity for that initial 48 hours. Reviews can occur after the first 48 hours.
Travel, hotel, and food reimbursements
For plan years starting January 1, 2026, if your plan grants a network exception for mental health or substance use care, it must repay reasonable travel, lodging, and food costs. Food and lodging use federal GSA per diem rates. Vehicle travel uses the IRS mileage rate. You may need to file a claim within 60 days, and reimbursement can be denied if the site of care is outside Illinois and over 100 miles away unless no closer option is available within 10 business days. Medicaid and CHIP plans are not covered by this reimbursement rule.
Stronger oversight of HMOs and health plans
Effective January 1, 2026, the law updates which parts of the Insurance Code apply to HMOs and to voluntary health service plans. In HMO mergers or takeovers, the Director now gives primary weight to keeping member benefits and to the HMO’s finances, and can require actuarial certifications, pro forma statements, and a 3-year business plan. These steps improve oversight and help protect enrollees from coverage disruptions.
Medicaid managed care rules update
Beginning January 1, 2026, the Department of Healthcare and Family Services may apply these network and access standards to Medicaid managed care and fee‑for‑service. This can change how plans work for Medicaid and CHIP enrollees and how they reach providers.
Stronger network standards and oversight
The Department sets yearly minimum provider‑to‑patient ratios and travel/wait‑time limits, and plans must meet them in the lowest cost‑sharing tier. Starting January 1, 2026, each in‑network hospital must have key specialists (radiology, pathology, anesthesia, emergency medicine) in‑network. The Director reviews these rules and can add specialties; if federal rules are stricter, they control. Insurers must report major network changes within 15 days. The Department can grant limited exceptions when no local providers meet standards, but not for the mental health time‑and‑distance rules.
Stronger network access in cheapest tier
Starting January 1, 2026, the lowest cost-sharing tier of a tiered plan must meet provider ratio and time/distance rules. Plans can count telehealth, mobile clinics, or centers of excellence to help meet access standards, as allowed by the Department. This does not apply to plans offered only as a group health plan.
Stricter insurer spending rules; some plans excluded
Insurers cannot count executive pay above base salary, company profits, or some lifestyle program costs as medical spending for MLR. This can increase the share of premiums treated as non-claims and may raise rebates. Excepted benefits and Medicaid or CHIP plans are not subject to these MLR rules, so people on those plans do not get these protections or rebates under this section.
Some HMOs treated as Illinois companies
Starting January 1, 2026, certain HMOs are deemed Illinois domestic companies for most Insurance Code rules if they meet set criteria, like having many Illinois enrollees. This changes which rules and oversight apply to those HMOs.
Sponsors & Cosponsors
Sponsor
Lindsey LaPointe
Democratic • House
Cosponsors
Adriane Johnson
Democratic • Senate
Ann M. Williams
Democratic • House
Anna Moeller
Democratic • House
Bob Morgan
Democratic • House
Camille Y. Lilly
Democratic • House
Dagmara Avelar
Democratic • House
Debbie Meyers-Martin
Democratic • House
Kimberly Du Buclet
Democratic • House
Laura Faver Dias
Democratic • House
Laura Fine
Democratic • Senate
Mary Edly-Allen
Democratic • Senate
Maura Hirschauer
Democratic • House
Maurice A. West, II
Democratic • House
Nabeela Syed
Democratic • House
Rachel Ventura
Democratic • Senate
Sara Feigenholtz
Democratic • Senate
Suzanne M. Ness
Democratic • House
Thaddeus Jones
Democratic • House
Roll Call Votes
House vote • 5/31/2025
Senate Committee Amendment No. 1 House Concurs
Yes: 84 • No: 32
House vote • 5/31/2025
Senate Floor Amendment No. 2 House Concurs
Yes: 84 • No: 32
House vote • 5/30/2025
Senate Committee Amendment No. 1 Motion to Concur Recommends Be Adopted Executive Committee;
Yes: 8 • No: 4
House vote • 5/30/2025
Senate Floor Amendment No. 2 Motion to Concur Recommends Be Adopted Executive Committee;
Yes: 8 • No: 4
Senate vote • 5/29/2025
Third Reading - Passed;
Yes: 45 • No: 11
Senate vote • 5/15/2025
Do Pass as Amended Executive;
Yes: 9 • No: 4
House vote • 4/10/2025
Third Reading - Short Debate - Passed
Yes: 112 • No: 0 • Other: 1
House vote • 4/9/2025
House Floor Amendment No. 2 Recommends Be Adopted Health Care Licenses Committee;
Yes: 15 • No: 0
House vote • 3/19/2025
Do Pass / Short Debate Health Care Licenses Committee;
Yes: 14 • No: 0
Actions Timeline
Public Act . . . . . . . . . 104-0028
7/1/2025HouseEffective Date January 1, 2026
7/1/2025HouseGovernor Approved
7/1/2025HouseSent to the Governor
6/24/2025HousePassed Both Houses
5/31/2025HouseHouse Concurs
5/31/2025HouseSenate Floor Amendment No. 2 House Concurs 084-032-000
5/31/2025HouseSenate Committee Amendment No. 1 House Concurs 084-032-000
5/31/2025HouseAdded Co-Sponsor Rep. Anna Moeller
5/31/2025HouseAdded Chief Co-Sponsor Rep. Bob Morgan
5/31/2025HouseAdded Chief Co-Sponsor Rep. Nabeela Syed
5/31/2025HouseAdded Co-Sponsor Rep. Kimberly Du Buclet
5/31/2025HouseAdded Co-Sponsor Rep. Ann M. Williams
5/31/2025HouseAdded Co-Sponsor Rep. Laura Faver Dias
5/31/2025HouseAdded Co-Sponsor Rep. Maurice A. West, II
5/31/2025HouseAdded Co-Sponsor Rep. Dagmara Avelar
5/31/2025HouseAdded Co-Sponsor Rep. Suzanne M. Ness
5/31/2025HouseAdded Co-Sponsor Rep. Maura Hirschauer
5/31/2025HouseSenate Floor Amendment No. 2 Motion to Concur Recommends Be Adopted Executive Committee; 008-004-000
5/30/2025HouseSenate Committee Amendment No. 1 Motion to Concur Recommends Be Adopted Executive Committee; 008-004-000
5/30/2025HouseAdded as Alternate Co-Sponsor Sen. Rachel Ventura
5/30/2025SenateSenate Floor Amendment No. 2 Motion to Concur Rules Referred to Executive Committee
5/30/2025HouseSenate Committee Amendment No. 1 Motion to Concur Rules Referred to Executive Committee
5/30/2025HouseChief Sponsor Changed to Rep. Lindsey LaPointe
5/30/2025HouseSenate Floor Amendment No. 2 Motion to Concur Referred to Rules Committee
5/29/2025House
Bill Text
Engrossed
Enrolled
House Amendment 1
House Amendment 2
Introduced
Senate Amendment 1
Senate Amendment 2