All Roll Calls
Yes: 379 • No: 87
IllinoisHB3019104th General Assembly (2025–2026)HouseWALLET
DENTAL PRACTICE ACT EXTENSION
Sponsored By: Sponsor information unavailable
Signed by Governor
Summary
Amends the Regulatory Sunset Act. Changes the repeal date of the Illinois Dental Practice Act from January 1, 2026 to January 1, 2036. Amends the Illinois Dental Practice Act. In the definition of "branches of dentistry", adds oral and maxillofacial pathology, dental public health, oral medicine, and orofacial pain to the included specialties. Creates a temporary dental hygiene license for dental students who meet certain requirements. Provides that a licensee holding a temporary dental hygiene license must practice under the supervision of a dentist. Provides that the temporary dental hygiene license is active for one year from its issuance date. Changes the implementation deadline for an order regarding the services that are necessary to be performed on a patient who is in a State or federal prison and who cannot travel to a dental office to 180 days of the order's issuance (rather than 45 days of the order's issuance). Removes language providing that provisions concerning public health dentistry are inoperative on and after January 1, 2026. Effective immediately.
health care licensesassignmentsexecutive
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Bill Overview
Analyzed Economic Effects
15 provisions identified: 12 benefits, 0 costs, 3 mixed.
Families gain stronger autism coverage protections
Affected policies amended, delivered, issued, or renewed after December 12, 2008 must cover autism diagnosis and treatment for people under 21. The law replaces the fixed $36,000 annual maximum with a maximum adjusted yearly using medical-care inflation. It bars visit limits, applies ordinary medical cost-sharing rules, and keeps unrelated care from counting against the autism maximum. Insurers cannot limit coverage solely because of an autism diagnosis or where treatment occurs. Requests for records or treatment plans cannot override the ban on prior approval for qualifying autism-related mental health care.
Families get doula and midwife coverage
Insurers must cover specified pregnancy, postpartum, and newborn services from perinatal doulas and licensed certified professional midwives. Covered services include home births, home visits, support during labor, abortion or miscarriage, and necessary home-birth equipment and supplies. For doula home visits other than home births, plans may limit coverage to 16 visits before and 16 after birth, miscarriage, or abortion. Plans do not have to cover more than $8,000 for those visits per pregnancy and following postpartum period.
Health plan spending reports protect rebates
Beginning January 1, 2026, insurers must file annual reports showing how premiums fund care, quality improvements, and other costs. Illinois must publish the reports, including copies of federal medical loss ratio reports. Calculations exclude taxes, regulatory fees, profits, executive pay above base salary, and specified wellness costs. Federal changes after January 15, 2025 that reduce reporting or rebates trigger supplemental state reporting or rebates preserving prior levels. The rules include grandfathered plans but exclude excepted benefits, Medicaid, and CHIP policies.
Less prior approval for mental care
Beginning January 1, 2026, plans cannot require prior approval for covered outpatient or partial-hospital mental health care from authorized providers, including supervised trainees. Other insurers may set notice deadlines of 2 business days for outpatient care and 48 hours for partial hospitalization. Medicaid managed care may set 24 hours, with one extra business day when its contractual process cannot accept notice. Ongoing review cannot begin before those deadlines; later reviews and HMO referrals for nonparticipating providers remain allowed. FDA-approved addiction medicines also avoid prior approval beyond applicable placement criteria, cannot require trying other drugs first, and must occupy the lowest formulary tier; court-ordered medication alone cannot justify exclusion.
Longer postpartum coverage with fewer copays
Affected policies amended, delivered, issued, or renewed on or after January 1, 2026 must cover postpartum care as an essential benefit. Coverage continues for 12 months after pregnancy ends, with comparable coverage required when the insured changes policies. Plans must offer high-risk pregnancy case management and cover recommended lactation home visits, breast pumps, equipment, and feeding aids. The specified postpartum services have no cost sharing, except inpatient or residential mental health care and specified higher-level residential substance treatment. This cost-sharing ban does not apply when it would disqualify a high-deductible plan from health savings account eligibility.
Mental care networks face access deadlines
Mental health and addiction networks must provide outpatient access within 30 minutes and 30 miles in Cook, DuPage, Kane, Lake, McHenry, and Will counties. Elsewhere, the limits are 60 minutes and 60 miles. Initial appointments must be available within 10 business days and follow-ups within 20 business days; inpatient and residential travel limits are 60 minutes and 60 miles statewide. When no network provider meets these standards, insurers must grant an exception at in-network benefit levels. County-level network failures also require out-of-network claims paid at in-network levels and retroactive reimbursement; state agencies set minimum provider-to-patient ratios annually.
Mental health help after pregnancy loss
The law extends specified mental health and substance use treatment benefits to covered people after miscarriage or stillbirth. Insurers cannot reduce or deny these benefits because the person has other related or unrelated diagnoses. Pregnancy- and postpartum-related treatment also receives the applicable protections against prior approval. For specified admissions, the first 48 hours are protected from ongoing or after-the-fact medical-necessity review.
More workers get mental health protections
Group health policies covering illness must cover medically necessary mental health and substance use treatment under parity rules. The mandate is no longer limited to policies that pay based on expenses incurred. State, county, municipal, and school district employee plans are expressly included. Applicable plans amended or renewed after 2019 must cover at least 45 inpatient days and 60 outpatient visits yearly, without lifetime day or visit limits. Medication-management visits do not count toward the required outpatient total, and covered patients may choose among authorized treating professionals.
Patients face fewer denied treatment bills
For qualifying behavioral health care at participating providers, later denials generally cannot leave patients owing charges through the denial date. Patients still owe applicable copayments, coinsurance, and deductibles. Protection against later denials generally covers the first 72 inpatient hours and outpatient or partial-hospital care before its notice deadline. Exceptions include lack of coverage, material misrepresentation, excluded services, care without consent or a court order, and specified outpatient medical-necessity findings. The provision excludes prescription and over-the-counter drugs and does not require Medicaid payment for services outside its legal coverage.
Patients gain stronger provider network protections
After a good-faith search using the directory and contacting the plan and provider, patients can obtain required network exceptions. Qualifying barriers include provider shortages, unreasonable distance or delays, and a preferred provider’s conscience-based refusal. The service cannot cost more than preferred-provider care; choosing an outside provider when suitable preferred care is available does not qualify. HMOs must notify patients of qualifying exception referrals, and beginning January 1, 2026, every network hospital needs a preferred radiologist, pathologist, anesthesiologist, and emergency doctor. Issuers must disclose network access information and report material changes within 15 business days; enforcement includes $5,000 daily late-filing fines, $5,000-per-policy violation penalties, and bans on inadequate plans.
Patients get faster inpatient mental care
Plans cannot require prior approval for covered inpatient hospital mental health treatment at participating providers. If the provider reports admission and the initial treatment plan within 48 hours, the first 72 hours avoid ongoing review. Providers must prepare discharge plans and arrange continued care. Insurers must approve qualifying recommended discharge care, subject to ongoing review. Residential care not identified in the discharge plan does not count as inpatient hospitalization under this protection.
Travel help when care networks fail
For plan years beginning January 1, 2026 or later, qualifying behavioral health network exceptions bring reasonable travel, food, and lodging reimbursement. Food and lodging use federal daily rates; vehicle travel uses the current IRS mileage rate. Insurers must explain potential eligibility and claims, may require filing within 60 days after the last service, and must allow appeals. They may deny costs for care both outside Illinois and over 100 miles from home, unless a good-faith search finds no provider within those geographic limits available within 10 business days. Medicaid and CHIP policies are excluded.
Addiction care gains safeguards; definitions change
Insurers may require treatment-start notice within 2 business days; Medicaid managed care uses a 24-hour contractual notice process. Medicaid providers get one extra business day when the plan cannot accept notice within that period. Ongoing review cannot begin before the deadline, and earlier participating-facility care generally has protection against later denials and billing beyond cost sharing. Coverage, fraud, excluded-service, medical-necessity, and consent exceptions apply; excluded services lack the billing protection. The non-Medicaid benefit definition drops listed level 3.3 and names level 2.5 High-Intensity Outpatient and level 3.7 Medically Managed Residential.
Treatment appeals change alongside review safeguards
Insurers and providers must supply records supporting medical necessity; the law removes the required dispute review by a jointly selected provider. Permitted reviews must follow statutory safeguards and accepted treatment standards, including addiction-care criteria and independent professional mental health criteria. Plans must allow the indicated care level, or the next higher level when the requested level is unavailable. Continued-care denials require 24-hour written notice, internal appeal decisions within 24 hours, and external decisions within 72 hours; benefits continue through the day after an upheld external denial. Agencies retain lawful screening and review powers, but cannot require prohibited reviews; insurers must publish criteria, test reviewer agreement against a 90% standard, correct shortfalls, and face public compliance audits.
Managed care oversight and refund rules
Beginning January 1, 2026, additional insurance rules apply to HMOs and voluntary health services plan corporations. These include applicable insurer spending-report and mental health parity requirements. State review of mergers, acquisitions, and sales affecting over 10% of HMO enrollees focuses on continued benefits and financial health rather than competition, with financial and actuarial submissions required. HMO contracts may provide group refunds or additional premiums limited to 20% of the period’s profitable or unprofitable experience. These arrangements must be disclosed in coverage documents.
Sponsors & Cosponsors
Sponsors
There is no primary sponsor on record.
Cosponsors
Adriane L. 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
Lindsey LaPointe
Democratic • House
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 Floor Amendment No. 2 House Concurs
Yes: 84 • No: 32
House vote • 5/31/2025
Senate Committee Amendment No. 1 House Concurs
Yes: 84 • No: 32
House vote • 5/30/2025
Senate Floor Amendment No. 2 Motion to Concur Recommends Be Adopted Executive Committee;
Yes: 8 • No: 4
House vote • 5/30/2025
Senate Committee Amendment No. 1 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
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