IHA Daily Briefing: December 16

Medicaid Rate Add-On Proposed for Specialized Child Psychiatric Services
On Dec. 4, the Illinois Dept. of Healthcare and Family Services released a Public Notice proposing a per diem Medicaid rate add-on of $1,636 for any freestanding children's hospital providing specialized psychiatric services to children diagnosed with autism spectrum disorder on an intensive behavioral health unit. The proposed change is effective for dates of service on or after Dec. 5, 2025 and has an estimated annual increase in Medicaid liability of $1.2 million.

The proposed change is subject to approval by the federal Centers for Medicare & Medicaid Services, which is expected to take around 90 days. Questions or comments on the proposed change can be submitted by Jan. 3 to [email protected].

Staff contact: Lia Daniels

IDPH Releases First-Ever Report on Alcohol Use in Illinois
The Illinois Dept. of Public Health (IDPH) yesterday issued its first-ever comprehensive report on the health and societal impacts of alcohol use in Illinois. The report, "Alcohol Use in Illinois," collects and analyzes data from multiple sources, including IDPH's own Illinois Behavioral Risk Factor Surveillance Survey and Illinois Youth Risk Behavior Surveillance Survey. IDPH said data from the report can be used by state and local health officials and community partners to develop targeted, evidence-based programs and interventions to address health-related concerns linked to alcohol use.

Key takeaways from the report include:

• Nearly 23% of Illinois high schoolers reported consuming at least one alcoholic beverage in the past 30 days, while more than 11% acknowledged binge drinking. Binge drinking is defined as consuming four or more drinks within a couple of hours for females and five or more for males.
• Among adults, 57% of respondents said they had consumed at least one alcoholic beverage in the past 30 days, while more than 18% acknowledged binge drinking within that same time frame.
• Both alcohol consumption and binge drinking rates increased as income levels increased. For Illinoisans making more than $75,000 a year, 69% reported drinking in the last 30 days, while over 22% reported binge drinking. For those making less than $15,000 a year, the rates were 35% and 16%.
• LGBTQ+ individuals were more likely to report binge drinking in the past 30 days (nearly 23%) than heterosexual persons (17%).
• From 2020-2023, more than 2,300 deaths statewide were from causes directly attributable to chronic alcohol use, such as alcoholic liver disease and alcohol dependency syndrome. More than 2,000 additional deaths were from causes "indirectly associated" with chronic alcohol use, including hypertension, coronary heart disease, and liver cancer.
• Deaths from alcohol-related liver disease varied widely by region, with the Peoria region (west-central Illinois) having the highest rate at 5.2 deaths per 100,000 people, more than double the lowest rate, in the Westchester region (greater Chicago area), which had 2.3 deaths per 100,000 people.

CMS Releases 2025 Measures Under Consideration List
The Centers for Medicare & Medicaid Services (CMS) yesterday published the "2025 Measures Under Consideration List," outlining 24 quality and efficiency measures that CMS is considering adopting through the federal rulemaking process for use in Medicare programs. This pre-rulemaking process is used to determine measures for the Medicare program, allowing time for interested parties to submit public comment and recommendations. CMS stated that it aims to align quality measures for the quality reporting programs with Make America Health Again (MAHA) initiatives and its existing quality reporting and value-based programs. The news release said public comment will be accepted from Dec. 16 through Jan. 6, and CMS will also convene a consensus-based multidisciplinary group to provide recommendations to the agency on these measures by Feb. 1.

Federal Lawmakers Support Classifying Nursing Programs as 'Professional Degrees'
More than 100 members of Congress, including many from Illinois, signed a letter submitted Dec. 12 to the U.S. Dept. of Education expressing concerns about the Department's proposal to omit post-baccalaureate nursing degrees from the regulatory definition of "professional degree" as part of a student loan rule. Under the proposal, nursing programs would be classified as "graduate degrees" and nursing student borrowing would be capped at $100,000 total, rather than $200,000 as allowed under professional programs. "At a time when our nation is facing a health care shortage, especially in primary care, now is not the time to cut off the student pipeline to these programs," the lawmakers wrote. "Consequently, we believe that post-baccalaureate nursing degrees should be included in the department's definition of a 'professional degree.'"

Get Covered Illinois Extends First Open Enrollment Deadline
Get Covered Illinois announced that Illinois residents now have until Dec. 31 to enroll in health insurance coverage that begins Jan. 1. This year marks Get Covered Illinois' first Open Enrollment Period operating a state-based marketplace independent of the federally run HealthCare.gov. Get Covered Illinois has extended its first enrollment deadline to ensure people have ample time to receive help, compare plans, and select the coverage that best meets their needs and budget.

During the extended enrollment period, Illinoisans can enroll in comprehensive health coverage. Every plan Get Covered Illinois offers includes prescription drugs, mental health services, pediatric care, emergency services, free preventive care and other essential health benefits. Illinoisans who want their coverage to begin Jan. 1 must enroll by the extended deadline of Dec. 31. They can explore plans, apply for financial help and enroll at GetCoveredIllinois.gov.

Free enrollment support is available in person, by phone, or with a local certified navigator or broker. The Get Covered Illinois Customer Assistance Center offers support in more than 250 languages and has extended hours during open enrollment. Customers can call 1-866-311-1119 (TTY: 711) for assistance.