Gov. JB Pritzker signed the annual Medicaid omnibus into law last week, putting into place enhanced rates for a variety of healthcare providers among other initiatives.

The law gives psychiatrists a one-time reimbursement rate hike of $264 per hour.

Rates are also increasing for:

  • Dental services related to sedation.
  • Home renal dialysis providers.
  • Optometric and optical services.
  • Supportive living services.
  • Children’s community-based healthcare centers.
  • Custom prosthetic and orthotic devices.

The law establishes payment rates for specialized mental health rehabilitation facilities too.

It also adds testing and treatment for SARS-CoV-2, respiratory syncytial virus, Group A strep infection and adult-stage head lice to pharmacists’ scope of practice. Medicaid health plans will have to cover the care as they do for doctors. The provision drew some pushback from physicians, but pharmacists welcomed it.

The omnibus establishes a “gold card” program to exempt highly rated hospitals or physicians from prior authorization for at least one year. Managed care organizations will identify providers based on the number of submitted service authorization requests in the preceding calendar year and whether they had a 90 percent or higher approval rate.

Exemptions would not apply to pharmacy services or durable medical equipment and supplies. The program will start in 2026.

The law also sets new reporting requirements for pharmacy benefit managers in the Medicaid program, including the aggregate wholesale acquisition cost for drugs dispensed to enrollees, the administrative fees they received from all pharmaceutical manufacturers and payments from each managed care organization.

Other provisions in the omnibus will:

  • Create a new add-on payment for safety-net hospitals based on inpatient general acute and psychiatric care.
  • Establish a 72-hour rule to permit emergency department physicians to admit a patient for inpatient care to stabilize a medical emergency condition without seeking prior authorization from a managed care organization.
  • ​​Increase​​ the allowance for residents of a supportive living facility to $120 per month.
  • Change existing law so the Department of Children and Family Services must reimburse hospitals for inpatient psychiatric stays beyond medical necessity starting on the third day of care for the child, rather than the 11th day.
  • Remove prior authorization for administration of prescription psychotropic drugs for adults with serious mental illness.
  • Establish facility fees for birthing centers.