Governor Takes Bill Action

SPRINGFIELD - Governor Bruce Rauner took action today on the following bills:

Bill No.: HB 1
An Act Concerning Health
Action: Amendatory Veto
Note: Veto Message Below

Bill No.: HB 1336
An Act Concerning Liquor
Action: Signed
Effective: January 1, 2016

Bill No.: HB 3237
An Act Concerning Liquor
Action: Signed
Effective: Immediate

Bill No.: HB 3444
An Act Concerning Local Government
Action: Signed
Effective: Immediate

Bill No.: HB 3484
An Act Concerning Public Employee Benefits
Action: Signed
Effective: Immediate

Bill No.: HB 3485
An Act Concerning Finance
Action: Signed
Effective: January 1, 2016

Bill No.: HB 3556
An Act Concerning Local Government
Action: Signed
Effective: January 1, 2016

Bill No.: HB 3841
An Act Concerning Regulation
Action: Signed
Effective: Immediate

Bill No.: HB 3848
An Act Concerning Public Health
Action: Signed
Effective: January 1, 2016

Bill No.: HB 4006
An Act Concerning Burn Victims
Action: Signed
Effective: January 1, 2016

Bill No.: SB 100
An Act Concerning Education
Action: Signed
Effective: September 15, 2016

Bill No.: SB 418
An Act Concerning Public Aid
Action: Signed
Effective: January 1, 2016

Bill No.: SB 1800
An Act Concerning Local Government
Action: Signed
Effective: Immediate

Veto Message for HB 1

To the Honorable Members of
The Illinois House of Representatives,
99th General Assembly:

Today I return House Bill 1, the Heroin Crisis Act, with a specific recommendation for change.

House Bill 1 is a comprehensive effort to address opioid abuse from all angles. The bill is a result of the recommendations of the bi-partisan Heroin Task Force. I thank the sponsors of this bill and the members of the Task Force for their hard work over the past several years in addressing the growing heroin problem in Illinois.

First, the bill contains a number of important changes to increase the availability of an opioid antagonist and to provide for proper training on its use. It requires private insurance coverage for at least one opioid antagonist, as well as acute treatment and clinical stabilization services, which will be valuable in providing treatment for opioid users who need help in overcoming addiction.

The bill allows a licensed pharmacist, after completing a training program, to dispense an opioid antagonist in accordance with the procedures established by State agencies. It requires law enforcement and first responders to possess opioid antagonists and provide training on the administration of such antagonists. It allows a school nurse to administer an opioid antagonist to a student having an opioid overdose. It provides protection from civil liability to those individuals, including family members, who administer an opioid antagonist in good faith.

Second, in addition to the training requirements, House Bill 1 contains a number of substance abuse and mental health education requirements: the Department of Human Services and the State Board of Education will develop a three-year heroin and opioid prevention pilot program for all schools in the State; the Department of Human Services will also develop materials to educate opioid prescription holders on the dangers of these drugs; and the Department of Insurance will convene two working groups, one to discuss treatment of substance abuse and mental illness and another to educate consumers on parity between State and federal mental health laws.

Third, the bill addresses safety and public information concerns. It strengthens the Prescription Monitoring Program (PMP) to provide comprehensive information to physicians and pharmacists. Dispensers must report information to the PMP within one day, instead of seven days, of dispensing a controlled substance. To prevent medication shopping, the PMP may issue a report to the prescriber and dispenser when a person is identified as having three or more prescribers or pharmacies. The bill establishes a full-time Clinical Director of the PMP and an Advisory Committee to implement the PMP effectively. Physicians must now document in a patient's medical record the medical necessity of any three sequential 30-day prescriptions for Schedule II narcotics. To increase the safe disposal of medications, the Illinois Environmental Protection Agency is tasked with establishing a medication take-back program and providing information on the safe disposal of unused medication. The Department of Insurance will enforce parity between State and federal mental health laws. House Bill 1 also requires sharing of overdose information among law enforcement, physicians, and state agencies to ensure we have accurate data as we continue to look for solutions to this epidemic in Illinois.

Finally, the bill addresses criminal justice concerns and improves access to treatment by permitting multiple entries to drug court and no longer allowing a prosecutor to unilaterally block entry to drug court. It requires mandatory education for state's attorneys and public defenders on substance abuse and addiction. As a deterrent for individuals fraudulently acquiring controlled substances through "doctor shopping", it increases penalties for attempting to acquire or obtaining possession of a controlled substance through fraudulent means.

I support all of the above measures and applaud the multi-faceted approach to combating this epidemic in Illinois. Unfortunately, the bill also includes provisions that will impose a very costly mandate on the State's Medicaid providers. I am returning the bill with a recommendation to address that concern.

House Bill 1 mandates that fee-for-service and medical assistance Medicaid programs cover all forms of medication assisted treatment of alcohol or opioid dependence, and it removes utilization controls and prior authorization requirements. These changes would limit our ability to contain rising costs at a time when the State is facing unprecedented fiscal difficulties.

Importantly, the State's Medicaid programs already cover multiple forms of medication necessary to treat alcohol and opioid dependence. But without adequate funding to support mandated coverage for all forms of treatment, regardless of cost, this change would add to the State's deficit.

In addition, removing utilization controls and prior authorization requirements could undermine doctors' ability to manage treatment. Doctors should be able to work with individuals addicted to opioids to arrive at a reasonable, comprehensive treatment plan. The Department of Healthcare and Family Services has developed a utilization control process to work with prescribing physicians to support individuals struggling with addiction, ensure appropriate utilization of medications, and prevent waste. Removing any prior authorization or utilization control would inhibit a doctor's ability to responsibly manage the overall treatment program for Medicaid patients.

Therefore, pursuant to Section 9(e) of Article IV of the Illinois Constitution of 1970, I hereby return House Bill 1, entitled "AN ACT concerning health", with the following specific recommendation for change:

On page 125, by deleting lines 3-25.

With this change, House Bill 1 will have my approval. I respectfully request your concurrence.

Sincerely, Bruce Rauner
GOVERNOR