New Illinois Laws Aim to Address Health Disparities

On August 11, 2023, Governor Pritzker signed into law Illinois House Bill 2450 (HB2450), an overwhelmingly bipartisan effort (103–1 in the House and 52–4 in the Senate) to require certain healthcare professionals in Illinois to complete at least one hour of cultural competency training as a condition for obtaining or renewing a license or registration. “Cultural competency” for purposes of the law is defined as “a set of integrated attitudes, knowledge, and skills that enables a health care professional or organization to care effectively for patients from diverse cultures, groups, and communities.” The cultural competency training requirement, which becomes effective on January 1, 2025, arises as a component of healthcare professionals’ continuing education obligations and is in addition to the existing implicit bias awareness and sexual harassment prevention training required of licensed physicians, nurses, clinical psychologists, optometrists, physical therapists, physician assistants, clinical social workers, nursing home administrators, occupational therapists, podiatrists, respiratory therapists, counselors, speech-language pathologists, audiologists, dentists and behavior analysts.

Illinois state requirements surrounding completion of the statutorily mandated training will vary based on two factors: the frequency of license renewal, and whether more training topics are added to providers’ obligations after this law goes into effect. For example, healthcare professionals whose license or registration renewal occurs every other year will need to complete all statutorily mandated topics within three renewal periods. However, if new statutorily mandated topics are added after the effective date of HB2450, a healthcare professional whose license or registration occurs every other year must complete all mandated trainings within four renewal periods. Healthcare professionals whose license or registration renewals occur every three years will need to complete all statutorily mandated topics within two renewal periods, and if any statutorily mandated topics are added by law after the effective date of HB2450, such professionals must complete all statutorily mandated topics within three renewal periods. The Illinois Department of Financial and Professional Regulation will maintain on its website a current list of statutorily mandated training topics, and every license, permit application or renewal form that the department provides to a healthcare professional will include a notification regarding the obligatory training requirements.

Healthcare disparities researchers debate whether cultural competency training for healthcare professionals has a greater impact in improving patient outcomes than patient/provider concordance (see, e.g., Gina Guillaume, MD, Racial Concordance, Rather than Cultural Competency Training, Can Change Outcomes, Letter to the Editor, 54 FAM. MED. 745, 745–746 (2022)). Through passage of HB2450, Illinois supplements the Equity and Representation in Health Care Act, which became effective January 1, 2023, and establishes scholarship and loan repayment programs to stimulate proportional representation by “race, ethnicity, language, gender, sexual orientation, gender identity and disability status” in the healthcare provider community across the state, and particularly in areas with provider shortages or greater health disparities. Healthcare professionals may apply for loan repayment assistance if they are working at, or accepted an offer of employment at, a medical facility; have a degree in medicine, nursing, dentistry, physical therapy or other relevant profession; and hold a license or degree to practice. Applications will be reviewed and prioritized based on the following applicant categories:

• “Those who identify as persons from a race, ethnicity, gender, sexual orientation, gender identity or disability status that is underrepresented in the healthcare sector
• First-generation post-secondary students
• Reservists in the US Armed Forces or military veterans
• Persons working in rural medical facilities.”

With HB2450 and the Equity and Representation in Health Care Act, Illinois takes a bifurcated approach to ensuring compliance with federal health equity obligations. Specifically, the Medicaid Act and Children’s Health Insurance Program rules obligate states to have methods to “promote access and delivery of services in a culturally competent manner to all beneficiaries, including those with limited English proficiency, diverse cultural and ethnic backgrounds, disabilities, and regardless of gender, sexual orientation or gender identity.” Section 1557 of the Affordable Care Act prohibits the discrimination or denial of benefits associated with any healthcare program or activity receiving federal financial assistance on the basis of race, color, national origin, age, disability or sex. Accrediting institutions such as the Joint Commission and the National Committee for Quality Assurance have established standards for cultural competency and health equity, including training for healthcare providers, and offer health equity certification opportunities for health plans and organizations to demonstrate a dedication to addressing the needs of diverse populations. The US Department of Health and Human Services (HHS) Office of Minority Health has developed the National Culturally and Linguistically Appropriate Services (CLAS) Standards to advance health equity, improve quality of care and eliminate disparities in healthcare. HHS has established a helpful resource page for those looking for more information regarding cultural competency education.