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| AN ACT in relation to budget implementation.
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| Be it enacted by the People of the State of Illinois, |
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| represented in the General Assembly:
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| Section 1. Short title. This Act may be cited as the FY2005 | 5 |
| Budget Implementation (Human Services) Act. |
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| Section 5. Purpose. It is the purpose of this Act to make | 7 |
| changes in State programs that are necessary to implement the | 8 |
| Governor's FY2005 budget recommendations concerning human | 9 |
| services. |
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| Section 7. The Illinois Administrative Procedure Act is | 11 |
| amended by changing Section 5-45 as follows:
| 12 |
| (5 ILCS 100/5-45) (from Ch. 127, par. 1005-45)
| 13 |
| Sec. 5-45. Emergency rulemaking.
| 14 |
| (a) "Emergency" means the existence of any situation that | 15 |
| any agency
finds reasonably constitutes a threat to the public | 16 |
| interest, safety, or
welfare.
| 17 |
| (b) If any agency finds that an
emergency exists that | 18 |
| requires adoption of a rule upon fewer days than
is required by | 19 |
| Section 5-40 and states in writing its reasons for that
| 20 |
| finding, the agency may adopt an emergency rule without prior | 21 |
| notice or
hearing upon filing a notice of emergency rulemaking | 22 |
| with the Secretary of
State under Section 5-70. The notice | 23 |
| shall include the text of the
emergency rule and shall be | 24 |
| published in the Illinois Register. Consent
orders or other | 25 |
| court orders adopting settlements negotiated by an agency
may | 26 |
| be adopted under this Section. Subject to applicable | 27 |
| constitutional or
statutory provisions, an emergency rule | 28 |
| becomes effective immediately upon
filing under Section 5-65 or | 29 |
| at a stated date less than 10 days
thereafter. The agency's | 30 |
| finding and a statement of the specific reasons
for the finding |
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| shall be filed with the rule. The agency shall take
reasonable | 2 |
| and appropriate measures to make emergency rules known to the
| 3 |
| persons who may be affected by them.
| 4 |
| (c) An emergency rule may be effective for a period of not | 5 |
| longer than
150 days, but the agency's authority to adopt an | 6 |
| identical rule under Section
5-40 is not precluded. No | 7 |
| emergency rule may be adopted more
than once in any 24 month | 8 |
| period, except that this limitation on the number
of emergency | 9 |
| rules that may be adopted in a 24 month period does not apply
| 10 |
| to (i) emergency rules that make additions to and deletions | 11 |
| from the Drug
Manual under Section 5-5.16 of the Illinois | 12 |
| Public Aid Code or the
generic drug formulary under Section | 13 |
| 3.14 of the Illinois Food, Drug
and Cosmetic Act or (ii) | 14 |
| emergency rules adopted by the Pollution Control
Board before | 15 |
| July 1, 1997 to implement portions of the Livestock Management
| 16 |
| Facilities Act. Two or more emergency rules having | 17 |
| substantially the same
purpose and effect shall be deemed to be | 18 |
| a single rule for purposes of this
Section.
| 19 |
| (d) In order to provide for the expeditious and timely | 20 |
| implementation
of the State's fiscal year 1999 budget, | 21 |
| emergency rules to implement any
provision of Public Act 90-587 | 22 |
| or 90-588
or any other budget initiative for fiscal year 1999 | 23 |
| may be adopted in
accordance with this Section by the agency | 24 |
| charged with administering that
provision or initiative, | 25 |
| except that the 24-month limitation on the adoption
of | 26 |
| emergency rules and the provisions of Sections 5-115 and 5-125 | 27 |
| do not apply
to rules adopted under this subsection (d). The | 28 |
| adoption of emergency rules
authorized by this subsection (d) | 29 |
| shall be deemed to be necessary for the
public interest, | 30 |
| safety, and welfare.
| 31 |
| (e) In order to provide for the expeditious and timely | 32 |
| implementation
of the State's fiscal year 2000 budget, | 33 |
| emergency rules to implement any
provision of this amendatory | 34 |
| Act of the 91st General Assembly
or any other budget initiative | 35 |
| for fiscal year 2000 may be adopted in
accordance with this | 36 |
| Section by the agency charged with administering that
provision |
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| or initiative, except that the 24-month limitation on the | 2 |
| adoption
of emergency rules and the provisions of Sections | 3 |
| 5-115 and 5-125 do not apply
to rules adopted under this | 4 |
| subsection (e). The adoption of emergency rules
authorized by | 5 |
| this subsection (e) shall be deemed to be necessary for the
| 6 |
| public interest, safety, and welfare.
| 7 |
| (f) In order to provide for the expeditious and timely | 8 |
| implementation
of the State's fiscal year 2001 budget, | 9 |
| emergency rules to implement any
provision of this amendatory | 10 |
| Act of the 91st General Assembly
or any other budget initiative | 11 |
| for fiscal year 2001 may be adopted in
accordance with this | 12 |
| Section by the agency charged with administering that
provision | 13 |
| or initiative, except that the 24-month limitation on the | 14 |
| adoption
of emergency rules and the provisions of Sections | 15 |
| 5-115 and 5-125 do not apply
to rules adopted under this | 16 |
| subsection (f). The adoption of emergency rules
authorized by | 17 |
| this subsection (f) shall be deemed to be necessary for the
| 18 |
| public interest, safety, and welfare.
| 19 |
| (g) In order to provide for the expeditious and timely | 20 |
| implementation
of the State's fiscal year 2002 budget, | 21 |
| emergency rules to implement any
provision of this amendatory | 22 |
| Act of the 92nd General Assembly
or any other budget initiative | 23 |
| for fiscal year 2002 may be adopted in
accordance with this | 24 |
| Section by the agency charged with administering that
provision | 25 |
| or initiative, except that the 24-month limitation on the | 26 |
| adoption
of emergency rules and the provisions of Sections | 27 |
| 5-115 and 5-125 do not apply
to rules adopted under this | 28 |
| subsection (g). The adoption of emergency rules
authorized by | 29 |
| this subsection (g) shall be deemed to be necessary for the
| 30 |
| public interest, safety, and welfare.
| 31 |
| (h) In order to provide for the expeditious and timely | 32 |
| implementation
of the State's fiscal year 2003 budget, | 33 |
| emergency rules to implement any
provision of this amendatory | 34 |
| Act of the 92nd General Assembly
or any other budget initiative | 35 |
| for fiscal year 2003 may be adopted in
accordance with this | 36 |
| Section by the agency charged with administering that
provision |
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| or initiative, except that the 24-month limitation on the | 2 |
| adoption
of emergency rules and the provisions of Sections | 3 |
| 5-115 and 5-125 do not apply
to rules adopted under this | 4 |
| subsection (h). The adoption of emergency rules
authorized by | 5 |
| this subsection (h) shall be deemed to be necessary for the
| 6 |
| public interest, safety, and welfare.
| 7 |
| (i) In order to provide for the expeditious and timely | 8 |
| implementation
of the State's fiscal year 2004 budget, | 9 |
| emergency rules to implement any
provision of this amendatory | 10 |
| Act of the 93rd General Assembly
or any other budget initiative | 11 |
| for fiscal year 2004 may be adopted in
accordance with this | 12 |
| Section by the agency charged with administering that
provision | 13 |
| or initiative, except that the 24-month limitation on the | 14 |
| adoption
of emergency rules and the provisions of Sections | 15 |
| 5-115 and 5-125 do not apply
to rules adopted under this | 16 |
| subsection (i). The adoption of emergency rules
authorized by | 17 |
| this subsection (i) shall be deemed to be necessary for the
| 18 |
| public interest, safety, and welfare.
| 19 |
| (j) In order to provide for the expeditious and timely | 20 |
| implementation of the provisions of the State's fiscal year | 21 |
| 2005 budget as provided under the Fiscal Year 2005 Budget | 22 |
| Implementation (Human Services) Act, emergency rules to | 23 |
| implement any provision of the Fiscal Year 2005 Budget | 24 |
| Implementation (Human Services) Act may be adopted in | 25 |
| accordance with this Section by the agency charged with | 26 |
| administering that provision, except that the 24-month | 27 |
| limitation on the adoption of emergency rules and the | 28 |
| provisions of Sections 5-115 and 5-125 do not apply to rules | 29 |
| adopted under this subsection (j). The Department of Public Aid | 30 |
| may also adopt rules under this subsection (j) necessary to | 31 |
| administer the Illinois Public Aid Code and the Children's | 32 |
| Health Insurance Program Act. The adoption of emergency rules | 33 |
| authorized by this subsection (j) shall be deemed to be | 34 |
| necessary for the public interest, safety, and welfare.
| 35 |
| (Source: P.A. 92-10, eff. 6-11-01; 92-597, eff. 6-28-02; 93-20, | 36 |
| eff.
6-20-03.)
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| Section 10. The Mental Health and Developmental | 2 |
| Disabilities Administrative Act is amended by changing Section | 3 |
| 18.4 and adding Section 18.5 as follows:
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| (20 ILCS 1705/18.4)
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| Sec. 18.4. Community Mental Health Medicaid Trust Fund; | 6 |
| reimbursement.
| 7 |
| (a) The Community Mental Health Medicaid Trust Fund is | 8 |
| hereby created
in the State Treasury.
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| (b) Except as otherwise provided in this Section, any
Any
| 10 |
| funds paid to the State by the federal government under Title | 11 |
| XIX
or Title XXI of the Social Security Act for services | 12 |
| delivered by community
mental health services providers, and | 13 |
| any interest earned thereon, shall be
deposited directly into | 14 |
| the Community Mental Health Medicaid Trust Fund. Beginning with | 15 |
| State fiscal year 2005, the first $95,000,000 received by the | 16 |
| Department shall be deposited 26.3% into the General Revenue | 17 |
| Fund and 73.7% into the Community Mental Health Medicaid Trust | 18 |
| Fund. Amounts received in excess of $95,000,000 in any State | 19 |
| fiscal year shall be deposited 50% into the General Revenue | 20 |
| Fund and 50% into the Community Mental Health Medicaid Trust | 21 |
| Fund. The Department shall analyze the budgeting and | 22 |
| programmatic impact of this funding allocation and report to | 23 |
| the Governor and the General Assembly the results of this | 24 |
| analysis and any recommendations for change, no later than | 25 |
| December 31, 2005.
| 26 |
| (c) The Department shall reimburse community mental health | 27 |
| services
providers for Medicaid-reimbursed mental health | 28 |
| services provided to eligible
individuals. Moneys in the | 29 |
| Community Mental Health Medicaid Trust Fund may be
used for | 30 |
| that purpose.
| 31 |
| (d) As used in this Section:
| 32 |
| "Medicaid-reimbursed mental health services" means | 33 |
| services provided by a
community mental health provider under | 34 |
| an agreement with the Department that
is eligible for |
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| reimbursement under the federal Title XIX program or Title XXI
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| program.
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| "Provider" means a community agency that is funded by the | 4 |
| Department to
provide a Medicaid-reimbursed service.
| 5 |
| "Services" means mental health services provided under one | 6 |
| of the
following programs:
| 7 |
| (1) Medicaid Clinic Option;
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| (2) Medicaid Rehabilitation Option;
| 9 |
| (3) Targeted Case Management.
| 10 |
| (Source: P.A. 92-597, eff. 6-28-02.)
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| (20 ILCS 1705/18.5 new) | 12 |
| Sec. 18.5. Community Developmental Disability Services | 13 |
| Medicaid Trust Fund; reimbursement. | 14 |
| (a) The Community Developmental Disability Services | 15 |
| Medicaid Trust Fund is hereby created in the State treasury.
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| (b) Any funds in excess of $16,700,000 in any fiscal year | 17 |
| paid to the State by the federal government under Title XIX or | 18 |
| Title XXI of the Social Security Act for services delivered by | 19 |
| community developmental disability services providers for | 20 |
| services relating to Developmental Training and Community | 21 |
| Integrated Living Arrangements as a result of the conversion of | 22 |
| such providers from a grant payment methodology to a | 23 |
| fee-for-service payment methodology, or any other funds paid to | 24 |
| the State for any subsequent revenue maximization initiatives | 25 |
| performed by such providers, and any interest earned thereon, | 26 |
| shall be deposited directly into the Community Developmental | 27 |
| Disability Services Medicaid Trust Fund. One-third of this | 28 |
| amount shall be used only to pay for Medicaid-reimbursed | 29 |
| community developmental disability services provided to | 30 |
| eligible individuals, and the remainder shall be transferred to | 31 |
| the General Revenue Fund. | 32 |
| (c) For purposes of this Section: | 33 |
| "Medicaid-reimbursed developmental disability services" | 34 |
| means services provided by a community developmental | 35 |
| disability provider under an agreement with the Department that |
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| is eligible for reimbursement under the federal Title XIX | 2 |
| program or Title XXI program. | 3 |
| "Provider" means a qualified entity as defined in the | 4 |
| State's Home and
Community-Based Services Waiver for Persons | 5 |
| with Developmental Disabilities that is funded by the | 6 |
| Department to provide a Medicaid-reimbursed service. | 7 |
| "Revenue maximization alternatives" do not include | 8 |
| increases in
funds paid to the State as a result of growth in | 9 |
| spending through service expansion or
rate increases. |
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| Section 20. The State Finance Act is amended by changing | 11 |
| Sections 6z-58 and 25 and by adding Section 8.55 as follows:
| 12 |
| (30 ILCS 105/6z-58)
| 13 |
| Sec. 6z-58. The Family Care Fund.
| 14 |
| (a) There is created in the State treasury the Family Care | 15 |
| Fund. Interest
earned by the Fund shall be credited to the | 16 |
| Fund.
| 17 |
| (b) The Fund is created solely for the purposes of | 18 |
| receiving, investing, and
distributing moneys in accordance | 19 |
| with (i) an approved waiver under the Social
Security Act | 20 |
| resulting from the Family Care waiver request submitted by the
| 21 |
| Illinois Department of Public Aid on February 15, 2002 and (ii) | 22 |
| an interagency agreement between the Department of Public Aid | 23 |
| and another agency of State government . The Fund shall consist
| 24 |
| of:
| 25 |
| (1) All federal financial participation moneys | 26 |
| received pursuant to the
approved waiver, except for moneys | 27 |
| received pursuant to expenditures for
medical services by | 28 |
| the Department of Public Aid from any other fund; and
| 29 |
| (2) All other moneys received by the Fund from any | 30 |
| source, including
interest thereon.
| 31 |
| (c) Subject to appropriation, the moneys in the Fund shall | 32 |
| be disbursed for
reimbursement of medical services and other | 33 |
| costs associated with persons
receiving such services :
| 34 |
| (1) under programs administered by the Department of |
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| Public Aid; and | 2 |
| (2) pursuant to an interagency agreement, under | 3 |
| programs administered by another agency of State | 4 |
| government.
under the waiver due to their relationship with
| 5 |
| children receiving medical services pursuant to Article V | 6 |
| of the Illinois
Public Aid Code or the Children's Health | 7 |
| Insurance Program Act.
| 8 |
| (Source: P.A. 92-600, eff. 6-28-02; 93-20, eff. 6-20-03.)
| 9 |
| (30 ILCS 105/8.55 new) | 10 |
| Sec. 8.55. Interfund transfers. On or after July 1, 2004 | 11 |
| and until June 30, 2006, in addition to any other transfers | 12 |
| that may be provided for by law, at the direction of and upon | 13 |
| notification from the Director of Public Aid, the State | 14 |
| Comptroller shall direct and the State Treasurer shall transfer | 15 |
| amounts into the General Revenue Fund from the designated funds | 16 |
| not exceeding the following totals: | 17 |
| Hospital Provider Fund ............................$36,000,000 | 18 |
| Health and Human Services Medicaid Trust Fund ...$124,000,000. | 19 |
| Transfers of moneys under this Section may not exceed a | 20 |
| total of $80,000,000 in any State fiscal year.
| 21 |
| (30 ILCS 105/25) (from Ch. 127, par. 161)
| 22 |
| Sec. 25. Fiscal year limitations.
| 23 |
| (a) All appropriations shall be
available for expenditure | 24 |
| for the fiscal year or for a lesser period if the
Act making | 25 |
| that appropriation so specifies. A deficiency or emergency
| 26 |
| appropriation shall be available for expenditure only through | 27 |
| June 30 of
the year when the Act making that appropriation is | 28 |
| enacted unless that Act
otherwise provides.
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| (b) Outstanding liabilities as of June 30, payable from | 30 |
| appropriations
which have otherwise expired, may be paid out of | 31 |
| the expiring
appropriations during the 2-month period ending at | 32 |
| the
close of business on August 31. Any service involving
| 33 |
| professional or artistic skills or any personal services by an | 34 |
| employee whose
compensation is subject to income tax |
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| withholding must be performed as of June
30 of the fiscal year | 2 |
| in order to be considered an "outstanding liability as of
June | 3 |
| 30" that is thereby eligible for payment out of the expiring
| 4 |
| appropriation.
| 5 |
| However, payment of tuition reimbursement claims under | 6 |
| Section 14-7.03 or
18-3 of the School Code may be made by the | 7 |
| State Board of Education from its
appropriations for those | 8 |
| respective purposes for any fiscal year, even though
the claims | 9 |
| reimbursed by the payment may be claims attributable to a prior
| 10 |
| fiscal year, and payments may be made at the direction of the | 11 |
| State
Superintendent of Education from the fund from which the | 12 |
| appropriation is made
without regard to any fiscal year | 13 |
| limitations.
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| Medical payments may be made by the Department of Veterans' | 15 |
| Affairs from
its
appropriations for those purposes for any | 16 |
| fiscal year, without regard to the
fact that the medical | 17 |
| services being compensated for by such payment may have
been | 18 |
| rendered in a prior fiscal year.
| 19 |
| Medical payments may be made by the Department of Public | 20 |
| Aid and medical payments and child care
payments may be made by | 21 |
| the Department of
Human Services (as successor to the | 22 |
| Department of Public Aid) from
appropriations for those | 23 |
| purposes for any fiscal year,
without regard to the fact that | 24 |
| the medical or child care services being
compensated for by | 25 |
| such payment may have been rendered in a prior fiscal
year; and | 26 |
| payments may be made at the direction of the Department of
| 27 |
| Central Management Services from the Health Insurance Reserve | 28 |
| Fund and the
Local Government Health Insurance Reserve Fund | 29 |
| without regard to any fiscal
year limitations.
| 30 |
| Medical payments may be made by the Department of Human | 31 |
| Services from its appropriations relating to substance abuse | 32 |
| treatment services for any fiscal year, without regard to the | 33 |
| fact that the medical services being compensated for by such | 34 |
| payment may have been rendered in a prior fiscal year, provided | 35 |
| the payments are made on a fee-for-service basis consistent | 36 |
| with requirements established for Medicaid reimbursement by |
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| the Department of Public Aid. | 2 |
| Additionally, payments may be made by the Department of | 3 |
| Human Services from
its appropriations, or any other State | 4 |
| agency from its appropriations with
the approval of the | 5 |
| Department of Human Services, from the Immigration Reform
and | 6 |
| Control Fund for purposes authorized pursuant to the | 7 |
| Immigration Reform
and Control Act of 1986, without regard to | 8 |
| any fiscal year limitations.
| 9 |
| Further, with respect to costs incurred in fiscal years | 10 |
| 2002 and 2003 only,
payments may be made by the State Treasurer | 11 |
| from its
appropriations
from the Capital Litigation Trust Fund | 12 |
| without regard to any fiscal year
limitations.
| 13 |
| Lease payments may be made by the Department of Central | 14 |
| Management
Services under the sale and leaseback provisions of
| 15 |
| Section 7.4 of
the State Property Control Act with respect to | 16 |
| the James R. Thompson Center and
the
Elgin Mental Health Center | 17 |
| and surrounding land from appropriations for that
purpose | 18 |
| without regard to any fiscal year
limitations.
| 19 |
| Lease payments may be made under the sale and leaseback | 20 |
| provisions of
Section 7.5 of the State Property Control Act | 21 |
| with
respect to the
Illinois State Toll Highway Authority | 22 |
| headquarters building and surrounding
land
without regard to | 23 |
| any fiscal year
limitations.
| 24 |
| (c) Further, payments may be made by the Department of | 25 |
| Public Health and the
Department of Human Services (acting as | 26 |
| successor to the Department of Public
Health under the | 27 |
| Department of Human Services Act)
from their respective | 28 |
| appropriations for grants for medical care to or on
behalf of | 29 |
| persons
suffering from chronic renal disease, persons | 30 |
| suffering from hemophilia, rape
victims, and premature and | 31 |
| high-mortality risk infants and their mothers and
for grants | 32 |
| for supplemental food supplies provided under the United States
| 33 |
| Department of Agriculture Women, Infants and Children | 34 |
| Nutrition Program,
for any fiscal year without regard to the | 35 |
| fact that the services being
compensated for by such payment | 36 |
| may have been rendered in a prior fiscal year.
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| (d) The Department of Public Health and the Department of | 2 |
| Human Services
(acting as successor to the Department of Public | 3 |
| Health under the Department of
Human Services Act) shall each | 4 |
| annually submit to the State Comptroller, Senate
President, | 5 |
| Senate
Minority Leader, Speaker of the House, House Minority | 6 |
| Leader, and the
respective Chairmen and Minority Spokesmen of | 7 |
| the
Appropriations Committees of the Senate and the House, on | 8 |
| or before
December 31, a report of fiscal year funds used to | 9 |
| pay for services
provided in any prior fiscal year. This report | 10 |
| shall document by program or
service category those | 11 |
| expenditures from the most recently completed fiscal
year used | 12 |
| to pay for services provided in prior fiscal years.
| 13 |
| (e) The Department of Public Aid ,
and the Department of | 14 |
| Human Services
(acting as successor to the Department of Public | 15 |
| Aid) , and the Department of Human Services making | 16 |
| fee-for-service payments relating to substance abuse treatment | 17 |
| services provided during a previous fiscal year shall each | 18 |
| annually
submit to the State
Comptroller, Senate President, | 19 |
| Senate Minority Leader, Speaker of the House,
House Minority | 20 |
| Leader, the respective Chairmen and Minority Spokesmen of the
| 21 |
| Appropriations Committees of the Senate and the House, on or | 22 |
| before November
30, a report that shall document by program or | 23 |
| service category those
expenditures from the most recently | 24 |
| completed fiscal year used to pay for (i)
services provided in | 25 |
| prior fiscal years and (ii) services for which claims were
| 26 |
| received in prior fiscal years.
| 27 |
| (f) The Department of Human Services (as successor to the | 28 |
| Department of
Public Aid) shall annually submit to the State
| 29 |
| Comptroller, Senate President, Senate Minority Leader, Speaker | 30 |
| of the House,
House Minority Leader, and the respective | 31 |
| Chairmen and Minority Spokesmen of
the Appropriations | 32 |
| Committees of the Senate and the House, on or before
December | 33 |
| 31, a report
of fiscal year funds used to pay for services | 34 |
| (other than medical care)
provided in any prior fiscal year. | 35 |
| This report shall document by program or
service category those | 36 |
| expenditures from the most recently completed fiscal
year used |
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| to pay for services provided in prior fiscal years.
| 2 |
| (g) In addition, each annual report required to be | 3 |
| submitted by the
Department of Public Aid under subsection (e) | 4 |
| shall include the following
information with respect to the | 5 |
| State's Medicaid program:
| 6 |
| (1) Explanations of the exact causes of the variance | 7 |
| between the previous
year's estimated and actual | 8 |
| liabilities.
| 9 |
| (2) Factors affecting the Department of Public Aid's | 10 |
| liabilities,
including but not limited to numbers of aid | 11 |
| recipients, levels of medical
service utilization by aid | 12 |
| recipients, and inflation in the cost of medical
services.
| 13 |
| (3) The results of the Department's efforts to combat | 14 |
| fraud and abuse.
| 15 |
| (h) As provided in Section 4 of the General Assembly | 16 |
| Compensation Act,
any utility bill for service provided to a | 17 |
| General Assembly
member's district office for a period | 18 |
| including portions of 2 consecutive
fiscal years may be paid | 19 |
| from funds appropriated for such expenditure in
either fiscal | 20 |
| year.
| 21 |
| (i) An agency which administers a fund classified by the | 22 |
| Comptroller as an
internal service fund may issue rules for:
| 23 |
| (1) billing user agencies in advance
based on estimated | 24 |
| charges for goods or services;
| 25 |
| (2) issuing credits during
the subsequent fiscal year | 26 |
| for all user agency payments received during the
prior | 27 |
| fiscal year which were in excess of the final amounts owed | 28 |
| by the user
agency for that period; and
| 29 |
| (3) issuing catch-up billings to user agencies
during | 30 |
| the subsequent fiscal year for amounts remaining due when | 31 |
| payments
received from the user agency during the prior | 32 |
| fiscal year were less than the
total amount owed for that | 33 |
| period.
| 34 |
| User agencies are authorized to reimburse internal service | 35 |
| funds for catch-up
billings by vouchers drawn against their | 36 |
| respective appropriations for the
fiscal year in which the |
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| catch-up billing was issued.
| 2 |
| (Source: P.A. 92-885, eff. 1-13-03; 93-19, eff. 6-20-03.)
|
|
3 |
| Section 22. The Illinois Income Tax Act is amended by | 4 |
| changing Section 917 as follows:
| 5 |
| (35 ILCS 5/917) (from Ch. 120, par. 9-917)
| 6 |
| Sec. 917. Confidentiality and information sharing.
| 7 |
| (a) Confidentiality.
Except as provided in this Section, | 8 |
| all information received by the Department
from returns filed | 9 |
| under this Act, or from any investigation conducted under
the | 10 |
| provisions of this Act, shall be confidential, except for | 11 |
| official purposes
within the Department or pursuant to official | 12 |
| procedures for collection
of any State tax or pursuant to an | 13 |
| investigation or audit by the Illinois
State Scholarship | 14 |
| Commission of a delinquent student loan or monetary award
or | 15 |
| enforcement of any civil or criminal penalty or sanction
| 16 |
| imposed by this Act or by another statute imposing a State tax, | 17 |
| and any
person who divulges any such information in any manner, | 18 |
| except for such
purposes and pursuant to order of the Director | 19 |
| or in accordance with a proper
judicial order, shall be guilty | 20 |
| of a Class A misdemeanor. However, the
provisions of this | 21 |
| paragraph are not applicable to information furnished
to a | 22 |
| licensed attorney representing the taxpayer where an appeal or | 23 |
| a protest
has been filed on behalf of the taxpayer.
| 24 |
| (b) Public information. Nothing contained in this Act shall | 25 |
| prevent
the Director from publishing or making available to the | 26 |
| public the names
and addresses of persons filing returns under | 27 |
| this Act, or from publishing
or making available reasonable | 28 |
| statistics concerning the operation of the
tax wherein the | 29 |
| contents of returns are grouped into aggregates in such a
way | 30 |
| that the information contained in any individual return shall | 31 |
| not be
disclosed.
| 32 |
| (c) Governmental agencies. The Director may make available | 33 |
| to the
Secretary of the Treasury of the United States or his | 34 |
| delegate, or the
proper officer or his delegate of any other |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| state imposing a tax upon or
measured by income, for | 2 |
| exclusively official purposes, information received
by the | 3 |
| Department in the administration of this Act, but such | 4 |
| permission
shall be granted only if the United States or such | 5 |
| other state, as the case
may be, grants the Department | 6 |
| substantially similar privileges. The Director
may exchange | 7 |
| information with the Illinois Department of Public Aid and the
| 8 |
| Department of Human Services (acting as successor to the | 9 |
| Department of Public
Aid under the Department of Human Services | 10 |
| Act) for
the purpose of verifying sources and amounts of income | 11 |
| and for other purposes
directly connected with the | 12 |
| administration of this Act and the Illinois
Public Aid Code. | 13 |
| The Director may exchange information with the Director of
the | 14 |
| Department of Employment Security for the purpose of verifying | 15 |
| sources
and amounts of income and for other purposes directly | 16 |
| connected with the
administration of this Act and Acts | 17 |
| administered by the Department of
Employment
Security.
The | 18 |
| Director may make available to the Illinois Industrial | 19 |
| Commission
information regarding employers for the purpose of | 20 |
| verifying the insurance
coverage required under the Workers' | 21 |
| Compensation Act and Workers'
Occupational Diseases Act. The | 22 |
| Director may exchange information with the Illinois Department | 23 |
| on Aging for the purpose of verifying sources and amounts of | 24 |
| income for purposes directly related to confirming eligibility | 25 |
| for participation in the programs of benefits authorized by the | 26 |
| Senior Citizens and Disabled Persons Property Tax Relief and | 27 |
| Pharmaceutical Assistance Act.
| 28 |
| The Director may make available to any State agency, | 29 |
| including the
Illinois Supreme Court, which licenses persons to | 30 |
| engage in any occupation,
information that a person licensed by | 31 |
| such agency has failed to file
returns under this Act or pay | 32 |
| the tax, penalty and interest shown therein,
or has failed to | 33 |
| pay any final assessment of tax, penalty or interest due
under | 34 |
| this Act.
The Director may make available to any State agency, | 35 |
| including the Illinois
Supreme
Court, information regarding | 36 |
| whether a bidder, contractor, or an affiliate of a
bidder or
|
|
|
|
SB2208 Enrolled |
- 15 - |
LRB093 15827 RCE 41444 b |
|
| 1 |
| contractor has failed to file returns under this Act or pay the | 2 |
| tax, penalty,
and interest
shown therein, or has failed to pay | 3 |
| any final assessment of tax, penalty, or
interest due
under | 4 |
| this Act, for the limited purpose of enforcing bidder and | 5 |
| contractor
certifications.
For purposes of this Section, the | 6 |
| term "affiliate" means any entity that (1)
directly,
| 7 |
| indirectly, or constructively controls another entity, (2) is | 8 |
| directly,
indirectly, or
constructively controlled by another | 9 |
| entity, or (3) is subject to the control
of
a common
entity. | 10 |
| For purposes of this subsection (a), an entity controls another | 11 |
| entity
if
it owns,
directly or individually, more than 10% of | 12 |
| the voting securities of that
entity.
As used in
this | 13 |
| subsection (a), the term "voting security" means a security | 14 |
| that (1)
confers upon the
holder the right to vote for the | 15 |
| election of members of the board of directors
or similar
| 16 |
| governing body of the business or (2) is convertible into, or | 17 |
| entitles the
holder to receive
upon its exercise, a security | 18 |
| that confers such a right to vote. A general
partnership
| 19 |
| interest is a voting security.
| 20 |
| The Director may make available to any State agency, | 21 |
| including the
Illinois
Supreme Court, units of local | 22 |
| government, and school districts, information
regarding
| 23 |
| whether a bidder or contractor is an affiliate of a person who | 24 |
| is not
collecting
and
remitting Illinois Use taxes, for the | 25 |
| limited purpose of enforcing bidder and
contractor
| 26 |
| certifications.
| 27 |
| The Director may also make available to the Secretary of | 28 |
| State
information that a corporation which has been issued a | 29 |
| certificate of
incorporation by the Secretary of State has | 30 |
| failed to file returns under
this Act or pay the tax, penalty | 31 |
| and interest shown therein, or has failed
to pay any final | 32 |
| assessment of tax, penalty or interest due under this Act.
An | 33 |
| assessment is final when all proceedings in court for
review of | 34 |
| such assessment have terminated or the time for the taking
| 35 |
| thereof has expired without such proceedings being instituted. | 36 |
| For
taxable years ending on or after December 31, 1987, the |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| Director may make
available to the Director or principal | 2 |
| officer of any Department of the
State of Illinois, information | 3 |
| that a person employed by such Department
has failed to file | 4 |
| returns under this Act or pay the tax, penalty and
interest | 5 |
| shown therein. For purposes of this paragraph, the word
| 6 |
| "Department" shall have the same meaning as provided in Section | 7 |
| 3 of the
State Employees Group Insurance Act of 1971.
| 8 |
| (d) The Director shall make available for public
inspection | 9 |
| in the Department's principal office and for publication, at | 10 |
| cost,
administrative decisions issued on or after January
1, | 11 |
| 1995. These decisions are to be made available in a manner so | 12 |
| that the
following
taxpayer information is not disclosed:
| 13 |
| (1) The names, addresses, and identification numbers | 14 |
| of the taxpayer,
related entities, and employees.
| 15 |
| (2) At the sole discretion of the Director, trade | 16 |
| secrets
or other confidential information identified as | 17 |
| such by the taxpayer, no later
than 30 days after receipt | 18 |
| of an administrative decision, by such means as the
| 19 |
| Department shall provide by rule.
| 20 |
| The Director shall determine the
appropriate extent of the
| 21 |
| deletions allowed in paragraph (2). In the event the taxpayer | 22 |
| does not submit
deletions,
the Director shall make only the | 23 |
| deletions specified in paragraph (1).
| 24 |
| The Director shall make available for public inspection and | 25 |
| publication an
administrative decision within 180 days after | 26 |
| the issuance of the
administrative
decision. The term | 27 |
| "administrative decision" has the same meaning as defined in
| 28 |
| Section 3-101 of Article III of the Code of Civil Procedure. | 29 |
| Costs collected
under this Section shall be paid into the Tax | 30 |
| Compliance and Administration
Fund.
| 31 |
| (e) Nothing contained in this Act shall prevent the | 32 |
| Director from
divulging
information to any person pursuant to a | 33 |
| request or authorization made by the
taxpayer, by an authorized | 34 |
| representative of the taxpayer, or, in the case of
information | 35 |
| related to a joint return, by the spouse filing the joint | 36 |
| return
with the taxpayer.
|
|
|
|
SB2208 Enrolled |
- 17 - |
LRB093 15827 RCE 41444 b |
|
| 1 |
| (Source: P.A. 93-25, eff. 6-20-03.)
|
|
2 |
| Section 25. The Nursing Home Care Act is amended by | 3 |
| changing Section 3-103 as follows:
| 4 |
| (210 ILCS 45/3-103) (from Ch. 111 1/2, par. 4153-103)
| 5 |
| Sec. 3-103. The procedure for obtaining a valid license | 6 |
| shall be as follows:
| 7 |
| (1) Application to operate a facility shall be made to
the | 8 |
| Department on forms furnished by the Department.
| 9 |
| (2)
All license applications shall be accompanied with an | 10 |
| application fee.
The fee
for an annual license shall be $995
| 11 |
| based on the licensed capacity of the facility
and shall be | 12 |
| determined as follows: 0-49 licensed beds, a flat fee of $500;
| 13 |
| 50-99 licensed beds, a flat fee of $750; and for any facility | 14 |
| with 100 or more
licensed beds, a fee of
$1,000 plus $10 per | 15 |
| licensed bed . Facilities that pay a fee or assessment pursuant | 16 |
| to Article V-C of the Illinois Public Aid Code shall be exempt | 17 |
| from the license fee imposed under this item (2). The fee for a | 18 |
| 2-year
license shall be double the fee for the annual license | 19 |
| set forth in the
preceding sentence. The first $600,000 of such
| 20 |
| fees collected each fiscal year
shall be deposited with the | 21 |
| State Treasurer into the Long Term Care
Monitor/Receiver Fund, | 22 |
| which has been created as a special fund in the State
treasury. | 23 |
| Any such fees in excess of $600,000 collected in a fiscal year | 24 |
| shall
be deposited into the General Revenue Fund.
This special | 25 |
| fund is to be used by the Department for expenses related to
| 26 |
| the appointment of monitors and receivers as contained in | 27 |
| Sections 3-501
through 3-517. At the end of each fiscal year, | 28 |
| any funds in excess of
$1,000,000 held in the Long Term Care | 29 |
| Monitor/Receiver Fund shall be
deposited in the State's General | 30 |
| Revenue Fund. The application shall be under
oath and the | 31 |
| submission of false or misleading information shall be a Class
| 32 |
| A misdemeanor. The application shall contain the following | 33 |
| information:
| 34 |
| (a) The name and address of the applicant if an |
|
|
|
SB2208 Enrolled |
- 18 - |
LRB093 15827 RCE 41444 b |
|
| 1 |
| individual, and if a firm,
partnership, or association, of | 2 |
| every member thereof, and in the case of
a corporation, the | 3 |
| name and address thereof and of its officers and its
| 4 |
| registered agent, and in the case of a unit of local | 5 |
| government, the name
and address of its chief executive | 6 |
| officer;
| 7 |
| (b) The name and location of the facility for which a | 8 |
| license is sought;
| 9 |
| (c) The name of the person or persons under whose | 10 |
| management or
supervision
the facility will be conducted;
| 11 |
| (d) The number and type of residents for which | 12 |
| maintenance, personal care,
or nursing is to be provided; | 13 |
| and
| 14 |
| (e) Such information relating to the number, | 15 |
| experience, and training
of the employees of the facility, | 16 |
| any management agreements for the operation
of the | 17 |
| facility, and of the moral character of the applicant and | 18 |
| employees
as the Department may deem necessary.
| 19 |
| (3) Each initial application shall be accompanied by a | 20 |
| financial
statement setting forth the financial condition of | 21 |
| the applicant and by a
statement from the unit of local | 22 |
| government having zoning jurisdiction over
the facility's | 23 |
| location stating that the location of the facility is not in
| 24 |
| violation of a zoning ordinance. An initial application for a | 25 |
| new facility
shall be accompanied by a permit as required by | 26 |
| the "Illinois Health Facilities
Planning Act". After the | 27 |
| application is approved, the applicant shall
advise the | 28 |
| Department every 6 months of any changes in the information
| 29 |
| originally provided in the application.
| 30 |
| (4) Other information necessary to determine the identity | 31 |
| and qualifications
of an applicant to operate a facility in | 32 |
| accordance with this Act shall
be included in the application | 33 |
| as required by the Department in regulations.
| 34 |
| (Source: P.A. 93-32, eff. 7-1-03.)
|
|
35 |
| Section 27. The Pharmacy Practice Act of 1987 is amended by |
|
|
|
SB2208 Enrolled |
- 19 - |
LRB093 15827 RCE 41444 b |
|
| 1 |
| changing Section 25 as follows:
| 2 |
| (225 ILCS 85/25) (from Ch. 111, par. 4145)
| 3 |
| (Section scheduled to be repealed on January 1, 2008)
| 4 |
| Sec. 25. No person shall compound, or sell or offer for | 5 |
| sale, or
cause to be compounded, sold or offered for sale any | 6 |
| medicine or preparation
under or by a name recognized in the | 7 |
| United States Pharmacopoeia
National Formulary, for internal | 8 |
| or external use, which differs from
the standard of strength, | 9 |
| quality or purity as determined by the test
laid down in the | 10 |
| United States Pharmacopoeia National Formulary official at
the | 11 |
| time
of
such compounding, sale or offering for sale. Nor shall | 12 |
| any person
compound, sell or offer for sale, or cause to be | 13 |
| compounded, sold,
or offered for sale, any drug, medicine, | 14 |
| poison, chemical or pharmaceutical
preparation, the strength | 15 |
| or purity of which shall fall below the professed
standard of | 16 |
| strength or purity under which it is sold. If the physician
or | 17 |
| other authorized prescriber, when transmitting an oral or | 18 |
| written
prescription, does not prohibit drug product | 19 |
| selection, a different
brand name or nonbrand name drug product | 20 |
| of the same generic name may
be dispensed by the pharmacist, | 21 |
| provided that the selected drug
has
a unit price less than the | 22 |
| drug product specified in the prescription
and provided that | 23 |
| the selection is permitted, is not subject to review at a
| 24 |
| meeting of
the Technical Advisory Council, is not subject to a | 25 |
| hearing in accordance
with this Section, or is not specifically | 26 |
| prohibited by the
current Drug Product
Selection Formulary | 27 |
| issued by the Department of Public Health pursuant
to Section | 28 |
| 3.14 of the Illinois Food, Drug and Cosmetics Act, as amended .
| 29 |
| A generic drug determined to be therapeutically equivalent by | 30 |
| the
United States Food and Drug Administration (FDA) shall be
| 31 |
| available for substitution in Illinois in accordance with this
| 32 |
| Act and the Illinois Food, Drug and Cosmetic Act, provided that
| 33 |
| each manufacturer submits to the Director of the Department of | 34 |
| Public Health a notification containing product
technical | 35 |
| bioequivalence information as a prerequisite to product
|
|
|
|
SB2208 Enrolled |
- 20 - |
LRB093 15827 RCE 41444 b |
|
| 1 |
| substitution when they have completed all required testing to
| 2 |
| support FDA product approval and, in any event, the information
| 3 |
| shall be submitted no later than 60 days prior to product
| 4 |
| substitution in the State. If the Technical Advisory Council
| 5 |
| finds that a generic drug product may have issues related to | 6 |
| the
practice of medicine or the practice of pharmacy, the | 7 |
| Technical
Advisory Council shall review the generic drug | 8 |
| product
at its next regularly
scheduled Technical Advisory | 9 |
| Council meeting. Following the
Technical Advisory Council's | 10 |
| review and initial recommendation that a generic
drug product | 11 |
| not be included in the Illinois Formulary, a hearing shall be | 12 |
| conducted in accordance with the rules of
the Department
of | 13 |
| Public Health and Article 10 of the Illinois
Administrative | 14 |
| Procedure Act if requested by the manufacturer. The
Technical | 15 |
| Advisory Council
shall make its recommendation to the | 16 |
| Department of Public Health
within 20 business days after the | 17 |
| public hearing. If the
Department of Public Health, on the | 18 |
| recommendation of the
Technical Advisory Council, determines | 19 |
| that, based upon a
preponderance of the evidence, the drug is | 20 |
| not bioequivalent, not
therapeutically equivalent, or could | 21 |
| cause clinically significant
harm to the health or safety of | 22 |
| patients receiving that generic drug,
the Department of Public | 23 |
| Health may prohibit the generic drug
from substitution in the | 24 |
| State. A decision by the Department of Public Health
to
| 25 |
| prohibit a drug product from substitution shall constitute a
| 26 |
| final administrative decision within the meaning of Section | 27 |
| 22.2
of the Illinois Food, Drug and Cosmetic Act and Section | 28 |
| 3-101 of
the Code of Civil Procedure, and shall be subject to | 29 |
| judicial
review pursuant to the provisions of Article III of | 30 |
| the
Administrative Review Law. A decision to prohibit a generic
| 31 |
| drug from substitution must be accompanied by a written | 32 |
| detailed
explanation of the basis for the decision.
On the | 33 |
| prescription forms of prescribers,
shall be placed a signature | 34 |
| line and the words "may substitute" and
"may not substitute". | 35 |
| The prescriber, in his or her own handwriting,
shall place a | 36 |
| mark beside either the "may substitute" or "may not substitute"
|
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| alternatives to guide the pharmacist in the dispensing of the | 2 |
| prescription.
A prescriber placing a mark beside the "may | 3 |
| substitute" alternative
or failing in his or her own | 4 |
| handwriting to place a mark beside either
alternative | 5 |
| authorizes drug product selection in accordance with this
Act. | 6 |
| Preprinted or rubber stamped marks, or other deviations from
| 7 |
| the above prescription format shall not be permitted. The | 8 |
| prescriber
shall sign the form in his or her own handwriting to | 9 |
| authorize the
issuance of the prescription. When a person | 10 |
| presents a prescription
to be dispensed, the pharmacist to whom | 11 |
| it is presented may inform
the person if the pharmacy has | 12 |
| available a different brand name or
nonbrand name of the same | 13 |
| generic drug prescribed and the price of
the different brand | 14 |
| name or nonbrand name of the drug
product. If
the person | 15 |
| presenting the prescription is the one to whom the drug
is to | 16 |
| be administered, the pharmacist may dispense the prescription
| 17 |
| with the brand prescribed or a different brand name or nonbrand | 18 |
| name
product of the same generic name that has been permitted | 19 |
| by the Department
of Public Health , if the drug is of lesser | 20 |
| unit cost and the
patient
is informed and agrees to the | 21 |
| selection and the pharmacist shall enter
such information into | 22 |
| the pharmacy record. If the person
presenting
the prescription | 23 |
| is someone other than the one to whom the drug is
to be | 24 |
| administered the pharmacist shall not dispense the | 25 |
| prescription
with a brand other than the one specified in the | 26 |
| prescription unless
the pharmacist has the written or oral | 27 |
| authorization to select brands
from the person to whom the drug | 28 |
| is to be administered or a parent,
legal guardian or spouse of | 29 |
| that person.
| 30 |
| In every case in which a selection is made as permitted by | 31 |
| the Illinois
Food, Drug and Cosmetic Act, the pharmacist shall | 32 |
| indicate on the pharmacy
record of the filled prescription the | 33 |
| name or other identification
of the manufacturer of the drug | 34 |
| which has been dispensed.
| 35 |
| The selection of any drug product by a pharmacist shall not | 36 |
| constitute
evidence of negligence if the selected nonlegend |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| drug product was of
the same dosage form and each of its active | 2 |
| ingredients did not vary
by more than 1 percent from the active | 3 |
| ingredients of the prescribed,
brand name, nonlegend drug | 4 |
| product or if the selected legend drug product
was included in | 5 |
| the Illinois Drug Product Selection Formulary current
at the | 6 |
| time the prescription was dispensed . Failure of a prescribing
| 7 |
| physician to specify that drug product selection is prohibited | 8 |
| does not
constitute evidence of negligence
unless that | 9 |
| practitioner has reasonable cause to believe that the health
| 10 |
| condition of the patient for whom the physician is prescribing | 11 |
| warrants
the use of the brand name drug product and not | 12 |
| another.
| 13 |
| The Department is authorized to employ an analyst or | 14 |
| chemist of recognized
or approved standing whose duty it shall | 15 |
| be to examine into any claimed
adulteration, illegal | 16 |
| substitution, improper selection, alteration,
or other | 17 |
| violation hereof, and report the result of his investigation,
| 18 |
| and if such report justify such action the Department shall | 19 |
| cause the
offender to be prosecuted.
| 20 |
| (Source: P.A. 91-766, eff. 9-1-00; 92-112, eff. 7-20-01.)
|
|
21 |
| Section 30. The Illinois Public Aid Code is amended by | 22 |
| changing Sections 5-5, 5-5.4, 5A-2, 5A-4, 5A-5, 5A-7, and 5A-12 | 23 |
| and adding Sections 5-5.4c and 12-10.7 as follows: | 24 |
| (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
| 25 |
| Sec. 5-5. Medical services. The Illinois Department, by | 26 |
| rule, shall
determine the quantity and quality of and the rate | 27 |
| of reimbursement for the
medical assistance for which
payment | 28 |
| will be authorized, and the medical services to be provided,
| 29 |
| which may include all or part of the following: (1) inpatient | 30 |
| hospital
services; (2) outpatient hospital services; (3) other | 31 |
| laboratory and
X-ray services; (4) skilled nursing home | 32 |
| services; (5) physicians'
services whether furnished in the | 33 |
| office, the patient's home, a
hospital, a skilled nursing home, | 34 |
| or elsewhere; (6) medical care, or any
other type of remedial |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| care furnished by licensed practitioners; (7)
home health care | 2 |
| services; (8) private duty nursing service; (9) clinic
| 3 |
| services; (10) dental services; (11) physical therapy and | 4 |
| related
services; (12) prescribed drugs, dentures, and | 5 |
| prosthetic devices; and
eyeglasses prescribed by a physician | 6 |
| skilled in the diseases of the eye,
or by an optometrist, | 7 |
| whichever the person may select; (13) other
diagnostic, | 8 |
| screening, preventive, and rehabilitative services; (14)
| 9 |
| transportation and such other expenses as may be necessary; | 10 |
| (15) medical
treatment of sexual assault survivors, as defined | 11 |
| in
Section 1a of the Sexual Assault Survivors Emergency | 12 |
| Treatment Act, for
injuries sustained as a result of the sexual | 13 |
| assault, including
examinations and laboratory tests to | 14 |
| discover evidence which may be used in
criminal proceedings | 15 |
| arising from the sexual assault; (16) the
diagnosis and | 16 |
| treatment of sickle cell anemia; and (17)
any other medical | 17 |
| care, and any other type of remedial care recognized
under the | 18 |
| laws of this State, but not including abortions, or induced
| 19 |
| miscarriages or premature births, unless, in the opinion of a | 20 |
| physician,
such procedures are necessary for the preservation | 21 |
| of the life of the
woman seeking such treatment, or except an | 22 |
| induced premature birth
intended to produce a live viable child | 23 |
| and such procedure is necessary
for the health of the mother or | 24 |
| her unborn child. The Illinois Department,
by rule, shall | 25 |
| prohibit any physician from providing medical assistance
to | 26 |
| anyone eligible therefor under this Code where such physician | 27 |
| has been
found guilty of performing an abortion procedure in a | 28 |
| wilful and wanton
manner upon a woman who was not pregnant at | 29 |
| the time such abortion
procedure was performed. The term "any | 30 |
| other type of remedial care" shall
include nursing care and | 31 |
| nursing home service for persons who rely on
treatment by | 32 |
| spiritual means alone through prayer for healing.
| 33 |
| Notwithstanding any other provision of this Section, a | 34 |
| comprehensive
tobacco use cessation program that includes | 35 |
| purchasing prescription drugs or
prescription medical devices | 36 |
| approved by the Food and Drug administration shall
be covered |
|
|
|
SB2208 Enrolled |
- 24 - |
LRB093 15827 RCE 41444 b |
|
| 1 |
| under the medical assistance
program under this Article for | 2 |
| persons who are otherwise eligible for
assistance under this | 3 |
| Article.
| 4 |
| Notwithstanding any other provision of this Code, the | 5 |
| Illinois
Department may not require, as a condition of payment | 6 |
| for any laboratory
test authorized under this Article, that a | 7 |
| physician's handwritten signature
appear on the laboratory | 8 |
| test order form. The Illinois Department may,
however, impose | 9 |
| other appropriate requirements regarding laboratory test
order | 10 |
| documentation.
| 11 |
| The Illinois Department of Public Aid shall provide the | 12 |
| following services to
persons
eligible for assistance under | 13 |
| this Article who are participating in
education, training or | 14 |
| employment programs operated by the Department of Human
| 15 |
| Services as successor to the Department of Public Aid:
| 16 |
| (1) dental services, which shall include but not be | 17 |
| limited to
prosthodontics; and
| 18 |
| (2) eyeglasses prescribed by a physician skilled in the | 19 |
| diseases of the
eye, or by an optometrist, whichever the | 20 |
| person may select.
| 21 |
| The Illinois Department, by rule, may distinguish and | 22 |
| classify the
medical services to be provided only in accordance | 23 |
| with the classes of
persons designated in Section 5-2.
| 24 |
| The Illinois Department shall authorize the provision of, | 25 |
| and shall
authorize payment for, screening by low-dose | 26 |
| mammography for the presence of
occult breast cancer for women | 27 |
| 35 years of age or older who are eligible
for medical | 28 |
| assistance under this Article, as follows: a baseline
mammogram | 29 |
| for women 35 to 39 years of age and an
annual mammogram for | 30 |
| women 40 years of age or older. All screenings
shall
include a | 31 |
| physical breast exam, instruction on self-examination and
| 32 |
| information regarding the frequency of self-examination and | 33 |
| its value as a
preventative tool. As used in this Section, | 34 |
| "low-dose mammography" means
the x-ray examination of the | 35 |
| breast using equipment dedicated specifically
for mammography, | 36 |
| including the x-ray tube, filter, compression device,
image |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| receptor, and cassettes, with an average radiation exposure | 2 |
| delivery
of less than one rad mid-breast, with 2 views for each | 3 |
| breast.
| 4 |
| Any medical or health care provider shall immediately | 5 |
| recommend, to
any pregnant woman who is being provided prenatal | 6 |
| services and is suspected
of drug abuse or is addicted as | 7 |
| defined in the Alcoholism and Other Drug Abuse
and Dependency | 8 |
| Act, referral to a local substance abuse treatment provider
| 9 |
| licensed by the Department of Human Services or to a licensed
| 10 |
| hospital which provides substance abuse treatment services. | 11 |
| The Department of
Public Aid shall assure coverage for the cost | 12 |
| of treatment of the drug abuse or
addiction for pregnant | 13 |
| recipients in accordance with the Illinois Medicaid
Program in | 14 |
| conjunction with the Department of Human Services.
| 15 |
| All medical providers providing medical assistance to | 16 |
| pregnant women
under this Code shall receive information from | 17 |
| the Department on the
availability of services under the Drug | 18 |
| Free Families with a Future or any
comparable program providing | 19 |
| case management services for addicted women,
including | 20 |
| information on appropriate referrals for other social services
| 21 |
| that may be needed by addicted women in addition to treatment | 22 |
| for addiction.
| 23 |
| The Illinois Department, in cooperation with the | 24 |
| Departments of Human
Services (as successor to the Department | 25 |
| of Alcoholism and Substance
Abuse) and Public Health, through a | 26 |
| public awareness campaign, may
provide information concerning | 27 |
| treatment for alcoholism and drug abuse and
addiction, prenatal | 28 |
| health care, and other pertinent programs directed at
reducing | 29 |
| the number of drug-affected infants born to recipients of | 30 |
| medical
assistance.
| 31 |
| Neither the Illinois Department of Public Aid nor the | 32 |
| Department of Human
Services shall sanction the recipient | 33 |
| solely on the basis of
her substance abuse.
| 34 |
| The Illinois Department shall establish such regulations | 35 |
| governing
the dispensing of health services under this Article | 36 |
| as it shall deem
appropriate. The Department
should
seek the |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| advice of formal professional advisory committees appointed by
| 2 |
| the Director of the Illinois Department for the purpose of | 3 |
| providing regular
advice on policy and administrative matters, | 4 |
| information dissemination and
educational activities for | 5 |
| medical and health care providers, and
consistency in | 6 |
| procedures to the Illinois Department.
| 7 |
| The Illinois Department may develop and contract with | 8 |
| Partnerships of
medical providers to arrange medical services | 9 |
| for persons eligible under
Section 5-2 of this Code. | 10 |
| Implementation of this Section may be by
demonstration projects | 11 |
| in certain geographic areas. The Partnership shall
be | 12 |
| represented by a sponsor organization. The Department, by rule, | 13 |
| shall
develop qualifications for sponsors of Partnerships. | 14 |
| Nothing in this
Section shall be construed to require that the | 15 |
| sponsor organization be a
medical organization.
| 16 |
| The sponsor must negotiate formal written contracts with | 17 |
| medical
providers for physician services, inpatient and | 18 |
| outpatient hospital care,
home health services, treatment for | 19 |
| alcoholism and substance abuse, and
other services determined | 20 |
| necessary by the Illinois Department by rule for
delivery by | 21 |
| Partnerships. Physician services must include prenatal and
| 22 |
| obstetrical care. The Illinois Department shall reimburse | 23 |
| medical services
delivered by Partnership providers to clients | 24 |
| in target areas according to
provisions of this Article and the | 25 |
| Illinois Health Finance Reform Act,
except that:
| 26 |
| (1) Physicians participating in a Partnership and | 27 |
| providing certain
services, which shall be determined by | 28 |
| the Illinois Department, to persons
in areas covered by the | 29 |
| Partnership may receive an additional surcharge
for such | 30 |
| services.
| 31 |
| (2) The Department may elect to consider and negotiate | 32 |
| financial
incentives to encourage the development of | 33 |
| Partnerships and the efficient
delivery of medical care.
| 34 |
| (3) Persons receiving medical services through | 35 |
| Partnerships may receive
medical and case management | 36 |
| services above the level usually offered
through the |
|
|
|
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LRB093 15827 RCE 41444 b |
|
| 1 |
| medical assistance program.
| 2 |
| Medical providers shall be required to meet certain | 3 |
| qualifications to
participate in Partnerships to ensure the | 4 |
| delivery of high quality medical
services. These | 5 |
| qualifications shall be determined by rule of the Illinois
| 6 |
| Department and may be higher than qualifications for | 7 |
| participation in the
medical assistance program. Partnership | 8 |
| sponsors may prescribe reasonable
additional qualifications | 9 |
| for participation by medical providers, only with
the prior | 10 |
| written approval of the Illinois Department.
| 11 |
| Nothing in this Section shall limit the free choice of | 12 |
| practitioners,
hospitals, and other providers of medical | 13 |
| services by clients.
In order to ensure patient freedom of | 14 |
| choice, the Illinois Department shall
immediately promulgate | 15 |
| all rules and take all other necessary actions so that
provided | 16 |
| services may be accessed from therapeutically certified | 17 |
| optometrists
to the full extent of the Illinois Optometric | 18 |
| Practice Act of 1987 without
discriminating between service | 19 |
| providers.
| 20 |
| The Department shall apply for a waiver from the United | 21 |
| States Health
Care Financing Administration to allow for the | 22 |
| implementation of
Partnerships under this Section.
| 23 |
| The Illinois Department shall require health care | 24 |
| providers to maintain
records that document the medical care | 25 |
| and services provided to recipients
of Medical Assistance under | 26 |
| this Article. The Illinois Department shall
require health care | 27 |
| providers to make available, when authorized by the
patient, in | 28 |
| writing, the medical records in a timely fashion to other
| 29 |
| health care providers who are treating or serving persons | 30 |
| eligible for
Medical Assistance under this Article. All | 31 |
| dispensers of medical services
shall be required to maintain | 32 |
| and retain business and professional records
sufficient to | 33 |
| fully and accurately document the nature, scope, details and
| 34 |
| receipt of the health care provided to persons eligible for | 35 |
| medical
assistance under this Code, in accordance with | 36 |
| regulations promulgated by
the Illinois Department. The rules |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| and regulations shall require that proof
of the receipt of | 2 |
| prescription drugs, dentures, prosthetic devices and
| 3 |
| eyeglasses by eligible persons under this Section accompany | 4 |
| each claim
for reimbursement submitted by the dispenser of such | 5 |
| medical services.
No such claims for reimbursement shall be | 6 |
| approved for payment by the Illinois
Department without such | 7 |
| proof of receipt, unless the Illinois Department
shall have put | 8 |
| into effect and shall be operating a system of post-payment
| 9 |
| audit and review which shall, on a sampling basis, be deemed | 10 |
| adequate by
the Illinois Department to assure that such drugs, | 11 |
| dentures, prosthetic
devices and eyeglasses for which payment | 12 |
| is being made are actually being
received by eligible | 13 |
| recipients. Within 90 days after the effective date of
this | 14 |
| amendatory Act of 1984, the Illinois Department shall establish | 15 |
| a
current list of acquisition costs for all prosthetic devices | 16 |
| and any
other items recognized as medical equipment and | 17 |
| supplies reimbursable under
this Article and shall update such | 18 |
| list on a quarterly basis, except that
the acquisition costs of | 19 |
| all prescription drugs shall be updated no
less frequently than | 20 |
| every 30 days as required by Section 5-5.12.
| 21 |
| The rules and regulations of the Illinois Department shall | 22 |
| require
that a written statement including the required opinion | 23 |
| of a physician
shall accompany any claim for reimbursement for | 24 |
| abortions, or induced
miscarriages or premature births. This | 25 |
| statement shall indicate what
procedures were used in providing | 26 |
| such medical services.
| 27 |
| The Illinois Department shall require all dispensers of | 28 |
| medical
services, other than an individual practitioner or | 29 |
| group of practitioners,
desiring to participate in the Medical | 30 |
| Assistance program
established under this Article to disclose | 31 |
| all financial, beneficial,
ownership, equity, surety or other | 32 |
| interests in any and all firms,
corporations, partnerships, | 33 |
| associations, business enterprises, joint
ventures, agencies, | 34 |
| institutions or other legal entities providing any
form of | 35 |
| health care services in this State under this Article.
| 36 |
| The Illinois Department may require that all dispensers of |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| medical
services desiring to participate in the medical | 2 |
| assistance program
established under this Article disclose, | 3 |
| under such terms and conditions as
the Illinois Department may | 4 |
| by rule establish, all inquiries from clients
and attorneys | 5 |
| regarding medical bills paid by the Illinois Department, which
| 6 |
| inquiries could indicate potential existence of claims or liens | 7 |
| for the
Illinois Department.
| 8 |
| Enrollment of a vendor that provides non-emergency medical | 9 |
| transportation,
defined by the Department by rule,
shall be
| 10 |
| conditional for 180 days. During that time, the Department of | 11 |
| Public Aid may
terminate the vendor's eligibility to | 12 |
| participate in the medical assistance
program without cause. | 13 |
| That termination of eligibility is not subject to the
| 14 |
| Department's hearing process.
| 15 |
| The Illinois Department shall establish policies, | 16 |
| procedures,
standards and criteria by rule for the acquisition, | 17 |
| repair and replacement
of orthotic and prosthetic devices and | 18 |
| durable medical equipment. Such
rules shall provide, but not be | 19 |
| limited to, the following services: (1)
immediate repair or | 20 |
| replacement of such devices by recipients without
medical | 21 |
| authorization; and (2) rental, lease, purchase or | 22 |
| lease-purchase of
durable medical equipment in a | 23 |
| cost-effective manner, taking into
consideration the | 24 |
| recipient's medical prognosis, the extent of the
recipient's | 25 |
| needs, and the requirements and costs for maintaining such
| 26 |
| equipment. Such rules shall enable a recipient to temporarily | 27 |
| acquire and
use alternative or substitute devices or equipment | 28 |
| pending repairs or
replacements of any device or equipment | 29 |
| previously authorized for such
recipient by the Department. | 30 |
| Rules under clause (2) above shall not provide
for purchase or | 31 |
| lease-purchase of durable medical equipment or supplies
used | 32 |
| for the purpose of oxygen delivery and respiratory care.
| 33 |
| The Department shall execute, relative to the nursing home | 34 |
| prescreening
project, written inter-agency agreements with the | 35 |
| Department of Human
Services and the Department on Aging, to | 36 |
| effect the following: (i) intake
procedures and common |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| eligibility criteria for those persons who are receiving
| 2 |
| non-institutional services; and (ii) the establishment and | 3 |
| development of
non-institutional services in areas of the State | 4 |
| where they are not currently
available or are undeveloped.
| 5 |
| The Illinois Department shall develop and operate, in | 6 |
| cooperation
with other State Departments and agencies and in | 7 |
| compliance with
applicable federal laws and regulations, | 8 |
| appropriate and effective
systems of health care evaluation and | 9 |
| programs for monitoring of
utilization of health care services | 10 |
| and facilities, as it affects
persons eligible for medical | 11 |
| assistance under this Code.
| 12 |
| The Illinois Department shall report annually to the | 13 |
| General Assembly,
no later than the second Friday in April of | 14 |
| 1979 and each year
thereafter, in regard to:
| 15 |
| (a) actual statistics and trends in utilization of | 16 |
| medical services by
public aid recipients;
| 17 |
| (b) actual statistics and trends in the provision of | 18 |
| the various medical
services by medical vendors;
| 19 |
| (c) current rate structures and proposed changes in | 20 |
| those rate structures
for the various medical vendors; and
| 21 |
| (d) efforts at utilization review and control by the | 22 |
| Illinois Department.
| 23 |
| The period covered by each report shall be the 3 years | 24 |
| ending on the June
30 prior to the report. The report shall | 25 |
| include suggested legislation
for consideration by the General | 26 |
| Assembly. The filing of one copy of the
report with the | 27 |
| Speaker, one copy with the Minority Leader and one copy
with | 28 |
| the Clerk of the House of Representatives, one copy with the | 29 |
| President,
one copy with the Minority Leader and one copy with | 30 |
| the Secretary of the
Senate, one copy with the Legislative | 31 |
| Research Unit, and such additional
copies
with the State | 32 |
| Government Report Distribution Center for the General
Assembly | 33 |
| as is required under paragraph (t) of Section 7 of the State
| 34 |
| Library Act shall be deemed sufficient to comply with this | 35 |
| Section.
| 36 |
| (Source: P.A. 92-16, eff. 6-28-01; 92-651, eff. 7-11-02; |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| 92-789, eff. 8-6-02; 93-632, eff. 2-1-04.)
| 2 |
| (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
| 3 |
| Sec. 5-5.4. Standards of Payment - Department of Public | 4 |
| Aid.
The Department of Public Aid shall develop standards of | 5 |
| payment of skilled
nursing and intermediate care services in | 6 |
| facilities providing such services
under this Article which:
| 7 |
| (1) Provide for the determination of a facility's payment
| 8 |
| for skilled nursing and intermediate care services on a | 9 |
| prospective basis.
The amount of the payment rate for all | 10 |
| nursing facilities certified by the
Department of Public Health | 11 |
| under the Nursing Home Care Act as Intermediate
Care for the | 12 |
| Developmentally Disabled facilities, Long Term Care for Under | 13 |
| Age
22 facilities, Skilled Nursing facilities, or Intermediate | 14 |
| Care facilities
under the
medical assistance program shall be | 15 |
| prospectively established annually on the
basis of historical, | 16 |
| financial, and statistical data reflecting actual costs
from | 17 |
| prior years, which shall be applied to the current rate year | 18 |
| and updated
for inflation, except that the capital cost element | 19 |
| for newly constructed
facilities shall be based upon projected | 20 |
| budgets. The annually established
payment rate shall take | 21 |
| effect on July 1 in 1984 and subsequent years. No rate
increase | 22 |
| and no
update for inflation shall be provided on or after July | 23 |
| 1, 1994 and before
July 1, 2005
2004 , unless specifically | 24 |
| provided for in this
Section.
The changes made by this | 25 |
| amendatory Act of the 93rd General Assembly extending the | 26 |
| duration of the prohibition against a rate increase or update | 27 |
| for inflation are effective retroactive to July 1, 2004.
| 28 |
| For facilities licensed by the Department of Public Health | 29 |
| under the Nursing
Home Care Act as Intermediate Care for the | 30 |
| Developmentally Disabled facilities
or Long Term Care for Under | 31 |
| Age 22 facilities, the rates taking effect on July
1, 1998 | 32 |
| shall include an increase of 3%. For facilities licensed by the
| 33 |
| Department of Public Health under the Nursing Home Care Act as | 34 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 35 |
| the rates taking effect on July 1,
1998 shall include an |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| increase of 3% plus $1.10 per resident-day, as defined by
the | 2 |
| Department.
| 3 |
| For facilities licensed by the Department of Public Health | 4 |
| under the
Nursing Home Care Act as Intermediate Care for the | 5 |
| Developmentally Disabled
facilities or Long Term Care for Under | 6 |
| Age 22 facilities, the rates taking
effect on July 1, 1999 | 7 |
| shall include an increase of 1.6% plus $3.00 per
resident-day, | 8 |
| as defined by the Department. For facilities licensed by the
| 9 |
| Department of Public Health under the Nursing Home Care Act as | 10 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 11 |
| the rates taking effect on July 1,
1999 shall include an | 12 |
| increase of 1.6% and, for services provided on or after
October | 13 |
| 1, 1999, shall be increased by $4.00 per resident-day, as | 14 |
| defined by
the Department.
| 15 |
| For facilities licensed by the Department of Public Health | 16 |
| under the
Nursing Home Care Act as Intermediate Care for the | 17 |
| Developmentally Disabled
facilities or Long Term Care for Under | 18 |
| Age 22 facilities, the rates taking
effect on July 1, 2000 | 19 |
| shall include an increase of 2.5% per resident-day,
as defined | 20 |
| by the Department. For facilities licensed by the Department of
| 21 |
| Public Health under the Nursing Home Care Act as Skilled | 22 |
| Nursing facilities or
Intermediate Care facilities, the rates | 23 |
| taking effect on July 1, 2000 shall
include an increase of 2.5% | 24 |
| per resident-day, as defined by the Department.
| 25 |
| For facilities licensed by the Department of Public Health | 26 |
| under the
Nursing Home Care Act as skilled nursing facilities | 27 |
| or intermediate care
facilities, a new payment methodology must | 28 |
| be implemented for the nursing
component of the rate effective | 29 |
| July 1, 2003. The Department of Public Aid
shall develop the | 30 |
| new payment methodology using the Minimum Data Set
(MDS) as the | 31 |
| instrument to collect information concerning nursing home
| 32 |
| resident condition necessary to compute the rate. The | 33 |
| Department of Public Aid
shall develop the new payment | 34 |
| methodology to meet the unique needs of
Illinois nursing home | 35 |
| residents while remaining subject to the appropriations
| 36 |
| provided by the General Assembly.
A transition period from the |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| payment methodology in effect on June 30, 2003
to the payment | 2 |
| methodology in effect on July 1, 2003 shall be provided for a
| 3 |
| period not exceeding 2 years after implementation of the new | 4 |
| payment
methodology as follows:
| 5 |
| (A) For a facility that would receive a lower
nursing | 6 |
| component rate per patient day under the new system than | 7 |
| the facility
received
effective on the date immediately | 8 |
| preceding the date that the Department
implements the new | 9 |
| payment methodology, the nursing component rate per | 10 |
| patient
day for the facility
shall be held at
the level in | 11 |
| effect on the date immediately preceding the date that the
| 12 |
| Department implements the new payment methodology until a | 13 |
| higher nursing
component rate of
reimbursement is achieved | 14 |
| by that
facility.
| 15 |
| (B) For a facility that would receive a higher nursing | 16 |
| component rate per
patient day under the payment | 17 |
| methodology in effect on July 1, 2003 than the
facility | 18 |
| received effective on the date immediately preceding the | 19 |
| date that the
Department implements the new payment | 20 |
| methodology, the nursing component rate
per patient day for | 21 |
| the facility shall be adjusted.
| 22 |
| (C) Notwithstanding paragraphs (A) and (B), the | 23 |
| nursing component rate per
patient day for the facility | 24 |
| shall be adjusted subject to appropriations
provided by the | 25 |
| General Assembly.
| 26 |
| For facilities licensed by the Department of Public Health | 27 |
| under the
Nursing Home Care Act as Intermediate Care for the | 28 |
| Developmentally Disabled
facilities or Long Term Care for Under | 29 |
| Age 22 facilities, the rates taking
effect on March 1, 2001 | 30 |
| shall include a statewide increase of 7.85%, as
defined by the | 31 |
| Department.
| 32 |
| For facilities licensed by the Department of Public Health | 33 |
| under the
Nursing Home Care Act as Intermediate Care for the | 34 |
| Developmentally Disabled
facilities or Long Term Care for Under | 35 |
| Age 22 facilities, the rates taking
effect on April 1, 2002 | 36 |
| shall include a statewide increase of 2.0%, as
defined by the |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| Department.
This increase terminates on July 1, 2002;
beginning | 2 |
| July 1, 2002 these rates are reduced to the level of the rates
| 3 |
| in effect on March 31, 2002, as defined by the Department.
| 4 |
| For facilities licensed by the Department of Public Health | 5 |
| under the
Nursing Home Care Act as skilled nursing facilities | 6 |
| or intermediate care
facilities, the rates taking effect on | 7 |
| July 1, 2001 shall be computed using the most recent cost | 8 |
| reports
on file with the Department of Public Aid no later than | 9 |
| April 1, 2000,
updated for inflation to January 1, 2001. For | 10 |
| rates effective July 1, 2001
only, rates shall be the greater | 11 |
| of the rate computed for July 1, 2001
or the rate effective on | 12 |
| June 30, 2001.
| 13 |
| Notwithstanding any other provision of this Section, for | 14 |
| facilities
licensed by the Department of Public Health under | 15 |
| the Nursing Home Care Act
as skilled nursing facilities or | 16 |
| intermediate care facilities, the Illinois
Department shall | 17 |
| determine by rule the rates taking effect on July 1, 2002,
| 18 |
| which shall be 5.9% less than the rates in effect on June 30, | 19 |
| 2002.
| 20 |
| Notwithstanding any other provision of this Section, for | 21 |
| facilities
licensed by the Department of Public Health under | 22 |
| the Nursing Home Care Act as
skilled nursing
facilities or | 23 |
| intermediate care facilities, if the payment methodologies | 24 |
| required under Section 5A-12 and the waiver granted under 42 | 25 |
| CFR 433.68 are approved by the United States Centers for | 26 |
| Medicare and Medicaid Services,
the Illinois Department shall
| 27 |
| determine by rule the rates taking effect on July 1, 2004
2003, | 28 |
| which shall be 3.0% greater
less than the rates in effect on | 29 |
| June 30, 2004
2002 . These rates
This rate shall take
effect | 30 |
| only upon approval and
implementation of the payment | 31 |
| methodologies required under Section 5A-12.
| 32 |
| Notwithstanding any other provisions of this Section, for | 33 |
| facilities licensed by the Department of Public Health under | 34 |
| the Nursing Home Care Act as skilled nursing facilities or | 35 |
| intermediate care facilities, the rates taking effect on | 36 |
| January 1, 2005 shall be 3% more than the rates in effect on |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| December 31, 2004.
| 2 |
| For facilities
licensed
by the
Department of Public Health | 3 |
| under the Nursing Home Care Act as Intermediate
Care for
the | 4 |
| Developmentally Disabled facilities or as long-term care | 5 |
| facilities for
residents under 22 years of age, the rates | 6 |
| taking effect on July 1,
2003 shall
include a statewide | 7 |
| increase of 4%, as defined by the Department.
| 8 |
| Rates established effective each July 1 shall govern | 9 |
| payment
for services rendered throughout that fiscal year, | 10 |
| except that rates
established on July 1, 1996 shall be | 11 |
| increased by 6.8% for services
provided on or after January 1, | 12 |
| 1997. Such rates will be based
upon the rates calculated for | 13 |
| the year beginning July 1, 1990, and for
subsequent years | 14 |
| thereafter until June 30, 2001 shall be based on the
facility | 15 |
| cost reports
for the facility fiscal year ending at any point | 16 |
| in time during the previous
calendar year, updated to the | 17 |
| midpoint of the rate year. The cost report
shall be on file | 18 |
| with the Department no later than April 1 of the current
rate | 19 |
| year. Should the cost report not be on file by April 1, the | 20 |
| Department
shall base the rate on the latest cost report filed | 21 |
| by each skilled care
facility and intermediate care facility, | 22 |
| updated to the midpoint of the
current rate year. In | 23 |
| determining rates for services rendered on and after
July 1, | 24 |
| 1985, fixed time shall not be computed at less than zero. The
| 25 |
| Department shall not make any alterations of regulations which | 26 |
| would reduce
any component of the Medicaid rate to a level | 27 |
| below what that component would
have been utilizing in the rate | 28 |
| effective on July 1, 1984.
| 29 |
| (2) Shall take into account the actual costs incurred by | 30 |
| facilities
in providing services for recipients of skilled | 31 |
| nursing and intermediate
care services under the medical | 32 |
| assistance program.
| 33 |
| (3) Shall take into account the medical and psycho-social
| 34 |
| characteristics and needs of the patients.
| 35 |
| (4) Shall take into account the actual costs incurred by | 36 |
| facilities in
meeting licensing and certification standards |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| imposed and prescribed by the
State of Illinois, any of its | 2 |
| political subdivisions or municipalities and by
the U.S. | 3 |
| Department of Health and Human Services pursuant to Title XIX | 4 |
| of the
Social Security Act.
| 5 |
| The Department of Public Aid shall develop precise | 6 |
| standards for
payments to reimburse nursing facilities for any | 7 |
| utilization of
appropriate rehabilitative personnel for the | 8 |
| provision of rehabilitative
services which is authorized by | 9 |
| federal regulations, including
reimbursement for services | 10 |
| provided by qualified therapists or qualified
assistants, and | 11 |
| which is in accordance with accepted professional
practices. | 12 |
| Reimbursement also may be made for utilization of other
| 13 |
| supportive personnel under appropriate supervision.
| 14 |
| (Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01; 92-597, | 15 |
| eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff. 1-1-03; 93-20, | 16 |
| eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, eff. 2-3-04; revised | 17 |
| 2-3-04.)
| 18 |
| (305 ILCS 5/5-5.4c new)
| 19 |
| Sec. 5-5.4c. Bed
reserves; approval. The Department of | 20 |
| Public Aid shall approve bed reserves at a daily rate of 75% of | 21 |
| an individual's current
Medicaid per diem, for nursing | 22 |
| facilities 90% or more of
whose residents are Medicaid | 23 |
| recipients and that have
occupancy levels of at least 93% for | 24 |
| resident bed reserves
not exceeding 10 days. | 25 |
| (305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) | 26 |
| (Section scheduled to be repealed on July 1, 2005) | 27 |
| Sec. 5A-2. Assessment; no local authorization to tax.
| 28 |
| (a) Subject to Sections 5A-3 and 5A-10, an annual | 29 |
| assessment on inpatient
services is imposed on
each
hospital
| 30 |
| provider in an amount equal to the hospital's occupied bed days | 31 |
| multiplied by $84.19 for State fiscal years 2004 and 2005 , if | 32 |
| the payment methodologies required under 5A-12 and the waiver | 33 |
| granted under 42 CFR 433.68 are approved with an effective date | 34 |
| prior to July 1, 2004; or the assessment will be imposed for |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| fiscal year 2005 only, if the payment methodologies required | 2 |
| under Section 5A-12 and the waiver granted under 42 CFR 433.68 | 3 |
| are approved with an effective date on or after July 1, 2004
in | 4 |
| an amount equal to
the
hospital's occupied bed days multiplied | 5 |
| by $84.19 .
| 6 |
| The
Department of Public Aid shall use the number of | 7 |
| occupied bed days as reported
by
each hospital on the Annual | 8 |
| Survey of Hospitals conducted by the
Department of Public | 9 |
| Health to calculate the hospital's annual assessment. If
the | 10 |
| sum
of a hospital's occupied bed days is not reported on the | 11 |
| Annual Survey of
Hospitals or if there are data errors in the | 12 |
| reported sum of a hospital's occupied bed days as determined by | 13 |
| the Department of Public Aid , then the Department of Public Aid | 14 |
| may obtain the sum of occupied bed
days
from any source | 15 |
| available, including, but not limited to, records maintained by
| 16 |
| the hospital provider, which may be inspected at all times | 17 |
| during business
hours
of the day by the Department of Public | 18 |
| Aid or its duly authorized agents and
employees.
| 19 |
| (b) Nothing in this amendatory Act of the 93rd General | 20 |
| Assembly
shall be construed to authorize
any home rule unit or | 21 |
| other unit of local government to license for revenue or
to | 22 |
| impose a tax or assessment upon hospital providers or the | 23 |
| occupation of
hospital provider, or a tax or assessment | 24 |
| measured by the income or earnings of
a hospital provider.
| 25 |
| (c) As provided in Section 5A-14, this Section is repealed | 26 |
| on July 1,
2005.
| 27 |
| (Source: P.A. 93-659, eff. 2-3-04.)
| 28 |
| (305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4) | 29 |
| Sec. 5A-4. Payment of assessment; penalty.
| 30 |
| (a) The annual assessment imposed by Section 5A-2 for State | 31 |
| fiscal year
2004
shall be due
and payable on June 18 of
the
| 32 |
| year.
The assessment imposed by Section 5A-2 for State fiscal | 33 |
| year 2005
shall be
due and payable in quarterly installments, | 34 |
| each equalling one-fourth of the
assessment for the year, on | 35 |
| July 19, October 19, January 18, and April 19 of
the year.
No |
|
|
|
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|
| 1 |
| installment payment of an assessment imposed by Section 5A-2 | 2 |
| shall be due
and
payable, however, until after: (i) the | 3 |
| hospital provider
receives written
notice from the Department | 4 |
| of Public Aid that the payment methodologies to
hospitals
| 5 |
| required under
Section 5A-12 have been approved by the Centers | 6 |
| for Medicare and Medicaid
Services of
the U.S. Department of | 7 |
| Health and Human Services and the waiver under 42 CFR
433.68 | 8 |
| for the assessment imposed by Section 5A-2 has been granted by | 9 |
| the
Centers for Medicare and Medicaid Services of the U.S. | 10 |
| Department of Health and
Human Services; and (ii) the hospital
| 11 |
| has
received the payments required under Section 5A-12.
Upon | 12 |
| notification to the Department of approval of the payment | 13 |
| methodologies required under Section 5A-12 and the waiver | 14 |
| granted under 42 CFR 433.68, all quarterly installments | 15 |
| otherwise due under Section 5A-2 prior to the date of | 16 |
| notification shall be due and payable to the Department within | 17 |
| 30 days of the date of notification.
| 18 |
| (b) The Illinois Department is authorized to establish
| 19 |
| delayed payment schedules for hospital providers that are | 20 |
| unable
to make installment payments when due under this Section | 21 |
| due to
financial difficulties, as determined by the Illinois | 22 |
| Department.
| 23 |
| (c) If a hospital provider fails to pay the full amount of
| 24 |
| an installment when due (including any extensions granted under
| 25 |
| subsection (b)), there shall, unless waived by the Illinois
| 26 |
| Department for reasonable cause, be added to the assessment
| 27 |
| imposed by Section 5A-2 a penalty
assessment equal to the | 28 |
| lesser of (i) 5% of the amount of the
installment not paid on | 29 |
| or before the due date plus 5% of the
portion thereof remaining | 30 |
| unpaid on the last day of each 30-day period
thereafter or (ii) | 31 |
| 100% of the installment amount not paid on or
before the due | 32 |
| date. For purposes of this subsection, payments
will be | 33 |
| credited first to unpaid installment amounts (rather than
to | 34 |
| penalty or interest), beginning with the most delinquent
| 35 |
| installments.
| 36 |
| (Source: P.A. 93-659, eff. 2-3-04.)
|
|
|
|
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LRB093 15827 RCE 41444 b |
|
| 1 |
| (305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5) | 2 |
| Sec. 5A-5. Notice; penalty; maintenance of records.
| 3 |
| (a) After December 31 of each year (except as otherwise | 4 |
| provided in this
subsection), and on or before
March 31 of the | 5 |
| succeeding year, the
The Department of Public Aid shall send a
| 6 |
| notice of assessment to every hospital provider subject
to | 7 |
| assessment under this Article. The notice of assessment shall | 8 |
| notify the hospital of its assessment and
for the State fiscal | 9 |
| year commencing on the next July 1, except that
the notice for | 10 |
| the State fiscal year commencing July 1, 2003 shall be sent | 11 |
| within 14 days of receipt by the Department of notification | 12 |
| from the Centers for Medicare and Medicaid Services of the U.S. | 13 |
| Department of Health and Human Services that the payment | 14 |
| methodologies required under Section 5A-12 and the waiver | 15 |
| granted under 42 CFR 433.68 have been approved
on
or
before | 16 |
| June 1, 2004 . The notice
shall be on a form
prepared by the | 17 |
| Illinois Department and shall state the following:
| 18 |
| (1) The name of the hospital provider.
| 19 |
| (2) The address of the hospital provider's principal | 20 |
| place
of business from which the provider engages in the | 21 |
| occupation of hospital
provider in this State, and the name | 22 |
| and address of each hospital
operated, conducted, or | 23 |
| maintained by the provider in this State.
| 24 |
| (3) The occupied bed days of the
hospital
provider, the | 25 |
| amount of
assessment imposed under Section 5A-2 for the | 26 |
| State fiscal year
for which the notice is sent, and the | 27 |
| amount of
each quarterly
installment to be paid during the | 28 |
| State fiscal year.
| 29 |
| (4) (Blank).
| 30 |
| (5) Other reasonable information as determined by the | 31 |
| Illinois
Department.
| 32 |
| (b) If a hospital provider conducts, operates, or
maintains | 33 |
| more than one hospital licensed by the Illinois
Department of | 34 |
| Public Health, the provider shall pay the
assessment for each | 35 |
| hospital separately.
|
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| (c) Notwithstanding any other provision in this Article, in
| 2 |
| the case of a person who ceases to conduct, operate, or | 3 |
| maintain a
hospital in respect of which the person is subject | 4 |
| to assessment
under this Article as a hospital provider, the | 5 |
| assessment for the State
fiscal year in which the cessation | 6 |
| occurs shall be adjusted by
multiplying the assessment computed | 7 |
| under Section 5A-2 by a
fraction, the numerator of which is the | 8 |
| number of days in the
year during which the provider conducts, | 9 |
| operates, or maintains
the hospital and the denominator of | 10 |
| which is 365. Immediately
upon ceasing to conduct, operate, or | 11 |
| maintain a hospital, the person
shall pay the assessment
for | 12 |
| the year as so adjusted (to the extent not previously paid).
| 13 |
| (d) Notwithstanding any other provision in this Article, a
| 14 |
| provider who commences conducting, operating, or maintaining a
| 15 |
| hospital, upon notice by the Illinois Department,
shall pay the | 16 |
| assessment computed under Section 5A-2 and
subsection (e) in | 17 |
| installments on the due dates stated in the
notice and on the | 18 |
| regular installment due dates for the State
fiscal year | 19 |
| occurring after the due dates of the initial
notice.
| 20 |
| (e) Notwithstanding any other provision in this Article, in
| 21 |
| the case of a hospital provider that did not conduct, operate, | 22 |
| or
maintain a hospital throughout calendar year 2001, the | 23 |
| assessment for that State fiscal year
shall be computed on the | 24 |
| basis of hypothetical occupied bed days for the full calendar | 25 |
| year as determined by the Illinois Department.
| 26 |
| (f) (Blank).
| 27 |
| (g) (Blank).
| 28 |
| (h) (Blank).
| 29 |
| (Source: P.A. 93-659, eff. 2-3-04.)
| 30 |
| (305 ILCS 5/5A-7) (from Ch. 23, par. 5A-7)
| 31 |
| Sec. 5A-7. Administration; enforcement provisions.
| 32 |
| (a) The Illinois Department shall establish and maintain a | 33 |
| listing of all hospital providers appearing in the licensing | 34 |
| records of the Illinois Department of Public Health, which | 35 |
| shall show each provider's name and principal place of business |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| and the name and address of each hospital operated, conducted, | 2 |
| or maintained by the provider in this State. The Illinois | 3 |
| Department shall administer and enforce this Article and | 4 |
| collect the assessments and penalty assessments imposed under | 5 |
| this Article using procedures employed in its administration of | 6 |
| this Code generally. The Illinois Department, its Director, and | 7 |
| every hospital provider subject to assessment measured by | 8 |
| occupied bed days shall have the following powers, duties, and | 9 |
| rights: | 10 |
| (1) The Illinois Department may initiate either | 11 |
| administrative or judicial proceedings, or both, to | 12 |
| enforce provisions of this Article. Administrative | 13 |
| enforcement proceedings initiated hereunder shall be | 14 |
| governed by the Illinois Department's administrative | 15 |
| rules. Judicial enforcement proceedings initiated | 16 |
| hereunder shall be governed by the rules of procedure | 17 |
| applicable in the courts of this State. | 18 |
| (2) No proceedings for collection, refund, credit, or | 19 |
| other adjustment of an assessment amount shall be issued | 20 |
| more than 3 years after the due date of the assessment, | 21 |
| except in the case of an extended period agreed to in | 22 |
| writing by the Illinois Department and the hospital | 23 |
| provider before the expiration of this limitation period. | 24 |
| (3) Any unpaid assessment under this Article shall | 25 |
| become a lien upon the assets of the hospital upon which it | 26 |
| was assessed. If any hospital provider, outside the usual | 27 |
| course of its business, sells or transfers the major part | 28 |
| of any one or more of (A) the real property and | 29 |
| improvements, (B) the machinery and equipment, or (C) the | 30 |
| furniture or fixtures, of any hospital that is subject to | 31 |
| the provisions of this Article, the seller or transferor | 32 |
| shall pay the Illinois Department the amount of any | 33 |
| assessment, assessment penalty, and interest (if any) due | 34 |
| from it under this Article up to the date of the sale or | 35 |
| transfer. If the seller or transferor fails to pay any | 36 |
| assessment, assessment penalty, and interest (if any) due, |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| the purchaser or transferee of such asset shall be liable | 2 |
| for the amount of the assessment, penalties, and interest | 3 |
| (if any) up to the amount of the reasonable value of the | 4 |
| property acquired by the purchaser or transferee. The | 5 |
| purchaser or transferee shall continue to be liable until | 6 |
| the purchaser or transferee pays the full amount of the | 7 |
| assessment, penalties, and interest (if any) up to the | 8 |
| amount of the reasonable value of the property acquired by | 9 |
| the purchaser or transferee or until the purchaser or | 10 |
| transferee receives from the Illinois Department a | 11 |
| certificate showing that such assessment, penalty, and | 12 |
| interest have been paid or a certificate from the Illinois | 13 |
| Department showing that no assessment, penalty, or | 14 |
| interest is due from the seller or transferor under this | 15 |
| Article. | 16 |
| (4) Payments under this Article are not subject to the | 17 |
| Illinois Prompt Payment Act. Credits or refunds shall not | 18 |
| bear interest. | 19 |
| (b) In addition to any other remedy provided for and | 20 |
| without sending a notice of assessment liability, the Illinois | 21 |
| Department may collect an unpaid assessment by withholding, as | 22 |
| payment of the assessment, reimbursements or other amounts | 23 |
| otherwise payable by the Illinois Department to the hospital | 24 |
| provider.
| 25 |
| (a) To the extent practicable, the Illinois Department | 26 |
| shall administer
and enforce this Article and collect the | 27 |
| assessments, interest, and penalty
assessments imposed under | 28 |
| this Article using procedures employed in its
administration of | 29 |
| this Code generally and, as it deems appropriate, in a
manner | 30 |
| similar to that in which the Department of Revenue administers | 31 |
| and
collects the retailers' occupation tax under the Retailers' | 32 |
| Occupation Tax
Act ("ROTA"). Instead of certificates of | 33 |
| registration, the Illinois
Department shall establish and | 34 |
| maintain a listing of all hospital providers
appearing in the | 35 |
| licensing records of the Department of Public Health,
which | 36 |
| shall show each provider's name, principal place of business, |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| and the
name and address of each hospital operated, conducted, | 2 |
| or maintained by the
provider in this State. In addition, the | 3 |
| following specified provisions of
the Retailers' Occupation | 4 |
| Tax Act are incorporated by reference into this
Section except | 5 |
| that the Illinois Department and its Director (rather than
the | 6 |
| Department of Revenue and its Director) and every hospital | 7 |
| provider
subject to assessment measured by occupied bed days | 8 |
| (rather than persons subject
to retailers' occupation tax | 9 |
| measured by gross receipts from the sale of
tangible personal | 10 |
| property at retail) shall have the powers, duties, and rights | 11 |
| specified in these ROTA
provisions, as modified in this Section | 12 |
| or by the Illinois Department in a
manner consistent with this | 13 |
| Article and except as manifestly inconsistent
with the other | 14 |
| provisions of this Article:
| 15 |
| (1) ROTA, Section 4 (examination of return; notice of
| 16 |
| correction; evidence; limitations; protest and hearing), | 17 |
| except
that (i) the Illinois Department shall issue notices | 18 |
| of
assessment liability (rather than notices of tax | 19 |
| liability as
provided in ROTA, Section 4); (ii) in the case | 20 |
| of a fraudulent
return or in the case of an extended period | 21 |
| agreed to by the
Illinois Department and the hospital | 22 |
| provider before the
expiration of the limitation period, no | 23 |
| notice of assessment
liability shall be issued more than 3 | 24 |
| years after the later of
the due date of the return | 25 |
| required by Section 5A-5 or the date
the return (or an | 26 |
| amended return) was filed (rather within the period
stated | 27 |
| in ROTA, Section 4); and (iii) the penalty provisions of | 28 |
| ROTA,
Section 4 shall not apply.
| 29 |
| (2) ROTA, Sec. 5 (failure to make return; failure to | 30 |
| pay
assessment), except that the penalty and interest | 31 |
| provisions
of ROTA, Section 5 shall not apply.
| 32 |
| (3) ROTA, Section 5a (lien; attachment; termination; | 33 |
| notice;
protest; review; release of lien; status of lien).
| 34 |
| (4) ROTA, Section 5b (State lien notices; State lien | 35 |
| index;
duties of recorder and registrar of titles).
| 36 |
| (5) ROTA, Section 5c (liens; certificate of release).
|
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| (6) ROTA, Section 5d (Department not required to | 2 |
| furnish bond;
claim to property attached or levied upon).
| 3 |
| (7) ROTA, Section 5e (foreclosure on liens; | 4 |
| enforcement).
| 5 |
| (8) ROTA, Section 5f (demand for payment; levy and sale | 6 |
| of
property; limitation).
| 7 |
| (9) ROTA, Section 5g (sale of property; redemption).
| 8 |
| (10) ROTA, Section 5j (sales on transfers outside usual | 9 |
| course
of business; report; payment of assessment; rights | 10 |
| and duties of
purchaser; penalty), except that notice shall | 11 |
| be provided to the
Illinois Department as specified by | 12 |
| rule.
| 13 |
| (11) ROTA, Section 6 (erroneous payments; credit or | 14 |
| refund),
provided that (i) the Illinois Department may only | 15 |
| apply an
amount otherwise subject to credit or refund to a | 16 |
| liability
arising under this Article; (ii) except in the | 17 |
| case of an
extended period agreed to by the Illinois | 18 |
| Department and the
hospital provider before the expiration | 19 |
| of this limitation
period, a claim for credit or refund | 20 |
| must be filed no more than 3
years after the due date of | 21 |
| the return required by Section 5A-5 (rather
than the time | 22 |
| limitation stated in ROTA, Section 6); and (iii) credits or
| 23 |
| refunds shall not bear interest.
| 24 |
| (12) ROTA, Section 6a (claims for credit or refund).
| 25 |
| (13) ROTA, Section 6b (tentative determination of | 26 |
| claim; notice;
hearing; review), provided that a hospital | 27 |
| provider or its
representative shall have 60 days (rather | 28 |
| than 20 days) within
which to file a protest and request | 29 |
| for hearing in response to a
tentative determination of | 30 |
| claim.
| 31 |
| (14) ROTA, Section 6c (finality of tentative | 32 |
| determinations).
| 33 |
| (15) ROTA, Section 8 (investigations and hearings).
| 34 |
| (16) ROTA, Section 9 (witness; immunity).
| 35 |
| (17) ROTA, Section 10 (issuance of subpoenas; | 36 |
| attendance of
witnesses; production of books and records).
|
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| (18) ROTA, Section 11 (information confidential; | 2 |
| exceptions).
| 3 |
| (19) ROTA, Section 12 (rules and regulations; hearing;
| 4 |
| appeals), except that a hospital provider shall not be | 5 |
| required
to file a bond or be subject to a lien in lieu | 6 |
| thereof in order
to seek court review under the | 7 |
| Administrative Review Law of a
final assessment or revised | 8 |
| final assessment or the equivalent
thereof issued by the | 9 |
| Illinois Department under this Article.
| 10 |
| (b) In addition to any other remedy
provided for and | 11 |
| without sending a notice of assessment
liability, the Illinois | 12 |
| Department may collect an unpaid
assessment by withholding, as | 13 |
| payment of the assessment,
reimbursements or other amounts | 14 |
| otherwise payable by the Illinois
Department to the provider.
| 15 |
| (Source: P.A. 93-659, eff. 2-3-04.)
| 16 |
| (305 ILCS 5/5A-12)
| 17 |
| (Section scheduled to be repealed on July 1, 2005) | 18 |
| Sec. 5A-12. Hospital access improvement payments.
| 19 |
| (a) To improve access to hospital services, for hospital | 20 |
| services rendered
on or
after June 1, 2004, the Department of | 21 |
| Public Aid shall make
payments
to hospitals as set forth in | 22 |
| this Section, except for hospitals described in
subsection (b) | 23 |
| of
Section 5A-3.
These payments shall be paid on a quarterly | 24 |
| basis. For State fiscal year 2004 , if the effective date of the | 25 |
| approval of the payment methodology required under this Section | 26 |
| and the waiver granted under 42 CFR 433.68 by the Centers for | 27 |
| Medicare and Medicaid Services of the U.S. Department of Health | 28 |
| and Human Services is prior to July 1, 2004 ,
the
Department | 29 |
| shall pay the total amounts required for fiscal year 2004 under | 30 |
| this Section within 25 days of the latest notification ;
these
| 31 |
| amounts shall be paid on or before June 15
of the year . No | 32 |
| payment shall be made for State fiscal year 2004 if the | 33 |
| effective date of the approval is on or after July 1, 2004.
In | 34 |
| State fiscal year 2005
subsequent State fiscal years ,
the total
| 35 |
| amounts required under this Section shall be paid in 4 equal |
|
|
|
SB2208 Enrolled |
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LRB093 15827 RCE 41444 b |
|
| 1 |
| installments on or
before
July 15, October 15, January 14, and | 2 |
| April 15
of the year , except that if the date of notification | 3 |
| of the approval of the payment methodologies required under | 4 |
| this Section and the waiver granted under 42 CFR 433.68 is on | 5 |
| or after July 1, 2004, the sum of amounts required under this | 6 |
| Section prior to the date of notification shall be paid within | 7 |
| 25 days of the date of the last notification . Payments under
| 8 |
| this
Section are not due and payable, however, until (i) the | 9 |
| methodologies described
in
this
Section are approved by the | 10 |
| federal government in an appropriate State Plan
amendment,
(ii) | 11 |
| the assessment imposed under this Article is determined to be a
| 12 |
| permissible tax under Title XIX of the Social Security Act, and | 13 |
| (iii) the
assessment is in effect.
| 14 |
| (b) High volume payment. In addition to rates paid for | 15 |
| inpatient hospital
services, the Department of Public Aid shall | 16 |
| pay, to each Illinois hospital
that provided
more than 20,000 | 17 |
| Medicaid inpatient days of care during State fiscal year 2001
| 18 |
| (except
for hospitals
that qualify for adjustment payments | 19 |
| under Section 5-5.02 for the 12-month
period beginning on | 20 |
| October 1, 2002), $190 for each
Medicaid inpatient day
of care | 21 |
| provided during that fiscal year. A hospital that provided less | 22 |
| than
30,000 Medicaid inpatient days of
care during that period, | 23 |
| however, is not entitled to receive more than
$3,500,000 per | 24 |
| year
in such payments.
| 25 |
| (c) Medicaid inpatient utilization rate adjustment. In | 26 |
| addition to rates
paid for
inpatient hospital services, the | 27 |
| Department of Public Aid shall pay each
Illinois hospital
| 28 |
| (except for hospitals described in Section 5A-3), for each | 29 |
| Medicaid inpatient
day of
care provided
during State fiscal | 30 |
| year 2001, an amount equal to the product of $57.25
multiplied | 31 |
| by the
quotient of 1 divided by the greater of 1.6% or the | 32 |
| hospital's Medicaid
inpatient
utilization rate (as used to | 33 |
| determine eligibility for adjustment payments
under Section | 34 |
| 5-5.02 for the 12-month period beginning on October 1, 2002). | 35 |
| The
total payments under this
subsection to a
hospital may
not | 36 |
| exceed $10,500,000 annually.
|
|
|
|
SB2208 Enrolled |
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|
| 1 |
| (d) Psychiatric base rate adjustment.
| 2 |
| (1) In addition to rates paid for
inpatient
psychiatric | 3 |
| services, the Department of Public Aid shall pay each | 4 |
| Illinois
general acute care hospital with a distinct | 5 |
| part-psychiatric unit, for
each Medicaid inpatient | 6 |
| psychiatric day of care provided in State fiscal year
2001, | 7 |
| an
amount equal
to $400 less the hospital's per-diem rate | 8 |
| for Medicaid inpatient psychiatric
services as in effect on | 9 |
| October 1, 2003. In no
event, however, shall that amount be | 10 |
| less than zero.
| 11 |
| (2) For distinct
part-psychiatric units of Illinois
| 12 |
| general acute care hospitals, except for all hospitals | 13 |
| excluded in Section
5A-3,
whose inpatient per-diem rate as | 14 |
| in effect on
October 1, 2003 is greater than
$400, the
| 15 |
| Department shall pay, in addition to any other amounts | 16 |
| authorized under this
Code, $25
for each Medicaid inpatient | 17 |
| psychiatric day of care provided in State fiscal
year 2001.
| 18 |
| (e) Supplemental tertiary care adjustment. In addition to | 19 |
| rates paid for
inpatient
services, the Department of Public Aid | 20 |
| shall pay to each Illinois hospital
eligible for
tertiary care | 21 |
| adjustment payments under 89 Ill. Adm. Code 148.296, as in | 22 |
| effect
for State fiscal year
2003, a supplemental tertiary care | 23 |
| adjustment payment equal to
the tertiary
care adjustment | 24 |
| payment required under 89 Ill. Adm. Code 148.296, as in effect
| 25 |
| for State fiscal year
2003.
| 26 |
| (f) Medicaid outpatient utilization rate adjustment. In | 27 |
| addition to rates
paid for
outpatient hospital services, the | 28 |
| Department of Public Aid shall pay each
Illinois hospital
| 29 |
| (except for hospitals described in Section 5A-3), an amount | 30 |
| equal to the
product of 2.45%
multiplied by the hospital's | 31 |
| Medicaid outpatient charges multiplied by the
quotient of 1
| 32 |
| divided by the greater of 1.6% or the hospital's Medicaid | 33 |
| outpatient
utilization rate. The
total payments under this | 34 |
| subsection to a hospital may not exceed $6,750,000
annually.
| 35 |
| For purposes of this subsection:
| 36 |
| "Medicaid outpatient charges" means the charges for |
|
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| outpatient services
provided to Medicaid patients for State | 2 |
| fiscal year 2001 as submitted by the
hospital on the UB-92 | 3 |
| billing form or under the ambulatory procedure listing
and
| 4 |
| adjudicated by the Department of Public Aid on or before | 5 |
| September 12, 2003.
| 6 |
| "Medicaid outpatient utilization rate" means a fraction, | 7 |
| the numerator of
which is the hospital's Medicaid outpatient | 8 |
| charges and the denominator of
which
is the total number of the | 9 |
| hospital's charges for outpatient services for the
hospital's | 10 |
| fiscal year ending in 2001.
| 11 |
| (g) State outpatient service adjustment. In addition to | 12 |
| rates paid for
outpatient
hospital services, the Department of | 13 |
| Public Aid shall pay each Illinois
hospital an amount
equal to | 14 |
| the product of 75.5% multiplied by the hospital's Medicaid | 15 |
| outpatient
services
submitted to
the Department on the UB-92 | 16 |
| billing form for State fiscal year 2001 multiplied
by the
| 17 |
| hospital's outpatient access fraction.
| 18 |
| For purposes of this subsection,
"outpatient access
| 19 |
| fraction" means a fraction, the numerator of which is the | 20 |
| hospital's Medicaid
payments
for outpatient services for | 21 |
| ambulatory procedure listing services submitted to
the | 22 |
| Department on the UB-92 billing form
for State
fiscal year | 23 |
| 2001, and the denominator of which is the hospital's Medicaid
| 24 |
| outpatient
services submitted to the Department on the UB-92 | 25 |
| billing form for State fiscal
year
2001.
| 26 |
| The total payments under this subsection to a hospital may | 27 |
| not exceed
$3,000,000
annually.
| 28 |
| (h) Rural hospital outpatient adjustment. In addition to | 29 |
| rates paid for
outpatient
hospital services, the Department of | 30 |
| Public Aid shall pay each Illinois rural
hospital an
amount | 31 |
| equal to the product of $14,500,000 multiplied by the rural | 32 |
| hospital
outpatient
adjustment fraction.
| 33 |
| For purposes of this subsection, "rural hospital
| 34 |
| outpatient
adjustment fraction" means a fraction, the | 35 |
| numerator of which is the hospital's
Medicaid
visits for | 36 |
| outpatient services for
ambulatory procedure listing services
|
|
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| submitted to the Department on the UB-92 billing
form for
State | 2 |
| fiscal year 2001, and the denominator of which is the total | 3 |
| Medicaid
visits for
outpatient services for ambulatory | 4 |
| procedure listing services for all Illinois
rural hospitals | 5 |
| submitted to the
Department on the UB-92 billing form for State | 6 |
| fiscal year 2001.
| 7 |
| For purposes
of this subsection, "rural
hospital" has the | 8 |
| same meaning as in 89 Ill. Adm. Code 148.25, as in effect on
| 9 |
| September
30, 2003.
| 10 |
| (i) Merged/closed hospital adjustment. If any hospital | 11 |
| files a
combined Medicaid cost report with another hospital | 12 |
| after January 1, 2001, and
if
that hospital subsequently | 13 |
| closes, then except for the payments
described in
subsection | 14 |
| (e), all payments described in the various subsections of this
| 15 |
| Section shall, before the application of the annual limitation | 16 |
| amount specified
in each such subsection, be multiplied by a | 17 |
| fraction, the numerator of which is
the number
of occupied bed | 18 |
| days attributable to the open hospital and the denominator of
| 19 |
| which is the sum of the number of occupied bed days of each | 20 |
| open hospital and
each
closed hospital. For purposes of this | 21 |
| subsection, "occupied bed
days" has the same meaning as the | 22 |
| term is defined in subsection (a) of
Section 5A-2.
| 23 |
| (j) For purposes of this Section, the terms "Medicaid | 24 |
| days", "Medicaid
charges", and "Medicaid services" do not | 25 |
| include any days, charges, or services
for which Medicare was | 26 |
| liable for payment.
| 27 |
| (k) As provided in Section 5A-14, this Section is repealed | 28 |
| on July 1,
2005.
| 29 |
| (Source: P.A. 93-659, eff. 2-3-04.) | 30 |
| (305 ILCS 5/12-10.7 new)
| 31 |
| Sec. 12-10.7. The Health and Human Services Medicaid Trust | 32 |
| Fund. | 33 |
| (a) The Health and Human Services Medicaid Trust Fund shall | 34 |
| consist of (i) moneys appropriated or transferred into the | 35 |
| Fund, pursuant to statute, (ii) federal financial |
|
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| participation moneys received pursuant to expenditures from | 2 |
| the Fund, and (iii) the interest earned on moneys in the Fund. | 3 |
| (b) Subject to appropriation, the moneys in the Fund shall | 4 |
| be used by a State agency for such purposes as that agency may, | 5 |
| by the appropriation language, be directed.
|
|
6 |
| Section 35. The Senior Citizens and Disabled Persons | 7 |
| Property Tax Relief and
Pharmaceutical Assistance Act is | 8 |
| amended by changing Section 6 as follows:
| 9 |
| (320 ILCS 25/6) (from Ch. 67 1/2, par. 406)
| 10 |
| Sec. 6. Administration.
| 11 |
| (a) In general. Upon receipt of a timely filed claim, the | 12 |
| Department
shall determine whether the claimant is a person | 13 |
| entitled to a grant under
this Act and the amount of grant to | 14 |
| which he is entitled under this Act.
The Department may require | 15 |
| the claimant to furnish reasonable proof of the
statements of | 16 |
| domicile, household income, rent paid, property taxes accrued
| 17 |
| and other matters on which entitlement is based, and may | 18 |
| withhold payment
of a grant until such additional proof is | 19 |
| furnished.
| 20 |
| (b) Rental determination. If the Department finds that the | 21 |
| gross rent
used in the computation by a claimant of rent | 22 |
| constituting property taxes
accrued exceeds the fair rental | 23 |
| value for the right to occupy that
residence, the Department | 24 |
| may determine the fair rental value for that
residence and | 25 |
| recompute rent constituting property taxes accrued | 26 |
| accordingly.
| 27 |
| (c) Fraudulent claims. The Department shall deny claims | 28 |
| which have been
fraudulently prepared or when it finds that the | 29 |
| claimant has acquired title
to his residence or has paid rent | 30 |
| for his residence primarily for the
purpose of receiving a | 31 |
| grant under this Act.
| 32 |
| (d) Pharmaceutical Assistance.
The Department shall allow | 33 |
| all pharmacies licensed under the Pharmacy
Practice Act of 1987 | 34 |
| to participate as authorized pharmacies unless they
have been |
|
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| removed from that status for cause pursuant to the terms of | 2 |
| this
Section. The Director of the Department may enter
into a | 3 |
| written contract with any State agency, instrumentality or | 4 |
| political
subdivision, or a fiscal intermediary for the purpose | 5 |
| of making payments to
authorized pharmacies for covered | 6 |
| prescription drugs and coordinating the
program of | 7 |
| pharmaceutical assistance established by this Act with other
| 8 |
| programs that provide payment for covered prescription drugs. | 9 |
| Such
agreement shall establish procedures for properly | 10 |
| contracting for pharmacy
services, validating reimbursement | 11 |
| claims, validating compliance of
dispensing pharmacists with | 12 |
| the contracts for participation required under
this Section, | 13 |
| validating the reasonable costs of covered prescription
drugs, | 14 |
| and otherwise providing for the effective administration of | 15 |
| this Act.
| 16 |
| The Department shall promulgate rules and regulations to | 17 |
| implement and
administer the program of pharmaceutical | 18 |
| assistance required by this Act,
which shall include the | 19 |
| following:
| 20 |
| (1) Execution of contracts with pharmacies to dispense | 21 |
| covered
prescription drugs. Such contracts shall stipulate | 22 |
| terms and conditions for
authorized pharmacies | 23 |
| participation and the rights of the State to
terminate such | 24 |
| participation for breach of such contract or for violation
| 25 |
| of this Act or related rules and regulations of the | 26 |
| Department;
| 27 |
| (2) Establishment of maximum limits on the size of | 28 |
| prescriptions,
new or refilled, which shall be in amounts | 29 |
| sufficient for 34 days, except as
otherwise specified by | 30 |
| rule for medical or utilization control reasons;
| 31 |
| (3) Establishment of liens upon any and all causes of | 32 |
| action which accrue
to
a beneficiary as a result of | 33 |
| injuries for which covered prescription drugs are
directly | 34 |
| or indirectly required and for which the Director made | 35 |
| payment
or became liable for under this Act;
| 36 |
| (4) Charge or collection of payments from third parties |
|
|
|
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| or private plans
of assistance, or from other programs of | 2 |
| public assistance for any claim
that is properly chargeable | 3 |
| under the assignment of benefits executed by
beneficiaries | 4 |
| as a requirement of eligibility for the pharmaceutical
| 5 |
| assistance identification card under this Act; | 6 |
| (4.5) Provision for automatic enrollment of | 7 |
| beneficiaries into a Medicare Discount Card program | 8 |
| authorized under the federal Medicare Modernization Act of | 9 |
| 2003 (P.L. 108-391) to coordinate coverage including | 10 |
| Medicare Transitional Assistance;
| 11 |
| (5) Inspection of appropriate records and audit of | 12 |
| participating
authorized pharmacies to ensure contract | 13 |
| compliance, and to determine any
fraudulent transactions | 14 |
| or practices under this Act;
| 15 |
| (6) Annual determination of the reasonable costs of | 16 |
| covered prescription
drugs for which payments are made | 17 |
| under this Act, as provided in Section 3.16;
| 18 |
| (7) Payment to pharmacies under this Act in accordance | 19 |
| with the State
Prompt Payment Act.
| 20 |
| The Department shall annually report to the Governor and | 21 |
| the General
Assembly by March 1st of each year on the | 22 |
| administration of pharmaceutical
assistance under this Act. By | 23 |
| the effective date of this Act the
Department shall determine | 24 |
| the reasonable costs of covered prescription
drugs in | 25 |
| accordance with Section 3.16 of this Act.
| 26 |
| (Source: P.A. 91-357, eff. 7-29-99; 92-651, eff. 7-11-02.)
|
|
27 |
| Section 40. The Illinois Food, Drug and Cosmetic Act is | 28 |
| amended by changing Section 3.14 as follows:
| 29 |
| (410 ILCS 620/3.14) (from Ch. 56 1/2, par. 503.14)
| 30 |
| Sec. 3.14. Dispensing or causing to be dispensed a | 31 |
| different drug in
place of the drug or brand of drug ordered or | 32 |
| prescribed without the
express permission of the person | 33 |
| ordering or prescribing.
However, this Section does not | 34 |
| prohibit the interchange of different brands
of the same |
|
|
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| generically equivalent drug product, when the drug
products
are | 2 |
| not required to bear the legend "Caution: Federal law prohibits | 3 |
| dispensing
without prescription", provided that the same | 4 |
| dosage form is dispensed and
there is no greater than 1% | 5 |
| variance in the stated amount of each active
ingredient of the | 6 |
| drug products. Nothing in this Section shall
prohibit
the | 7 |
| selection of different brands of the same generic drug, based | 8 |
| upon a drug formulary listing which is developed, maintained, | 9 |
| and issued
by the Department of Public Health under which drug | 10 |
| product selection is
permitted, is not subject to review at a | 11 |
| meeting of the Technical Advisory Council, is not subject to a | 12 |
| hearing in
accordance with this Section, or is not specifically | 13 |
| prohibited.
A generic drug determined to be therapeutically | 14 |
| equivalent by the
United States Food and Drug Administration | 15 |
| (FDA) shall be available
for substitution in Illinois in | 16 |
| accordance with this Act and the
Pharmacy Practice Act of 1987, | 17 |
| provided that each manufacturer
submits to the Director of the | 18 |
| Department of Public Health a notification containing product | 19 |
| technical
bioequivalence information as a prerequisite to | 20 |
| product
substitution when they have completed all required | 21 |
| testing to
support FDA product approval and, in any event, the | 22 |
| information
shall be submitted no later than 60 days prior to | 23 |
| product
substitution in the State. If the Technical Advisory | 24 |
| Council
finds that a generic drug product may have issues | 25 |
| related to the
practice of medicine or the practice of | 26 |
| pharmacy, the Technical
Advisory Council shall review the | 27 |
| generic drug product
at its next regularly
scheduled Technical | 28 |
| Advisory Council meeting. Following the
Technical Advisory | 29 |
| Council's review and initial recommendation that a generic
drug | 30 |
| product not be included in the Illinois Formulary, a hearing | 31 |
| shall be conducted in accordance with the
Department's Rules of | 32 |
| Practice and Procedure in Administrative
Hearings (77 Ill. | 33 |
| Admin. Code 100) and Article 10 of the Illinois
Administrative | 34 |
| Procedure Act if requested by the manufacturer. The
Technical | 35 |
| Advisory Council
shall make its recommendation to the | 36 |
| Department of Public Health
within 20 business days after the |
|
|
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| 1 |
| public hearing. If the
Department of Public Health, on the | 2 |
| recommendation of the
Technical Advisory Council, determines | 3 |
| that, based upon a
preponderance of the evidence, the drug is | 4 |
| not bioequivalent, not
therapeutically equivalent, or could | 5 |
| cause clinically significant
harm to the health or safety of | 6 |
| patients receiving that generic drug,
the Department of Public | 7 |
| Health may prohibit the generic drug
from substitution in the | 8 |
| State. A decision by the Department to
prohibit a drug product | 9 |
| from substitution shall constitute a
final administrative | 10 |
| decision within the meaning of Section 22.2
of the Illinois | 11 |
| Food, Drug and Cosmetic Act and Section 3-101 of
the Code of | 12 |
| Civil Procedure, and shall be subject to judicial
review | 13 |
| pursuant to the provisions of Article III of the
Administrative | 14 |
| Review Law. A decision to prohibit a generic
drug from | 15 |
| substitution must be accompanied by a written detailed
| 16 |
| explanation of the basis for the decision.
Determination of | 17 |
| products which may
be selected shall be recommended by a | 18 |
| Technical Advisory Council of the
Department, selected by the | 19 |
| Director of Public Health, which council shall
consist of 7 | 20 |
| persons including 2 physicians, 2 pharmacists, 2 | 21 |
| pharmacologists
and one other prescriber who have special | 22 |
| knowledge of generic drugs and
formulary. Technical Advisory | 23 |
| Council members shall serve without pay, and
shall be appointed | 24 |
| for a 3 year term and until their successors are appointed
and | 25 |
| qualified. The procedures for operation of the Drug Product | 26 |
| Selection
Program shall be promulgated by the Director, however | 27 |
| the actual list of
products prohibited or approved for drug | 28 |
| product selection need not be
promulgated. The
Technical | 29 |
| Advisory Council shall take cognizance of federal studies, the | 30 |
| U.S.
Pharmacopoeia - National Formulary, or other recognized | 31 |
| authoritative sources,
and shall advise the Director of any | 32 |
| necessary modifications.
Drug products previously approved by | 33 |
| the Technical Advisory
Council for generic interchange may be | 34 |
| substituted in the State
of Illinois without further review | 35 |
| subject to the conditions of
approval in the State of
Illinois | 36 |
| prior to the effective date of this amendatory Act of
the 91st |
|
|
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| General Assembly.
| 2 |
| Timely notice of revisions to the formulary shall be | 3 |
| furnished at no charge
to all pharmacies by the Department. | 4 |
| Single copies of the drug formulary shall
be made available at | 5 |
| no charge upon request to licensed prescribers, student
| 6 |
| pharmacists, and pharmacists practicing pharmacy in this State | 7 |
| under a
reciprocal license. The Department shall offer | 8 |
| subscriptions to the drug
formulary and its revisions to other | 9 |
| interested parties at a reasonable charge
to be established by | 10 |
| rule. Before the Department makes effective any additions
to or | 11 |
| deletions from the procedures for operation of the Drug Product | 12 |
| Selection
Program under this Section, the Department shall file | 13 |
| proposed rules to amend
the procedures for operation of the | 14 |
| program under Section 5-40 of the Illinois
Administrative | 15 |
| Procedure Act. The Department shall issue necessary rules and
| 16 |
| regulations for the implementation of this Section.
| 17 |
| (Source: P.A. 91-766, eff. 9-1-00; 92-112, eff. 7-20-01.)
|
|
18 |
| Section 99. Effective date. This Act takes effect upon |
19 |
| becoming law.
|