SB2170 Engrossed LRB094 13493 DRJ 50420 b

1     AN ACT concerning business.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Nursing Home Care Act is amended by adding
5 Sections 2-217 and 2-218 as follows:
 
6     (210 ILCS 45/2-217 new)
7     Sec. 2-217. Order for transportation of resident by
8 ambulance. If a facility orders transportation of a resident of
9 the facility by ambulance, the facility must maintain a written
10 record that shows (i) the name of the person who placed the
11 order for that transportation and (ii) the medical reason for
12 that transportation. The facility must maintain the record for
13 a period of at least 3 years after the date of the order for
14 transportation by ambulance.
 
15     (210 ILCS 45/2-218 new)
16     Sec. 2-218. Inducement to vehicle service provider;
17 penalty.
18     (a) If the Department determines, after an opportunity for
19 a hearing in accordance with rules adopted by the Department,
20 that (i) a facility knowingly or willingly offered or provided,
21 solicited, or received any remuneration (including any
22 kickback, bribe, rebate, or discount) directly or indirectly,
23 overtly or covertly, in cash or in kind, to any Vehicle Service
24 Provider licensed under the Emergency Medical Services (EMS)
25 Systems Act for the purpose of providing referrals for
26 transportation by the Vehicle Service Provider or (ii) an
27 employee or contractual agent of a facility knowingly or
28 willingly falsified any documentation of medical necessity for
29 non-emergency ambulance transportation, the Department may
30 impose against the facility, or against the employer of the
31 facility's contractual agent in the case of an individual who

 

 

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1 became the facility's contractual agent by virtue of his or her
2 employment by that employer, a civil penalty in an amount not
3 exceeding $10,000.
4     (b) If the Department makes a determination described in
5 subsection (a), the Department shall refer that determination
6 to the United States Department of Health and Human Services
7 Office of Inspector General.
 
8     Section 10. The Emergency Medical Services (EMS) Systems
9 Act is amended by changing Section 3.85 as follows:
 
10     (210 ILCS 50/3.85)
11     Sec. 3.85. Vehicle Service Providers.
12     (a) "Vehicle Service Provider" means an entity licensed by
13 the Department to provide emergency or non-emergency medical
14 services in compliance with this Act, the rules promulgated by
15 the Department pursuant to this Act, and an operational plan
16 approved by its EMS System(s), utilizing at least ambulances or
17 specialized emergency medical service vehicles (SEMSV).
18         (1) "Ambulance" means any publicly or privately owned
19     on-road vehicle that is specifically designed, constructed
20     or modified and equipped, and is intended to be used for,
21     and is maintained or operated for the emergency
22     transportation of persons who are sick, injured, wounded or
23     otherwise incapacitated or helpless, or the non-emergency
24     medical transportation of persons who require the presence
25     of medical personnel to monitor the individual's condition
26     or medical apparatus being used on such individuals.
27         (2) "Specialized Emergency Medical Services Vehicle"
28     or "SEMSV" means a vehicle or conveyance, other than those
29     owned or operated by the federal government, that is
30     primarily intended for use in transporting the sick or
31     injured by means of air, water, or ground transportation,
32     that is not an ambulance as defined in this Act. The term
33     includes watercraft, aircraft and special purpose ground
34     transport vehicles or conveyances not intended for use on

 

 

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1     public roads.
2         (3) An ambulance or SEMSV may also be designated as a
3     Limited Operation Vehicle or Special-Use Vehicle:
4             (A) "Limited Operation Vehicle" means a vehicle
5         which is licensed by the Department to provide basic,
6         intermediate or advanced life support emergency or
7         non-emergency medical services that are exclusively
8         limited to specific events or locales.
9             (B) "Special-Use Vehicle" means any publicly or
10         privately owned vehicle that is specifically designed,
11         constructed or modified and equipped, and is intended
12         to be used for, and is maintained or operated solely
13         for the emergency or non-emergency transportation of a
14         specific medical class or category of persons who are
15         sick, injured, wounded or otherwise incapacitated or
16         helpless (e.g. high-risk obstetrical patients,
17         neonatal patients).
18     (b) The Department shall have the authority and
19 responsibility to:
20         (1) Require all Vehicle Service Providers, both
21     publicly and privately owned, to function within an EMS
22     System;
23         (2) Require a Vehicle Service Provider utilizing
24     ambulances to have a primary affiliation with an EMS System
25     within the EMS Region in which its Primary Service Area is
26     located, which is the geographic areas in which the
27     provider renders the majority of its emergency responses.
28     This requirement shall not apply to Vehicle Service
29     Providers which exclusively utilize Limited Operation
30     Vehicles;
31         (3) Establish licensing standards and requirements for
32     Vehicle Service Providers, through rules adopted pursuant
33     to this Act, including but not limited to:
34             (A) Vehicle design, specification, operation and
35         maintenance standards;
36             (B) Equipment requirements;

 

 

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1             (C) Staffing requirements; and
2             (D) Annual license renewal.
3         (4) License all Vehicle Service Providers that have met
4     the Department's requirements for licensure, unless such
5     Provider is owned or licensed by the federal government.
6     All Provider licenses issued by the Department shall
7     specify the level and type of each vehicle covered by the
8     license (BLS, ILS, ALS, ambulance, SEMSV, limited
9     operation vehicle, special use vehicle);
10         (5) Annually inspect all licensed Vehicle Service
11     Providers, and relicense such Providers that have met the
12     Department's requirements for license renewal;
13         (6) Suspend, revoke, refuse to issue or refuse to renew
14     the license of any Vehicle Service Provider, or that
15     portion of a license pertaining to a specific vehicle
16     operated by the Provider, after an opportunity for a
17     hearing, when findings show that the Provider or one or
18     more of its vehicles has failed to comply with the
19     standards and requirements of this Act or rules adopted by
20     the Department pursuant to this Act;
21         (6.5) Impose against a Vehicle Service Provider a civil
22     penalty in an amount not exceeding $10,000, if the
23     Department determines, after an opportunity for a hearing
24     in accordance with rules adopted by the Department, that
25     the Vehicle Service Provider knowingly or willingly
26     offered or provided, solicited, or received any
27     remuneration (including any kickback, bribe, rebate, or
28     discount) directly or indirectly, overtly or covertly, in
29     cash or in kind, to any long-term care facility licensed
30     under the Nursing Home Care Act or any hospital licensed
31     under the Hospital Licensing Act for the purpose of
32     influencing the long-term care facility or hospital to
33     provide referrals to the Vehicle Service Provider for the
34     transportation of residents of the long-term care facility
35     or patients of the hospital; the Department shall refer any
36     such determination to the United States Department of

 

 

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1     Health and Human Services Office of Inspector General;
2         (7) Issue an Emergency Suspension Order for any
3     Provider or vehicle licensed under this Act, when the
4     Director or his designee has determined that an immediate
5     and serious danger to the public health, safety and welfare
6     exists. Suspension or revocation proceedings which offer
7     an opportunity for hearing shall be promptly initiated
8     after the Emergency Suspension Order has been issued;
9         (8) Exempt any licensed vehicle from subsequent
10     vehicle design standards or specifications required by the
11     Department, as long as said vehicle is continuously in
12     compliance with the vehicle design standards and
13     specifications originally applicable to that vehicle, or
14     until said vehicle's title of ownership is transferred;
15         (9) Exempt any vehicle (except an SEMSV) which was
16     being used as an ambulance on or before December 15, 1980,
17     from vehicle design standards and specifications required
18     by the Department, until said vehicle's title of ownership
19     is transferred. Such vehicles shall not be exempt from all
20     other licensing standards and requirements prescribed by
21     the Department;
22         (10) Prohibit any Vehicle Service Provider from
23     advertising, identifying its vehicles, or disseminating
24     information in a false or misleading manner concerning the
25     Provider's type and level of vehicles, location, primary
26     service area, response times, level of personnel,
27     licensure status or System participation; and
28         (11) Charge each Vehicle Service Provider a fee, to be
29     submitted with each application for licensure and license
30     renewal, which shall not exceed $25.00 per vehicle, up to
31     $500.00 per Provider.
32 (Source: P.A. 89-177, eff. 7-19-95.)
 
33     Section 15. The Hospital Licensing Act is amended by adding
34 Sections 6.22 and 6.23 as follows:
 

 

 

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1     (210 ILCS 85/6.22 new)
2     Sec. 6.22. Order for transportation of patient by
3 ambulance. If a hospital orders transportation of a patient of
4 the hospital by ambulance, the hospital must maintain a written
5 record that shows (i) the name of the person who placed the
6 order for that transportation and (ii) the medical reason for
7 that transportation. The hospital must maintain the record for
8 a period of at least 3 years after the date of the order for
9 transportation by ambulance.
 
10     (210 ILCS 85/6.23 new)
11     Sec. 6.23. Inducement to vehicle service provider;
12 penalty.
13     (a) If the Department determines, after an opportunity for
14 a hearing in accordance with rules adopted by the Department,
15 that (i) a hospital knowingly or willingly offered or provided,
16 solicited, or received any remuneration (including any
17 kickback, bribe, rebate, or discount) directly or indirectly,
18 overtly or covertly, in cash or in kind, to any Vehicle Service
19 Provider licensed under the Emergency Medical Services (EMS)
20 Systems Act for the purpose of providing referrals for
21 transportation by the Vehicle Service Provider or (ii) an
22 employee or contractual agent of a hospital knowingly or
23 willingly falsified any documentation of medical necessity for
24 non-emergency ambulance transportation, the Department may
25 impose against the hospital, or against the employer of the
26 hospital's contractual agent in the case of an individual who
27 became the hospital's contractual agent by virtue of his or her
28 employment by that employer, a civil penalty in an amount not
29 exceeding $10,000.
30     (b) If the Department makes a determination described in
31 subsection (a), the Department shall refer that determination
32 to the United States Department of Health and Human Services
33 Office of Inspector General.
 
34     Section 20. The Consumer Fraud and Deceptive Business

 

 

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1 Practices Act is amended by adding Section 2XX as follows:
 
2     (815 ILCS 505/2XX new)
3     Sec. 2XX. Notification requirements for non-emergency
4 ambulance services.
5     (a) In this Section:
6     "Ambulance service provider" means a Vehicle Service
7 Provider, as defined in the Emergency Medical Services (EMS)
8 Systems Act, who provides non-emergency transportation
9 services by ambulance.
10     "Patient" means a person who is transported by an ambulance
11 service provider.
12     (b) An ambulance service provider shall provide a written
13 notice, and a verbal explanation of the written notice, prior
14 to non-emergency ambulance transports that originate at a
15 hospital or other health care facility when no written
16 documentation of medical necessity is available at the time of
17 transport. This notice must meet all of the following
18 requirements:
19         (1) The following caption must appear at the beginning
20     of the notice, in at least 14-point type: Notice to Patient
21     Regarding Non-Emergency Ambulance Services.
22         (2) The remainder of the notice must be expressed in
23     clear, simple language and in at least 14-point type.
24         (3) The notice must contain each of the following
25     statements:
26             (A) Notice: Medicare and other insurers may not pay
27         for any part of the cost of your transport by ambulance
28         unless certified by your physician or healthcare
29         provider as allowed under federal rules as being
30         medically necessary.
31             (B) The purpose of this notice is to help you make
32         an informed choice about whether or not you want to be
33         transported by ambulance, knowing that you might have
34         to pay for this transport yourself. Before you make any
35         decision about your options, you should:

 

 

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1                 (i) Read this entire notice carefully.
2                 (ii) Ask a representative of the physician or
3             facility ordering transport to explain, if you do
4             not understand or are not sure, the guidelines
5             regarding medical necessity for transport by
6             ambulance and to tell you whether or not you meet
7             these guidelines.
8                 (iii) Ask us how much being transported by
9             ambulance will cost you, in case you have to pay
10             for transport by ambulance out of your own pocket
11             or through other insurance. The estimated cost
12             will be $(amount).
13             (C) Please choose one option by checking one box
14         and signing and dating your selection below:
15                 (i) Option 1. Yes. I want to be transported by
16             ambulance. I understand that Medicare and many
17             other insurers may not pay for any part of the cost
18             of my ambulance transport unless certified by my
19             physician or healthcare provider as allowed under
20             federal rules as being medically necessary. I
21             understand that you will file a claim on my behalf
22             to Medicare or my other insurer. I understand that
23             you may bill me for items or services and that I
24             may have to pay the bill while Medicare or my other
25             insurer is making its decision. If Medicare or my
26             other insurer does pay on my behalf, I understand
27             that you will refund to me any payments that I made
28             to you that are due to me. If Medicare or my other
29             insurer denies payment, I agree to be personally
30             and fully responsible for payment. I understand
31             that I can appeal the decision made by Medicare or
32             my other insurer.
33                 (ii) Option 2. No. I have decided not to be
34             transported by ambulance.
35         (4) The notice must be signed by the patient or by the
36     patient's authorized representative.

 

 

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1         (5) The notice must contain the patient's full name and
2     the date of service.
3         (6) The notice must contain the full name and business
4     address (including the street name and number, city, state,
5     and zip code) of the ambulance service provider.
6     (c) If a patient is physically or mentally unable to sign
7 the notice described in subsection (b) at the time of transport
8 by ambulance and no authorized representative of the patient is
9 available to sign the notice on the patient's behalf, the
10 ambulance service provider must be able to provide
11 documentation of the patient's inability to sign the notice and
12 the unavailability of an authorized representative. In any case
13 described in this subsection (c), the ambulance service
14 provider shall be considered to have met the requirements of
15 subsection (b).
16     (d) If an ambulance service provider has obtained
17 documentation of medical necessity prior to transport and the
18 patient's Medicare or other insurer denies the claim for
19 transport by ambulance despite this fact, the ambulance service
20 provider is considered to have met the requirements of
21 subsection (b).
22     (e) In addition to any other penalty provided in this Act,
23 if the court finds that an ambulance service provider has
24 violated any provision of subsection (b), the court may order
25 that the ambulance service provider pay to the patient an
26 amount equal to 3 times the amount claimed due by the ambulance
27 provider, including any interest, collection costs, and
28 attorney's fees claimed by the ambulance service provider, and
29 any attorney's fees incurred by the patient.