97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB3348

 

Introduced 2/24/2011, by Rep. Dan Reitz

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-4.2  from Ch. 23, par. 5-4.2
305 ILCS 5/5-5  from Ch. 23, par. 5-5

    Amends the Illinois Public Aid Code. Provides for payment for ground ambulance services under the medical assistance program. Provides that for ground ambulance services provided to a medical assistance recipient on or after July 1, 2011, the Department of Healthcare and Family Services shall provide payment to ground ambulance services providers for base charges and mileage charges based upon the lesser of the provider's charge, as reflected on the provider's claim form, or the Illinois Medicaid Ambulance Fee Schedule payment rates. Provides for establishment of the Illinois Medicaid Ambulance Fee Schedule, and provides for a 2-year phase-in of that Schedule. Provides that effective for dates of service on or after July 1, 2011, the Department shall update the Illinois Medicaid Ambulance Fee Schedule payment rates to be in compliance with the Medicare Ambulance Fee Schedule payment rates for ground ambulance services in effect at the time of the update. Makes other changes in connection with medical assistance payments for ground ambulance services. Effective July 1, 2011.


LRB097 06117 KTG 46190 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB3348LRB097 06117 KTG 46190 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-4.2 and 5-5 as follows:
 
6    (305 ILCS 5/5-4.2)  (from Ch. 23, par. 5-4.2)
7    Sec. 5-4.2. Ground ambulance Ambulance services payments.
8    (a) For purposes of this Section, the following terms have
9the following meanings:
10    "Department" means the Illinois Department of Healthcare
11and Family Services.
12    "Ground ambulance services" means medical transportation
13services that are described as ground ambulance services by the
14Centers for Medicare and Medicaid Services and provided in a
15vehicle that is licensed as an ambulance by the Illinois
16Department of Public Health pursuant to the Emergency Medical
17Services (EMS) Systems Act.
18    "Ground ambulance services provider" means a vehicle
19service provider as described in the Emergency Medical Services
20(EMS) Systems Act that operates licensed ambulances for the
21purpose of providing emergency ambulance services, or
22non-emergency ambulance services, or both. For purposes of this
23Section, this includes both ambulance providers and ambulance

 

 

HB3348- 2 -LRB097 06117 KTG 46190 b

1suppliers as described by the Centers for Medicare and Medicaid
2Services.
3    "Payment principles of Medicare" means: the accepted
4method propounded by the Centers for Medicare and Medicaid
5Services and used to determine the payment system for ground
6ambulance services providers and suppliers under Title XVIII of
7the Social Security Act. These principles are outlined in the
8United States Code, the Code of Federal Regulations, and the
9CMS Online Manual System, including, but not limited to, the
10Medicare Benefit Policy Manual and the Medicare Claims
11Processing Manual, and include the statues, regulations,
12policies, procedures, definitions, guidelines, and coding
13systems, including the Health Care Common Procedure Coding
14System (HCPCS) and ambulance condition coding system, as well
15as other resources which have been or will be developed and
16recognized by the Centers for Medicare and Medicaid Services.
17    "Rural county" means: any county not located in a U.S.
18Bureau of the Census Metropolitan Statistical Area (MSA); or
19any county located within a U.S. Bureau of the Census
20Metropolitan Statistical Area but having a population of 60,000
21or less.
22    (b) It is the intent of the General Assembly to provide for
23the payment for ground ambulance services as part of the State
24Medicaid plan and to provide adequate payment for ground
25ambulance services under the State Medicaid plan so as to
26ensure adequate access to ground ambulance services for both

 

 

HB3348- 3 -LRB097 06117 KTG 46190 b

1recipients of aid under this Article and for the general
2population of Illinois. Unless otherwise indicated in this
3Section, the practices of the Department concerning payments
4for ground ambulance services provided to recipients of aid
5under this Article shall be consistent with the payment
6principles of Medicare.
7    (c) For ground ambulance services provided to a recipient
8of aid under this Article on or after July 1, 2011, the
9Department shall provide payment to ground ambulance services
10providers for base charges and mileage charges based upon the
11lesser of the provider's charge, as reflected on the provider's
12claim form, or the Illinois Medicaid Ambulance Fee Schedule
13payment rates calculated in accordance with this Section.
14    Effective July 1, 2011, the Illinois Medicaid Ambulance Fee
15Schedule shall be established and shall include only the ground
16ambulance services payment rates outlined in the Medicare
17Ambulance Fee Schedule as promulgated by the Centers for
18Medicare and Medicaid Services in effect as of July 1, 2011 and
19adjusted for the 4 Medicare Localities in Illinois, with an
20adjustment of 100% of the Medicare Ambulance Fee Schedule
21payment rates, by Medicare Locality, for both base rates and
22mileage for rural counties, and an adjustment of 80% of the
23Medicare Ambulance Fee Schedule payment rates, by Medicare
24Locality, for both base rates and mileage for all other
25counties. The transition from the current payment system to the
26Illinois Medicaid Ambulance Fee Schedule shall be by a 2-year

 

 

HB3348- 4 -LRB097 06117 KTG 46190 b

1phase-in as follows:
2        (1) Effective for dates of service from July 1, 2011
3    through June 30, 2012, for each individual base rate and
4    mileage rate, the payment rate for ground ambulance
5    services shall be based on 50% of the Medicaid payment rate
6    in effect as of January 1, 2011 and 50% of the Illinois
7    Medicaid Ambulance Fee Schedule amount in effect on July 1,
8    2011 for the designated Medicare Locality, except that any
9    payment rate that was previously approved by the Department
10    that exceeds this amount shall remain in force.
11        (2) Effective for dates of service on or after July 1,
12    2012, for each individual base rate and mileage rate, the
13    payment rate for ground ambulance services shall be based
14    on 100% of the Illinois Medicaid Ambulance Fee Schedule
15    amount in effect on July 1, 2012 for the designated
16    Medicare Locality, except that any payment rate that was
17    previously approved by the Department that exceeds this
18    amount shall remain in force.
19    Notwithstanding the payment principles in subsection (b)
20of this Section, the Department shall develop the Illinois
21Medicaid Ambulance Fee Schedule using the ground mileage
22payment rate, as defined by the Centers for Medicare and
23Medicaid Services, and no other mileage rates which act as
24enhancements to the ground mileage rate, whether permanent or
25temporary, shall be recognized by the Department.
26    (d) Payment for mileage shall be per loaded mile with no

 

 

HB3348- 5 -LRB097 06117 KTG 46190 b

1loaded mileage included in the base rate. If a natural
2disaster, weather, road repairs, traffic congestion, or other
3conditions necessitate a route other than the most direct
4route, payment shall be based upon the actual distance
5traveled. When a ground ambulance services provider provides
6transport pursuant to an emergency call as defined by the
7Centers for Medicare and Medicaid Services, no reduction in the
8mileage payment shall be made based upon the fact that a closer
9facility may have been available, so long as the ground
10ambulance services provider provided transport to the
11recipient's facility of choice within the scope of the Illinois
12Emergency Medical Services (EMS) Systems Act and associated
13rules and the policies and procedures of the EMS System of
14which the provider is a member.
15    (e) The Department shall provide payment for emergency
16ground ambulance services provided to a recipient of aid under
17this Article according to the requirements provided in
18subsection (b) of this Section when those services are provided
19pursuant to a request made through a 9-1-1 or equivalent
20emergency telephone number for evaluation, treatment, and
21transport from or on behalf of an individual with a condition
22of such a nature that a prudent layperson would have reasonably
23expected that a delay in seeking immediate medical attention
24would have been hazardous to life or health. This standard is
25deemed to be met if there is an emergency medical condition
26manifesting itself by acute symptoms of sufficient severity,

 

 

HB3348- 6 -LRB097 06117 KTG 46190 b

1including but not limited to severe pain, such that a prudent
2layperson who possesses an average knowledge of medicine and
3health can reasonably expect that the absence of immediate
4medical attention could result in placing the health of the
5individual or, with respect to a pregnant woman, the health of
6the woman or her unborn child, in serious jeopardy, cause
7serious impairment to bodily functions, or cause serious
8dysfunction of any bodily organ or part.
9    (f) For ground ambulance services provided to a recipient
10enrolled in a Medicaid managed care plan by a ground ambulance
11services provider that is not a contracted provider to the
12Medicaid managed care plan in question, the amount of the
13payment for ground ambulance services by the Medicaid managed
14care plan shall be the lesser of the provider's charge, as
15reflected on the provider's claim form, or the Illinois
16Medicaid Ambulance Fee Schedule payment rates calculated in
17accordance with this Section.
18    (g) Nothing in this Section prohibits the Department from
19setting payment rates for out-of-State ground ambulance
20services providers by administrative rule.
21    (h) Effective for dates of service on or after July 1,
222011, payments for stretcher van services provided by ground
23ambulance services providers shall be as follows:
24        (1) For each individual base rate, the amount of the
25    payment shall be the lesser of the provider's charge, as
26    reflected on the provider's claim form, or 80% of the

 

 

HB3348- 7 -LRB097 06117 KTG 46190 b

1    Illinois Medicaid Ambulance Fee Schedule payment rate for
2    the basic life support non-emergency base rate.
3        (2) For each loaded mile, the amount of the payment
4    shall be the lesser of the provider's charge, as reflected
5    on the provider's claim form, or 80% of the Illinois
6    Medicaid Ambulance Fee Schedule payment rate for mileage.
7    For ambulance services provided to a recipient of aid under
8this Article on or after January 1, 1993, the Illinois
9Department shall reimburse ambulance service providers at
10rates calculated in accordance with this Section. It is the
11intent of the General Assembly to provide adequate
12reimbursement for ambulance services so as to ensure adequate
13access to services for recipients of aid under this Article and
14to provide appropriate incentives to ambulance service
15providers to provide services in an efficient and
16cost-effective manner. Thus, it is the intent of the General
17Assembly that the Illinois Department implement a
18reimbursement system for ambulance services that, to the extent
19practicable and subject to the availability of funds
20appropriated by the General Assembly for this purpose, is
21consistent with the payment principles of Medicare. To ensure
22uniformity between the payment principles of Medicare and
23Medicaid, the Illinois Department shall follow, to the extent
24necessary and practicable and subject to the availability of
25funds appropriated by the General Assembly for this purpose,
26the statutes, laws, regulations, policies, procedures,

 

 

HB3348- 8 -LRB097 06117 KTG 46190 b

1principles, definitions, guidelines, and manuals used to
2determine the amounts paid to ambulance service providers under
3Title XVIII of the Social Security Act (Medicare).
4    For ambulance services provided to a recipient of aid under
5this Article on or after January 1, 1996, the Illinois
6Department shall reimburse ambulance service providers based
7upon the actual distance traveled if a natural disaster,
8weather conditions, road repairs, or traffic congestion
9necessitates the use of a route other than the most direct
10route.
11    For purposes of this Section, "ambulance services"
12includes medical transportation services provided by means of
13an ambulance, medi-car, service car, or taxi.
14    This Section does not prohibit separate billing by
15ambulance service providers for oxygen furnished while
16providing advanced life support services.
17    (j) Beginning with services rendered on or after July 1,
182008, all providers of non-emergency medi-car and service car
19transportation must certify that the driver and employee
20attendant, as applicable, have completed a safety program
21approved by the Department to protect both the patient and the
22driver, prior to transporting a patient. The provider must
23maintain this certification in its records. The provider shall
24produce such documentation upon demand by the Department or its
25representative. Failure to produce documentation of such
26training shall result in recovery of any payments made by the

 

 

HB3348- 9 -LRB097 06117 KTG 46190 b

1Department for services rendered by a non-certified driver or
2employee attendant. Medi-car and service car providers must
3maintain legible documentation in their records of the driver
4and, as applicable, employee attendant that actually
5transported the patient. Providers must recertify all drivers
6and employee attendants every 3 years.
7    Notwithstanding the requirements above, any public
8transportation provider of medi-car and service car
9transportation that receives federal funding under 49 U.S.C.
105307 and 5311 need not certify its drivers and employee
11attendants under this Section, since safety training is already
12federally mandated.
13(Source: P.A. 95-501, eff. 8-28-07.)
 
14    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
15    Sec. 5-5. Medical services. The Illinois Department, by
16rule, shall determine the quantity and quality of and the rate
17of reimbursement for the medical assistance for which payment
18will be authorized, and the medical services to be provided,
19which may include all or part of the following: (1) inpatient
20hospital services; (2) outpatient hospital services; (3) other
21laboratory and X-ray services; (4) skilled nursing home
22services; (5) physicians' services whether furnished in the
23office, the patient's home, a hospital, a skilled nursing home,
24or elsewhere; (6) medical care, or any other type of remedial
25care furnished by licensed practitioners; (7) home health care

 

 

HB3348- 10 -LRB097 06117 KTG 46190 b

1services; (8) private duty nursing service; (9) clinic
2services; (10) dental services, including prevention and
3treatment of periodontal disease and dental caries disease for
4pregnant women, provided by an individual licensed to practice
5dentistry or dental surgery; for purposes of this item (10),
6"dental services" means diagnostic, preventive, or corrective
7procedures provided by or under the supervision of a dentist in
8the practice of his or her profession; (11) physical therapy
9and related services; (12) prescribed drugs, dentures, and
10prosthetic devices; and eyeglasses prescribed by a physician
11skilled in the diseases of the eye, or by an optometrist,
12whichever the person may select; (13) other diagnostic,
13screening, preventive, and rehabilitative services; (14)
14transportation and such other expenses as may be necessary,
15provided that payment for ground ambulance services shall be as
16provided in Section 5-4.2; (15) medical treatment of sexual
17assault survivors, as defined in Section 1a of the Sexual
18Assault Survivors Emergency Treatment Act, for injuries
19sustained as a result of the sexual assault, including
20examinations and laboratory tests to discover evidence which
21may be used in criminal proceedings arising from the sexual
22assault; (16) the diagnosis and treatment of sickle cell
23anemia; and (17) any other medical care, and any other type of
24remedial care recognized under the laws of this State, but not
25including abortions, or induced miscarriages or premature
26births, unless, in the opinion of a physician, such procedures

 

 

HB3348- 11 -LRB097 06117 KTG 46190 b

1are necessary for the preservation of the life of the woman
2seeking such treatment, or except an induced premature birth
3intended to produce a live viable child and such procedure is
4necessary for the health of the mother or her unborn child. The
5Illinois Department, by rule, shall prohibit any physician from
6providing medical assistance to anyone eligible therefor under
7this Code where such physician has been found guilty of
8performing an abortion procedure in a wilful and wanton manner
9upon a woman who was not pregnant at the time such abortion
10procedure was performed. The term "any other type of remedial
11care" shall include nursing care and nursing home service for
12persons who rely on treatment by spiritual means alone through
13prayer for healing.
14    Notwithstanding any other provision of this Section, a
15comprehensive tobacco use cessation program that includes
16purchasing prescription drugs or prescription medical devices
17approved by the Food and Drug Administration shall be covered
18under the medical assistance program under this Article for
19persons who are otherwise eligible for assistance under this
20Article.
21    Notwithstanding any other provision of this Code, the
22Illinois Department may not require, as a condition of payment
23for any laboratory test authorized under this Article, that a
24physician's handwritten signature appear on the laboratory
25test order form. The Illinois Department may, however, impose
26other appropriate requirements regarding laboratory test order

 

 

HB3348- 12 -LRB097 06117 KTG 46190 b

1documentation.
2    The Department of Healthcare and Family Services shall
3provide the following services to persons eligible for
4assistance under this Article who are participating in
5education, training or employment programs operated by the
6Department of Human Services as successor to the Department of
7Public Aid:
8        (1) dental services provided by or under the
9    supervision of a dentist; and
10        (2) eyeglasses prescribed by a physician skilled in the
11    diseases of the eye, or by an optometrist, whichever the
12    person may select.
13    Notwithstanding any other provision of this Code and
14subject to federal approval, the Department may adopt rules to
15allow a dentist who is volunteering his or her service at no
16cost to render dental services through an enrolled
17not-for-profit health clinic without the dentist personally
18enrolling as a participating provider in the medical assistance
19program. A not-for-profit health clinic shall include a public
20health clinic or Federally Qualified Health Center or other
21enrolled provider, as determined by the Department, through
22which dental services covered under this Section are performed.
23The Department shall establish a process for payment of claims
24for reimbursement for covered dental services rendered under
25this provision.
26    The Illinois Department, by rule, may distinguish and

 

 

HB3348- 13 -LRB097 06117 KTG 46190 b

1classify the medical services to be provided only in accordance
2with the classes of persons designated in Section 5-2.
3    The Department of Healthcare and Family Services must
4provide coverage and reimbursement for amino acid-based
5elemental formulas, regardless of delivery method, for the
6diagnosis and treatment of (i) eosinophilic disorders and (ii)
7short bowel syndrome when the prescribing physician has issued
8a written order stating that the amino acid-based elemental
9formula is medically necessary.
10    The Illinois Department shall authorize the provision of,
11and shall authorize payment for, screening by low-dose
12mammography for the presence of occult breast cancer for women
1335 years of age or older who are eligible for medical
14assistance under this Article, as follows:
15        (A) A baseline mammogram for women 35 to 39 years of
16    age.
17        (B) An annual mammogram for women 40 years of age or
18    older.
19        (C) A mammogram at the age and intervals considered
20    medically necessary by the woman's health care provider for
21    women under 40 years of age and having a family history of
22    breast cancer, prior personal history of breast cancer,
23    positive genetic testing, or other risk factors.
24        (D) A comprehensive ultrasound screening of an entire
25    breast or breasts if a mammogram demonstrates
26    heterogeneous or dense breast tissue, when medically

 

 

HB3348- 14 -LRB097 06117 KTG 46190 b

1    necessary as determined by a physician licensed to practice
2    medicine in all of its branches.
3    All screenings shall include a physical breast exam,
4instruction on self-examination and information regarding the
5frequency of self-examination and its value as a preventative
6tool. For purposes of this Section, "low-dose mammography"
7means the x-ray examination of the breast using equipment
8dedicated specifically for mammography, including the x-ray
9tube, filter, compression device, and image receptor, with an
10average radiation exposure delivery of less than one rad per
11breast for 2 views of an average size breast. The term also
12includes digital mammography.
13    On and after July 1, 2008, screening and diagnostic
14mammography shall be reimbursed at the same rate as the
15Medicare program's rates, including the increased
16reimbursement for digital mammography.
17    The Department shall convene an expert panel including
18representatives of hospitals, free-standing mammography
19facilities, and doctors, including radiologists, to establish
20quality standards. Based on these quality standards, the
21Department shall provide for bonus payments to mammography
22facilities meeting the standards for screening and diagnosis.
23The bonus payments shall be at least 15% higher than the
24Medicare rates for mammography.
25    Subject to federal approval, the Department shall
26establish a rate methodology for mammography at federally

 

 

HB3348- 15 -LRB097 06117 KTG 46190 b

1qualified health centers and other encounter-rate clinics.
2These clinics or centers may also collaborate with other
3hospital-based mammography facilities.
4    The Department shall establish a methodology to remind
5women who are age-appropriate for screening mammography, but
6who have not received a mammogram within the previous 18
7months, of the importance and benefit of screening mammography.
8    The Department shall establish a performance goal for
9primary care providers with respect to their female patients
10over age 40 receiving an annual mammogram. This performance
11goal shall be used to provide additional reimbursement in the
12form of a quality performance bonus to primary care providers
13who meet that goal.
14    The Department shall devise a means of case-managing or
15patient navigation for beneficiaries diagnosed with breast
16cancer. This program shall initially operate as a pilot program
17in areas of the State with the highest incidence of mortality
18related to breast cancer. At least one pilot program site shall
19be in the metropolitan Chicago area and at least one site shall
20be outside the metropolitan Chicago area. An evaluation of the
21pilot program shall be carried out measuring health outcomes
22and cost of care for those served by the pilot program compared
23to similarly situated patients who are not served by the pilot
24program.
25    Any medical or health care provider shall immediately
26recommend, to any pregnant woman who is being provided prenatal

 

 

HB3348- 16 -LRB097 06117 KTG 46190 b

1services and is suspected of drug abuse or is addicted as
2defined in the Alcoholism and Other Drug Abuse and Dependency
3Act, referral to a local substance abuse treatment provider
4licensed by the Department of Human Services or to a licensed
5hospital which provides substance abuse treatment services.
6The Department of Healthcare and Family Services shall assure
7coverage for the cost of treatment of the drug abuse or
8addiction for pregnant recipients in accordance with the
9Illinois Medicaid Program in conjunction with the Department of
10Human Services.
11    All medical providers providing medical assistance to
12pregnant women under this Code shall receive information from
13the Department on the availability of services under the Drug
14Free Families with a Future or any comparable program providing
15case management services for addicted women, including
16information on appropriate referrals for other social services
17that may be needed by addicted women in addition to treatment
18for addiction.
19    The Illinois Department, in cooperation with the
20Departments of Human Services (as successor to the Department
21of Alcoholism and Substance Abuse) and Public Health, through a
22public awareness campaign, may provide information concerning
23treatment for alcoholism and drug abuse and addiction, prenatal
24health care, and other pertinent programs directed at reducing
25the number of drug-affected infants born to recipients of
26medical assistance.

 

 

HB3348- 17 -LRB097 06117 KTG 46190 b

1    Neither the Department of Healthcare and Family Services
2nor the Department of Human Services shall sanction the
3recipient solely on the basis of her substance abuse.
4    The Illinois Department shall establish such regulations
5governing the dispensing of health services under this Article
6as it shall deem appropriate. The Department should seek the
7advice of formal professional advisory committees appointed by
8the Director of the Illinois Department for the purpose of
9providing regular advice on policy and administrative matters,
10information dissemination and educational activities for
11medical and health care providers, and consistency in
12procedures to the Illinois Department.
13    Notwithstanding any other provision of law, a health care
14provider under the medical assistance program may elect, in
15lieu of receiving direct payment for services provided under
16that program, to participate in the State Employees Deferred
17Compensation Plan adopted under Article 24 of the Illinois
18Pension Code. A health care provider who elects to participate
19in the plan does not have a cause of action against the State
20for any damages allegedly suffered by the provider as a result
21of any delay by the State in crediting the amount of any
22contribution to the provider's plan account.
23    The Illinois Department may develop and contract with
24Partnerships of medical providers to arrange medical services
25for persons eligible under Section 5-2 of this Code.
26Implementation of this Section may be by demonstration projects

 

 

HB3348- 18 -LRB097 06117 KTG 46190 b

1in certain geographic areas. The Partnership shall be
2represented by a sponsor organization. The Department, by rule,
3shall develop qualifications for sponsors of Partnerships.
4Nothing in this Section shall be construed to require that the
5sponsor organization be a medical organization.
6    The sponsor must negotiate formal written contracts with
7medical providers for physician services, inpatient and
8outpatient hospital care, home health services, treatment for
9alcoholism and substance abuse, and other services determined
10necessary by the Illinois Department by rule for delivery by
11Partnerships. Physician services must include prenatal and
12obstetrical care. The Illinois Department shall reimburse
13medical services delivered by Partnership providers to clients
14in target areas according to provisions of this Article and the
15Illinois Health Finance Reform Act, except that:
16        (1) Physicians participating in a Partnership and
17    providing certain services, which shall be determined by
18    the Illinois Department, to persons in areas covered by the
19    Partnership may receive an additional surcharge for such
20    services.
21        (2) The Department may elect to consider and negotiate
22    financial incentives to encourage the development of
23    Partnerships and the efficient delivery of medical care.
24        (3) Persons receiving medical services through
25    Partnerships may receive medical and case management
26    services above the level usually offered through the

 

 

HB3348- 19 -LRB097 06117 KTG 46190 b

1    medical assistance program.
2    Medical providers shall be required to meet certain
3qualifications to participate in Partnerships to ensure the
4delivery of high quality medical services. These
5qualifications shall be determined by rule of the Illinois
6Department and may be higher than qualifications for
7participation in the medical assistance program. Partnership
8sponsors may prescribe reasonable additional qualifications
9for participation by medical providers, only with the prior
10written approval of the Illinois Department.
11    Nothing in this Section shall limit the free choice of
12practitioners, hospitals, and other providers of medical
13services by clients. In order to ensure patient freedom of
14choice, the Illinois Department shall immediately promulgate
15all rules and take all other necessary actions so that provided
16services may be accessed from therapeutically certified
17optometrists to the full extent of the Illinois Optometric
18Practice Act of 1987 without discriminating between service
19providers.
20    The Department shall apply for a waiver from the United
21States Health Care Financing Administration to allow for the
22implementation of Partnerships under this Section.
23    The Illinois Department shall require health care
24providers to maintain records that document the medical care
25and services provided to recipients of Medical Assistance under
26this Article. The Illinois Department shall require health care

 

 

HB3348- 20 -LRB097 06117 KTG 46190 b

1providers to make available, when authorized by the patient, in
2writing, the medical records in a timely fashion to other
3health care providers who are treating or serving persons
4eligible for Medical Assistance under this Article. All
5dispensers of medical services shall be required to maintain
6and retain business and professional records sufficient to
7fully and accurately document the nature, scope, details and
8receipt of the health care provided to persons eligible for
9medical assistance under this Code, in accordance with
10regulations promulgated by the Illinois Department. The rules
11and regulations shall require that proof of the receipt of
12prescription drugs, dentures, prosthetic devices and
13eyeglasses by eligible persons under this Section accompany
14each claim for reimbursement submitted by the dispenser of such
15medical services. No such claims for reimbursement shall be
16approved for payment by the Illinois Department without such
17proof of receipt, unless the Illinois Department shall have put
18into effect and shall be operating a system of post-payment
19audit and review which shall, on a sampling basis, be deemed
20adequate by the Illinois Department to assure that such drugs,
21dentures, prosthetic devices and eyeglasses for which payment
22is being made are actually being received by eligible
23recipients. Within 90 days after the effective date of this
24amendatory Act of 1984, the Illinois Department shall establish
25a current list of acquisition costs for all prosthetic devices
26and any other items recognized as medical equipment and

 

 

HB3348- 21 -LRB097 06117 KTG 46190 b

1supplies reimbursable under this Article and shall update such
2list on a quarterly basis, except that the acquisition costs of
3all prescription drugs shall be updated no less frequently than
4every 30 days as required by Section 5-5.12.
5    The rules and regulations of the Illinois Department shall
6require that a written statement including the required opinion
7of a physician shall accompany any claim for reimbursement for
8abortions, or induced miscarriages or premature births. This
9statement shall indicate what procedures were used in providing
10such medical services.
11    The Illinois Department shall require all dispensers of
12medical services, other than an individual practitioner or
13group of practitioners, desiring to participate in the Medical
14Assistance program established under this Article to disclose
15all financial, beneficial, ownership, equity, surety or other
16interests in any and all firms, corporations, partnerships,
17associations, business enterprises, joint ventures, agencies,
18institutions or other legal entities providing any form of
19health care services in this State under this Article.
20    The Illinois Department may require that all dispensers of
21medical services desiring to participate in the medical
22assistance program established under this Article disclose,
23under such terms and conditions as the Illinois Department may
24by rule establish, all inquiries from clients and attorneys
25regarding medical bills paid by the Illinois Department, which
26inquiries could indicate potential existence of claims or liens

 

 

HB3348- 22 -LRB097 06117 KTG 46190 b

1for the Illinois Department.
2    Enrollment of a vendor that provides non-emergency medical
3transportation, defined by the Department by rule, shall be
4conditional for 180 days. During that time, the Department of
5Healthcare and Family Services may terminate the vendor's
6eligibility to participate in the medical assistance program
7without cause. That termination of eligibility is not subject
8to the Department's hearing process.
9    The Illinois Department shall establish policies,
10procedures, standards and criteria by rule for the acquisition,
11repair and replacement of orthotic and prosthetic devices and
12durable medical equipment. Such rules shall provide, but not be
13limited to, the following services: (1) immediate repair or
14replacement of such devices by recipients without medical
15authorization; and (2) rental, lease, purchase or
16lease-purchase of durable medical equipment in a
17cost-effective manner, taking into consideration the
18recipient's medical prognosis, the extent of the recipient's
19needs, and the requirements and costs for maintaining such
20equipment. Such rules shall enable a recipient to temporarily
21acquire and use alternative or substitute devices or equipment
22pending repairs or replacements of any device or equipment
23previously authorized for such recipient by the Department.
24    The Department shall execute, relative to the nursing home
25prescreening project, written inter-agency agreements with the
26Department of Human Services and the Department on Aging, to

 

 

HB3348- 23 -LRB097 06117 KTG 46190 b

1effect the following: (i) intake procedures and common
2eligibility criteria for those persons who are receiving
3non-institutional services; and (ii) the establishment and
4development of non-institutional services in areas of the State
5where they are not currently available or are undeveloped.
6    The Illinois Department shall develop and operate, in
7cooperation with other State Departments and agencies and in
8compliance with applicable federal laws and regulations,
9appropriate and effective systems of health care evaluation and
10programs for monitoring of utilization of health care services
11and facilities, as it affects persons eligible for medical
12assistance under this Code.
13    The Illinois Department shall report annually to the
14General Assembly, no later than the second Friday in April of
151979 and each year thereafter, in regard to:
16        (a) actual statistics and trends in utilization of
17    medical services by public aid recipients;
18        (b) actual statistics and trends in the provision of
19    the various medical services by medical vendors;
20        (c) current rate structures and proposed changes in
21    those rate structures for the various medical vendors; and
22        (d) efforts at utilization review and control by the
23    Illinois Department.
24    The period covered by each report shall be the 3 years
25ending on the June 30 prior to the report. The report shall
26include suggested legislation for consideration by the General

 

 

HB3348- 24 -LRB097 06117 KTG 46190 b

1Assembly. The filing of one copy of the report with the
2Speaker, one copy with the Minority Leader and one copy with
3the Clerk of the House of Representatives, one copy with the
4President, one copy with the Minority Leader and one copy with
5the Secretary of the Senate, one copy with the Legislative
6Research Unit, and such additional copies with the State
7Government Report Distribution Center for the General Assembly
8as is required under paragraph (t) of Section 7 of the State
9Library Act shall be deemed sufficient to comply with this
10Section.
11    Rulemaking authority to implement Public Act 95-1045, if
12any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17(Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07;
1895-1045, eff. 3-27-09; 96-156, eff. 1-1-10; 96-806, eff.
197-1-10; 96-926, eff. 1-1-11; 96-1000, eff. 7-2-10.)
 
20    Section 95. No acceleration or delay. Where this Act makes
21changes in a statute that is represented in this Act by text
22that is not yet or no longer in effect (for example, a Section
23represented by multiple versions), the use of that text does
24not accelerate or delay the taking effect of (i) the changes
25made by this Act or (ii) provisions derived from any other

 

 

HB3348- 25 -LRB097 06117 KTG 46190 b

1Public Act.
 
2    Section 99. Effective date. This Act takes effect July 1,
32011.