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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

 

 

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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 statutes, 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

 

 

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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 as follows:

 

 

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1Effective for dates of service on or after July 1, 2011, for
2each individual base rate and mileage rate, the payment rate
3for ground ambulance services shall be based on the Illinois
4Medicaid Ambulance Fee Schedule amount in effect on July 1,
52011 for the designated Medicare Locality, except that any
6payment rate that was previously approved by the Department
7that exceeds this amount shall remain in force.
8    Notwithstanding the payment principles in subsection (b)
9of this Section, the Department shall develop the Illinois
10Medicaid Ambulance Fee Schedule using the ground mileage
11payment rate, as defined by the Centers for Medicare and
12Medicaid Services, and no other mileage rates which act as
13enhancements to the ground mileage rate, whether permanent or
14temporary, shall be recognized by the Department.
15    (d) Payment for mileage shall be per loaded mile with no
16loaded mileage included in the base rate. If a natural
17disaster, weather, road repairs, traffic congestion, or other
18conditions necessitate a route other than the most direct
19route, payment shall be based upon the actual distance
20traveled. When a ground ambulance services provider provides
21transport pursuant to an emergency call as defined by the
22Centers for Medicare and Medicaid Services, no reduction in the
23mileage payment shall be made based upon the fact that a closer
24facility may have been available, so long as the ground
25ambulance services provider provided transport to the
26recipient's facility of choice or other appropriate facility

 

 

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1described within the scope of the Illinois Emergency Medical
2Services (EMS) Systems Act and associated rules or the policies
3and procedures of the EMS System of which the provider is a
4member.
5    (e) The Department shall provide payment for emergency
6ground ambulance services provided to a recipient of aid under
7this Article according to the requirements provided in
8subsection (b) of this Section when those services are provided
9pursuant to a request made through a 9-1-1 or equivalent
10emergency telephone number for evaluation, treatment, and
11transport from or on behalf of an individual with a condition
12of such a nature that a prudent layperson would have reasonably
13expected that a delay in seeking immediate medical attention
14would have been hazardous to life or health. This standard is
15deemed to be met if there is an emergency medical condition
16manifesting itself by acute symptoms of sufficient severity,
17including but not limited to severe pain, such that a prudent
18layperson who possesses an average knowledge of medicine and
19health can reasonably expect that the absence of immediate
20medical attention could result in placing the health of the
21individual or, with respect to a pregnant woman, the health of
22the woman or her unborn child, in serious jeopardy, cause
23serious impairment to bodily functions, or cause serious
24dysfunction of any bodily organ or part.
25    (f) For ground ambulance services provided to a recipient
26enrolled in a Medicaid managed care plan by a ground ambulance

 

 

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1services provider that is not a contracted provider to the
2Medicaid managed care plan in question, the amount of the
3payment for ground ambulance services by the Medicaid managed
4care plan shall be the lesser of the provider's charge, as
5reflected on the provider's claim form, or the Illinois
6Medicaid Ambulance Fee Schedule payment rates calculated in
7accordance with this Section.
8    (g) Nothing in this Section prohibits the Department from
9setting payment rates for out-of-State ground ambulance
10services providers by administrative rule.
11    (g-5) Nothing in this Section prohibits the Department from
12setting payment rates for State ground ambulance services
13providers by administrative rule pending the availability of
14appropriations dedicated to rate increases provided under
15subsections (c) and (h) of this Section.
16    (h) Effective for dates of service on or after July 1,
172011, payments for stretcher van services provided by ground
18ambulance services providers shall be as follows:
19        (1) For each individual base rate, the amount of the
20    payment shall be the lesser of the provider's charge, as
21    reflected on the provider's claim form, or 80% of the
22    Illinois Medicaid Ambulance Fee Schedule payment rate for
23    the basic life support non-emergency base rate.
24        (2) For each loaded mile, the amount of the payment
25    shall be the lesser of the provider's charge, as reflected
26    on the provider's claim form, or 80% of the Illinois

 

 

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1    Medicaid Ambulance Fee Schedule payment rate for mileage.
2    (i) All payments under subsections (c) and (h) of this
3Section are subject to the availability of appropriations for
4those purposes.
5    For ambulance services provided to a recipient of aid under
6this Article on or after January 1, 1993, the Illinois
7Department shall reimburse ambulance service providers at
8rates calculated in accordance with this Section. It is the
9intent of the General Assembly to provide adequate
10reimbursement for ambulance services so as to ensure adequate
11access to services for recipients of aid under this Article and
12to provide appropriate incentives to ambulance service
13providers to provide services in an efficient and
14cost-effective manner. Thus, it is the intent of the General
15Assembly that the Illinois Department implement a
16reimbursement system for ambulance services that, to the extent
17practicable and subject to the availability of funds
18appropriated by the General Assembly for this purpose, is
19consistent with the payment principles of Medicare. To ensure
20uniformity between the payment principles of Medicare and
21Medicaid, the Illinois Department shall follow, to the extent
22necessary and practicable and subject to the availability of
23funds appropriated by the General Assembly for this purpose,
24the statutes, laws, regulations, policies, procedures,
25principles, definitions, guidelines, and manuals used to
26determine the amounts paid to ambulance service providers under

 

 

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1Title XVIII of the Social Security Act (Medicare).
2    For ambulance services provided to a recipient of aid under
3this Article on or after January 1, 1996, the Illinois
4Department shall reimburse ambulance service providers based
5upon the actual distance traveled if a natural disaster,
6weather conditions, road repairs, or traffic congestion
7necessitates the use of a route other than the most direct
8route.
9    For purposes of this Section, "ambulance services"
10includes medical transportation services provided by means of
11an ambulance, medi-car, service car, or taxi.
12    This Section does not prohibit separate billing by
13ambulance service providers for oxygen furnished while
14providing advanced life support services.
15    (j) Beginning with services rendered on or after July 1,
162008, all providers of non-emergency medi-car and service car
17transportation must certify that the driver and employee
18attendant, as applicable, have completed a safety program
19approved by the Department to protect both the patient and the
20driver, prior to transporting a patient. The provider must
21maintain this certification in its records. The provider shall
22produce such documentation upon demand by the Department or its
23representative. Failure to produce documentation of such
24training shall result in recovery of any payments made by the
25Department for services rendered by a non-certified driver or
26employee attendant. Medi-car and service car providers must

 

 

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1maintain legible documentation in their records of the driver
2and, as applicable, employee attendant that actually
3transported the patient. Providers must recertify all drivers
4and employee attendants every 3 years.
5    Notwithstanding the requirements above, any public
6transportation provider of medi-car and service car
7transportation that receives federal funding under 49 U.S.C.
85307 and 5311 need not certify its drivers and employee
9attendants under this Section, since safety training is already
10federally mandated.
11(Source: P.A. 95-501, eff. 8-28-07.)
 
12    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
13    Sec. 5-5. Medical services. The Illinois Department, by
14rule, shall determine the quantity and quality of and the rate
15of reimbursement for the medical assistance for which payment
16will be authorized, and the medical services to be provided,
17which may include all or part of the following: (1) inpatient
18hospital services; (2) outpatient hospital services; (3) other
19laboratory and X-ray services; (4) skilled nursing home
20services; (5) physicians' services whether furnished in the
21office, the patient's home, a hospital, a skilled nursing home,
22or elsewhere; (6) medical care, or any other type of remedial
23care furnished by licensed practitioners; (7) home health care
24services; (8) private duty nursing service; (9) clinic
25services; (10) dental services, including prevention and

 

 

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

 

 

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

 

 

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

 

 

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1    The Department of Healthcare and Family Services must
2provide coverage and reimbursement for amino acid-based
3elemental formulas, regardless of delivery method, for the
4diagnosis and treatment of (i) eosinophilic disorders and (ii)
5short bowel syndrome when the prescribing physician has issued
6a written order stating that the amino acid-based elemental
7formula is medically necessary.
8    The Illinois Department shall authorize the provision of,
9and shall authorize payment for, screening by low-dose
10mammography for the presence of occult breast cancer for women
1135 years of age or older who are eligible for medical
12assistance under this Article, as follows:
13        (A) A baseline mammogram for women 35 to 39 years of
14    age.
15        (B) An annual mammogram for women 40 years of age or
16    older.
17        (C) A mammogram at the age and intervals considered
18    medically necessary by the woman's health care provider for
19    women under 40 years of age and having a family history of
20    breast cancer, prior personal history of breast cancer,
21    positive genetic testing, or other risk factors.
22        (D) A comprehensive ultrasound screening of an entire
23    breast or breasts if a mammogram demonstrates
24    heterogeneous or dense breast tissue, when medically
25    necessary as determined by a physician licensed to practice
26    medicine in all of its branches.

 

 

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

 

 

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

 

 

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1Act, referral to a local substance abuse treatment provider
2licensed by the Department of Human Services or to a licensed
3hospital which provides substance abuse treatment services.
4The Department of Healthcare and Family Services shall assure
5coverage for the cost of treatment of the drug abuse or
6addiction for pregnant recipients in accordance with the
7Illinois Medicaid Program in conjunction with the Department of
8Human Services.
9    All medical providers providing medical assistance to
10pregnant women under this Code shall receive information from
11the Department on the availability of services under the Drug
12Free Families with a Future or any comparable program providing
13case management services for addicted women, including
14information on appropriate referrals for other social services
15that may be needed by addicted women in addition to treatment
16for addiction.
17    The Illinois Department, in cooperation with the
18Departments of Human Services (as successor to the Department
19of Alcoholism and Substance Abuse) and Public Health, through a
20public awareness campaign, may provide information concerning
21treatment for alcoholism and drug abuse and addiction, prenatal
22health care, and other pertinent programs directed at reducing
23the number of drug-affected infants born to recipients of
24medical assistance.
25    Neither the Department of Healthcare and Family Services
26nor the Department of Human Services shall sanction the

 

 

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1recipient solely on the basis of her substance abuse.
2    The Illinois Department shall establish such regulations
3governing the dispensing of health services under this Article
4as it shall deem appropriate. The Department should seek the
5advice of formal professional advisory committees appointed by
6the Director of the Illinois Department for the purpose of
7providing regular advice on policy and administrative matters,
8information dissemination and educational activities for
9medical and health care providers, and consistency in
10procedures to the Illinois Department.
11    Notwithstanding any other provision of law, a health care
12provider under the medical assistance program may elect, in
13lieu of receiving direct payment for services provided under
14that program, to participate in the State Employees Deferred
15Compensation Plan adopted under Article 24 of the Illinois
16Pension Code. A health care provider who elects to participate
17in the plan does not have a cause of action against the State
18for any damages allegedly suffered by the provider as a result
19of any delay by the State in crediting the amount of any
20contribution to the provider's plan account.
21    The Illinois Department may develop and contract with
22Partnerships of medical providers to arrange medical services
23for persons eligible under Section 5-2 of this Code.
24Implementation of this Section may be by demonstration projects
25in certain geographic areas. The Partnership shall be
26represented by a sponsor organization. The Department, by rule,

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1non-institutional services; and (ii) the establishment and
2development of non-institutional services in areas of the State
3where they are not currently available or are undeveloped.
4    The Illinois Department shall develop and operate, in
5cooperation with other State Departments and agencies and in
6compliance with applicable federal laws and regulations,
7appropriate and effective systems of health care evaluation and
8programs for monitoring of utilization of health care services
9and facilities, as it affects persons eligible for medical
10assistance under this Code.
11    The Illinois Department shall report annually to the
12General Assembly, no later than the second Friday in April of
131979 and each year thereafter, in regard to:
14        (a) actual statistics and trends in utilization of
15    medical services by public aid recipients;
16        (b) actual statistics and trends in the provision of
17    the various medical services by medical vendors;
18        (c) current rate structures and proposed changes in
19    those rate structures for the various medical vendors; and
20        (d) efforts at utilization review and control by the
21    Illinois Department.
22    The period covered by each report shall be the 3 years
23ending on the June 30 prior to the report. The report shall
24include suggested legislation for consideration by the General
25Assembly. The filing of one copy of the report with the
26Speaker, one copy with the Minority Leader and one copy with

 

 

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1the Clerk of the House of Representatives, one copy with the
2President, one copy with the Minority Leader and one copy with
3the Secretary of the Senate, one copy with the Legislative
4Research Unit, and such additional copies with the State
5Government Report Distribution Center for the General Assembly
6as is required under paragraph (t) of Section 7 of the State
7Library Act shall be deemed sufficient to comply with this
8Section.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07;
1695-1045, eff. 3-27-09; 96-156, eff. 1-1-10; 96-806, eff.
177-1-10; 96-926, eff. 1-1-11; 96-1000, eff. 7-2-10.)
 
18    Section 99. Effective date. This Act takes effect July 1,
192011.