Illinois General Assembly - Bill Status for SB1273

Replaces everything after the enacting clause. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that managed care organizations (MCOs), including managed care community networks, shall be subject to a specified provision of the Code concerning ambulance services payments with regard to the following matters: mileage criteria and methodology, emergency and urgently needed methodology and criteria, appeals processes including post authorization for non-prescheduled, non-emergency transportation, and uniform certification of medical necessity for non-emergency ambulance transportation. Provides that appeal decisions issued by MCOs shall be appealable to the Director of the Department of Healthcare and Family Services, and the Director's decision on these appeals shall be a final administrative decision subject to review under the Administrative Review Law. Provides that the uniform certification of medical necessity for non-emergency transportation requirements shall be effective for dates of service beginning no later than 90 days after the effective date of this amendatory Act; and that the mileage criteria and methodology, emergency and urgently needed methodology, and criteria and appeals processes, including post authorization for non-prescheduled, non-emergency transportation, shall be effective for dates of service beginning no later than July 1, 2015 and for any and all outstanding claims that exist at the time of implementation of the methodologies, appeals, and post authorization processes. Provides that upon the effective date of this amendatory Act, MCOs shall not unreasonably refuse to contract with ground ambulance services providers and medi-car services providers, shall not unreasonably restrict access to and the availability of ground ambulance services and medi-car services, and shall ensure that recipients of the Department's programs shall not be liable for ground ambulance services and medi-car services expenses consistent with federal law, the Illinois Insurance Code, and any amendments, regulations, policies, and guidelines thereto, including, but not limited to, a specified provision under the Illinois Administrative Code. Provides that it is the intention of the General Assembly that the State action exemption to the application of federal and State antitrust statutes be fully available to the Department and MCOs and their agents and designees, and all employees, officers, subsidiaries, and designees thereof, to the extent the activities are authorized under the Code. Provides that it is the policy of the State that certain powers may be exercised by the Department and MCOs and their agents and designees and all employees, officers, subsidiaries, and designees thereof, notwithstanding the effects on competition and notwithstanding any displacement of competition. Provides that the Department shall actively supervise the activities of MCOs, including, but not limited to, their decisions, in order to ensure that MCOs and their agents and designees and all employees, officers, subsidiaries, and designees thereof, promote State policy and not individual interest. Effective immediately.

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