Illinois General Assembly - Bill Status for SB1254

Amends the Medical Assistance Article of 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 January 1, 2016, 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 that effective January 1, 2016, the Illinois Medicaid Ambulance Fee Schedule shall be established and shall include only the ground ambulance services payment rates outlined in the Medicare Ambulance Fee Schedule as promulgated by the Centers for Medicare and Medicaid Services in effect as of July 1, 2013 and adjusted for the 4 Medicare Localities in Illinois, with an adjustment of 80% of the Medicare Ambulance Fee Schedule payment rates, by Medicare Locality, for both base rates and mileage for all counties. Provides that for ground ambulance services provided where the point of pickup is in a rural county, the Department shall pay an amount equal to one and one-half times the ground mileage rate for the first 17 miles of such a transport and the ground mileage rate for the remaining miles of the transport. Makes other changes in connection with medical assistance payments for ground ambulance services. Effective July 1, 2015.

Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill, but with the following changes: In a provision under the Nursing Home Care Act concerning ambulance transportation orders for nursing home residents, and in a provision under the Hospital Licensing Act concerning ambulance transportation arrangements for hospital patients: (i) provides that, beginning for dates of service no later than 90 days after the effective date of the amendatory Act, the nursing facility or hospital shall utilize the uniform certification of medical necessity for non-emergency ambulance transportation pursuant to the Illinois Public Aid Code for all non-emergency ambulance transportation, regardless of whether the payer for the transport is a governmental payer or a non-governmental payer and regardless of the type of health care program or insurance the individual participates in; (ii) provides that the State action exemption shall be available to the Department in relation to federal and State antitrust statutes; (iii) provides that it is the policy of the State that certain powers may be exercised by the Department of Public Health, its vendors, agents, designees, and facilities, and all employees, officers, subsidiaries, and designees thereof, notwithstanding the effects on competition and notwithstanding any displacement of competition; (iv) requires the Department to supervise the authorized activities of certain non-Department individuals or entities; and (v) removes all references to "Physician Certification Statement or equivalent form" under the Hospital Licensing Act and instead uses the term "uniform certification of medical necessity for non-emergency ambulance transportation". Further amends the Illinois Public Aid Code. Makes changes to the definitions of "ground ambulance services", "ground ambulance services provider", and "payment principles of Medicare". Deletes "rural county" and its definition. Defines "medi-car services provider", "medi-car services", "service care services", and "emergency and urgently needed services". Provides that for ground ambulance services and medi-car services provided to recipients covered by a medical assistance program administered by the Department, payment shall be based upon the zip code of the point of pick-up of the recipient by the ground ambulance services provider or medi-car services provider (rather than for ground ambulance services provided to a recipient of aid under the Medical Assistance Article on or after January 1, 2016, the Department 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 calculated in accordance with a specified provision of the Code; and that the Department shall establish the transition from the current payment system to the Illinois Medicaid Ambulance Fee Schedule by implementing certain payment rates adjusted for the 4 Medicare Localities in Illinois). Provides that due to the unique mobile nature of ambulance and medi-car services, ground ambulance services providers and medi-car services providers are required to only submit enrollment applications for the primary office location where the provider's business is headquartered. Adds language concerning payments for emergency and urgently needed services. Deletes a provision concerning payments for ground ambulance services provided to a recipient enrolled in a Medicaid managed care plan by a ground ambulance services provider that is not a contracted provider to the Medicaid managed care plan in question. Makes changes concerning Department rules by which ground ambulance services providers (rather than ground ambulance service providers) and medi-car services providers of non-emergency medical transportation may appeal any decision by the Department or its agent for which certain denials were not received prior to the time of transport. Adds provisions concerning (1) uniform certification of medical necessity for non-emergency ambulance transportation of patients covered by a medical assistance program administered by the Department or by the federal Medicare program; (2) certain powers that may be exercised by the Department; (3) the Department's supervision of certain activities of non-Departmental individuals; (4) the Department's exemption from State and federal antitrust statutes; and (5) the Department's establishment of a technical advisory group to collaborate with and assist in the development of the regulations, policies, or procedures necessary to implement this amendatory Act. Changes the effective date to immediate (rather than effective July 1, 2015).

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