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Illinois Compiled Statutes
Information maintained by the Legislative Reference Bureau Updating the database of the Illinois Compiled Statutes (ILCS) is an ongoing process. Recent laws may not yet be included in the ILCS database, but they are found on this site as Public Acts soon after they become law. For information concerning the relationship between statutes and Public Acts, refer to the Guide. Because the statute database is maintained primarily for legislative drafting purposes, statutory changes are sometimes included in the statute database before they take effect. If the source note at the end of a Section of the statutes includes a Public Act that has not yet taken effect, the version of the law that is currently in effect may have already been removed from the database and you should refer to that Public Act to see the changes made to the current law.
PUBLIC AID (305 ILCS 5/) Illinois Public Aid Code. 305 ILCS 5/5-13
(305 ILCS 5/5-13) (from Ch. 23, par. 5-13)
Sec. 5-13. Claim against estate of recipients. To the extent permitted under
the federal Social Security Act, the amount expended under this Article (1) for
a person of any age who is an inpatient in a nursing facility, an intermediate
care facility for persons with intellectual disabilities, or other medical institution, or (2)
for a person aged 55 or more, shall be a claim against the person's
estate or a claim against the estate of the person's spouse,
regardless of the order of death, but no recovery may
be had thereon until after the death of the surviving spouse, if any, and then
only at such time when there is no surviving child who is under age 21, or
blind, or is a child with a permanent total disability. This Section, however, shall not
bar recovery at the death of the person of amounts of medical assistance paid
to or in his behalf to which he was not entitled; provided that such
recovery shall not be enforced against any real estate while it is occupied
as a homestead by the surviving spouse or other dependent, if no claims by
other creditors have been filed against the estate, or if such claims have
been filed, they remain dormant for failure of prosecution or failure of
the claimant to compel administration of the estate for the purpose of
payment. The term "estate", as used in this Section, with respect to a
deceased person, means all real and personal property and other assets included
within the person's estate, as that term is used in the Probate Act of 1975;
however, in the case of a deceased person who has received (or is entitled to
receive) benefits under a long-term care insurance policy in connection with
which assets or resources are disregarded to the extent that payments are made
or because the deceased person received (or was entitled to receive) benefits
under a long-term care insurance policy, "estate" also includes any
other real and personal property and other assets in which the deceased person
had any legal title or interest at the time of his or her death (to the extent
of that interest), including assets conveyed to a survivor, heir, or assignee
of the deceased person through joint tenancy, tenancy in common, survivorship,
life estate, living trust, or other arrangement. The term "homestead", as used
in this Section, means the dwelling house and contiguous real estate occupied
by a surviving spouse or relative, as defined by the rules and regulations of
the Illinois Department, regardless of the value of the property.
A claim arising under this Section against assets conveyed to a survivor,
heir, or assignee of the deceased person through joint tenancy, tenancy in
common, survivorship, life estate, living trust, or other arrangement is not
effective until the claim is recorded or filed in the manner provided for a
notice of lien in Section 3-10.2. The claim is subject to the same
requirements and conditions to which liens on real property interests are
subject under Sections 3-10.1 through 3-10.10. A claim arising under this
Section attaches to interests owned or subsequently acquired by the estate of a
recipient or the estate of a recipient's surviving spouse.
The transfer or conveyance of any real or personal property of the estate
as
defined in this Section shall be subject to the fraudulent transfer conditions
that apply to real property in Section 3-11 of this Code.
The provisions of this Section shall not affect the validity of claims
against estates for medical assistance provided prior to January 1, 1966 to
aged or blind persons or persons with disabilities receiving aid under Articles V, VII and
VII-A of the 1949 Code.
(Source: P.A. 99-143, eff. 7-27-15.)
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305 ILCS 5/5-13.1 (305 ILCS 5/5-13.1) Sec. 5-13.1. Cost-effectiveness waiver, hardship waivers, and making information about waivers more accessible. (a) It is the intent of the General Assembly to ease the burden of liens and estate recovery for correctly paid benefits for participants, applicants, and their families and heirs, and to make information about waivers more widely available. (b) The Department shall waive estate recovery under Sections 3-9 and 5-13 where recovery would not be cost-effective, would work an undue hardship, or for any other just reason, and shall make information about waivers and estate recovery easily accessible. (1) Cost-effectiveness waiver. Subject to federal | | approval, the Department shall waive any claim against the first $25,000 of any estate to prevent substantial and unreasonable hardship. The Department shall consider the gross assets in the estate, including, but not limited to, the net value of real estate less mortgages or liens with priority over the Department's claims. The Department may increase the cost-effectiveness threshold in the future.
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| (2) Undue hardship waiver. The Department may develop
| | additional hardship waiver standards in addition to those already employed, including, but not limited to, waivers aimed at preserving income-producing real property or a modest home as defined by rule.
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| (3) Accessible information. The Department shall make
| | information about estate recovery and hardship waivers easily accessible. The Department shall maintain information about how to request a hardship waiver on its website in English, Spanish, and the next 4 most commonly used languages, including a short guide and simple form to facilitate requesting hardship exemptions in each language. On an annual basis, the Department shall publicly report on the number of estate recovery cases that are pursued and the number of undue hardship exemptions granted, including demographic data of the deceased beneficiaries where available.
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(Source: P.A. 102-1037, eff. 6-2-22.)
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305 ILCS 5/5-13.2
(305 ILCS 5/5-13.2)
Sec. 5-13.2.
Notice of claim for payment or against estate.
If the Illinois Department determines, more than 120 days after a person
becomes an institutionalized person, that (i) the institutionalized person, the
institutionalized person's spouse, or any other person is required under this
Code to reimburse the Illinois Department for any part of the amount of medical
assistance provided under this Article to or on behalf of the institutionalized
person or (ii) the institutionalized person's estate is liable for any amount
of medical assistance provided to or on behalf of the institutionalized person,
the Illinois Department shall not make any claim for payment of that amount on
demand, but rather shall establish, in cooperation with the institutionalized
person (and that person's spouse or primary caretaker, if applicable), a
schedule for payment of the amount owed to the Illinois Department.
(Source: P.A. 88-162; 88-670, eff. 12-2-94.)
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305 ILCS 5/5-13.5
(305 ILCS 5/5-13.5)
Sec. 5-13.5. (Repealed).
(Source: P.A. 88-670, eff. 12-2-94. Repealed by P.A. 102-1037, eff. 6-2-22.)
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305 ILCS 5/5-14
(305 ILCS 5/5-14) (from Ch. 23, par. 5-14)
Sec. 5-14.
Exemption for Townships.
Nothing in this Article shall be
construed as requiring townships to provide, in whole or in part, medical
assistance to persons who are not residents of the State of Illinois.
In all instances under this Article where medical aid or assistance to
a person who is not a resident of this State would otherwise be in whole
or in part, the responsibility of a township, the Illinois Department shall
be responsible for such aid or assistance.
The Illinois Department shall, by rule or regulation, insure that provision
of such aid or assistance to a non-resident is identical to the uniform
standard of eligibility established by the Illinois Department.
(Source: P.A. 81-519.)
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305 ILCS 5/5-15 (305 ILCS 5/5-15) (from Ch. 23, par. 5-15)
Sec. 5-15. (a) The Illinois Department is authorized to contract
with community based organizations serving low income communities for a
three year period to demonstrate how and the extent to which preventive
health programs can decrease utilization of medical care services and/or
improve health status.
(b) As used in this Section (1) a community based organization is an
organization established as a not-for-profit corporation under laws of the
State of Illinois which serves a defined geographic community and is
governed by members of that community; and (2) a preventive health program
is any program, service or intervention the purpose of which is to
identify, resolve, or ameliorate problems which contribute to the
utilization of medical services.
(c) The Illinois Department is authorized, for evaluation purposes, to
release names of recipients and other pertinent identification and medical
utilization information to the community organizations under contract.
(d) Contractors shall maintain strict confidentiality of information
released by the Illinois Department by following guidelines established by
the Illinois Department, which shall require that recipients sign a release
for any further use or disclosure of such information.
(Source: P.A. 93-632, eff. 2-1-04.)
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305 ILCS 5/5-15.5
(305 ILCS 5/5-15.5)
Sec. 5-15.5.
Preventive physical examinations; demonstration program.
(a) The Illinois Department may establish and implement a demonstration
program of preventive physical examinations over a 3-year period commencing on
January 1, 1994, for persons receiving assistance under Article IV of this
Code and persons eligible for assistance under this Article who are otherwise
eligible for assistance under Article IV but who fail to qualify for cash
assistance under Article IV on the basis of need. Notwithstanding any other
provision of this Section, however, persons who are pregnant or who are less
than 21 years of age shall not be eligible to participate in the demonstration
program. The demonstration program may be implemented for recipients in at
least 2 counties, one with a population of not more than 650,000 as determined
by the 1990 federal census, and one with a population of not more than 100,000
as determined by the 1990 federal census. The Illinois Department may
establish by rule the nature and scope of the preventive physical examinations
required under this Section, except that the services may include, as
appropriate, blood pressure reading, complete blood test appropriate to the
population and risk factors, family planning, nutrition counselling, smoking
evaluation, temperature, urinalysis, chest x-ray, tuberculosis screening, and
appropriate referrals.
(b) Participation in the demonstration program shall be voluntary, and
eligible recipients shall not be subject to sanctions for refusing or failing
to submit to a preventive physical examination or any portion of such an
examination. The Illinois Department may by rule limit each eligible recipient
to one examination during the demonstration period.
(c) For the purpose of carrying out its responsibilities under this Section,
the Illinois Department is authorized to enter into cooperative arrangements
with for-profit and non-profit medical clinics and hospitals, local health
departments, and other providers of medical services. The Illinois Department
of Public Health shall cooperate in the development and establishment of this
demonstration program. During the period of the demonstration program, the
Illinois Department of Public Aid shall study the cost benefit of providing
preventive physical examinations to the targeted group of recipients of public
aid.
(d) Implementation of the demonstration program shall be contingent on the
receipt of all necessary federal waivers.
(Source: P.A. 88-396.)
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305 ILCS 5/5-16
(305 ILCS 5/5-16) (from Ch. 23, par. 5-16)
Sec. 5-16.
Managed Care.
The Illinois Department may develop and implement
a Primary Care Sponsor System consistent with the provisions of this Section.
The purpose of this managed care delivery system shall be to contain the costs
of providing medical care to Medicaid recipients by having one provider
responsible for managing all aspects of a recipient's medical care. This
managed care system shall have the following characteristics:
(a) The Department, by rule, shall establish criteria | | to determine which clients must participate in this program;
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(b) Providers participating in the program may be
| | paid an amount per patient per month, to be set by the Illinois Department, for managing each recipient's medical care;
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(c) Providers eligible to participate in the program
| | shall be physicians licensed to practice medicine in all its branches, and the Illinois Department may terminate a provider's participation if the provider is determined to have failed to comply with any applicable program standard or procedure established by the Illinois Department;
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(d) Each recipient required to participate in the
| | program must select from a panel of primary care providers or networks established by the Department in their communities;
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(e) A recipient may change his designated primary
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(1) when the designated source becomes
| | unavailable, as the Illinois Department shall determine by rule; or
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(2) when the designated primary care provider
| | notifies the Illinois Department that it wishes to withdraw from any obligation as primary care provider; or
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(3) in other situations, as the Illinois
| | Department shall provide by rule;
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(f) The Illinois Department shall, by rule, establish
| | procedures for providing medical services when the designated source becomes unavailable or wishes to withdraw from any obligation as primary care provider taking into consideration the need for emergency or temporary medical assistance and ensuring that the recipient has continuous and unrestricted access to medical care from the date on which such unavailability or withdrawal becomes effective until such time as the recipient designates a primary care source;
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(g) Only medical care services authorized by a
| | recipient's designated provider, except for emergency services, services performed by a provider that is owned or operated by a county and that provides non-emergency services without regard to ability to pay and such other services as provided by the Illinois Department, shall be subject to payment by the Illinois Department. The Illinois Department shall enter into an intergovernmental agreement with each county that owns or operates such a provider to develop and implement policies to minimize the provision of medical care services provided by county owned or operated providers pursuant to the foregoing exception.
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The Illinois Department shall seek and obtain necessary authorization
provided under federal law to implement such a program including the waiver of
any federal regulations.
The Illinois Department may implement the amendatory changes to
this Section made by this amendatory Act of 1991 through the use of emergency
rules in accordance with the provisions of Section 5.02 of the Illinois
Administrative Procedure Act. For purposes of the Illinois Administrative
Procedure Act, the adoption of rules to implement the amendatory changes to
this Section made by this amendatory Act of 1991 shall be deemed an emergency
and necessary for the public interest, safety and welfare.
The Illinois Department may establish a managed care system demonstration
program, on a limited basis, as described in this Section. The demonstration
program shall terminate on June 30, 1997. Within 30 days after the end of each
year of the demonstration program's operation, the Illinois Department shall
report to the Governor and the General Assembly concerning the operation of the
demonstration program.
(Source: P.A. 87-14; 88-490.)
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305 ILCS 5/5-16.1
(305 ILCS 5/5-16.1) (from Ch. 23, par. 5-16.1)
Sec. 5-16.1. Case Management Services. The Illinois Department may
develop, implement and evaluate a Case Management Services Program which
provides services consistent with the provisions of this Section, and the
Inter-Agency Agreement between the Department of Healthcare and Family Services (formerly Department of Public Aid) and the
Department of Public Health, for a targeted population on a less than
Statewide basis in the State of Illinois. The purpose of this Case
Management Services Program shall be to assist eligible participants in
gaining access to needed medical, social, educational and other services
thereby reducing the likelihood of long-term welfare dependency. The Case
Management Services Program shall have the following characteristics:
(a) It shall be conducted for a period of no less | | than 5 consecutive fiscal years in one urban area containing a high proportion, as determined by Department of Healthcare and Family Services and Department of Public Health records, of Medicaid eligible pregnant or parenting girls under 17 years of age at the time of the initial assessment and in one rural area containing a high proportion, as determined by Department of Healthcare and Family Services and Department of Public Health records, of Medicaid eligible pregnant or parenting girls under 17 years of age at the time of the initial assessment.
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(b) Providers participating in the program shall be
| | paid an amount per patient per month, to be set by the Illinois Department, for the case management services provided.
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(c) Providers eligible to participate in the program
| | shall be nurses or social workers, licensed to practice in Illinois, who comply with the rules and regulations established by the Illinois Department and the Inter-Agency Agreement between the Department of Healthcare and Family Services (formerly Department of Public Aid) and the Department of Public Health. The Illinois Department may terminate a provider's participation in the program if the provider is determined to have failed to comply with any applicable program standard or procedure established by the Illinois Department.
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(d) Each eligible participant in an area where the
| | Case Management Services Program is being conducted may voluntarily designate a case manager, of her own choosing to assume responsibility for her care.
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(e) A participant may change her designated case
| | manager provided that she informs the Illinois Department by the 20th day of the month in order for the change to be effective in the following month.
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(f) The Illinois Department shall, by rule, establish
| | procedures for providing case management services when the designated source becomes unavailable or wishes to withdraw from any obligation as case management services provider.
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(g) In accordance with rules adopted by the Illinois
| | Department, a participant may discontinue participation in the program upon timely notice to the Illinois Department, in which case the participant shall remain eligible for assistance under all applicable provisions of Article V of this Code.
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The Illinois Department shall take any necessary steps to obtain
authorization or waiver under federal law to implement a Case Management
Services Program. Participation shall be voluntary for the provider and
the recipient.
(Source: P.A. 95-331, eff. 8-21-07.)
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305 ILCS 5/5-16.2
(305 ILCS 5/5-16.2)
Sec. 5-16.2.
Long range plan for case management.
The Illinois Department
shall develop a long range plan for the implementation of case management
services, as defined in Section 5-16.1 of this Act, throughout Illinois. The
long range plan shall include: (i) a geographic overview of the State and the
proportion, as determined by the Department of Public Aid and the Department of
Public Health records, of Medicaid eligible pregnant or parenting girls under
17 years of age at the time of the initial assessment; (ii) identification of
high proportion areas; (iii) goals for reducing the likelihood of long-term
welfare dependency; (iv) the time frames for accomplishing the identified
goals; and (v) specific recommendations for administrative or legislative
policies and programs necessary to complete the identified goals. The long
range plan shall take into consideration other resources currently serving the
identified population. The long range plan shall be completed no later than
July 1, 1994, and provided to the Governor and the General Assembly in the form
of a written report.
(Source: P.A. 88-70.)
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305 ILCS 5/5-16.3
(305 ILCS 5/5-16.3)
Sec. 5-16.3.
(Repealed).
(Source: P.A. 90-742, eff. 8-13-98. Repealed by P.A. 92-370, eff. 8-15-01.)
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305 ILCS 5/5-16.4
(305 ILCS 5/5-16.4)
Sec. 5-16.4. (Repealed).
(Source: P.A. 95-331, eff. 8-21-07. Repealed by P.A. 99-933, eff. 1-27-17.)
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305 ILCS 5/5-16.5
(305 ILCS 5/5-16.5)
Sec. 5-16.5.
Expedited payments.
(a) (Blank).
(b) In a county with a population of 3,000,000 or more, a managed care
community network shall receive expedited payment of its capitated
reimbursement for each of its managed care enrollees if both of the following
criteria are met:
(1) At least 75% of its membership is composed of | | hospitals that are qualified on or after July 1, 1994 as disproportionate share hospitals.
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(2) At least 75% of its managed care enrollees
| | receive services at the disproportionate share hospitals or those hospitals' affiliated sites.
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(c) For counties whose population is less than 3,000,000, the Illinois
Department shall establish by rule the terms and conditions under which a
managed care community network shall receive expedited payment, including a
determination of the qualifying percentage criteria for
disproportionate share hospitals and managed care enrollees
within a network receiving services at disproportionate share hospitals or
their affiliated sites.
(Source: P.A. 88-554, eff. 7-26-94; 89-21, eff. 7-1-95.)
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305 ILCS 5/5-16.6
(305 ILCS 5/5-16.6)
Sec. 5-16.6.
Provider compliance with certain requirements.
The Illinois
Department shall inquire of appropriate State agencies concerning the status of
all providers' compliance with State income tax requirements, child support
payments in accordance with Article X of this Code, and educational loans
guaranteed by the Illinois State Scholarship Commission. The Illinois
Department may suspend from participation in the medical assistance program,
after reasonable notice and opportunity for a hearing in accordance with
Section
12-4.25 of this Code, those providers not in compliance with
these
requirements, unless payment arrangements acceptable to the appropriate State
agency are made.
(Source: P.A. 90-655, eff. 7-30-98.)
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305 ILCS 5/5-16.7
(305 ILCS 5/5-16.7)
Sec. 5-16.7. Post-parturition care. The medical assistance program shall
provide the post-parturition care benefits required to be covered by a policy
of accident and health insurance under Section 356s of the
Illinois Insurance Code.
On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e. (Source: P.A. 97-689, eff. 6-14-12.)
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305 ILCS 5/5-16.7a (305 ILCS 5/5-16.7a)
Sec. 5-16.7a. Reimbursement for epidural anesthesia services.
In addition to other procedures authorized by the
Department under this Code, the
Department shall provide reimbursement to medical providers for epidural
anesthesia services when ordered by the attending practitioner at the time of
delivery.
On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e. (Source: P.A. 97-689, eff. 6-14-12.) |
305 ILCS 5/5-16.8 (305 ILCS 5/5-16.8) (Text of Section from P.A. 102-1117) Sec. 5-16.8. Required health benefits. The medical assistance program shall (i) provide the post-mastectomy care benefits required to be covered by a policy of accident and health insurance under Section 356t and the coverage required under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60 of the Illinois Insurance Code, (ii) be subject to the provisions of Sections 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois Insurance Code, and (iii) be subject to the provisions of subsection (d-5) of Section 10 of the Network Adequacy and Transparency Act. The Department, by rule, shall adopt a model similar to the requirements of Section 356z.39 of the Illinois Insurance Code. On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e. To ensure full access to the benefits set forth in this Section, on and after January 1, 2016, the Department shall ensure that provider and hospital reimbursement for post-mastectomy care benefits required under this Section are no lower than the Medicare reimbursement rate. (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.) (Text of Section from P.A. 103-84, 103-91, and 103-420) Sec. 5-16.8. Required health benefits. The medical assistance program shall (i) provide the post-mastectomy care benefits required to be covered by a policy of accident and health insurance under Section 356t and the coverage required under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and 356z.61 of the Illinois Insurance Code, (ii) be subject to the provisions of Sections 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois Insurance Code, and (iii) be subject to the provisions of subsection (d-5) of Section 10 of the Network Adequacy and Transparency Act. The Department, by rule, shall adopt a model similar to the requirements of Section 356z.39 of the Illinois Insurance Code. On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e. To ensure full access to the benefits set forth in this Section, on and after January 1, 2016, the Department shall ensure that provider and hospital reimbursement for post-mastectomy care benefits required under this Section are no lower than the Medicare reimbursement rate. (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24.) |
305 ILCS 5/5-16.9
(305 ILCS 5/5-16.9)
Sec. 5-16.9. Woman's health care provider. The medical assistance
program is subject to the provisions of Section 356r of the Illinois
Insurance Code. The Illinois Department shall adopt rules to implement the
requirements of Section 356r of the Illinois Insurance Code in the medical
assistance program including managed care components.
On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e. (Source: P.A. 97-689, eff. 6-14-12.)
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305 ILCS 5/5-16.10
(305 ILCS 5/5-16.10)
Sec. 5-16.10.
Managed care entities; marketing.
A managed health care entity
providing services under this Article V
may not engage in door-to-door
marketing activities or marketing activities at an office of the Illinois
Department or a county department in order to enroll
recipients
in the entity's health
care
delivery system. The Department shall adopt rules defining "marketing
activities" prohibited by this Section.
Before a managed health care entity
providing services under this Article V
may market its health care delivery
system
to recipients,
the Illinois Department must approve a marketing plan submitted
by the entity to the Illinois Department. The Illinois Department shall adopt
guidelines for approving marketing plans submitted by managed health care
entities under this Section. Besides prohibiting door-to-door marketing
activities and marketing activities at public aid offices, the guidelines shall
include at least the following:
(1) A managed health care entity may not offer or | | provide any gift, favor, or other inducement in marketing its health care delivery system to integrated health care program enrollees. A managed health care entity may provide health care related items that are of nominal value and pre-approved by the Department to prospective enrollees. A managed health care entity may also provide to enrollees health care related items that have been pre-approved by the Department as an incentive to manage their health care appropriately.
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(2) All persons employed or otherwise engaged by a
| | managed health care entity to market the entity's health care delivery system to recipients or to supervise that marketing shall register with the Illinois Department.
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The Inspector General appointed under Section 12-13.1 may conduct
investigations to determine whether the marketing practices of managed health
care entities
providing services under this Article V
comply with
the guidelines.
(Source: P.A. 90-538, eff. 12-1-97.)
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