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90_HB3737
305 ILCS 5/5-11 from Ch. 23, par. 5-11
Amends the Medical Assistance Article of the Illinois
Public Aid Code. In provisions authorizing the Department of
Public Aid to enter into contracts with public or private
organizations to act for it in supplying medical services to
those eligible under this Article, provides that any
contracts for the provision of emergency services shall
provide that emergency services are those health care
services for a medical condition of recent onset and severity
that would lead a prudent lay person, possessing an average
knowledge of medicine and health, to believe that emergent
medical care is required. Provides that determination of
levels of care by such organizations shall be based upon the
symptoms and condition of the recipient at initial
examination by the physician and not upon the final
determination of the recipient's actual medical condition.
LRB9010764SMgc
LRB9010764SMgc
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Section 5-11.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Public Aid Code is amended by
6 changing Section 5-11 as follows:
7 (305 ILCS 5/5-11) (from Ch. 23, par. 5-11)
8 Sec. 5-11. Co-operative arrangements; contracts with
9 other State agencies, health care and rehabilitation
10 organizations, and fiscal intermediaries.
11 The Illinois Department may enter into co-operative
12 arrangements with State agencies responsible for
13 administering or supervising the administration of health
14 services and vocational rehabilitation services to the end
15 that there may be maximum utilization of such services in the
16 provision of medical assistance.
17 The Illinois Department shall, not later than June 30,
18 1993, enter into one or more co-operative arrangements with
19 the Department of Mental Health and Developmental
20 Disabilities providing that the Department of Mental Health
21 and Developmental Disabilities will be responsible for
22 administering or supervising all programs for services to
23 persons in community care facilities for persons with
24 developmental disabilities, including but not limited to
25 intermediate care facilities, that are supported by State
26 funds or by funding under Title XIX of the federal Social
27 Security Act. The responsibilities of the Department of
28 Mental Health and Developmental Disabilities under these
29 agreements are transferred to the Department of Human
30 Services as provided in the Department of Human Services Act.
31 The Department may also contract with such State health
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1 and rehabilitation agencies and other public or private
2 health care and rehabilitation organizations to act for it in
3 supplying designated medical services to persons eligible
4 therefor under this Article. Any contracts with health
5 services or health maintenance organizations shall be
6 restricted to organizations which have been certified as
7 being in compliance with standards promulgated pursuant to
8 the laws of this State governing the establishment and
9 operation of health services or health maintenance
10 organizations. Any contracts under this Section for the
11 provision of emergency services shall provide that emergency
12 services are those health care services for a medical
13 condition of recent onset and severity that would lead a
14 prudent lay person, possessing an average knowledge of
15 medicine and health, to believe that emergent medical care is
16 required. Determination of levels of care by such
17 organizations shall be based upon the symptoms and condition
18 of the recipient at the time the recipient is initially
19 examined by the physician and not upon the final
20 determination of the recipient's actual medical condition.
21 The Department may also contract with insurance companies or
22 other corporate entities serving as fiscal intermediaries in
23 this State for the Federal Government in respect to Medicare
24 payments under Title XVIII of the Federal Social Security Act
25 to act for the Department in paying medical care suppliers.
26 The provisions of Section 9 of "An Act in relation to State
27 finance", approved June 10, 1919, as amended,
28 notwithstanding, such contracts with State agencies, other
29 health care and rehabilitation organizations, or fiscal
30 intermediaries may provide for advance payments.
31 Not later than June 30, 1996, the Illinois Department
32 shall enter into one or more cooperative arrangements with
33 the Department of Public Health for the purpose of developing
34 a single survey for nursing facilities, including but not
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1 limited to facilities funded under Title XVIII or Title XIX
2 of the federal Social Security Act or both, which shall be
3 administered and conducted solely by the Department of Public
4 Health. The Departments shall test the single survey process
5 on a pilot basis, with both the Departments of Public Aid and
6 Public Health represented on the consolidated survey team.
7 The pilot will sunset June 30, 1997. After June 30, 1997,
8 unless otherwise determined by the Governor, a single survey
9 shall be implemented by the Department of Public Health which
10 would not preclude staff from the Department of Public Aid
11 from going on-site to nursing facilities to perform necessary
12 audits and reviews which shall not replicate the single State
13 agency survey required by this Act. This Section shall not
14 apply to community or intermediate care facilities for
15 persons with developmental disabilities.
16 (Source: P.A. 89-415, eff. 1-1-96; 89-507, eff. 7-1-97.)