State of Illinois
90th General Assembly
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90_SB0269

      305 ILCS 5/5-5            from Ch. 23, par. 5-5
      305 ILCS 5/6-1            from Ch. 23, par. 6-1
          Amends  the  Public  Aid   Code.    Replaces   provisions
      concerning  medical assistance and general assistance funding
      of abortions with identical language prohibiting  payment  of
      aid for abortions unless necessary for preserving the woman's
      life.   Permits  State  funds  to  be  used  for abortions to
      terminate a pregnancy  resulting  from  an  act  of  criminal
      sexual   assault   or  aggravated  criminal  sexual  assault.
      Provides that State funds shall only be used  to  the  extent
      that  payment  is  required by federal law as determined by a
      court  of  competent  jurisdiction.  Provides  that  if   any
      provision of this amendatory Act of 1997 is held invalid, the
      invalidity  does not affect the provisions which can be given
      effect without the invalid provision. Effective immediately.
                                                    LRB9000743SMdvA
                                              LRB9000743SMdvA
 1        AN ACT to amend the Illinois Public Aid Code by  changing
 2    Sections 5-5 and 6-1.
 3        WHEREAS,  There  has been entered in the Circuit Court of
 4    Cook County, in the case of Doe v. Wright,  case  no.  91  CH
 5    1958,  an  order (i) finding that Sections 5-5 and 6-1 of the
 6    Illinois Public Aid Code violate the  Illinois  Constitution,
 7    (ii)  enjoining  the  Department of Public Aid from enforcing
 8    those Sections insofar as  they  deny  reimbursement  for  an
 9    abortion  necessary  to protect a woman's health although not
10    necessary to  preserve  her  life,  and  (iii)  ordering  the
11    Department  to  provide  reimbursement  through  the  State's
12    medical   assistance  programs  for  abortions  necessary  to
13    protect a woman's health; and
14        WHEREAS, The General Assembly desires to  re-express  its
15    intent that State moneys not be used to provide reimbursement
16    for  abortions  unless necessary to preserve the woman's life
17    and that the Department of Public Aid  enforce  Sections  5-5
18    and  6-1  of  the  Illinois  Public  Aid  Code  in all cases;
19    therefore
20        Be it enacted by the People of  the  State  of  Illinois,
21    represented in the General Assembly:
22        Section  5.  The  Illinois  Public Aid Code is amended by
23    changing Sections 5-5 and 6-1 as follows:
24        (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
25        (Text of Section before amendment by P.A. 89-507)
26        Sec. 5-5.  Medical services. The Illinois Department,  by
27    rule,  shall  determine  the  quantity and quality of and the
28    rate of reimbursement for the medical  assistance  for  which
29    payment  will  be  authorized, and the medical services to be
30    provided, which may include all or part of the following: (1)
31    inpatient  hospital   services;   (2)   outpatient   hospital
                            -2-               LRB9000743SMdvA
 1    services;  (3)  other  laboratory  and  X-ray  services;  (4)
 2    skilled  nursing  home  services;  (5)  physicians'  services
 3    whether  furnished  in  the  office,  the  patient's  home, a
 4    hospital, a skilled nursing home, or elsewhere;  (6)  medical
 5    care,  or  any  other  type  of  remedial  care  furnished by
 6    licensed practitioners; (7) home health  care  services;  (8)
 7    private  duty  nursing  service;  (9)  clinic  services; (10)
 8    dental services; (11) physical therapy and related  services;
 9    (12)  prescribed drugs, dentures, and prosthetic devices; and
10    eyeglasses prescribed by a physician skilled in the  diseases
11    of  the  eye,  or by an optometrist, whichever the person may
12    select; (13) other  diagnostic,  screening,  preventive,  and
13    rehabilitative  services;  (14) transportation and such other
14    expenses as may  be  necessary;  (15)  medical  treatment  of
15    sexual  assault  survivors,  as  defined in Section 1a of the
16    Sexual  Assault  Survivors  Emergency  Treatment   Act,   for
17    injuries  sustained  as  a  result  of  the  sexual  assault,
18    including  examinations  and  laboratory  tests  to  discover
19    evidence  which  may  be used in criminal proceedings arising
20    from the sexual assault; (16) the diagnosis and treatment  of
21    sickle  cell anemia; and (17) any other medical care, and any
22    other type of remedial care recognized under the laws of this
23    State, but not including abortions, or  induced  miscarriages
24    or  premature  births, unless, in the opinion of a physician,
25    such procedures are necessary for  the  preservation  of  the
26    life  of  the  woman  seeking  such  treatment,  or except an
27    induced premature birth intended to  produce  a  live  viable
28    child  and  such procedure is necessary for the health of the
29    mother or her unborn child; State funds may also be  used  to
30    pay  for abortions to terminate a pregnancy resulting from an
31    act of criminal sexual assault, as defined in  Section  12-13
32    of  the  Criminal Code of 1961, an act of aggravated criminal
33    sexual assault, as defined in Section 12-14 of  the  Criminal
34    Code  of 1961, or an act of sexual relations within families,
                            -3-               LRB9000743SMdvA
 1    as defined in Section 11-11 of the Criminal Code of 1961, but
 2    only to  the  extent  that  payment  for  such  abortions  is
 3    required by federal law as determined by a court of competent
 4    jurisdiction;  provided  further that payment for an abortion
 5    to terminate a pregnancy resulting from an  act  of  criminal
 6    sexual assault, aggravated criminal sexual assault, or sexual
 7    relations  within  families  is reported to a law enforcement
 8    agency before the abortion is  performed  but  not  including
 9    abortions,  or  induced  miscarriages  or  premature  births,
10    unless,  in  the  opinion of a physician, such procedures are
11    necessary for the preservation  of  the  life  of  the  woman
12    seeking  such treatment, or except an induced premature birth
13    intended to produce a live viable child and such procedure is
14    necessary for the health of the mother or her  unborn  child.
15    The   Illinois   Department,  by  rule,  shall  prohibit  any
16    physician  from  providing  medical  assistance   to   anyone
17    eligible  therefor  under  this Code where such physician has
18    been found guilty of performing an abortion  procedure  in  a
19    wilful and wanton manner upon a woman who was not pregnant at
20    the time such abortion procedure was performed. The term "any
21    other  type  of remedial care" shall include nursing care and
22    nursing home service for persons who  rely  on  treatment  by
23    spiritual means alone through prayer for healing.
24        The  Illinois  Department  shall  provide  the  following
25    services  to  persons  eligible  for  assistance  under  this
26    Article  who  are  participating  in  education,  training or
27    employment programs:
28             (1)  dental services, which shall include but not be
29        limited to prosthodontics; and
30             (2)  eyeglasses prescribed by a physician skilled in
31        the diseases of the eye, or by an optometrist,  whichever
32        the person may select.
33        The  Illinois  Department,  by  rule, may distinguish and
34    classify  the  medical  services  to  be  provided  only   in
                            -4-               LRB9000743SMdvA
 1    accordance  with the classes of persons designated in Section
 2    5-2.
 3        The Illinois Department shall authorize the provision of,
 4    and  shall  authorize  payment  for,  screening  by  low-dose
 5    mammography for the presence  of  occult  breast  cancer  for
 6    women  35  years of age or older who are eligible for medical
 7    assistance  under  this  Article,  as  follows:   a  baseline
 8    mammogram for women 35 to 39 years of age; a mammogram  every
 9    1  to  2 years, even if no symptoms are present, for women 40
10    to 49 years of age; and an  annual  mammogram  for  women  50
11    years  of  age  or  older.   All  screenings  shall include a
12    physical breast exam,  instruction  on  self-examination  and
13    information  regarding  the frequency of self-examination and
14    its value as a preventative tool.  As used in  this  Section,
15    "low-dose  mammography"  means  the  x-ray examination of the
16    breast   using   equipment   dedicated    specifically    for
17    mammography,  including  the  x-ray tube, filter, compression
18    device,  image  receptor,  and  cassettes,  with  an  average
19    radiation exposure delivery of less than one rad  mid-breast,
20    with 2 views for each breast.
21        Any  medical  or  health  care provider shall immediately
22    recommend, to  any  pregnant  woman  who  is  being  provided
23    prenatal  services  and  is  suspected  of  drug  abuse or is
24    addicted as defined in the Alcoholism and  Other  Drug  Abuse
25    and  Dependency  Act,  referral  to  a  local substance abuse
26    treatment provider licensed by the Department  of  Alcoholism
27    and  Substance Abuse or to a licensed hospital which provides
28    substance abuse treatment services.  The Department of Public
29    Aid shall assure coverage for the cost of  treatment  of  the
30    drug abuse or addiction for pregnant recipients in accordance
31    with  the  Illinois  Medicaid Program in conjunction with the
32    Department of Alcoholism and Substance Abuse.
33        All medical providers  providing  medical  assistance  to
34    pregnant women under this Code shall receive information from
                            -5-               LRB9000743SMdvA
 1    the Department on the availability of services under the Drug
 2    Free  Families  with  a  Future  or  any  comparable  program
 3    providing   case  management  services  for  addicted  women,
 4    including information  on  appropriate  referrals  for  other
 5    social  services  that  may  be  needed  by addicted women in
 6    addition to treatment for addiction.
 7        The  Illinois  Department,  in   cooperation   with   the
 8    Departments  of  Alcoholism  and  Substance  Abuse and Public
 9    Health, through a  public  awareness  campaign,  may  provide
10    information  concerning  treatment  for  alcoholism  and drug
11    abuse  and  addiction,  prenatal  health  care,   and   other
12    pertinent   programs  directed  at  reducing  the  number  of
13    drug-affected  infants  born   to   recipients   of   medical
14    assistance.
15        The Department shall not sanction the recipient solely on
16    the basis of her substance abuse.
17        The  Illinois Department shall establish such regulations
18    governing  the  dispensing  of  health  services  under  this
19    Article as it shall deem appropriate.  In  formulating  these
20    regulations  the  Illinois  Department shall consult with and
21    give substantial weight to the recommendations offered by the
22    Citizens  Assembly/Council  on  Public  Aid.  The  Department
23    should  seek  the  advice  of  formal  professional  advisory
24    committees  appointed  by  the  Director  of   the   Illinois
25    Department  for  the  purpose  of providing regular advice on
26    policy and administrative matters, information  dissemination
27    and  educational  activities  for  medical  and  health  care
28    providers,  and  consistency  in  procedures  to the Illinois
29    Department.
30        The Illinois Department may  develop  and  contract  with
31    Partnerships of medical providers to arrange medical services
32    for   persons  eligible  under  Section  5-2  of  this  Code.
33    Implementation  of  this  Section  may  be  by  demonstration
34    projects in certain geographic areas.  The Partnership  shall
                            -6-               LRB9000743SMdvA
 1    be represented by a sponsor organization.  The Department, by
 2    rule,   shall   develop   qualifications   for   sponsors  of
 3    Partnerships.  Nothing in this Section shall be construed  to
 4    require   that   the   sponsor   organization  be  a  medical
 5    organization.
 6        The sponsor must negotiate formal written contracts  with
 7    medical  providers  for  physician  services,  inpatient  and
 8    outpatient hospital care, home health services, treatment for
 9    alcoholism and substance abuse, and other services determined
10    necessary  by the Illinois Department by rule for delivery by
11    Partnerships.  Physician services must include  prenatal  and
12    obstetrical  care.   The  Illinois Department shall reimburse
13    medical  services  delivered  by  Partnership  providers   to
14    clients  in  target  areas  according  to  provisions of this
15    Article and the Illinois Health Finance  Reform  Act,  except
16    that:
17             (1)  Physicians  participating  in a Partnership and
18        providing certain services, which shall be determined  by
19        the  Illinois  Department, to persons in areas covered by
20        the Partnership may receive an additional  surcharge  for
21        such services.
22             (2)  The   Department  may  elect  to  consider  and
23        negotiate   financial   incentives   to   encourage   the
24        development of Partnerships and the efficient delivery of
25        medical care.
26             (3)  Persons  receiving  medical  services   through
27        Partnerships  may  receive  medical  and  case management
28        services above the  level  usually  offered  through  the
29        medical assistance program.
30        Medical  providers  shall  be  required  to  meet certain
31    qualifications to participate in Partnerships to  ensure  the
32    delivery   of   high   quality   medical   services.    These
33    qualifications  shall  be  determined by rule of the Illinois
34    Department  and  may  be  higher  than   qualifications   for
                            -7-               LRB9000743SMdvA
 1    participation in the medical assistance program.  Partnership
 2    sponsors  may  prescribe reasonable additional qualifications
 3    for participation by medical providers, only with  the  prior
 4    written approval of the Illinois Department.
 5        Nothing  in  this  Section shall limit the free choice of
 6    practitioners, hospitals,  and  other  providers  of  medical
 7    services by clients.
 8        The  Department  shall apply for a waiver from the United
 9    States Health Care Financing Administration to allow for  the
10    implementation of Partnerships under this Section.
11        The   Illinois   Department  shall  require  health  care
12    providers to maintain records that document the medical  care
13    and  services  provided  to  recipients of Medical Assistance
14    under this Article.  The Illinois  Department  shall  require
15    health  care  providers to make available, when authorized by
16    the patient, in writing, the  medical  records  in  a  timely
17    fashion  to  other  health care providers who are treating or
18    serving persons eligible for Medical  Assistance  under  this
19    Article.    All  dispensers  of  medical  services  shall  be
20    required to maintain and  retain  business  and  professional
21    records  sufficient  to  fully  and  accurately  document the
22    nature,  scope,  details  and  receipt  of  the  health  care
23    provided to persons eligible  for  medical  assistance  under
24    this  Code, in accordance with regulations promulgated by the
25    Illinois Department. The rules and regulations shall  require
26    that  proof  of  the receipt of prescription drugs, dentures,
27    prosthetic devices and eyeglasses by eligible  persons  under
28    this Section accompany each claim for reimbursement submitted
29    by the dispenser of such medical services. No such claims for
30    reimbursement  shall  be approved for payment by the Illinois
31    Department without such proof of receipt, unless the Illinois
32    Department shall have put into effect and shall be  operating
33    a  system  of post-payment audit and review which shall, on a
34    sampling basis, be deemed adequate by the Illinois Department
                            -8-               LRB9000743SMdvA
 1    to assure that such drugs, dentures, prosthetic  devices  and
 2    eyeglasses for which payment is being made are actually being
 3    received  by  eligible  recipients.  Within 90 days after the
 4    effective date of this amendatory Act of 1984,  the  Illinois
 5    Department  shall  establish  a  current  list of acquisition
 6    costs  for  all  prosthetic  devices  and  any  other   items
 7    recognized  as  medical  equipment  and supplies reimbursable
 8    under this Article and shall update such list on a  quarterly
 9    basis,  except that the acquisition costs of all prescription
10    drugs shall be updated no less frequently than every 30  days
11    as required by Section 5-5.12.
12        The  rules  and  regulations  of  the Illinois Department
13    shall require that a written statement including the required
14    opinion  of  a  physician  shall  accompany  any  claim   for
15    reimbursement  for  abortions,  or  induced  miscarriages  or
16    premature   births.    This  statement  shall  indicate  what
17    procedures were used in providing such medical services.
18        The Illinois Department shall require that all dispensers
19    of medical services, other than an individual practitioner or
20    group  of  practitioners,  desiring  to  participate  in  the
21    Medical Assistance program established under this Article  to
22    disclose all financial, beneficial, ownership, equity, surety
23    or  other  interests  in  any  and  all  firms, corporations,
24    partnerships,  associations,  business   enterprises,   joint
25    ventures,  agencies,  institutions  or  other  legal entities
26    providing any form of health  care  services  in  this  State
27    under this Article.
28        The  Illinois  Department may require that all dispensers
29    of medical services desiring to participate  in  the  medical
30    assistance  program  established under this Article disclose,
31    under such terms and conditions as  the  Illinois  Department
32    may  by  rule  establish,  all  inquiries  from  clients  and
33    attorneys  regarding  medical  bills  paid  by  the  Illinois
34    Department,   which   inquiries   could   indicate  potential
                            -9-               LRB9000743SMdvA
 1    existence of claims or liens for the Illinois Department.
 2        The  Illinois  Department   shall   establish   policies,
 3    procedures,   standards   and   criteria   by  rule  for  the
 4    acquisition,  repair  and   replacement   of   orthotic   and
 5    prosthetic devices and durable medical equipment.  Such rules
 6    shall provide, but not be limited to, the following services:
 7    (1)  immediate  repair  or  replacement  of  such  devices by
 8    recipients without medical  authorization;  and  (2)  rental,
 9    lease,   purchase   or   lease-purchase  of  durable  medical
10    equipment   in   a   cost-effective   manner,   taking   into
11    consideration the recipient's medical prognosis,  the  extent
12    of  the recipient's needs, and the requirements and costs for
13    maintaining  such  equipment.   Such  rules  shall  enable  a
14    recipient to  temporarily  acquire  and  use  alternative  or
15    substitute   devices   or   equipment   pending   repairs  or
16    replacements of any device or equipment previously authorized
17    for such recipient by the Department. Rules under clause  (2)
18    above  shall  not  provide  for purchase or lease-purchase of
19    durable medical equipment or supplies used for the purpose of
20    oxygen delivery and respiratory care.
21        The Department shall execute,  relative  to  the  nursing
22    home  prescreening  project,  written inter-agency agreements
23    with  the  Department  of  Rehabilitation  Services  and  the
24    Department on Aging, to  effect  the  following:  (i)  intake
25    procedures  and common eligibility criteria for those persons
26    who are receiving non-institutional services;  and  (ii)  the
27    establishment  and  development of non-institutional services
28    in areas of the State where they are not currently  available
29    or are undeveloped.
30        The  Illinois  Department  shall  develop and operate, in
31    cooperation with other State Departments and agencies and  in
32    compliance  with  applicable  federal  laws  and regulations,
33    appropriate and effective systems of health  care  evaluation
34    and  programs  for  monitoring  of utilization of health care
                            -10-              LRB9000743SMdvA
 1    services and facilities, as it affects persons  eligible  for
 2    medical  assistance  under this Code. The Illinois Department
 3    shall report regularly the results of the operation  of  such
 4    systems  and  programs  to  the  Citizens Assembly/Council on
 5    Public Aid to enable the Committee to ensure,  from  time  to
 6    time, that these programs are effective and meaningful.
 7        The  Illinois  Department  shall  report  annually to the
 8    General Assembly, no later than the second Friday in April of
 9    1979 and each year thereafter, in regard to:
10             (a)  actual statistics and trends in utilization  of
11        medical services by public aid recipients;
12             (b)  actual  statistics  and trends in the provision
13        of the various medical services by medical vendors;
14             (c)  current rate structures and proposed changes in
15        those rate structures for the  various  medical  vendors;
16        and
17             (d)  efforts  at  utilization  review and control by
18        the Illinois Department.
19        The period covered by each report shall be  the  3  years
20    ending  on the June 30 prior to the report.  The report shall
21    include  suggested  legislation  for  consideration  by   the
22    General  Assembly.  The filing of one copy of the report with
23    the Speaker, one copy with the Minority Leader and  one  copy
24    with the Clerk of the House of Representatives, one copy with
25    the President, one copy with the Minority Leader and one copy
26    with   the  Secretary  of  the  Senate,  one  copy  with  the
27    Legislative Research Unit, such additional  copies  with  the
28    State  Government  Report Distribution Center for the General
29    Assembly as is required under paragraph (t) of Section  7  of
30    the  State  Library  Act  and  one  copy  with  the  Citizens
31    Assembly/Council  on  Public  Aid  or  its successor shall be
32    deemed sufficient to comply with this Section.
33    (Source: P.A.  88-670,  eff.  12-2-94;  89-21,  eff.  7-1-95;
34    89-517, eff. 1-1-97.)
                            -11-              LRB9000743SMdvA
 1        (Text of Section after amendment by P.A. 89-507)
 2        Sec.  5-5.  Medical services. The Illinois Department, by
 3    rule, shall determine the quantity and  quality  of  and  the
 4    rate  of  reimbursement  for the medical assistance for which
 5    payment will be authorized, and the medical  services  to  be
 6    provided, which may include all or part of the following: (1)
 7    inpatient   hospital   services;   (2)   outpatient  hospital
 8    services;  (3)  other  laboratory  and  X-ray  services;  (4)
 9    skilled  nursing  home  services;  (5)  physicians'  services
10    whether furnished  in  the  office,  the  patient's  home,  a
11    hospital,  a  skilled nursing home, or elsewhere; (6) medical
12    care, or  any  other  type  of  remedial  care  furnished  by
13    licensed  practitioners;  (7)  home health care services; (8)
14    private duty  nursing  service;  (9)  clinic  services;  (10)
15    dental  services; (11) physical therapy and related services;
16    (12) prescribed drugs, dentures, and prosthetic devices;  and
17    eyeglasses  prescribed by a physician skilled in the diseases
18    of the eye, or by an optometrist, whichever  the  person  may
19    select;  (13)  other  diagnostic,  screening, preventive, and
20    rehabilitative services; (14) transportation and  such  other
21    expenses  as  may  be  necessary;  (15)  medical treatment of
22    sexual assault survivors, as defined in  Section  1a  of  the
23    Sexual   Assault   Survivors  Emergency  Treatment  Act,  for
24    injuries  sustained  as  a  result  of  the  sexual  assault,
25    including  examinations  and  laboratory  tests  to  discover
26    evidence which may be used in  criminal  proceedings  arising
27    from  the sexual assault; (16) the diagnosis and treatment of
28    sickle cell anemia; and (17) any other medical care, and  any
29    other type of remedial care recognized under the laws of this
30    State,  but  not including abortions, or induced miscarriages
31    or premature births, unless, in the opinion of  a  physician,
32    such  procedures  are  necessary  for the preservation of the
33    life of the  woman  seeking  such  treatment,  or  except  an
34    induced  premature  birth  intended  to produce a live viable
                            -12-              LRB9000743SMdvA
 1    child and such procedure is necessary for the health  of  the
 2    mother  or  her unborn child; State funds may also be used to
 3    pay for abortions to terminate a pregnancy resulting from  an
 4    act  of  criminal sexual assault, as defined in Section 12-13
 5    of the Criminal Code of 1961, an act of  aggravated  criminal
 6    sexual  assault,  as defined in Section 12-14 of the Criminal
 7    Code of 1961, or an act of sexual relations within  families,
 8    as defined in Section 11-11 of the Criminal Code of 1961, but
 9    only  to  the  extent  that  payment  for  such  abortions is
10    required by federal law as determined by a court of competent
11    jurisdiction; provided further that payment for  an  abortion
12    to  terminate  a  pregnancy resulting from an act of criminal
13    sexual assault, aggravated criminal sexual assault, or sexual
14    relations within families is reported to  a  law  enforcement
15    agency  before  the  abortion  is performed but not including
16    abortions,  or  induced  miscarriages  or  premature  births,
17    unless, in the opinion of a physician,  such  procedures  are
18    necessary  for  the  preservation  of  the  life of the woman
19    seeking such treatment, or except an induced premature  birth
20    intended to produce a live viable child and such procedure is
21    necessary  for  the health of the mother or her unborn child.
22    The  Illinois  Department,  by  rule,  shall   prohibit   any
23    physician   from   providing  medical  assistance  to  anyone
24    eligible therefor under this Code where  such  physician  has
25    been  found  guilty  of performing an abortion procedure in a
26    wilful and wanton manner upon a woman who was not pregnant at
27    the time such abortion procedure was performed. The term "any
28    other type of remedial care" shall include nursing  care  and
29    nursing  home  service  for  persons who rely on treatment by
30    spiritual means alone through prayer for healing.
31        The Illinois Department of Public Aid shall  provide  the
32    following  services  to persons eligible for assistance under
33    this Article who are participating in education, training  or
34    employment  programs  operated  by  the  Department  of Human
                            -13-              LRB9000743SMdvA
 1    Services as successor to the Department of Public Aid:
 2             (1)  dental services, which shall include but not be
 3        limited to prosthodontics; and
 4             (2)  eyeglasses prescribed by a physician skilled in
 5        the diseases of the eye, or by an optometrist,  whichever
 6        the person may select.
 7        The  Illinois  Department,  by  rule, may distinguish and
 8    classify  the  medical  services  to  be  provided  only   in
 9    accordance  with the classes of persons designated in Section
10    5-2.
11        The Illinois Department shall authorize the provision of,
12    and  shall  authorize  payment  for,  screening  by  low-dose
13    mammography for the presence  of  occult  breast  cancer  for
14    women  35  years of age or older who are eligible for medical
15    assistance  under  this  Article,  as  follows:   a  baseline
16    mammogram for women 35 to 39 years of age; a mammogram  every
17    1  to  2 years, even if no symptoms are present, for women 40
18    to 49 years of age; and an  annual  mammogram  for  women  50
19    years  of  age  or  older.   All  screenings  shall include a
20    physical breast exam,  instruction  on  self-examination  and
21    information  regarding  the frequency of self-examination and
22    its value as a preventative tool.  As used in  this  Section,
23    "low-dose  mammography"  means  the  x-ray examination of the
24    breast   using   equipment   dedicated    specifically    for
25    mammography,  including  the  x-ray tube, filter, compression
26    device,  image  receptor,  and  cassettes,  with  an  average
27    radiation exposure delivery of less than one rad  mid-breast,
28    with 2 views for each breast.
29        Any  medical  or  health  care provider shall immediately
30    recommend, to  any  pregnant  woman  who  is  being  provided
31    prenatal  services  and  is  suspected  of  drug  abuse or is
32    addicted as defined in the Alcoholism and  Other  Drug  Abuse
33    and  Dependency  Act,  referral  to  a  local substance abuse
34    treatment  provider  licensed  by  the  Department  of  Human
                            -14-              LRB9000743SMdvA
 1    Services or to a licensed hospital which  provides  substance
 2    abuse treatment services.  The Department of Public Aid shall
 3    assure  coverage  for the cost of treatment of the drug abuse
 4    or addiction for pregnant recipients in accordance  with  the
 5    Illinois  Medicaid Program in conjunction with the Department
 6    of Human Services.
 7        All medical providers  providing  medical  assistance  to
 8    pregnant women under this Code shall receive information from
 9    the Department on the availability of services under the Drug
10    Free  Families  with  a  Future  or  any  comparable  program
11    providing   case  management  services  for  addicted  women,
12    including information  on  appropriate  referrals  for  other
13    social  services  that  may  be  needed  by addicted women in
14    addition to treatment for addiction.
15        The  Illinois  Department,  in   cooperation   with   the
16    Departments of Human Services (as successor to the Department
17    of Alcoholism and Substance Abuse) and Public Health, through
18    a   public   awareness   campaign,  may  provide  information
19    concerning  treatment  for  alcoholism  and  drug  abuse  and
20    addiction, prenatal health care, and other pertinent programs
21    directed at reducing the number of drug-affected infants born
22    to recipients of medical assistance.
23        Neither the Illinois Department of  Public  Aid  nor  the
24    Department  of  Human  Services  shall sanction the recipient
25    solely on the basis of her substance abuse.
26        The Illinois Department shall establish such  regulations
27    governing  the  dispensing  of  health  services  under  this
28    Article  as  it shall deem appropriate.  In formulating these
29    regulations the Illinois Department shall  consult  with  and
30    give substantial weight to the recommendations offered by the
31    Citizens  Assembly/Council  on  Public  Aid.  The  Department
32    should  seek  the  advice  of  formal  professional  advisory
33    committees   appointed   by  the  Director  of  the  Illinois
34    Department for the purpose of  providing  regular  advice  on
                            -15-              LRB9000743SMdvA
 1    policy  and administrative matters, information dissemination
 2    and  educational  activities  for  medical  and  health  care
 3    providers, and consistency  in  procedures  to  the  Illinois
 4    Department.
 5        The  Illinois  Department  may  develop and contract with
 6    Partnerships of medical providers to arrange medical services
 7    for  persons  eligible  under  Section  5-2  of  this   Code.
 8    Implementation  of  this  Section  may  be  by  demonstration
 9    projects  in certain geographic areas.  The Partnership shall
10    be represented by a sponsor organization.  The Department, by
11    rule,  shall   develop   qualifications   for   sponsors   of
12    Partnerships.   Nothing in this Section shall be construed to
13    require  that  the  sponsor   organization   be   a   medical
14    organization.
15        The  sponsor must negotiate formal written contracts with
16    medical  providers  for  physician  services,  inpatient  and
17    outpatient hospital care, home health services, treatment for
18    alcoholism and substance abuse, and other services determined
19    necessary by the Illinois Department by rule for delivery  by
20    Partnerships.   Physician  services must include prenatal and
21    obstetrical care.  The Illinois  Department  shall  reimburse
22    medical   services  delivered  by  Partnership  providers  to
23    clients in target  areas  according  to  provisions  of  this
24    Article  and  the  Illinois Health Finance Reform Act, except
25    that:
26             (1)  Physicians participating in a  Partnership  and
27        providing  certain services, which shall be determined by
28        the Illinois Department, to persons in areas  covered  by
29        the  Partnership  may receive an additional surcharge for
30        such services.
31             (2)  The  Department  may  elect  to  consider   and
32        negotiate   financial   incentives   to   encourage   the
33        development of Partnerships and the efficient delivery of
34        medical care.
                            -16-              LRB9000743SMdvA
 1             (3)  Persons   receiving  medical  services  through
 2        Partnerships may  receive  medical  and  case  management
 3        services  above  the  level  usually  offered through the
 4        medical assistance program.
 5        Medical providers  shall  be  required  to  meet  certain
 6    qualifications  to  participate in Partnerships to ensure the
 7    delivery   of   high   quality   medical   services.    These
 8    qualifications shall be determined by rule  of  the  Illinois
 9    Department   and   may  be  higher  than  qualifications  for
10    participation in the medical assistance program.  Partnership
11    sponsors may prescribe reasonable  additional  qualifications
12    for  participation  by medical providers, only with the prior
13    written approval of the Illinois Department.
14        Nothing in this Section shall limit the  free  choice  of
15    practitioners,  hospitals,  and  other  providers  of medical
16    services by clients.
17        The Department shall apply for a waiver from  the  United
18    States  Health Care Financing Administration to allow for the
19    implementation of Partnerships under this Section.
20        The  Illinois  Department  shall  require   health   care
21    providers  to maintain records that document the medical care
22    and services provided to  recipients  of  Medical  Assistance
23    under  this  Article.   The Illinois Department shall require
24    health care providers to make available, when  authorized  by
25    the  patient,  in  writing,  the  medical records in a timely
26    fashion to other health care providers who  are  treating  or
27    serving  persons  eligible  for Medical Assistance under this
28    Article.   All  dispensers  of  medical  services  shall   be
29    required  to  maintain  and  retain business and professional
30    records sufficient  to  fully  and  accurately  document  the
31    nature,  scope,  details  and  receipt  of  the  health  care
32    provided  to  persons  eligible  for medical assistance under
33    this Code, in accordance with regulations promulgated by  the
34    Illinois  Department. The rules and regulations shall require
                            -17-              LRB9000743SMdvA
 1    that proof of the receipt of  prescription  drugs,  dentures,
 2    prosthetic  devices  and eyeglasses by eligible persons under
 3    this Section accompany each claim for reimbursement submitted
 4    by the dispenser of such medical services. No such claims for
 5    reimbursement shall be approved for payment by  the  Illinois
 6    Department without such proof of receipt, unless the Illinois
 7    Department  shall have put into effect and shall be operating
 8    a system of post-payment audit and review which shall,  on  a
 9    sampling basis, be deemed adequate by the Illinois Department
10    to  assure  that such drugs, dentures, prosthetic devices and
11    eyeglasses for which payment is being made are actually being
12    received by eligible recipients. Within  90  days  after  the
13    effective  date  of this amendatory Act of 1984, the Illinois
14    Department shall establish  a  current  list  of  acquisition
15    costs   for  all  prosthetic  devices  and  any  other  items
16    recognized as medical  equipment  and  supplies  reimbursable
17    under  this Article and shall update such list on a quarterly
18    basis, except that the acquisition costs of all  prescription
19    drugs  shall be updated no less frequently than every 30 days
20    as required by Section 5-5.12.
21        The rules and  regulations  of  the  Illinois  Department
22    shall require that a written statement including the required
23    opinion   of  a  physician  shall  accompany  any  claim  for
24    reimbursement  for  abortions,  or  induced  miscarriages  or
25    premature  births.   This  statement  shall   indicate   what
26    procedures were used in providing such medical services.
27        The Illinois Department shall require that all dispensers
28    of medical services, other than an individual practitioner or
29    group  of  practitioners,  desiring  to  participate  in  the
30    Medical  Assistance program established under this Article to
31    disclose all financial, beneficial, ownership, equity, surety
32    or other  interests  in  any  and  all  firms,  corporations,
33    partnerships,   associations,   business  enterprises,  joint
34    ventures, agencies,  institutions  or  other  legal  entities
                            -18-              LRB9000743SMdvA
 1    providing  any  form  of  health  care services in this State
 2    under this Article.
 3        The Illinois Department may require that  all  dispensers
 4    of  medical  services  desiring to participate in the medical
 5    assistance program established under this  Article  disclose,
 6    under  such  terms  and conditions as the Illinois Department
 7    may  by  rule  establish,  all  inquiries  from  clients  and
 8    attorneys  regarding  medical  bills  paid  by  the  Illinois
 9    Department,  which   inquiries   could   indicate   potential
10    existence of claims or liens for the Illinois Department.
11        The   Illinois   Department   shall  establish  policies,
12    procedures,  standards  and  criteria   by   rule   for   the
13    acquisition,   repair   and   replacement   of  orthotic  and
14    prosthetic devices and durable medical equipment.  Such rules
15    shall provide, but not be limited to, the following services:
16    (1) immediate  repair  or  replacement  of  such  devices  by
17    recipients  without  medical  authorization;  and (2) rental,
18    lease,  purchase  or  lease-purchase   of   durable   medical
19    equipment   in   a   cost-effective   manner,   taking   into
20    consideration  the  recipient's medical prognosis, the extent
21    of the recipient's needs, and the requirements and costs  for
22    maintaining  such  equipment.   Such  rules  shall  enable  a
23    recipient  to  temporarily  acquire  and  use  alternative or
24    substitute  devices   or   equipment   pending   repairs   or
25    replacements of any device or equipment previously authorized
26    for  such recipient by the Department. Rules under clause (2)
27    above shall not provide for  purchase  or  lease-purchase  of
28    durable medical equipment or supplies used for the purpose of
29    oxygen delivery and respiratory care.
30        The  Department  shall  execute,  relative to the nursing
31    home prescreening project,  written  inter-agency  agreements
32    with  the  Department of Human Services and the Department on
33    Aging, to effect the following:  (i)  intake  procedures  and
34    common   eligibility  criteria  for  those  persons  who  are
                            -19-              LRB9000743SMdvA
 1    receiving   non-institutional   services;   and   (ii)    the
 2    establishment  and  development of non-institutional services
 3    in areas of the State where they are not currently  available
 4    or are undeveloped.
 5        The  Illinois  Department  shall  develop and operate, in
 6    cooperation with other State Departments and agencies and  in
 7    compliance  with  applicable  federal  laws  and regulations,
 8    appropriate and effective systems of health  care  evaluation
 9    and  programs  for  monitoring  of utilization of health care
10    services and facilities, as it affects persons  eligible  for
11    medical  assistance  under this Code. The Illinois Department
12    shall report regularly the results of the operation  of  such
13    systems  and  programs  to  the  Citizens Assembly/Council on
14    Public Aid to enable the Committee to ensure,  from  time  to
15    time, that these programs are effective and meaningful.
16        The  Illinois  Department  shall  report  annually to the
17    General Assembly, no later than the second Friday in April of
18    1979 and each year thereafter, in regard to:
19             (a)  actual statistics and trends in utilization  of
20        medical services by public aid recipients;
21             (b)  actual  statistics  and trends in the provision
22        of the various medical services by medical vendors;
23             (c)  current rate structures and proposed changes in
24        those rate structures for the  various  medical  vendors;
25        and
26             (d)  efforts  at  utilization  review and control by
27        the Illinois Department.
28        The period covered by each report shall be  the  3  years
29    ending  on the June 30 prior to the report.  The report shall
30    include  suggested  legislation  for  consideration  by   the
31    General  Assembly.  The filing of one copy of the report with
32    the Speaker, one copy with the Minority Leader and  one  copy
33    with the Clerk of the House of Representatives, one copy with
34    the President, one copy with the Minority Leader and one copy
                            -20-              LRB9000743SMdvA
 1    with   the  Secretary  of  the  Senate,  one  copy  with  the
 2    Legislative Research Unit, such additional  copies  with  the
 3    State  Government  Report Distribution Center for the General
 4    Assembly as is required under paragraph (t) of Section  7  of
 5    the  State  Library  Act  and  one  copy  with  the  Citizens
 6    Assembly/Council  on  Public  Aid  or  its successor shall be
 7    deemed sufficient to comply with this Section.
 8    (Source: P.A.  88-670,  eff.  12-2-94;  89-21,  eff.  7-1-95;
 9    89-507, eff. 7-1-97; 89-517, eff. 1-1-97; revised 8-26-96.)
10        (305 ILCS 5/6-1) (from Ch. 23, par. 6-1)
11        Sec.  6-1.   Eligibility  requirements.  Financial aid in
12    meeting basic maintenance requirements shall be  given  under
13    this  Article  to  or  in  behalf  of  persons  who  meet the
14    eligibility conditions of Sections 6-1.1 through  6-1.10.  In
15    addition,  each  unit  of  local  government  subject to this
16    Article shall provide  persons  receiving  financial  aid  in
17    meeting basic maintenance requirements with financial aid for
18    either  (a)  necessary treatment, care, and supplies required
19    because of  illness  or  disability,  or  (b)  acute  medical
20    treatment,  care,  and supplies only. If a local governmental
21    unit elects  to  provide  financial  aid  for  acute  medical
22    treatment,  care,  and  supplies  only,  the general types of
23    acute  medical  treatment,  care,  and  supplies  for   which
24    financial  aid  is provided shall be specified in the general
25    assistance rules of the local governmental unit, which  rules
26    shall  provide  that financial aid is provided, at a minimum,
27    for acute medical treatment, care, or  supplies  necessitated
28    by   a   medical   condition  for  which  prior  approval  or
29    authorization of medical treatment, care, or supplies is  not
30    required  by  the  general  assistance  rules of the Illinois
31    Department. Nothing in this Article  shall  be  construed  to
32    permit  the  granting  of  financial aid where the purpose of
33    such aid is to obtain an  abortion,  induced  miscarriage  or
                            -21-              LRB9000743SMdvA
 1    induced   premature   birth  unless,  in  the  opinion  of  a
 2    physician, such procedures are necessary for the preservation
 3    of the life of the woman seeking such treatment, or except an
 4    induced premature birth intended to  produce  a  live  viable
 5    child  and  such procedure is necessary for the health of the
 6    mother or her unborn child; State funds may also be  used  to
 7    pay  for abortions to terminate a pregnancy resulting from an
 8    act of criminal sexual assault, as defined in  Section  12-13
 9    of  the  Criminal Code of 1961, an act of aggravated criminal
10    sexual assault, as defined in Section 12-14 of  the  Criminal
11    Code of 1961,  or an act of sexual relations within families,
12    as defined in Section 11-11 of the Criminal Code of 1961, but
13    only  to  the  extent  that  payment  for  such  abortions is
14    required by federal law as determined by a court of competent
15    jurisdiction; provided further that payment for  an  abortion
16    to  terminate  a  pregnancy resulting from an act of criminal
17    sexual assault, aggravated criminal sexual assault, or sexual
18    relations within families is reported to  a  law  enforcement
19    agency  before  the  abortion  is  performed. Nothing in this
20    Article  shall  be  construed  to  permit  the  granting   of
21    financial  aid  where the purpose of such aid is to obtain an
22    abortion, induced  miscarriage  or  induced  premature  birth
23    unless,  in  the  opinion of a physician, such procedures are
24    necessary for the preservation  of  the  life  of  the  woman
25    seeking  such treatment, or except an induced premature birth
26    intended to produce a live viable child and such procedure is
27    necessary for the health of the mother or her unborn child.
28        Until August 1, 1969, children who require  care  outside
29    their   own  homes,  where  no  other  sources  of  funds  or
30    insufficient funds are available  to  provide  the  necessary
31    care,  are included among persons eligible for aid under this
32    Article.  After July 31, 1969, the Department of Children and
33    Family Services shall have the  responsibility  of  providing
34    child  welfare  services  to  such  children,  as provided in
                            -22-              LRB9000743SMdvA
 1    Section 5 of "An Act creating the Department of Children  and
 2    Family   Services,  codifying  its  powers  and  duties,  and
 3    repealing certain Acts and Sections herein  named",  approved
 4    June 4, 1963, as amended.
 5        In  cities,  villages and incorporated towns of more than
 6    500,000 population, the Illinois Department may  establish  a
 7    separate program under this Article.  The 2 programs shall be
 8    differentiated,  but  the  placement  of  persons  under both
 9    programs shall be based upon their ability  or  inability  to
10    engage  in  employment  in  accordance  with  the  rules  and
11    regulations  promulgated  by  the  Illinois  Department.   In
12    establishing  rules and regulations for determining whether a
13    person  is  able  to  engage  in  employment,  the   Illinois
14    Department  may  establish rules different than those set out
15    under Section 11-20.  In determining need and the  amount  of
16    aid  under  Sections  6-1.2  and  6-2 for the 2 programs, the
17    Illinois Department may establish different standards for the
18    2 programs based upon the specific  needs  of  the  different
19    populations  to  be  served  by the 2 programs.  The Illinois
20    Department  may  enter  into  contracts  with   entities   to
21    establish work or training related projects under the program
22    established  for  persons  determined to be able to engage in
23    employment.
24    (Source: P.A. 89-646, eff. 1-1-97.)
25        Setion 90.  Severability.  If any provision, word, phrase
26    or clause of this amendatory Act of 1997 or  its  application
27    to any person or circumstance is held invalid, the invalidity
28    does  not  affect  the provisions, words, phrases, clauses or
29    application of this amendatory Act of 1997 which can be given
30    effect without the invalid provision, word,  phrase,  clause,
31    or  application,  and  to  this  end  the  provisions, words,
32    phrases, and clauses of  this  amendatory  Act  of  1997  are
33    declared to be severable.
                            -23-              LRB9000743SMdvA
 1        Section  95.   No  acceleration or delay.  Where this Act
 2    makes changes in a statute that is represented in this Act by
 3    text that is not yet or no longer in effect (for  example,  a
 4    Section  represented  by  multiple versions), the use of that
 5    text does not accelerate or delay the taking  effect  of  (i)
 6    the  changes made by this Act or (ii) provisions derived from
 7    any other Public Act.
 8        Section 99.  Effective date.  This Act takes effect  upon
 9    becoming law.

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