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90_SB0882
305 ILCS 5/5-5 from Ch. 23, par. 5-5
Amends the Medicaid Article of the Public Aid Code.
Makes stylistic changes in a Section concerning requirement
that the Department of Public Aid provide certain medical
services for persons participating in education, training, or
employment programs.
LRB9003202DJmg
LRB9003202DJmg
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Section 5-5.
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 5-5 as follows:
7 (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
8 (Text of Section before amendment by P.A. 89-507)
9 Sec. 5-5. Medical services. The Illinois Department, by
10 rule, shall determine the quantity and quality of and the
11 rate of reimbursement for the medical assistance for which
12 payment will be authorized, and the medical services to be
13 provided, which may include all or part of the following: (1)
14 inpatient hospital services; (2) outpatient hospital
15 services; (3) other laboratory and X-ray services; (4)
16 skilled nursing home services; (5) physicians' services
17 whether furnished in the office, the patient's home, a
18 hospital, a skilled nursing home, or elsewhere; (6) medical
19 care, or any other type of remedial care furnished by
20 licensed practitioners; (7) home health care services; (8)
21 private duty nursing service; (9) clinic services; (10)
22 dental services; (11) physical therapy and related services;
23 (12) prescribed drugs, dentures, and prosthetic devices; and
24 eyeglasses prescribed by a physician skilled in the diseases
25 of the eye, or by an optometrist, whichever the person may
26 select; (13) other diagnostic, screening, preventive, and
27 rehabilitative services; (14) transportation and such other
28 expenses as may be necessary; (15) medical treatment of
29 sexual assault survivors, as defined in Section 1a of the
30 Sexual Assault Survivors Emergency Treatment Act, for
31 injuries sustained as a result of the sexual assault,
-2- LRB9003202DJmg
1 including examinations and laboratory tests to discover
2 evidence which may be used in criminal proceedings arising
3 from the sexual assault; (16) the diagnosis and treatment of
4 sickle cell anemia; and (17) any other medical care, and any
5 other type of remedial care recognized under the laws of this
6 State, but not including abortions, or induced miscarriages
7 or premature births, unless, in the opinion of a physician,
8 such procedures are necessary for the preservation of the
9 life of the woman seeking such treatment, or except an
10 induced premature birth intended to produce a live viable
11 child and such procedure is necessary for the health of the
12 mother or her unborn child. The Illinois Department, by rule,
13 shall prohibit any physician from providing medical
14 assistance to anyone eligible therefor under this Code where
15 such physician has been found guilty of performing an
16 abortion procedure in a wilful and wanton manner upon a woman
17 who was not pregnant at the time such abortion procedure was
18 performed. The term "any other type of remedial care" shall
19 include nursing care and nursing home service for persons who
20 rely on treatment by spiritual means alone through prayer for
21 healing.
22 The Illinois Department shall provide the following
23 services to persons who are eligible for assistance under
24 this Article and who are participating in education, training
25 or employment programs:
26 (1) dental services, which shall include but not be
27 limited to prosthodontics; and
28 (2) eyeglasses prescribed by a physician skilled in
29 the diseases of the eye, or by an optometrist, whichever
30 the person may select.
31 The Illinois Department, by rule, may distinguish and
32 classify the medical services to be provided only in
33 accordance with the classes of persons designated in Section
34 5-2.
-3- LRB9003202DJmg
1 The Illinois Department shall authorize the provision of,
2 and shall authorize payment for, screening by low-dose
3 mammography for the presence of occult breast cancer for
4 women 35 years of age or older who are eligible for medical
5 assistance under this Article, as follows: a baseline
6 mammogram for women 35 to 39 years of age; a mammogram every
7 1 to 2 years, even if no symptoms are present, for women 40
8 to 49 years of age; and an annual mammogram for women 50
9 years of age or older. All screenings shall include a
10 physical breast exam, instruction on self-examination and
11 information regarding the frequency of self-examination and
12 its value as a preventative tool. As used in this Section,
13 "low-dose mammography" means the x-ray examination of the
14 breast using equipment dedicated specifically for
15 mammography, including the x-ray tube, filter, compression
16 device, image receptor, and cassettes, with an average
17 radiation exposure delivery of less than one rad mid-breast,
18 with 2 views for each breast.
19 Any medical or health care provider shall immediately
20 recommend, to any pregnant woman who is being provided
21 prenatal services and is suspected of drug abuse or is
22 addicted as defined in the Alcoholism and Other Drug Abuse
23 and Dependency Act, referral to a local substance abuse
24 treatment provider licensed by the Department of Alcoholism
25 and Substance Abuse or to a licensed hospital which provides
26 substance abuse treatment services. The Department of Public
27 Aid shall assure coverage for the cost of treatment of the
28 drug abuse or addiction for pregnant recipients in accordance
29 with the Illinois Medicaid Program in conjunction with the
30 Department of Alcoholism and Substance Abuse.
31 All medical providers providing medical assistance to
32 pregnant women under this Code shall receive information from
33 the Department on the availability of services under the Drug
34 Free Families with a Future or any comparable program
-4- LRB9003202DJmg
1 providing case management services for addicted women,
2 including information on appropriate referrals for other
3 social services that may be needed by addicted women in
4 addition to treatment for addiction.
5 The Illinois Department, in cooperation with the
6 Departments of Alcoholism and Substance Abuse and Public
7 Health, through a public awareness campaign, may provide
8 information concerning treatment for alcoholism and drug
9 abuse and addiction, prenatal health care, and other
10 pertinent programs directed at reducing the number of
11 drug-affected infants born to recipients of medical
12 assistance.
13 The Department shall not sanction the recipient solely on
14 the basis of her substance abuse.
15 The Illinois Department shall establish such regulations
16 governing the dispensing of health services under this
17 Article as it shall deem appropriate. In formulating these
18 regulations the Illinois Department shall consult with and
19 give substantial weight to the recommendations offered by the
20 Citizens Assembly/Council on Public Aid. The Department
21 should seek the advice of formal professional advisory
22 committees appointed by the Director of the Illinois
23 Department for the purpose of providing regular advice on
24 policy and administrative matters, information dissemination
25 and educational activities for medical and health care
26 providers, and consistency in procedures to the Illinois
27 Department.
28 The Illinois Department may develop and contract with
29 Partnerships of medical providers to arrange medical services
30 for persons eligible under Section 5-2 of this Code.
31 Implementation of this Section may be by demonstration
32 projects in certain geographic areas. The Partnership shall
33 be represented by a sponsor organization. The Department, by
34 rule, shall develop qualifications for sponsors of
-5- LRB9003202DJmg
1 Partnerships. Nothing in this Section shall be construed to
2 require that the sponsor organization be a medical
3 organization.
4 The sponsor must negotiate formal written contracts with
5 medical providers for physician services, inpatient and
6 outpatient hospital care, home health services, treatment for
7 alcoholism and substance abuse, and other services determined
8 necessary by the Illinois Department by rule for delivery by
9 Partnerships. Physician services must include prenatal and
10 obstetrical care. The Illinois Department shall reimburse
11 medical services delivered by Partnership providers to
12 clients in target areas according to provisions of this
13 Article and the Illinois Health Finance Reform Act, except
14 that:
15 (1) Physicians participating in a Partnership and
16 providing certain services, which shall be determined by
17 the Illinois Department, to persons in areas covered by
18 the Partnership may receive an additional surcharge for
19 such services.
20 (2) The Department may elect to consider and
21 negotiate financial incentives to encourage the
22 development of Partnerships and the efficient delivery of
23 medical care.
24 (3) Persons receiving medical services through
25 Partnerships may receive medical and case management
26 services above the level usually offered through the
27 medical assistance program.
28 Medical providers shall be required to meet certain
29 qualifications to participate in Partnerships to ensure the
30 delivery of high quality medical services. These
31 qualifications shall be determined by rule of the Illinois
32 Department and may be higher than qualifications for
33 participation in the medical assistance program. Partnership
34 sponsors may prescribe reasonable additional qualifications
-6- LRB9003202DJmg
1 for participation by medical providers, only with the prior
2 written approval of the Illinois Department.
3 Nothing in this Section shall limit the free choice of
4 practitioners, hospitals, and other providers of medical
5 services by clients.
6 The Department shall apply for a waiver from the United
7 States Health Care Financing Administration to allow for the
8 implementation of Partnerships under this Section.
9 The Illinois Department shall require health care
10 providers to maintain records that document the medical care
11 and services provided to recipients of Medical Assistance
12 under this Article. The Illinois Department shall require
13 health care providers to make available, when authorized by
14 the patient, in writing, the medical records in a timely
15 fashion to other health care providers who are treating or
16 serving persons eligible for Medical Assistance under this
17 Article. All dispensers of medical services shall be
18 required to maintain and retain business and professional
19 records sufficient to fully and accurately document the
20 nature, scope, details and receipt of the health care
21 provided to persons eligible for medical assistance under
22 this Code, in accordance with regulations promulgated by the
23 Illinois Department. The rules and regulations shall require
24 that proof of the receipt of prescription drugs, dentures,
25 prosthetic devices and eyeglasses by eligible persons under
26 this Section accompany each claim for reimbursement submitted
27 by the dispenser of such medical services. No such claims for
28 reimbursement shall be approved for payment by the Illinois
29 Department without such proof of receipt, unless the Illinois
30 Department shall have put into effect and shall be operating
31 a system of post-payment audit and review which shall, on a
32 sampling basis, be deemed adequate by the Illinois Department
33 to assure that such drugs, dentures, prosthetic devices and
34 eyeglasses for which payment is being made are actually being
-7- LRB9003202DJmg
1 received by eligible recipients. Within 90 days after the
2 effective date of this amendatory Act of 1984, the Illinois
3 Department shall establish a current list of acquisition
4 costs for all prosthetic devices and any other items
5 recognized as medical equipment and supplies reimbursable
6 under this Article and shall update such list on a quarterly
7 basis, except that the acquisition costs of all prescription
8 drugs shall be updated no less frequently than every 30 days
9 as required by Section 5-5.12.
10 The rules and regulations of the Illinois Department
11 shall require that a written statement including the required
12 opinion of a physician shall accompany any claim for
13 reimbursement for abortions, or induced miscarriages or
14 premature births. This statement shall indicate what
15 procedures were used in providing such medical services.
16 The Illinois Department shall require that all dispensers
17 of medical services, other than an individual practitioner or
18 group of practitioners, desiring to participate in the
19 Medical Assistance program established under this Article to
20 disclose all financial, beneficial, ownership, equity, surety
21 or other interests in any and all firms, corporations,
22 partnerships, associations, business enterprises, joint
23 ventures, agencies, institutions or other legal entities
24 providing any form of health care services in this State
25 under this Article.
26 The Illinois Department may require that all dispensers
27 of medical services desiring to participate in the medical
28 assistance program established under this Article disclose,
29 under such terms and conditions as the Illinois Department
30 may by rule establish, all inquiries from clients and
31 attorneys regarding medical bills paid by the Illinois
32 Department, which inquiries could indicate potential
33 existence of claims or liens for the Illinois Department.
34 The Illinois Department shall establish policies,
-8- LRB9003202DJmg
1 procedures, standards and criteria by rule for the
2 acquisition, repair and replacement of orthotic and
3 prosthetic devices and durable medical equipment. Such rules
4 shall provide, but not be limited to, the following services:
5 (1) immediate repair or replacement of such devices by
6 recipients without medical authorization; and (2) rental,
7 lease, purchase or lease-purchase of durable medical
8 equipment in a cost-effective manner, taking into
9 consideration the recipient's medical prognosis, the extent
10 of the recipient's needs, and the requirements and costs for
11 maintaining such equipment. Such rules shall enable a
12 recipient to temporarily acquire and use alternative or
13 substitute devices or equipment pending repairs or
14 replacements of any device or equipment previously authorized
15 for such recipient by the Department. Rules under clause (2)
16 above shall not provide for purchase or lease-purchase of
17 durable medical equipment or supplies used for the purpose of
18 oxygen delivery and respiratory care.
19 The Department shall execute, relative to the nursing
20 home prescreening project, written inter-agency agreements
21 with the Department of Rehabilitation Services and the
22 Department on Aging, to effect the following: (i) intake
23 procedures and common eligibility criteria for those persons
24 who are receiving non-institutional services; and (ii) the
25 establishment and development of non-institutional services
26 in areas of the State where they are not currently available
27 or are undeveloped.
28 The Illinois Department shall develop and operate, in
29 cooperation with other State Departments and agencies and in
30 compliance with applicable federal laws and regulations,
31 appropriate and effective systems of health care evaluation
32 and programs for monitoring of utilization of health care
33 services and facilities, as it affects persons eligible for
34 medical assistance under this Code. The Illinois Department
-9- LRB9003202DJmg
1 shall report regularly the results of the operation of such
2 systems and programs to the Citizens Assembly/Council on
3 Public Aid to enable the Committee to ensure, from time to
4 time, that these programs are effective and meaningful.
5 The Illinois Department shall report annually to the
6 General Assembly, no later than the second Friday in April of
7 1979 and each year thereafter, in regard to:
8 (a) actual statistics and trends in utilization of
9 medical services by public aid recipients;
10 (b) actual statistics and trends in the provision
11 of the various medical services by medical vendors;
12 (c) current rate structures and proposed changes in
13 those rate structures for the various medical vendors;
14 and
15 (d) efforts at utilization review and control by
16 the Illinois Department.
17 The period covered by each report shall be the 3 years
18 ending on the June 30 prior to the report. The report shall
19 include suggested legislation for consideration by the
20 General Assembly. The filing of one copy of the report with
21 the Speaker, one copy with the Minority Leader and one copy
22 with the Clerk of the House of Representatives, one copy with
23 the President, one copy with the Minority Leader and one copy
24 with the Secretary of the Senate, one copy with the
25 Legislative Research Unit, such additional copies with the
26 State Government Report Distribution Center for the General
27 Assembly as is required under paragraph (t) of Section 7 of
28 the State Library Act and one copy with the Citizens
29 Assembly/Council on Public Aid or its successor shall be
30 deemed sufficient to comply with this Section.
31 (Source: P.A. 88-670, eff. 12-2-94; 89-21, eff. 7-1-95;
32 89-517, eff. 1-1-97.)
33 (Text of Section after amendment by P.A. 89-507)
34 Sec. 5-5. Medical services. The Illinois Department, by
-10- LRB9003202DJmg
1 rule, shall determine the quantity and quality of and the
2 rate of reimbursement for the medical assistance for which
3 payment will be authorized, and the medical services to be
4 provided, which may include all or part of the following: (1)
5 inpatient hospital services; (2) outpatient hospital
6 services; (3) other laboratory and X-ray services; (4)
7 skilled nursing home services; (5) physicians' services
8 whether furnished in the office, the patient's home, a
9 hospital, a skilled nursing home, or elsewhere; (6) medical
10 care, or any other type of remedial care furnished by
11 licensed practitioners; (7) home health care services; (8)
12 private duty nursing service; (9) clinic services; (10)
13 dental services; (11) physical therapy and related services;
14 (12) prescribed drugs, dentures, and prosthetic devices; and
15 eyeglasses prescribed by a physician skilled in the diseases
16 of the eye, or by an optometrist, whichever the person may
17 select; (13) other diagnostic, screening, preventive, and
18 rehabilitative services; (14) transportation and such other
19 expenses as may be necessary; (15) medical treatment of
20 sexual assault survivors, as defined in Section 1a of the
21 Sexual Assault Survivors Emergency Treatment Act, for
22 injuries sustained as a result of the sexual assault,
23 including examinations and laboratory tests to discover
24 evidence which may be used in criminal proceedings arising
25 from the sexual assault; (16) the diagnosis and treatment of
26 sickle cell anemia; and (17) any other medical care, and any
27 other type of remedial care recognized under the laws of this
28 State, but not including abortions, or induced miscarriages
29 or premature births, unless, in the opinion of a physician,
30 such procedures are necessary for the preservation of the
31 life of the woman seeking such treatment, or except an
32 induced premature birth intended to produce a live viable
33 child and such procedure is necessary for the health of the
34 mother or her unborn child. The Illinois Department, by rule,
-11- LRB9003202DJmg
1 shall prohibit any physician from providing medical
2 assistance to anyone eligible therefor under this Code where
3 such physician has been found guilty of performing an
4 abortion procedure in a wilful and wanton manner upon a woman
5 who was not pregnant at the time such abortion procedure was
6 performed. The term "any other type of remedial care" shall
7 include nursing care and nursing home service for persons who
8 rely on treatment by spiritual means alone through prayer for
9 healing.
10 The Illinois Department of Public Aid shall provide the
11 following services to persons who are eligible for assistance
12 under this Article and who are participating in education,
13 training or employment programs operated by the Department of
14 Human Services as successor to the Department of Public Aid:
15 (1) dental services, which shall include but not be
16 limited to prosthodontics; and
17 (2) eyeglasses prescribed by a physician skilled in
18 the diseases of the eye, or by an optometrist, whichever
19 the person may select.
20 The Illinois Department, by rule, may distinguish and
21 classify the medical services to be provided only in
22 accordance with the classes of persons designated in Section
23 5-2.
24 The Illinois Department shall authorize the provision of,
25 and shall authorize payment for, screening by low-dose
26 mammography for the presence of occult breast cancer for
27 women 35 years of age or older who are eligible for medical
28 assistance under this Article, as follows: a baseline
29 mammogram for women 35 to 39 years of age; a mammogram every
30 1 to 2 years, even if no symptoms are present, for women 40
31 to 49 years of age; and an annual mammogram for women 50
32 years of age or older. All screenings shall include a
33 physical breast exam, instruction on self-examination and
34 information regarding the frequency of self-examination and
-12- LRB9003202DJmg
1 its value as a preventative tool. As used in this Section,
2 "low-dose mammography" means the x-ray examination of the
3 breast using equipment dedicated specifically for
4 mammography, including the x-ray tube, filter, compression
5 device, image receptor, and cassettes, with an average
6 radiation exposure delivery of less than one rad mid-breast,
7 with 2 views for each breast.
8 Any medical or health care provider shall immediately
9 recommend, to any pregnant woman who is being provided
10 prenatal services and is suspected of drug abuse or is
11 addicted as defined in the Alcoholism and Other Drug Abuse
12 and Dependency Act, referral to a local substance abuse
13 treatment provider licensed by the Department of Human
14 Services or to a licensed hospital which provides substance
15 abuse treatment services. The Department of Public Aid shall
16 assure coverage for the cost of treatment of the drug abuse
17 or addiction for pregnant recipients in accordance with the
18 Illinois Medicaid Program in conjunction with the Department
19 of Human Services.
20 All medical providers providing medical assistance to
21 pregnant women under this Code shall receive information from
22 the Department on the availability of services under the Drug
23 Free Families with a Future or any comparable program
24 providing case management services for addicted women,
25 including information on appropriate referrals for other
26 social services that may be needed by addicted women in
27 addition to treatment for addiction.
28 The Illinois Department, in cooperation with the
29 Departments of Human Services (as successor to the Department
30 of Alcoholism and Substance Abuse) and Public Health, through
31 a public awareness campaign, may provide information
32 concerning treatment for alcoholism and drug abuse and
33 addiction, prenatal health care, and other pertinent programs
34 directed at reducing the number of drug-affected infants born
-13- LRB9003202DJmg
1 to recipients of medical assistance.
2 Neither the Illinois Department of Public Aid nor the
3 Department of Human Services shall sanction the recipient
4 solely on the basis of her substance abuse.
5 The Illinois Department shall establish such regulations
6 governing the dispensing of health services under this
7 Article as it shall deem appropriate. In formulating these
8 regulations the Illinois Department shall consult with and
9 give substantial weight to the recommendations offered by the
10 Citizens Assembly/Council on Public Aid. The Department
11 should seek the advice of formal professional advisory
12 committees appointed by the Director of the Illinois
13 Department for the purpose of providing regular advice on
14 policy and administrative matters, information dissemination
15 and educational activities for medical and health care
16 providers, and consistency in procedures to the Illinois
17 Department.
18 The Illinois Department may develop and contract with
19 Partnerships of medical providers to arrange medical services
20 for persons eligible under Section 5-2 of this Code.
21 Implementation of this Section may be by demonstration
22 projects in certain geographic areas. The Partnership shall
23 be represented by a sponsor organization. The Department, by
24 rule, shall develop qualifications for sponsors of
25 Partnerships. Nothing in this Section shall be construed to
26 require that the sponsor organization be a medical
27 organization.
28 The sponsor must negotiate formal written contracts with
29 medical providers for physician services, inpatient and
30 outpatient hospital care, home health services, treatment for
31 alcoholism and substance abuse, and other services determined
32 necessary by the Illinois Department by rule for delivery by
33 Partnerships. Physician services must include prenatal and
34 obstetrical care. The Illinois Department shall reimburse
-14- LRB9003202DJmg
1 medical services delivered by Partnership providers to
2 clients in target areas according to provisions of this
3 Article and the Illinois Health Finance Reform Act, except
4 that:
5 (1) Physicians participating in a Partnership and
6 providing certain services, which shall be determined by
7 the Illinois Department, to persons in areas covered by
8 the Partnership may receive an additional surcharge for
9 such services.
10 (2) The Department may elect to consider and
11 negotiate financial incentives to encourage the
12 development of Partnerships and the efficient delivery of
13 medical care.
14 (3) Persons receiving medical services through
15 Partnerships may receive medical and case management
16 services above the level usually offered through the
17 medical assistance program.
18 Medical providers shall be required to meet certain
19 qualifications to participate in Partnerships to ensure the
20 delivery of high quality medical services. These
21 qualifications shall be determined by rule of the Illinois
22 Department and may be higher than qualifications for
23 participation in the medical assistance program. Partnership
24 sponsors may prescribe reasonable additional qualifications
25 for participation by medical providers, only with the prior
26 written approval of the Illinois Department.
27 Nothing in this Section shall limit the free choice of
28 practitioners, hospitals, and other providers of medical
29 services by clients.
30 The Department shall apply for a waiver from the United
31 States Health Care Financing Administration to allow for the
32 implementation of Partnerships under this Section.
33 The Illinois Department shall require health care
34 providers to maintain records that document the medical care
-15- LRB9003202DJmg
1 and services provided to recipients of Medical Assistance
2 under this Article. The Illinois Department shall require
3 health care providers to make available, when authorized by
4 the patient, in writing, the medical records in a timely
5 fashion to other health care providers who are treating or
6 serving persons eligible for Medical Assistance under this
7 Article. All dispensers of medical services shall be
8 required to maintain and retain business and professional
9 records sufficient to fully and accurately document the
10 nature, scope, details and receipt of the health care
11 provided to persons eligible for medical assistance under
12 this Code, in accordance with regulations promulgated by the
13 Illinois Department. The rules and regulations shall require
14 that proof of the receipt of prescription drugs, dentures,
15 prosthetic devices and eyeglasses by eligible persons under
16 this Section accompany each claim for reimbursement submitted
17 by the dispenser of such medical services. No such claims for
18 reimbursement shall be approved for payment by the Illinois
19 Department without such proof of receipt, unless the Illinois
20 Department shall have put into effect and shall be operating
21 a system of post-payment audit and review which shall, on a
22 sampling basis, be deemed adequate by the Illinois Department
23 to assure that such drugs, dentures, prosthetic devices and
24 eyeglasses for which payment is being made are actually being
25 received by eligible recipients. Within 90 days after the
26 effective date of this amendatory Act of 1984, the Illinois
27 Department shall establish a current list of acquisition
28 costs for all prosthetic devices and any other items
29 recognized as medical equipment and supplies reimbursable
30 under this Article and shall update such list on a quarterly
31 basis, except that the acquisition costs of all prescription
32 drugs shall be updated no less frequently than every 30 days
33 as required by Section 5-5.12.
34 The rules and regulations of the Illinois Department
-16- LRB9003202DJmg
1 shall require that a written statement including the required
2 opinion of a physician shall accompany any claim for
3 reimbursement for abortions, or induced miscarriages or
4 premature births. This statement shall indicate what
5 procedures were used in providing such medical services.
6 The Illinois Department shall require that all dispensers
7 of medical services, other than an individual practitioner or
8 group of practitioners, desiring to participate in the
9 Medical Assistance program established under this Article to
10 disclose all financial, beneficial, ownership, equity, surety
11 or other interests in any and all firms, corporations,
12 partnerships, associations, business enterprises, joint
13 ventures, agencies, institutions or other legal entities
14 providing any form of health care services in this State
15 under this Article.
16 The Illinois Department may require that all dispensers
17 of medical services desiring to participate in the medical
18 assistance program established under this Article disclose,
19 under such terms and conditions as the Illinois Department
20 may by rule establish, all inquiries from clients and
21 attorneys regarding medical bills paid by the Illinois
22 Department, which inquiries could indicate potential
23 existence of claims or liens for the Illinois Department.
24 The Illinois Department shall establish policies,
25 procedures, standards and criteria by rule for the
26 acquisition, repair and replacement of orthotic and
27 prosthetic devices and durable medical equipment. Such rules
28 shall provide, but not be limited to, the following services:
29 (1) immediate repair or replacement of such devices by
30 recipients without medical authorization; and (2) rental,
31 lease, purchase or lease-purchase of durable medical
32 equipment in a cost-effective manner, taking into
33 consideration the recipient's medical prognosis, the extent
34 of the recipient's needs, and the requirements and costs for
-17- LRB9003202DJmg
1 maintaining such equipment. Such rules shall enable a
2 recipient to temporarily acquire and use alternative or
3 substitute devices or equipment pending repairs or
4 replacements of any device or equipment previously authorized
5 for such recipient by the Department. Rules under clause (2)
6 above shall not provide for purchase or lease-purchase of
7 durable medical equipment or supplies used for the purpose of
8 oxygen delivery and respiratory care.
9 The Department shall execute, relative to the nursing
10 home prescreening project, written inter-agency agreements
11 with the Department of Human Services and the Department on
12 Aging, to effect the following: (i) intake procedures and
13 common eligibility criteria for those persons who are
14 receiving non-institutional services; and (ii) the
15 establishment and development of non-institutional services
16 in areas of the State where they are not currently available
17 or are undeveloped.
18 The Illinois Department shall develop and operate, in
19 cooperation with other State Departments and agencies and in
20 compliance with applicable federal laws and regulations,
21 appropriate and effective systems of health care evaluation
22 and programs for monitoring of utilization of health care
23 services and facilities, as it affects persons eligible for
24 medical assistance under this Code. The Illinois Department
25 shall report regularly the results of the operation of such
26 systems and programs to the Citizens Assembly/Council on
27 Public Aid to enable the Committee to ensure, from time to
28 time, that these programs are effective and meaningful.
29 The Illinois Department shall report annually to the
30 General Assembly, no later than the second Friday in April of
31 1979 and each year thereafter, in regard to:
32 (a) actual statistics and trends in utilization of
33 medical services by public aid recipients;
34 (b) actual statistics and trends in the provision
-18- LRB9003202DJmg
1 of the various medical services by medical vendors;
2 (c) current rate structures and proposed changes in
3 those rate structures for the various medical vendors;
4 and
5 (d) efforts at utilization review and control by
6 the Illinois Department.
7 The period covered by each report shall be the 3 years
8 ending on the June 30 prior to the report. The report shall
9 include suggested legislation for consideration by the
10 General Assembly. The filing of one copy of the report with
11 the Speaker, one copy with the Minority Leader and one copy
12 with the Clerk of the House of Representatives, one copy with
13 the President, one copy with the Minority Leader and one copy
14 with the Secretary of the Senate, one copy with the
15 Legislative Research Unit, such additional copies with the
16 State Government Report Distribution Center for the General
17 Assembly as is required under paragraph (t) of Section 7 of
18 the State Library Act and one copy with the Citizens
19 Assembly/Council on Public Aid or its successor shall be
20 deemed sufficient to comply with this Section.
21 (Source: P.A. 88-670, eff. 12-2-94; 89-21, eff. 7-1-95;
22 89-507, eff. 7-1-97; 89-517, eff. 1-1-97; revised 8-26-96.)
23 Section 95. No acceleration or delay. Where this Act
24 makes changes in a statute that is represented in this Act by
25 text that is not yet or no longer in effect (for example, a
26 Section represented by multiple versions), the use of that
27 text does not accelerate or delay the taking effect of (i)
28 the changes made by this Act or (ii) provisions derived from
29 any other Public Act.