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92_HB3683
LRB9211038DJgc
1 AN ACT in relation to public aid.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Illinois Public Aid Code is amended by
5 changing Section 5-5 as follows:
6 (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
7 Sec. 5-5. Medical services. The Illinois Department, by
8 rule, shall determine the quantity and quality of and the
9 rate of reimbursement for the medical assistance for which
10 payment will be authorized, and the medical services to be
11 provided, which may include all or part of the following: (1)
12 inpatient hospital services; (2) outpatient hospital
13 services; (3) other laboratory and X-ray services; (4)
14 skilled nursing home services; (5) physicians' services
15 whether furnished in the office, the patient's home, a
16 hospital, a skilled nursing home, or elsewhere; (6) medical
17 care, or any other type of remedial care furnished by
18 licensed practitioners; (7) home health care services; (8)
19 private duty nursing service; (9) clinic services; (10)
20 dental services; (11) physical therapy and related services;
21 (12) prescribed drugs, dentures, and prosthetic devices; and
22 eyeglasses prescribed by a physician skilled in the diseases
23 of the eye, or by an optometrist, whichever the person may
24 select; (13) other diagnostic, screening, preventive, and
25 rehabilitative services; (14) transportation and such other
26 expenses as may be necessary; (15) medical treatment of
27 sexual assault survivors, as defined in Section 1a of the
28 Sexual Assault Survivors Emergency Treatment Act, for
29 injuries sustained as a result of the sexual assault,
30 including examinations and laboratory tests to discover
31 evidence which may be used in criminal proceedings arising
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1 from the sexual assault; (16) the diagnosis and treatment of
2 sickle cell anemia; and (17) any other medical care, and any
3 other type of remedial care recognized under the laws of this
4 State, but not including abortions, or induced miscarriages
5 or premature births, unless, in the opinion of a physician,
6 such procedures are necessary for the preservation of the
7 life of the woman seeking such treatment, or except an
8 induced premature birth intended to produce a live viable
9 child and such procedure is necessary for the health of the
10 mother or her unborn child. The Illinois Department, by rule,
11 shall prohibit any physician from providing medical
12 assistance to anyone eligible therefor under this Code where
13 such physician has been found guilty of performing an
14 abortion procedure in a wilful and wanton manner upon a woman
15 who was not pregnant at the time such abortion procedure was
16 performed. The term "any other type of remedial care" shall
17 include nursing care and nursing home service for persons who
18 rely on treatment by spiritual means alone through prayer for
19 healing.
20 Notwithstanding any other provision of this Section, a
21 comprehensive tobacco use cessation program that includes
22 purchasing prescription drugs or prescription medical devices
23 approved by the Food and Drug administration shall be covered
24 under the medical assistance program under this Article for
25 persons who are otherwise eligible for assistance under this
26 Article.
27 Notwithstanding any other provision of this Section,
28 medically necessary organ transplants shall be covered under
29 the medical assistance program under this Article for persons
30 who are otherwise eligible for assistance under this Article,
31 as well as for legal aliens residing in Illinois whose income
32 and assets render them eligible for assistance under this
33 Article, regardless of whether they meet the other
34 eligibility requirements under this Article.
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1 Notwithstanding any other provision of this Code, the
2 Illinois Department may not require, as a condition of
3 payment for any laboratory test authorized under this
4 Article, that a physician's handwritten signature appear on
5 the laboratory test order form. The Illinois Department may,
6 however, impose other appropriate requirements regarding
7 laboratory test order documentation.
8 The Illinois Department of Public Aid shall provide the
9 following services to persons eligible for assistance under
10 this Article who are participating in education, training or
11 employment programs operated by the Department of Human
12 Services as successor to the Department of Public Aid:
13 (1) dental services, which shall include but not be
14 limited to prosthodontics; and
15 (2) eyeglasses prescribed by a physician skilled in
16 the diseases of the eye, or by an optometrist, whichever
17 the person may select.
18 The Illinois Department, by rule, may distinguish and
19 classify the medical services to be provided only in
20 accordance with the classes of persons designated in Section
21 5-2.
22 The Illinois Department shall authorize the provision of,
23 and shall authorize payment for, screening by low-dose
24 mammography for the presence of occult breast cancer for
25 women 35 years of age or older who are eligible for medical
26 assistance under this Article, as follows: a baseline
27 mammogram for women 35 to 39 years of age and an annual
28 mammogram for women 40 years of age or older. All screenings
29 shall include a physical breast exam, instruction on
30 self-examination and information regarding the frequency of
31 self-examination and its value as a preventative tool. As
32 used in this Section, "low-dose mammography" means the x-ray
33 examination of the breast using equipment dedicated
34 specifically for mammography, including the x-ray tube,
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1 filter, compression device, image receptor, and cassettes,
2 with an average radiation exposure delivery of less than one
3 rad mid-breast, with 2 views for each breast.
4 Any medical or health care provider shall immediately
5 recommend, to any pregnant woman who is being provided
6 prenatal services and is suspected of drug abuse or is
7 addicted as defined in the Alcoholism and Other Drug Abuse
8 and Dependency Act, referral to a local substance abuse
9 treatment provider licensed by the Department of Human
10 Services or to a licensed hospital which provides substance
11 abuse treatment services. The Department of Public Aid shall
12 assure coverage for the cost of treatment of the drug abuse
13 or addiction for pregnant recipients in accordance with the
14 Illinois Medicaid Program in conjunction with the Department
15 of Human Services.
16 All medical providers providing medical assistance to
17 pregnant women under this Code shall receive information from
18 the Department on the availability of services under the Drug
19 Free Families with a Future or any comparable program
20 providing case management services for addicted women,
21 including information on appropriate referrals for other
22 social services that may be needed by addicted women in
23 addition to treatment for addiction.
24 The Illinois Department, in cooperation with the
25 Departments of Human Services (as successor to the Department
26 of Alcoholism and Substance Abuse) and Public Health, through
27 a public awareness campaign, may provide information
28 concerning treatment for alcoholism and drug abuse and
29 addiction, prenatal health care, and other pertinent programs
30 directed at reducing the number of drug-affected infants born
31 to recipients of medical assistance.
32 Neither the Illinois Department of Public Aid nor the
33 Department of Human Services shall sanction the recipient
34 solely on the basis of her substance abuse.
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1 The Illinois Department shall establish such regulations
2 governing the dispensing of health services under this
3 Article as it shall deem appropriate. In formulating these
4 regulations the Illinois Department shall consult with and
5 give substantial weight to the recommendations offered by the
6 Citizens Assembly/Council on Public Aid. The Department
7 should seek the advice of formal professional advisory
8 committees appointed by the Director of the Illinois
9 Department for the purpose of providing regular advice on
10 policy and administrative matters, information dissemination
11 and educational activities for medical and health care
12 providers, and consistency in procedures to the Illinois
13 Department.
14 The Illinois Department may develop and contract with
15 Partnerships of medical providers to arrange medical services
16 for persons eligible under Section 5-2 of this Code.
17 Implementation of this Section may be by demonstration
18 projects in certain geographic areas. The Partnership shall
19 be represented by a sponsor organization. The Department, by
20 rule, shall develop qualifications for sponsors of
21 Partnerships. Nothing in this Section shall be construed to
22 require that the sponsor organization be a medical
23 organization.
24 The sponsor must negotiate formal written contracts with
25 medical providers for physician services, inpatient and
26 outpatient hospital care, home health services, treatment for
27 alcoholism and substance abuse, and other services determined
28 necessary by the Illinois Department by rule for delivery by
29 Partnerships. Physician services must include prenatal and
30 obstetrical care. The Illinois Department shall reimburse
31 medical services delivered by Partnership providers to
32 clients in target areas according to provisions of this
33 Article and the Illinois Health Finance Reform Act, except
34 that:
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1 (1) Physicians participating in a Partnership and
2 providing certain services, which shall be determined by
3 the Illinois Department, to persons in areas covered by
4 the Partnership may receive an additional surcharge for
5 such services.
6 (2) The Department may elect to consider and
7 negotiate financial incentives to encourage the
8 development of Partnerships and the efficient delivery of
9 medical care.
10 (3) Persons receiving medical services through
11 Partnerships may receive medical and case management
12 services above the level usually offered through the
13 medical assistance program.
14 Medical providers shall be required to meet certain
15 qualifications to participate in Partnerships to ensure the
16 delivery of high quality medical services. These
17 qualifications shall be determined by rule of the Illinois
18 Department and may be higher than qualifications for
19 participation in the medical assistance program. Partnership
20 sponsors may prescribe reasonable additional qualifications
21 for participation by medical providers, only with the prior
22 written approval of the Illinois Department.
23 Nothing in this Section shall limit the free choice of
24 practitioners, hospitals, and other providers of medical
25 services by clients. In order to ensure patient freedom of
26 choice, the Illinois Department shall immediately promulgate
27 all rules and take all other necessary actions so that
28 provided services may be accessed from therapeutically
29 certified optometrists to the full extent of the Illinois
30 Optometric Practice Act of 1987 without discriminating
31 between service providers.
32 The Department shall apply for a waiver from the United
33 States Health Care Financing Administration to allow for the
34 implementation of Partnerships under this Section.
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1 The Illinois Department shall require health care
2 providers to maintain records that document the medical care
3 and services provided to recipients of Medical Assistance
4 under this Article. The Illinois Department shall require
5 health care providers to make available, when authorized by
6 the patient, in writing, the medical records in a timely
7 fashion to other health care providers who are treating or
8 serving persons eligible for Medical Assistance under this
9 Article. All dispensers of medical services shall be
10 required to maintain and retain business and professional
11 records sufficient to fully and accurately document the
12 nature, scope, details and receipt of the health care
13 provided to persons eligible for medical assistance under
14 this Code, in accordance with regulations promulgated by the
15 Illinois Department. The rules and regulations shall require
16 that proof of the receipt of prescription drugs, dentures,
17 prosthetic devices and eyeglasses by eligible persons under
18 this Section accompany each claim for reimbursement submitted
19 by the dispenser of such medical services. No such claims for
20 reimbursement shall be approved for payment by the Illinois
21 Department without such proof of receipt, unless the Illinois
22 Department shall have put into effect and shall be operating
23 a system of post-payment audit and review which shall, on a
24 sampling basis, be deemed adequate by the Illinois Department
25 to assure that such drugs, dentures, prosthetic devices and
26 eyeglasses for which payment is being made are actually being
27 received by eligible recipients. Within 90 days after the
28 effective date of this amendatory Act of 1984, the Illinois
29 Department shall establish a current list of acquisition
30 costs for all prosthetic devices and any other items
31 recognized as medical equipment and supplies reimbursable
32 under this Article and shall update such list on a quarterly
33 basis, except that the acquisition costs of all prescription
34 drugs shall be updated no less frequently than every 30 days
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1 as required by Section 5-5.12.
2 The rules and regulations of the Illinois Department
3 shall require that a written statement including the required
4 opinion of a physician shall accompany any claim for
5 reimbursement for abortions, or induced miscarriages or
6 premature births. This statement shall indicate what
7 procedures were used in providing such medical services.
8 The Illinois Department shall require that all dispensers
9 of medical services, other than an individual practitioner or
10 group of practitioners, desiring to participate in the
11 Medical Assistance program established under this Article to
12 disclose all financial, beneficial, ownership, equity, surety
13 or other interests in any and all firms, corporations,
14 partnerships, associations, business enterprises, joint
15 ventures, agencies, institutions or other legal entities
16 providing any form of health care services in this State
17 under this Article.
18 The Illinois Department may require that all dispensers
19 of medical services desiring to participate in the medical
20 assistance program established under this Article disclose,
21 under such terms and conditions as the Illinois Department
22 may by rule establish, all inquiries from clients and
23 attorneys regarding medical bills paid by the Illinois
24 Department, which inquiries could indicate potential
25 existence of claims or liens for the Illinois Department.
26 The Illinois Department shall establish policies,
27 procedures, standards and criteria by rule for the
28 acquisition, repair and replacement of orthotic and
29 prosthetic devices and durable medical equipment. Such rules
30 shall provide, but not be limited to, the following services:
31 (1) immediate repair or replacement of such devices by
32 recipients without medical authorization; and (2) rental,
33 lease, purchase or lease-purchase of durable medical
34 equipment in a cost-effective manner, taking into
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1 consideration the recipient's medical prognosis, the extent
2 of the recipient's needs, and the requirements and costs for
3 maintaining such equipment. Such rules shall enable a
4 recipient to temporarily acquire and use alternative or
5 substitute devices or equipment pending repairs or
6 replacements of any device or equipment previously authorized
7 for such recipient by the Department. Rules under clause (2)
8 above shall not provide for purchase or lease-purchase of
9 durable medical equipment or supplies used for the purpose of
10 oxygen delivery and respiratory care.
11 The Department shall execute, relative to the nursing
12 home prescreening project, written inter-agency agreements
13 with the Department of Human Services and the Department on
14 Aging, to effect the following: (i) intake procedures and
15 common eligibility criteria for those persons who are
16 receiving non-institutional services; and (ii) the
17 establishment and development of non-institutional services
18 in areas of the State where they are not currently available
19 or are undeveloped.
20 The Illinois Department shall develop and operate, in
21 cooperation with other State Departments and agencies and in
22 compliance with applicable federal laws and regulations,
23 appropriate and effective systems of health care evaluation
24 and programs for monitoring of utilization of health care
25 services and facilities, as it affects persons eligible for
26 medical assistance under this Code. The Illinois Department
27 shall report regularly the results of the operation of such
28 systems and programs to the Citizens Assembly/Council on
29 Public Aid to enable the Committee to ensure, from time to
30 time, that these programs are effective and meaningful.
31 The Illinois Department shall report annually to the
32 General Assembly, no later than the second Friday in April of
33 1979 and each year thereafter, in regard to:
34 (a) actual statistics and trends in utilization of
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1 medical services by public aid recipients;
2 (b) actual statistics and trends in the provision
3 of the various medical services by medical vendors;
4 (c) current rate structures and proposed changes in
5 those rate structures for the various medical vendors;
6 and
7 (d) efforts at utilization review and control by
8 the Illinois Department.
9 The period covered by each report shall be the 3 years
10 ending on the June 30 prior to the report. The report shall
11 include suggested legislation for consideration by the
12 General Assembly. The filing of one copy of the report with
13 the Speaker, one copy with the Minority Leader and one copy
14 with the Clerk of the House of Representatives, one copy with
15 the President, one copy with the Minority Leader and one copy
16 with the Secretary of the Senate, one copy with the
17 Legislative Research Unit, such additional copies with the
18 State Government Report Distribution Center for the General
19 Assembly as is required under paragraph (t) of Section 7 of
20 the State Library Act and one copy with the Citizens
21 Assembly/Council on Public Aid or its successor shall be
22 deemed sufficient to comply with this Section.
23 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
24 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
25 Section 99. Effective date. This Act takes effect upon
26 becoming law.