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Public Act 100-0135


 

Public Act 0135 100TH GENERAL ASSEMBLY

  
  
  

 


 
Public Act 100-0135
 
HB2909 EnrolledLRB100 08468 KTG 18586 b

    AN ACT concerning public aid.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Public Aid Code is amended by
changing Section 5-5f as follows:
 
    (305 ILCS 5/5-5f)
    Sec. 5-5f. Elimination and limitations of medical
assistance services. Notwithstanding any other provision of
this Code to the contrary, on and after July 1, 2012:
        (a) The following services shall no longer be a covered
    service available under this Code: group psychotherapy for
    residents of any facility licensed under the Nursing Home
    Care Act or the Specialized Mental Health Rehabilitation
    Act of 2013; and adult chiropractic services.
        (b) The Department shall place the following
    limitations on services: (i) the Department shall limit
    adult eyeglasses to one pair every 2 years; however, the
    limitation does not apply to an individual who needs
    different eyeglasses following a surgical procedure such
    as cataract surgery; (ii) the Department shall set an
    annual limit of a maximum of 20 visits for each of the
    following services: adult speech, hearing, and language
    therapy services, adult occupational therapy services, and
    physical therapy services; on or after October 1, 2014, the
    annual maximum limit of 20 visits shall expire but the
    Department shall require prior approval for all
    individuals for speech, hearing, and language therapy
    services, occupational therapy services, and physical
    therapy services; (iii) the Department shall limit adult
    podiatry services to individuals with diabetes; on or after
    October 1, 2014, podiatry services shall not be limited to
    individuals with diabetes; (iv) the Department shall pay
    for caesarean sections at the normal vaginal delivery rate
    unless a caesarean section was medically necessary; (v) the
    Department shall limit adult dental services to
    emergencies; beginning July 1, 2013, the Department shall
    ensure that the following conditions are recognized as
    emergencies: (A) dental services necessary for an
    individual in order for the individual to be cleared for a
    medical procedure, such as a transplant; (B) extractions
    and dentures necessary for a diabetic to receive proper
    nutrition; (C) extractions and dentures necessary as a
    result of cancer treatment; and (D) dental services
    necessary for the health of a pregnant woman prior to
    delivery of her baby; on or after July 1, 2014, adult
    dental services shall no longer be limited to emergencies,
    and dental services necessary for the health of a pregnant
    woman prior to delivery of her baby shall continue to be
    covered; and (vi) effective July 1, 2012, the Department
    shall place limitations and require concurrent review on
    every inpatient detoxification stay to prevent repeat
    admissions to any hospital for detoxification within 60
    days of a previous inpatient detoxification stay. The
    Department shall convene a workgroup of hospitals,
    substance abuse providers, care coordination entities,
    managed care plans, and other stakeholders to develop
    recommendations for quality standards, diversion to other
    settings, and admission criteria for patients who need
    inpatient detoxification, which shall be published on the
    Department's website no later than September 1, 2013.
        (c) The Department shall require prior approval of the
    following services: wheelchair repairs costing more than
    $400, coronary artery bypass graft, and bariatric surgery
    consistent with Medicare standards concerning patient
    responsibility. Wheelchair repair prior approval requests
    shall be adjudicated within one business day of receipt of
    complete supporting documentation. Providers may not break
    wheelchair repairs into separate claims for purposes of
    staying under the $400 threshold for requiring prior
    approval. The wholesale price of manual and power
    wheelchairs, durable medical equipment and supplies, and
    complex rehabilitation technology products and services
    shall be defined as actual acquisition cost including all
    discounts.
        (d) The Department shall establish benchmarks for
    hospitals to measure and align payments to reduce
    potentially preventable hospital readmissions, inpatient
    complications, and unnecessary emergency room visits. In
    doing so, the Department shall consider items, including,
    but not limited to, historic and current acuity of care and
    historic and current trends in readmission. The Department
    shall publish provider-specific historical readmission
    data and anticipated potentially preventable targets 60
    days prior to the start of the program. In the instance of
    readmissions, the Department shall adopt policies and
    rates of reimbursement for services and other payments
    provided under this Code to ensure that, by June 30, 2013,
    expenditures to hospitals are reduced by, at a minimum,
    $40,000,000.
        (e) The Department shall establish utilization
    controls for the hospice program such that it shall not pay
    for other care services when an individual is in hospice.
        (f) For home health services, the Department shall
    require Medicare certification of providers participating
    in the program and implement the Medicare face-to-face
    encounter rule. The Department shall require providers to
    implement auditable electronic service verification based
    on global positioning systems or other cost-effective
    technology.
        (g) For the Home Services Program operated by the
    Department of Human Services and the Community Care Program
    operated by the Department on Aging, the Department of
    Human Services, in cooperation with the Department on
    Aging, shall implement an electronic service verification
    based on global positioning systems or other
    cost-effective technology.
        (h) Effective with inpatient hospital admissions on or
    after July 1, 2012, the Department shall reduce the payment
    for a claim that indicates the occurrence of a
    provider-preventable condition during the admission as
    specified by the Department in rules. The Department shall
    not pay for services related to an other
    provider-preventable condition.
        As used in this subsection (h):
        "Provider-preventable condition" means a health care
    acquired condition as defined under the federal Medicaid
    regulation found at 42 CFR 447.26 or an other
    provider-preventable condition.
        "Other provider-preventable condition" means a wrong
    surgical or other invasive procedure performed on a
    patient, a surgical or other invasive procedure performed
    on the wrong body part, or a surgical procedure or other
    invasive procedure performed on the wrong patient.
        (i) The Department shall implement cost savings
    initiatives for advanced imaging services, cardiac imaging
    services, pain management services, and back surgery. Such
    initiatives shall be designed to achieve annual costs
    savings.
        (j) The Department shall ensure that beneficiaries
    with a diagnosis of epilepsy or seizure disorder in
    Department records will not require prior approval for
    anticonvulsants.
(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section
6-240, eff. 7-22-13; 98-104, Article 9, Section 9-5, eff.
7-22-13; 98-651, eff. 6-16-14; 98-756, eff. 7-16-14.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 8/18/2017