MEDICAID-AMBULANCE PAYMENTS Senate SponsorsSen. Sara Feigenholtz House Sponsors(Rep. Jay Hoffman, Bradley Stephens and Thaddeus Jones) 8/27/2021SenatePublic Act . . . . . . . . . 102-0650 305 ILCS 5/5-4.2from Ch. 23, par. 5-4.2Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision requiring the Department of Healthcare and Family Services to establish, by rule, a process by which a provider of ambulance services can appeal a denied request for payment of ambulance services (rather than payment of non-emergency transportation by means of ground ambulance service), provides that for all appeals concerning ambulance services provided on and after December 15, 2012, the provider shall establish the medical necessity of the transport utilizing the patient care report and any other materials available in accordance with specified criteria established under the Code. Provides that a Physician Certification Statement, Certificate of Transportation Services, or Medical Certification for Non-Emergency Ambulance form is not necessary to establish subject matter jurisdiction for appeal or medical necessity on appeal but may be considered if available. Provides that all Department rules, or parts thereof, in conflict with the provisions of the amendatory Act shall not apply. Provides that nothing in the amendatory Act shall be construed to affect any rights, actions, or causes of action that accrued prior to the effective date of the amendatory Act, except that the non-necessity of a Physician Certification Statement, Certificate of Transportation Services, or Medical Certification for Non-Emergency Ambulance form as provided in the amendatory Act shall be retroactively applied to the full extent permissible.Senate Floor Amendment No. 1 Replaces everything after the enacting clause. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for all claims concerning ambulance services provided to fee-for-service Medicaid beneficiaries denied for failure of submittal of a valid Physician Certification Statement, Certificate of Transportation Services, or Medical Certification for Non-Emergency Ambulance provided on and after December 15, 2012, the provider shall be able to appeal such denial and establish the medical necessity of the transport utilizing the patient care report and any other materials available in accordance with specified criteria established under the Code. Provides that a Physician Certification Statement, Certificate of Transportation Services, or Medical Certification for Non-Emergency Ambulance form is not necessary to establish subject matter jurisdiction for appeal or medical necessity on appeal but may be considered if available. Provides that all Department rules, or parts thereof, in conflict with the provisions of the amendatory Act shall not apply. Provides that nothing in the amendatory Act shall be construed to affect any rights, actions, or causes of action that accrued prior to the effective date of the amendatory Act, except that the non-necessity of a Physician Certification Statement, Certificate of Transportation Services, or Medical Certification for Non-Emergency Ambulance form as provided in the amendatory Act shall be retroactively applied to the full extent permissible, including allowing any claims denied for failure to 4procure such form which were not appealed at the time of denial to have an opportunity for proper appeal.House Floor Amendment No. 1 Replaces everything after the enacting clause. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for non-emergency ground ambulance claims properly denied under the policy of the Department of Healthcare and Family Services at the time the claim is filed due to failure to submit a valid Medical Certification for Non-Emergency Ambulance on and after December 15, 2012 and prior to January 1, 2021, the Department shall allot $2,000,000 to a pool to reimburse such claims if the provider proves medical necessity for the service by other means. Requires providers to submit any such denied claims for which they seek compensation to the Department no later than December 31, 2021 along with documentation of medical necessity. Provides that no later than May 31, 2022, the Department shall determine for which claims medical necessity was established. Provides that such claims for which medical necessity was established shall be paid at the rate in effect at the time of the service, provided the $2,000,000 is sufficient to pay at those rates. Provides that if the pool is not sufficient, claims shall be paid at a uniform percentage of the applicable rate such that the pool of $2,000,000 is exhausted. Provides that the appeal process described in a specified provision of the Code shall not be applicable to the Department's determinations. Effective immediately. 2/26/2021SenateFiled with Secretary by Sen. Sara Feigenholtz 2/26/2021SenateFirst Reading 2/26/2021SenateReferred to Assignments 3/23/2021SenateAssigned to Health 3/31/2021SenateTo Subcommittee on Medicaid 4/7/2021SenateReported Back To Health; 005-000-000 4/14/2021SenateDo Pass Health; 013-000-000 4/14/2021SenatePlaced on Calendar Order of 2nd Reading April 15, 2021 4/16/2021SenateSenate Floor Amendment No. 1 Filed with Secretary by Sen. Sara Feigenholtz 4/16/2021SenateSenate Floor Amendment No. 1 Referred to Assignments 4/20/2021SenateSenate Floor Amendment No. 1 Assignments Refers to Health 4/20/2021SenateSenate Floor Amendment No. 1 Recommend Do Adopt Health; 011-000-000 4/20/2021SenateSenate Floor Amendment No. 1 Adopted; Feigenholtz 4/20/2021SenateSecond Reading 4/20/2021SenatePlaced on Calendar Order of 3rd Reading April 21, 2021 4/21/2021SenateThird Reading - Passed; 056-000-000 4/28/2021HouseArrived in House 4/28/2021HouseChief House Sponsor Rep. Jay Hoffman 4/28/2021HouseFirst Reading 4/28/2021HouseReferred to Rules Committee 4/28/2021HouseAssigned to Appropriations-Human Services Committee 5/5/2021HouseAdded Alternate Co-Sponsor Rep. Bradley Stephens 5/13/2021HouseAdded Alternate Co-Sponsor Rep. Thaddeus Jones 5/13/2021HouseDo Pass / Short Debate Appropriations-Human Services Committee; 021-000-000 5/13/2021HousePlaced on Calendar 2nd Reading - Short Debate 5/19/2021HouseHouse Floor Amendment No. 1 Filed with Clerk by Rep. Jay Hoffman 5/19/2021HouseHouse Floor Amendment No. 1 Referred to Rules Committee 5/24/2021HouseHouse Floor Amendment No. 1 Recommends Be Adopted Rules Committee; 003-001-000 5/26/2021HouseSecond Reading - Short Debate 5/26/2021HouseHeld on Calendar Order of Second Reading - Short Debate 5/28/2021HouseFinal Action Deadline Extended-9(b) May 31, 2021 5/30/2021HouseHouse Floor Amendment No. 1 Adopted 5/30/2021HousePlaced on Calendar Order of 3rd Reading - Short Debate 5/30/2021HouseThird Reading - Short Debate - Passed 114-000-000 5/30/2021SenateSecretary's Desk - Concurrence House Amendment(s) 1 5/30/2021SenatePlaced on Calendar Order of Concurrence House Amendment(s) 1 - May 31, 2021 5/30/2021SenateHouse Floor Amendment No. 1 Motion to Concur Filed with Secretary Sen. Sara Feigenholtz 5/30/2021SenateHouse Floor Amendment No. 1 Motion to Concur Referred to Assignments 5/30/2021SenateHouse Floor Amendment No. 1 Motion to Concur Assignments Referred to State Government 5/31/2021SenateHouse Floor Amendment No. 1 Motion To Concur Recommended Do Adopt State Government; 009-000-000 5/31/2021SenateHouse Floor Amendment No. 1 Senate Concurs 058-000-000 5/31/2021SenateSenate Concurs 5/31/2021SenatePassed Both Houses 6/29/2021SenateSent to the Governor 8/27/2021SenateGovernor Approved 8/27/2021SenateEffective Date August 27, 2021 8/27/2021SenatePublic Act . . . . . . . . . 102-0650