Sen. Omar Aquino

Filed: 2/22/2018





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2    AMENDMENT NO. ______. Amend Senate Bill 2429 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-5 and 5-30 as follows:
6    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
7    Sec. 5-5. Medical services. The Illinois Department, by
8rule, shall determine the quantity and quality of and the rate
9of reimbursement for the medical assistance for which payment
10will be authorized, and the medical services to be provided,
11which may include all or part of the following: (1) inpatient
12hospital services; (2) outpatient hospital services; (3) other
13laboratory and X-ray services; (4) skilled nursing home
14services; (5) physicians' services whether furnished in the
15office, the patient's home, a hospital, a skilled nursing home,
16or elsewhere; (6) medical care, or any other type of remedial



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1care furnished by licensed practitioners; (7) home health care
2services; (8) private duty nursing service; (9) clinic
3services; (10) dental services, including prevention and
4treatment of periodontal disease and dental caries disease for
5pregnant women, provided by an individual licensed to practice
6dentistry or dental surgery; for purposes of this item (10),
7"dental services" means diagnostic, preventive, or corrective
8procedures provided by or under the supervision of a dentist in
9the practice of his or her profession; (11) physical therapy
10and related services; (12) prescribed drugs, dentures, and
11prosthetic devices; and eyeglasses prescribed by a physician
12skilled in the diseases of the eye, or by an optometrist,
13whichever the person may select; (13) other diagnostic,
14screening, preventive, and rehabilitative services, including
15to ensure that the individual's need for intervention or
16treatment of mental disorders or substance use disorders or
17co-occurring mental health and substance use disorders is
18determined using a uniform screening, assessment, and
19evaluation process inclusive of criteria, for children and
20adults; for purposes of this item (13), a uniform screening,
21assessment, and evaluation process refers to a process that
22includes an appropriate evaluation and, as warranted, a
23referral; "uniform" does not mean the use of a singular
24instrument, tool, or process that all must utilize; (14)
25transportation and such other expenses as may be necessary;
26(15) medical treatment of sexual assault survivors, as defined



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1in Section 1a of the Sexual Assault Survivors Emergency
2Treatment Act, for injuries sustained as a result of the sexual
3assault, including examinations and laboratory tests to
4discover evidence which may be used in criminal proceedings
5arising from the sexual assault; (16) the diagnosis and
6treatment of sickle cell anemia; and (17) any other medical
7care, and any other type of remedial care recognized under the
8laws of this State. The term "any other type of remedial care"
9shall include nursing care and nursing home service for persons
10who rely on treatment by spiritual means alone through prayer
11for healing.
12    Notwithstanding any other provision of this Section, a
13comprehensive tobacco use cessation program that includes
14purchasing prescription drugs or prescription medical devices
15approved by the Food and Drug Administration shall be covered
16under the medical assistance program under this Article for
17persons who are otherwise eligible for assistance under this
19    Notwithstanding any other provision of this Code,
20reproductive health care that is otherwise legal in Illinois
21shall be covered under the medical assistance program for
22persons who are otherwise eligible for medical assistance under
23this Article.
24    Notwithstanding any other provision of this Code, the
25Illinois Department may not require, as a condition of payment
26for any laboratory test authorized under this Article, that a



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1physician's handwritten signature appear on the laboratory
2test order form. The Illinois Department may, however, impose
3other appropriate requirements regarding laboratory test order
5    Upon receipt of federal approval of an amendment to the
6Illinois Title XIX State Plan for this purpose, the Department
7shall authorize the Chicago Public Schools (CPS) to procure a
8vendor or vendors to manufacture eyeglasses for individuals
9enrolled in a school within the CPS system. CPS shall ensure
10that its vendor or vendors are enrolled as providers in the
11medical assistance program and in any capitated Medicaid
12managed care entity (MCE) serving individuals enrolled in a
13school within the CPS system. Under any contract procured under
14this provision, the vendor or vendors must serve only
15individuals enrolled in a school within the CPS system. Claims
16for services provided by CPS's vendor or vendors to recipients
17of benefits in the medical assistance program under this Code,
18the Children's Health Insurance Program, or the Covering ALL
19KIDS Health Insurance Program shall be submitted to the
20Department or the MCE in which the individual is enrolled for
21payment and shall be reimbursed at the Department's or the
22MCE's established rates or rate methodologies for eyeglasses.
23    On and after July 1, 2012, the Department of Healthcare and
24Family Services may provide the following services to persons
25eligible for assistance under this Article who are
26participating in education, training or employment programs



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1operated by the Department of Human Services as successor to
2the Department of Public Aid:
3        (1) dental services provided by or under the
4    supervision of a dentist; and
5        (2) eyeglasses prescribed by a physician skilled in the
6    diseases of the eye, or by an optometrist, whichever the
7    person may select.
8    On and after July 1, 2018, the Department of Healthcare and
9Family Services shall provide dental services to any adult who
10is otherwise eligible for assistance under the medical
11assistance program. As used in this paragraph, "dental
12services" means diagnostic, preventative, restorative, or
13corrective procedures, including procedures and services for
14the prevention and treatment of periodontal disease and dental
15caries disease, provided by an individual who is licensed to
16practice dentistry or dental surgery or who is under the
17supervision of a dentist in the practice of his or her
19    On and after July 1, 2018, targeted dental services, as set
20forth in Exhibit D of the Consent Decree entered by the United
21States District Court for the Northern District of Illinois,
22Eastern Division, in the matter of Memisovski v. Maram, Case
23No. 92 C 1982, that are provided to adults under the medical
24assistance program shall be reimbursed at the rates set forth
25in the "New Rate" column in Exhibit D of the Consent Decree for
26targeted dental services that are provided to persons under the



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1age of 18 under the medical assistance program.
2    Notwithstanding any other provision of this Code and
3subject to federal approval, the Department may adopt rules to
4allow a dentist who is volunteering his or her service at no
5cost to render dental services through an enrolled
6not-for-profit health clinic without the dentist personally
7enrolling as a participating provider in the medical assistance
8program. A not-for-profit health clinic shall include a public
9health clinic or Federally Qualified Health Center or other
10enrolled provider, as determined by the Department, through
11which dental services covered under this Section are performed.
12The Department shall establish a process for payment of claims
13for reimbursement for covered dental services rendered under
14this provision.
15    The Illinois Department, by rule, may distinguish and
16classify the medical services to be provided only in accordance
17with the classes of persons designated in Section 5-2.
18    The Department of Healthcare and Family Services must
19provide coverage and reimbursement for amino acid-based
20elemental formulas, regardless of delivery method, for the
21diagnosis and treatment of (i) eosinophilic disorders and (ii)
22short bowel syndrome when the prescribing physician has issued
23a written order stating that the amino acid-based elemental
24formula is medically necessary.
25    The Illinois Department shall authorize the provision of,
26and shall authorize payment for, screening by low-dose



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1mammography for the presence of occult breast cancer for women
235 years of age or older who are eligible for medical
3assistance under this Article, as follows:
4        (A) A baseline mammogram for women 35 to 39 years of
5    age.
6        (B) An annual mammogram for women 40 years of age or
7    older.
8        (C) A mammogram at the age and intervals considered
9    medically necessary by the woman's health care provider for
10    women under 40 years of age and having a family history of
11    breast cancer, prior personal history of breast cancer,
12    positive genetic testing, or other risk factors.
13        (D) A comprehensive ultrasound screening and MRI of an
14    entire breast or breasts if a mammogram demonstrates
15    heterogeneous or dense breast tissue, when medically
16    necessary as determined by a physician licensed to practice
17    medicine in all of its branches.
18        (E) A screening MRI when medically necessary, as
19    determined by a physician licensed to practice medicine in
20    all of its branches.
21    All screenings shall include a physical breast exam,
22instruction on self-examination and information regarding the
23frequency of self-examination and its value as a preventative
24tool. For purposes of this Section, "low-dose mammography"
25means the x-ray examination of the breast using equipment
26dedicated specifically for mammography, including the x-ray



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1tube, filter, compression device, and image receptor, with an
2average radiation exposure delivery of less than one rad per
3breast for 2 views of an average size breast. The term also
4includes digital mammography and includes breast
5tomosynthesis. As used in this Section, the term "breast
6tomosynthesis" means a radiologic procedure that involves the
7acquisition of projection images over the stationary breast to
8produce cross-sectional digital three-dimensional images of
9the breast. If, at any time, the Secretary of the United States
10Department of Health and Human Services, or its successor
11agency, promulgates rules or regulations to be published in the
12Federal Register or publishes a comment in the Federal Register
13or issues an opinion, guidance, or other action that would
14require the State, pursuant to any provision of the Patient
15Protection and Affordable Care Act (Public Law 111-148),
16including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
17successor provision, to defray the cost of any coverage for
18breast tomosynthesis outlined in this paragraph, then the
19requirement that an insurer cover breast tomosynthesis is
20inoperative other than any such coverage authorized under
21Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and
22the State shall not assume any obligation for the cost of
23coverage for breast tomosynthesis set forth in this paragraph.
24    On and after January 1, 2016, the Department shall ensure
25that all networks of care for adult clients of the Department
26include access to at least one breast imaging Center of Imaging



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1Excellence as certified by the American College of Radiology.
2    On and after January 1, 2012, providers participating in a
3quality improvement program approved by the Department shall be
4reimbursed for screening and diagnostic mammography at the same
5rate as the Medicare program's rates, including the increased
6reimbursement for digital mammography.
7    The Department shall convene an expert panel including
8representatives of hospitals, free-standing mammography
9facilities, and doctors, including radiologists, to establish
10quality standards for mammography.
11    On and after January 1, 2017, providers participating in a
12breast cancer treatment quality improvement program approved
13by the Department shall be reimbursed for breast cancer
14treatment at a rate that is no lower than 95% of the Medicare
15program's rates for the data elements included in the breast
16cancer treatment quality program.
17    The Department shall convene an expert panel, including
18representatives of hospitals, free standing breast cancer
19treatment centers, breast cancer quality organizations, and
20doctors, including breast surgeons, reconstructive breast
21surgeons, oncologists, and primary care providers to establish
22quality standards for breast cancer treatment.
23    Subject to federal approval, the Department shall
24establish a rate methodology for mammography at federally
25qualified health centers and other encounter-rate clinics.
26These clinics or centers may also collaborate with other



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1hospital-based mammography facilities. By January 1, 2016, the
2Department shall report to the General Assembly on the status
3of the provision set forth in this paragraph.
4    The Department shall establish a methodology to remind
5women who are age-appropriate for screening mammography, but
6who have not received a mammogram within the previous 18
7months, of the importance and benefit of screening mammography.
8The Department shall work with experts in breast cancer
9outreach and patient navigation to optimize these reminders and
10shall establish a methodology for evaluating their
11effectiveness and modifying the methodology based on the
13    The Department shall establish a performance goal for
14primary care providers with respect to their female patients
15over age 40 receiving an annual mammogram. This performance
16goal shall be used to provide additional reimbursement in the
17form of a quality performance bonus to primary care providers
18who meet that goal.
19    The Department shall devise a means of case-managing or
20patient navigation for beneficiaries diagnosed with breast
21cancer. This program shall initially operate as a pilot program
22in areas of the State with the highest incidence of mortality
23related to breast cancer. At least one pilot program site shall
24be in the metropolitan Chicago area and at least one site shall
25be outside the metropolitan Chicago area. On or after July 1,
262016, the pilot program shall be expanded to include one site



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1in western Illinois, one site in southern Illinois, one site in
2central Illinois, and 4 sites within metropolitan Chicago. An
3evaluation of the pilot program shall be carried out measuring
4health outcomes and cost of care for those served by the pilot
5program compared to similarly situated patients who are not
6served by the pilot program.
7    The Department shall require all networks of care to
8develop a means either internally or by contract with experts
9in navigation and community outreach to navigate cancer
10patients to comprehensive care in a timely fashion. The
11Department shall require all networks of care to include access
12for patients diagnosed with cancer to at least one academic
13commission on cancer-accredited cancer program as an
14in-network covered benefit.
15    Any medical or health care provider shall immediately
16recommend, to any pregnant woman who is being provided prenatal
17services and is suspected of drug abuse or is addicted as
18defined in the Alcoholism and Other Drug Abuse and Dependency
19Act, referral to a local substance abuse treatment provider
20licensed by the Department of Human Services or to a licensed
21hospital which provides substance abuse treatment services.
22The Department of Healthcare and Family Services shall assure
23coverage for the cost of treatment of the drug abuse or
24addiction for pregnant recipients in accordance with the
25Illinois Medicaid Program in conjunction with the Department of
26Human Services.



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1    All medical providers providing medical assistance to
2pregnant women under this Code shall receive information from
3the Department on the availability of services under the Drug
4Free Families with a Future or any comparable program providing
5case management services for addicted women, including
6information on appropriate referrals for other social services
7that may be needed by addicted women in addition to treatment
8for addiction.
9    The Illinois Department, in cooperation with the
10Departments of Human Services (as successor to the Department
11of Alcoholism and Substance Abuse) and Public Health, through a
12public awareness campaign, may provide information concerning
13treatment for alcoholism and drug abuse and addiction, prenatal
14health care, and other pertinent programs directed at reducing
15the number of drug-affected infants born to recipients of
16medical assistance.
17    Neither the Department of Healthcare and Family Services
18nor the Department of Human Services shall sanction the
19recipient solely on the basis of her substance abuse.
20    The Illinois Department shall establish such regulations
21governing the dispensing of health services under this Article
22as it shall deem appropriate. The Department should seek the
23advice of formal professional advisory committees appointed by
24the Director of the Illinois Department for the purpose of
25providing regular advice on policy and administrative matters,
26information dissemination and educational activities for



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1medical and health care providers, and consistency in
2procedures to the Illinois Department.
3    The Illinois Department may develop and contract with
4Partnerships of medical providers to arrange medical services
5for persons eligible under Section 5-2 of this Code.
6Implementation of this Section may be by demonstration projects
7in certain geographic areas. The Partnership shall be
8represented by a sponsor organization. The Department, by rule,
9shall develop qualifications for sponsors of Partnerships.
10Nothing in this Section shall be construed to require that the
11sponsor organization be a medical organization.
12    The sponsor must negotiate formal written contracts with
13medical providers for physician services, inpatient and
14outpatient hospital care, home health services, treatment for
15alcoholism and substance abuse, and other services determined
16necessary by the Illinois Department by rule for delivery by
17Partnerships. Physician services must include prenatal and
18obstetrical care. The Illinois Department shall reimburse
19medical services delivered by Partnership providers to clients
20in target areas according to provisions of this Article and the
21Illinois Health Finance Reform Act, except that:
22        (1) Physicians participating in a Partnership and
23    providing certain services, which shall be determined by
24    the Illinois Department, to persons in areas covered by the
25    Partnership may receive an additional surcharge for such
26    services.



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1        (2) The Department may elect to consider and negotiate
2    financial incentives to encourage the development of
3    Partnerships and the efficient delivery of medical care.
4        (3) Persons receiving medical services through
5    Partnerships may receive medical and case management
6    services above the level usually offered through the
7    medical assistance program.
8    Medical providers shall be required to meet certain
9qualifications to participate in Partnerships to ensure the
10delivery of high quality medical services. These
11qualifications shall be determined by rule of the Illinois
12Department and may be higher than qualifications for
13participation in the medical assistance program. Partnership
14sponsors may prescribe reasonable additional qualifications
15for participation by medical providers, only with the prior
16written approval of the Illinois Department.
17    Nothing in this Section shall limit the free choice of
18practitioners, hospitals, and other providers of medical
19services by clients. In order to ensure patient freedom of
20choice, the Illinois Department shall immediately promulgate
21all rules and take all other necessary actions so that provided
22services may be accessed from therapeutically certified
23optometrists to the full extent of the Illinois Optometric
24Practice Act of 1987 without discriminating between service
26    The Department shall apply for a waiver from the United



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1States Health Care Financing Administration to allow for the
2implementation of Partnerships under this Section.
3    The Illinois Department shall require health care
4providers to maintain records that document the medical care
5and services provided to recipients of Medical Assistance under
6this Article. Such records must be retained for a period of not
7less than 6 years from the date of service or as provided by
8applicable State law, whichever period is longer, except that
9if an audit is initiated within the required retention period
10then the records must be retained until the audit is completed
11and every exception is resolved. The Illinois Department shall
12require health care providers to make available, when
13authorized by the patient, in writing, the medical records in a
14timely fashion to other health care providers who are treating
15or serving persons eligible for Medical Assistance under this
16Article. All dispensers of medical services shall be required
17to maintain and retain business and professional records
18sufficient to fully and accurately document the nature, scope,
19details and receipt of the health care provided to persons
20eligible for medical assistance under this Code, in accordance
21with regulations promulgated by the Illinois Department. The
22rules and regulations shall require that proof of the receipt
23of prescription drugs, dentures, prosthetic devices and
24eyeglasses by eligible persons under this Section accompany
25each claim for reimbursement submitted by the dispenser of such
26medical services. No such claims for reimbursement shall be



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1approved for payment by the Illinois Department without such
2proof of receipt, unless the Illinois Department shall have put
3into effect and shall be operating a system of post-payment
4audit and review which shall, on a sampling basis, be deemed
5adequate by the Illinois Department to assure that such drugs,
6dentures, prosthetic devices and eyeglasses for which payment
7is being made are actually being received by eligible
8recipients. Within 90 days after September 16, 1984 (the
9effective date of Public Act 83-1439), the Illinois Department
10shall establish a current list of acquisition costs for all
11prosthetic devices and any other items recognized as medical
12equipment and supplies reimbursable under this Article and
13shall update such list on a quarterly basis, except that the
14acquisition costs of all prescription drugs shall be updated no
15less frequently than every 30 days as required by Section
17    Notwithstanding any other law to the contrary, the Illinois
18Department shall, within 365 days after July 22, 2013 (the
19effective date of Public Act 98-104), establish procedures to
20permit skilled care facilities licensed under the Nursing Home
21Care Act to submit monthly billing claims for reimbursement
22purposes. Following development of these procedures, the
23Department shall, by July 1, 2016, test the viability of the
24new system and implement any necessary operational or
25structural changes to its information technology platforms in
26order to allow for the direct acceptance and payment of nursing



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1home claims.
2    Notwithstanding any other law to the contrary, the Illinois
3Department shall, within 365 days after August 15, 2014 (the
4effective date of Public Act 98-963), establish procedures to
5permit ID/DD facilities licensed under the ID/DD Community Care
6Act and MC/DD facilities licensed under the MC/DD Act to submit
7monthly billing claims for reimbursement purposes. Following
8development of these procedures, the Department shall have an
9additional 365 days to test the viability of the new system and
10to ensure that any necessary operational or structural changes
11to its information technology platforms are implemented.
12    The Illinois Department shall require all dispensers of
13medical services, other than an individual practitioner or
14group of practitioners, desiring to participate in the Medical
15Assistance program established under this Article to disclose
16all financial, beneficial, ownership, equity, surety or other
17interests in any and all firms, corporations, partnerships,
18associations, business enterprises, joint ventures, agencies,
19institutions or other legal entities providing any form of
20health care services in this State under this Article.
21    The Illinois Department may require that all dispensers of
22medical services desiring to participate in the medical
23assistance program established under this Article disclose,
24under such terms and conditions as the Illinois Department may
25by rule establish, all inquiries from clients and attorneys
26regarding medical bills paid by the Illinois Department, which



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1inquiries could indicate potential existence of claims or liens
2for the Illinois Department.
3    Enrollment of a vendor shall be subject to a provisional
4period and shall be conditional for one year. During the period
5of conditional enrollment, the Department may terminate the
6vendor's eligibility to participate in, or may disenroll the
7vendor from, the medical assistance program without cause.
8Unless otherwise specified, such termination of eligibility or
9disenrollment is not subject to the Department's hearing
10process. However, a disenrolled vendor may reapply without
12    The Department has the discretion to limit the conditional
13enrollment period for vendors based upon category of risk of
14the vendor.
15    Prior to enrollment and during the conditional enrollment
16period in the medical assistance program, all vendors shall be
17subject to enhanced oversight, screening, and review based on
18the risk of fraud, waste, and abuse that is posed by the
19category of risk of the vendor. The Illinois Department shall
20establish the procedures for oversight, screening, and review,
21which may include, but need not be limited to: criminal and
22financial background checks; fingerprinting; license,
23certification, and authorization verifications; unscheduled or
24unannounced site visits; database checks; prepayment audit
25reviews; audits; payment caps; payment suspensions; and other
26screening as required by federal or State law.



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1    The Department shall define or specify the following: (i)
2by provider notice, the "category of risk of the vendor" for
3each type of vendor, which shall take into account the level of
4screening applicable to a particular category of vendor under
5federal law and regulations; (ii) by rule or provider notice,
6the maximum length of the conditional enrollment period for
7each category of risk of the vendor; and (iii) by rule, the
8hearing rights, if any, afforded to a vendor in each category
9of risk of the vendor that is terminated or disenrolled during
10the conditional enrollment period.
11    To be eligible for payment consideration, a vendor's
12payment claim or bill, either as an initial claim or as a
13resubmitted claim following prior rejection, must be received
14by the Illinois Department, or its fiscal intermediary, no
15later than 180 days after the latest date on the claim on which
16medical goods or services were provided, with the following
18        (1) In the case of a provider whose enrollment is in
19    process by the Illinois Department, the 180-day period
20    shall not begin until the date on the written notice from
21    the Illinois Department that the provider enrollment is
22    complete.
23        (2) In the case of errors attributable to the Illinois
24    Department or any of its claims processing intermediaries
25    which result in an inability to receive, process, or
26    adjudicate a claim, the 180-day period shall not begin



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1    until the provider has been notified of the error.
2        (3) In the case of a provider for whom the Illinois
3    Department initiates the monthly billing process.
4        (4) In the case of a provider operated by a unit of
5    local government with a population exceeding 3,000,000
6    when local government funds finance federal participation
7    for claims payments.
8    For claims for services rendered during a period for which
9a recipient received retroactive eligibility, claims must be
10filed within 180 days after the Department determines the
11applicant is eligible. For claims for which the Illinois
12Department is not the primary payer, claims must be submitted
13to the Illinois Department within 180 days after the final
14adjudication by the primary payer.
15    In the case of long term care facilities, within 45
16calendar days of receipt by the facility of required
17prescreening information, new admissions with associated
18admission documents shall be submitted through the Medical
19Electronic Data Interchange (MEDI) or the Recipient
20Eligibility Verification (REV) System or shall be submitted
21directly to the Department of Human Services using required
22admission forms. Effective September 1, 2014, admission
23documents, including all prescreening information, must be
24submitted through MEDI or REV. Confirmation numbers assigned to
25an accepted transaction shall be retained by a facility to
26verify timely submittal. Once an admission transaction has been



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1completed, all resubmitted claims following prior rejection
2are subject to receipt no later than 180 days after the
3admission transaction has been completed.
4    Claims that are not submitted and received in compliance
5with the foregoing requirements shall not be eligible for
6payment under the medical assistance program, and the State
7shall have no liability for payment of those claims.
8    To the extent consistent with applicable information and
9privacy, security, and disclosure laws, State and federal
10agencies and departments shall provide the Illinois Department
11access to confidential and other information and data necessary
12to perform eligibility and payment verifications and other
13Illinois Department functions. This includes, but is not
14limited to: information pertaining to licensure;
15certification; earnings; immigration status; citizenship; wage
16reporting; unearned and earned income; pension income;
17employment; supplemental security income; social security
18numbers; National Provider Identifier (NPI) numbers; the
19National Practitioner Data Bank (NPDB); program and agency
20exclusions; taxpayer identification numbers; tax delinquency;
21corporate information; and death records.
22    The Illinois Department shall enter into agreements with
23State agencies and departments, and is authorized to enter into
24agreements with federal agencies and departments, under which
25such agencies and departments shall share data necessary for
26medical assistance program integrity functions and oversight.



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1The Illinois Department shall develop, in cooperation with
2other State departments and agencies, and in compliance with
3applicable federal laws and regulations, appropriate and
4effective methods to share such data. At a minimum, and to the
5extent necessary to provide data sharing, the Illinois
6Department shall enter into agreements with State agencies and
7departments, and is authorized to enter into agreements with
8federal agencies and departments, including but not limited to:
9the Secretary of State; the Department of Revenue; the
10Department of Public Health; the Department of Human Services;
11and the Department of Financial and Professional Regulation.
12    Beginning in fiscal year 2013, the Illinois Department
13shall set forth a request for information to identify the
14benefits of a pre-payment, post-adjudication, and post-edit
15claims system with the goals of streamlining claims processing
16and provider reimbursement, reducing the number of pending or
17rejected claims, and helping to ensure a more transparent
18adjudication process through the utilization of: (i) provider
19data verification and provider screening technology; and (ii)
20clinical code editing; and (iii) pre-pay, pre- or
21post-adjudicated predictive modeling with an integrated case
22management system with link analysis. Such a request for
23information shall not be considered as a request for proposal
24or as an obligation on the part of the Illinois Department to
25take any action or acquire any products or services.
26    The Illinois Department shall establish policies,



10000SB2429sam001- 23 -LRB100 16511 KTG 36326 a

1procedures, standards and criteria by rule for the acquisition,
2repair and replacement of orthotic and prosthetic devices and
3durable medical equipment. Such rules shall provide, but not be
4limited to, the following services: (1) immediate repair or
5replacement of such devices by recipients; and (2) rental,
6lease, purchase or lease-purchase of durable medical equipment
7in a cost-effective manner, taking into consideration the
8recipient's medical prognosis, the extent of the recipient's
9needs, and the requirements and costs for maintaining such
10equipment. Subject to prior approval, such rules shall enable a
11recipient to temporarily acquire and use alternative or
12substitute devices or equipment pending repairs or
13replacements of any device or equipment previously authorized
14for such recipient by the Department. Notwithstanding any
15provision of Section 5-5f to the contrary, the Department may,
16by rule, exempt certain replacement wheelchair parts from prior
17approval and, for wheelchairs, wheelchair parts, wheelchair
18accessories, and related seating and positioning items,
19determine the wholesale price by methods other than actual
20acquisition costs.
21    The Department shall require, by rule, all providers of
22durable medical equipment to be accredited by an accreditation
23organization approved by the federal Centers for Medicare and
24Medicaid Services and recognized by the Department in order to
25bill the Department for providing durable medical equipment to
26recipients. No later than 15 months after the effective date of



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1the rule adopted pursuant to this paragraph, all providers must
2meet the accreditation requirement.
3    The Department shall execute, relative to the nursing home
4prescreening project, written inter-agency agreements with the
5Department of Human Services and the Department on Aging, to
6effect the following: (i) intake procedures and common
7eligibility criteria for those persons who are receiving
8non-institutional services; and (ii) the establishment and
9development of non-institutional services in areas of the State
10where they are not currently available or are undeveloped; and
11(iii) notwithstanding any other provision of law, subject to
12federal approval, on and after July 1, 2012, an increase in the
13determination of need (DON) scores from 29 to 37 for applicants
14for institutional and home and community-based long term care;
15if and only if federal approval is not granted, the Department
16may, in conjunction with other affected agencies, implement
17utilization controls or changes in benefit packages to
18effectuate a similar savings amount for this population; and
19(iv) no later than July 1, 2013, minimum level of care
20eligibility criteria for institutional and home and
21community-based long term care; and (v) no later than October
221, 2013, establish procedures to permit long term care
23providers access to eligibility scores for individuals with an
24admission date who are seeking or receiving services from the
25long term care provider. In order to select the minimum level
26of care eligibility criteria, the Governor shall establish a



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1workgroup that includes affected agency representatives and
2stakeholders representing the institutional and home and
3community-based long term care interests. This Section shall
4not restrict the Department from implementing lower level of
5care eligibility criteria for community-based services in
6circumstances where federal approval has been granted.
7    The Illinois Department shall develop and operate, in
8cooperation with other State Departments and agencies and in
9compliance with applicable federal laws and regulations,
10appropriate and effective systems of health care evaluation and
11programs for monitoring of utilization of health care services
12and facilities, as it affects persons eligible for medical
13assistance under this Code.
14    The Illinois Department shall report annually to the
15General Assembly, no later than the second Friday in April of
161979 and each year thereafter, in regard to:
17        (a) actual statistics and trends in utilization of
18    medical services by public aid recipients;
19        (b) actual statistics and trends in the provision of
20    the various medical services by medical vendors;
21        (c) current rate structures and proposed changes in
22    those rate structures for the various medical vendors; and
23        (d) efforts at utilization review and control by the
24    Illinois Department.
25    The period covered by each report shall be the 3 years
26ending on the June 30 prior to the report. The report shall



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1include suggested legislation for consideration by the General
2Assembly. The filing of one copy of the report with the
3Speaker, one copy with the Minority Leader and one copy with
4the Clerk of the House of Representatives, one copy with the
5President, one copy with the Minority Leader and one copy with
6the Secretary of the Senate, one copy with the Legislative
7Research Unit, and such additional copies with the State
8Government Report Distribution Center for the General Assembly
9as is required under paragraph (t) of Section 7 of the State
10Library Act shall be deemed sufficient to comply with this
12    Rulemaking authority to implement Public Act 95-1045, if
13any, is conditioned on the rules being adopted in accordance
14with all provisions of the Illinois Administrative Procedure
15Act and all rules and procedures of the Joint Committee on
16Administrative Rules; any purported rule not so adopted, for
17whatever reason, is unauthorized.
18    On and after July 1, 2012, the Department shall reduce any
19rate of reimbursement for services or other payments or alter
20any methodologies authorized by this Code to reduce any rate of
21reimbursement for services or other payments in accordance with
22Section 5-5e.
23    Because kidney transplantation can be an appropriate, cost
24effective alternative to renal dialysis when medically
25necessary and notwithstanding the provisions of Section 1-11 of
26this Code, beginning October 1, 2014, the Department shall



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1cover kidney transplantation for noncitizens with end-stage
2renal disease who are not eligible for comprehensive medical
3benefits, who meet the residency requirements of Section 5-3 of
4this Code, and who would otherwise meet the financial
5requirements of the appropriate class of eligible persons under
6Section 5-2 of this Code. To qualify for coverage of kidney
7transplantation, such person must be receiving emergency renal
8dialysis services covered by the Department. Providers under
9this Section shall be prior approved and certified by the
10Department to perform kidney transplantation and the services
11under this Section shall be limited to services associated with
12kidney transplantation.
13    Notwithstanding any other provision of this Code to the
14contrary, on or after July 1, 2015, all FDA approved forms of
15medication assisted treatment prescribed for the treatment of
16alcohol dependence or treatment of opioid dependence shall be
17covered under both fee for service and managed care medical
18assistance programs for persons who are otherwise eligible for
19medical assistance under this Article and shall not be subject
20to any (1) utilization control, other than those established
21under the American Society of Addiction Medicine patient
22placement criteria, (2) prior authorization mandate, or (3)
23lifetime restriction limit mandate.
24    On or after July 1, 2015, opioid antagonists prescribed for
25the treatment of an opioid overdose, including the medication
26product, administration devices, and any pharmacy fees related



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1to the dispensing and administration of the opioid antagonist,
2shall be covered under the medical assistance program for
3persons who are otherwise eligible for medical assistance under
4this Article. As used in this Section, "opioid antagonist"
5means a drug that binds to opioid receptors and blocks or
6inhibits the effect of opioids acting on those receptors,
7including, but not limited to, naloxone hydrochloride or any
8other similarly acting drug approved by the U.S. Food and Drug
10    Upon federal approval, the Department shall provide
11coverage and reimbursement for all drugs that are approved for
12marketing by the federal Food and Drug Administration and that
13are recommended by the federal Public Health Service or the
14United States Centers for Disease Control and Prevention for
15pre-exposure prophylaxis and related pre-exposure prophylaxis
16services, including, but not limited to, HIV and sexually
17transmitted infection screening, treatment for sexually
18transmitted infections, medical monitoring, assorted labs, and
19counseling to reduce the likelihood of HIV infection among
20individuals who are not infected with HIV but who are at high
21risk of HIV infection.
22    Notwithstanding any other law to the contrary, the
23Department shall not adopt any rule or enter into any contract
24that prohibits reimbursement under the medical assistance
25program to an eligible clinic for a dental encounter for
26services performed by an individual licensed to practice



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1dentistry or dental hygiene under the Illinois Dental Practice
3(Source: P.A. 99-78, eff. 7-20-15; 99-180, eff. 7-29-15;
499-236, eff. 8-3-15; 99-407 (see Section 20 of P.A. 99-588 for
5the effective date of P.A. 99-407); 99-433, eff. 8-21-15;
699-480, eff. 9-9-15; 99-588, eff. 7-20-16; 99-642, eff.
77-28-16; 99-772, eff. 1-1-17; 99-895, eff. 1-1-17; 100-201,
8eff. 8-18-17; 100-395, eff. 1-1-18; 100-449, eff. 1-1-18;
9100-538, eff. 1-1-18; revised 10-26-17.)
10    (305 ILCS 5/5-30)
11    Sec. 5-30. Care coordination.
12    (a) At least 50% of recipients eligible for comprehensive
13medical benefits in all medical assistance programs or other
14health benefit programs administered by the Department,
15including the Children's Health Insurance Program Act and the
16Covering ALL KIDS Health Insurance Act, shall be enrolled in a
17care coordination program by no later than January 1, 2015. For
18purposes of this Section, "coordinated care" or "care
19coordination" means delivery systems where recipients will
20receive their care from providers who participate under
21contract in integrated delivery systems that are responsible
22for providing or arranging the majority of care, including
23primary care physician services, referrals from primary care
24physicians, diagnostic and treatment services, behavioral
25health services, in-patient and outpatient hospital services,



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1dental services, and rehabilitation and long-term care
2services. The Department shall designate or contract for such
3integrated delivery systems (i) to ensure enrollees have a
4choice of systems and of primary care providers within such
5systems; (ii) to ensure that enrollees receive quality care in
6a culturally and linguistically appropriate manner; and (iii)
7to ensure that coordinated care programs meet the diverse needs
8of enrollees with developmental, mental health, physical, and
9age-related disabilities. When the integrated delivery system
10requires the subcontracting of a dental administrator to
11provide dental services, care coordination shall include, but
12not be limited to, providing the dental administrator with the
13health status of medically compromised enrollees such as
14pregnant women and diabetic enrollees so that the dental
15administrator can actively promote and arrange for the
16enrollees to obtain the necessary dental services.
17    (b) Payment for such coordinated care shall be based on
18arrangements where the State pays for performance related to
19health care outcomes, the use of evidence-based practices, the
20use of primary care delivered through comprehensive medical
21homes, the use of electronic medical records, and the
22appropriate exchange of health information electronically made
23either on a capitated basis in which a fixed monthly premium
24per recipient is paid and full financial risk is assumed for
25the delivery of services, or through other risk-based payment



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1    (c) To qualify for compliance with this Section, the 50%
2goal shall be achieved by enrolling medical assistance
3enrollees from each medical assistance enrollment category,
4including parents, children, seniors, and people with
5disabilities to the extent that current State Medicaid payment
6laws would not limit federal matching funds for recipients in
7care coordination programs. In addition, services must be more
8comprehensively defined and more risk shall be assumed than in
9the Department's primary care case management program as of
10January 25, 2011 (the effective date of Public Act 96-1501).
11    (d) The Department shall report to the General Assembly in
12a separate part of its annual medical assistance program
13report, beginning April, 2012 until April, 2016, on the
14progress and implementation of the care coordination program
15initiatives established by the provisions of Public Act
1696-1501. The Department shall include in its April 2011 report
17a full analysis of federal laws or regulations regarding upper
18payment limitations to providers and the necessary revisions or
19adjustments in rate methodologies and payments to providers
20under this Code that would be necessary to implement
21coordinated care with full financial risk by a party other than
22the Department.
23    (e) Integrated Care Program for individuals with chronic
24mental health conditions.
25        (1) The Integrated Care Program shall encompass
26    services administered to recipients of medical assistance



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1    under this Article to prevent exacerbations and
2    complications using cost-effective, evidence-based
3    practice guidelines and mental health management
4    strategies.
5        (2) The Department may utilize and expand upon existing
6    contractual arrangements with integrated care plans under
7    the Integrated Care Program for providing the coordinated
8    care provisions of this Section.
9        (3) Payment for such coordinated care shall be based on
10    arrangements where the State pays for performance related
11    to mental health outcomes on a capitated basis in which a
12    fixed monthly premium per recipient is paid and full
13    financial risk is assumed for the delivery of services, or
14    through other risk-based payment arrangements such as
15    provider-based care coordination.
16        (4) The Department shall examine whether chronic
17    mental health management programs and services for
18    recipients with specific chronic mental health conditions
19    do any or all of the following:
20            (A) Improve the patient's overall mental health in
21        a more expeditious and cost-effective manner.
22            (B) Lower costs in other aspects of the medical
23        assistance program, such as hospital admissions,
24        emergency room visits, or more frequent and
25        inappropriate psychotropic drug use.
26        (5) The Department shall work with the facilities and



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1    any integrated care plan participating in the program to
2    identify and correct barriers to the successful
3    implementation of this subsection (e) prior to and during
4    the implementation to best facilitate the goals and
5    objectives of this subsection (e).
6    (f) A hospital that is located in a county of the State in
7which the Department mandates some or all of the beneficiaries
8of the Medical Assistance Program residing in the county to
9enroll in a Care Coordination Program, as set forth in Section
105-30 of this Code, shall not be eligible for any non-claims
11based payments not mandated by Article V-A of this Code for
12which it would otherwise be qualified to receive, unless the
13hospital is a Coordinated Care Participating Hospital no later
14than 60 days after June 14, 2012 (the effective date of Public
15Act 97-689) or 60 days after the first mandatory enrollment of
16a beneficiary in a Coordinated Care program. For purposes of
17this subsection, "Coordinated Care Participating Hospital"
18means a hospital that meets one of the following criteria:
19        (1) The hospital has entered into a contract to provide
20    hospital services with one or more MCOs to enrollees of the
21    care coordination program.
22        (2) The hospital has not been offered a contract by a
23    care coordination plan that the Department has determined
24    to be a good faith offer and that pays at least as much as
25    the Department would pay, on a fee-for-service basis, not
26    including disproportionate share hospital adjustment



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1    payments or any other supplemental adjustment or add-on
2    payment to the base fee-for-service rate, except to the
3    extent such adjustments or add-on payments are
4    incorporated into the development of the applicable MCO
5    capitated rates.
6    As used in this subsection (f), "MCO" means any entity
7which contracts with the Department to provide services where
8payment for medical services is made on a capitated basis.
9    (g) No later than August 1, 2013, the Department shall
10issue a purchase of care solicitation for Accountable Care
11Entities (ACE) to serve any children and parents or caretaker
12relatives of children eligible for medical assistance under
13this Article. An ACE may be a single corporate structure or a
14network of providers organized through contractual
15relationships with a single corporate entity. The solicitation
16shall require that:
17        (1) An ACE operating in Cook County be capable of
18    serving at least 40,000 eligible individuals in that
19    county; an ACE operating in Lake, Kane, DuPage, or Will
20    Counties be capable of serving at least 20,000 eligible
21    individuals in those counties and an ACE operating in other
22    regions of the State be capable of serving at least 10,000
23    eligible individuals in the region in which it operates.
24    During initial periods of mandatory enrollment, the
25    Department shall require its enrollment services
26    contractor to use a default assignment algorithm that



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1    ensures if possible an ACE reaches the minimum enrollment
2    levels set forth in this paragraph.
3        (2) An ACE must include at a minimum the following
4    types of providers: primary care, specialty care,
5    hospitals, and behavioral healthcare.
6        (3) An ACE shall have a governance structure that
7    includes the major components of the health care delivery
8    system, including one representative from each of the
9    groups listed in paragraph (2).
10        (4) An ACE must be an integrated delivery system,
11    including a network able to provide the full range of
12    services needed by Medicaid beneficiaries and system
13    capacity to securely pass clinical information across
14    participating entities and to aggregate and analyze that
15    data in order to coordinate care.
16        (5) An ACE must be capable of providing both care
17    coordination and complex case management, as necessary, to
18    beneficiaries. To be responsive to the solicitation, a
19    potential ACE must outline its care coordination and
20    complex case management model and plan to reduce the cost
21    of care.
22        (6) In the first 18 months of operation, unless the ACE
23    selects a shorter period, an ACE shall be paid care
24    coordination fees on a per member per month basis that are
25    projected to be cost neutral to the State during the term
26    of their payment and, subject to federal approval, be



10000SB2429sam001- 36 -LRB100 16511 KTG 36326 a

1    eligible to share in additional savings generated by their
2    care coordination.
3        (7) In months 19 through 36 of operation, unless the
4    ACE selects a shorter period, an ACE shall be paid on a
5    pre-paid capitation basis for all medical assistance
6    covered services, under contract terms similar to Managed
7    Care Organizations (MCO), with the Department sharing the
8    risk through either stop-loss insurance for extremely high
9    cost individuals or corridors of shared risk based on the
10    overall cost of the total enrollment in the ACE. The ACE
11    shall be responsible for claims processing, encounter data
12    submission, utilization control, and quality assurance.
13        (8) In the fourth and subsequent years of operation, an
14    ACE shall convert to a Managed Care Community Network
15    (MCCN), as defined in this Article, or Health Maintenance
16    Organization pursuant to the Illinois Insurance Code,
17    accepting full-risk capitation payments.
18    The Department shall allow potential ACE entities 5 months
19from the date of the posting of the solicitation to submit
20proposals. After the solicitation is released, in addition to
21the MCO rate development data available on the Department's
22website, subject to federal and State confidentiality and
23privacy laws and regulations, the Department shall provide 2
24years of de-identified summary service data on the targeted
25population, split between children and adults, showing the
26historical type and volume of services received and the cost of



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1those services to those potential bidders that sign a data use
2agreement. The Department may add up to 2 non-state government
3employees with expertise in creating integrated delivery
4systems to its review team for the purchase of care
5solicitation described in this subsection. Any such
6individuals must sign a no-conflict disclosure and
7confidentiality agreement and agree to act in accordance with
8all applicable State laws.
9    During the first 2 years of an ACE's operation, the
10Department shall provide claims data to the ACE on its
11enrollees on a periodic basis no less frequently than monthly.
12    Nothing in this subsection shall be construed to limit the
13Department's mandate to enroll 50% of its beneficiaries into
14care coordination systems by January 1, 2015, using all
15available care coordination delivery systems, including Care
16Coordination Entities (CCE), MCCNs, or MCOs, nor be construed
17to affect the current CCEs, MCCNs, and MCOs selected to serve
18seniors and persons with disabilities prior to that date.
19    Nothing in this subsection precludes the Department from
20considering future proposals for new ACEs or expansion of
21existing ACEs at the discretion of the Department.
22    (h) Department contracts with MCOs and other entities
23reimbursed by risk based capitation shall have a minimum
24medical loss ratio of 85%, shall require the entity to
25establish an appeals and grievances process for consumers and
26providers, and shall require the entity to provide a quality



10000SB2429sam001- 38 -LRB100 16511 KTG 36326 a

1assurance and utilization review program. Entities contracted
2with the Department to coordinate healthcare regardless of risk
3shall be measured utilizing the same quality metrics. The
4quality metrics may be population specific. Any contracted
5entity serving at least 5,000 seniors or people with
6disabilities or 15,000 individuals in other populations
7covered by the Medical Assistance Program that has been
8receiving full-risk capitation for a year shall be accredited
9by a national accreditation organization authorized by the
10Department within 2 years after the date it is eligible to
11become accredited. The requirements of this subsection shall
12apply to contracts with MCOs entered into or renewed or
13extended after June 1, 2013.
14    (h-5) The Department shall monitor and enforce compliance
15by MCOs with agreements they have entered into with providers
16on issues that include, but are not limited to, timeliness of
17payment, payment rates, and processes for obtaining prior
18approval. The Department may impose sanctions on MCOs for
19violating provisions of those agreements that include, but are
20not limited to, financial penalties, suspension of enrollment
21of new enrollees, and termination of the MCO's contract with
22the Department. As used in this subsection (h-5), "MCO" has the
23meaning ascribed to that term in Section 5-30.1 of this Code.
24    (h-6) With respect to the managed care organizations and
25their subcontracted dental administrator's provider agreements
26with dentists, the level of reimbursement to dentists for



10000SB2429sam001- 39 -LRB100 16511 KTG 36326 a

1providing dental services shall be equal to at least the
2fee-for-service dental program administered by the Department.
3    (i) Unless otherwise required by federal law, Medicaid
4Managed Care Entities and their respective business associates
5shall not disclose, directly or indirectly, including by
6sending a bill or explanation of benefits, information
7concerning the sensitive health services received by enrollees
8of the Medicaid Managed Care Entity to any person other than
9covered entities and business associates, which may receive,
10use, and further disclose such information solely for the
11purposes permitted under applicable federal and State laws and
12regulations if such use and further disclosure satisfies all
13applicable requirements of such laws and regulations. The
14Medicaid Managed Care Entity or its respective business
15associates may disclose information concerning the sensitive
16health services if the enrollee who received the sensitive
17health services requests the information from the Medicaid
18Managed Care Entity or its respective business associates and
19authorized the sending of a bill or explanation of benefits.
20Communications including, but not limited to, statements of
21care received or appointment reminders either directly or
22indirectly to the enrollee from the health care provider,
23health care professional, and care coordinators, remain
24permissible. Medicaid Managed Care Entities or their
25respective business associates may communicate directly with
26their enrollees regarding care coordination activities for



10000SB2429sam001- 40 -LRB100 16511 KTG 36326 a

1those enrollees.
2    For the purposes of this subsection, the term "Medicaid
3Managed Care Entity" includes Care Coordination Entities,
4Accountable Care Entities, Managed Care Organizations, and
5Managed Care Community Networks.
6    For purposes of this subsection, the term "sensitive health
7services" means mental health services, substance abuse
8treatment services, reproductive health services, family
9planning services, services for sexually transmitted
10infections and sexually transmitted diseases, and services for
11sexual assault or domestic abuse. Services include prevention,
12screening, consultation, examination, treatment, or follow-up.
13    For purposes of this subsection, "business associate",
14"covered entity", "disclosure", and "use" have the meanings
15ascribed to those terms in 45 CFR 160.103.
16    Nothing in this subsection shall be construed to relieve a
17Medicaid Managed Care Entity or the Department of any duty to
18report incidents of sexually transmitted infections to the
19Department of Public Health or to the local board of health in
20accordance with regulations adopted under a statute or
21ordinance or to report incidents of sexually transmitted
22infections as necessary to comply with the requirements under
23Section 5 of the Abused and Neglected Child Reporting Act or as
24otherwise required by State or federal law.
25    The Department shall create policy in order to implement
26the requirements in this subsection.



10000SB2429sam001- 41 -LRB100 16511 KTG 36326 a

1    (j) Managed Care Entities (MCEs), including MCOs and all
2other care coordination organizations, shall develop and
3maintain a written language access policy that sets forth the
4standards, guidelines, and operational plan to ensure language
5appropriate services and that is consistent with the standard
6of meaningful access for populations with limited English
7proficiency. The language access policy shall describe how the
8MCEs will provide all of the following required services:
9        (1) Translation (the written replacement of text from
10    one language into another) of all vital documents and forms
11    as identified by the Department.
12        (2) Qualified interpreter services (the oral
13    communication of a message from one language into another
14    by a qualified interpreter).
15        (3) Staff training on the language access policy,
16    including how to identify language needs, access and
17    provide language assistance services, work with
18    interpreters, request translations, and track the use of
19    language assistance services.
20        (4) Data tracking that identifies the language need.
21        (5) Notification to participants on the availability
22    of language access services and on how to access such
23    services.
24    (k) The Department shall actively monitor the contractual
25relationship between Managed Care Organizations (MCOs) and any
26dental administrator contracted by an MCO to provide dental



10000SB2429sam001- 42 -LRB100 16511 KTG 36326 a

1services. The Department shall adopt appropriate dental
2Healthcare Effectiveness Data and Information Set measures or
3other dental quality performance measures as part of its
4monitoring and shall include additional specific dental
5performance measurers in its Health Plan Comparison Tool and
6Illinois Medicaid Plan Report Card that is available on the
7Department's website for enrolled individuals.
8    The Department shall collect from each MCO specific
9information about the types of contracted, broad-based care
10coordination occurring between the MCO and any dental
11administrator, including, but not limited to, pregnant women
12and diabetic patients in need of oral care.
13    (l) No health plan or its subcontractors by contract,
14written policy, or procedure shall contain any clause
15attempting to limit the right of medical assistance recipients
16under any medical assistance program administered by the
17Department to obtain dental services from any qualified
18Medicaid provider who undertakes to provide those services.
19    (m) Notwithstanding any other law to the contrary, the
20Department shall not adopt any rule or enter into any contract
21that prohibits reimbursement under the medical assistance
22program to an eligible clinic for a dental encounter for
23services performed by an individual licensed to practice
24dentistry or dental hygiene under the Illinois Dental Practice
26(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14;



10000SB2429sam001- 43 -LRB100 16511 KTG 36326 a

199-106, eff. 1-1-16; 99-181, eff. 7-29-15; 99-566, eff. 1-1-17;
299-642, eff. 7-28-16.)
3    Section 99. Effective date. This Act takes effect upon
4becoming law.".