Rep. Jay Hoffman

Filed: 3/12/2019

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 2977

2    AMENDMENT NO. ______. Amend House Bill 2977 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-4.2 as follows:
 
6    (305 ILCS 5/5-4.2)  (from Ch. 23, par. 5-4.2)
7    Sec. 5-4.2. Ambulance services payments.
8    (a) For ambulance services provided to a recipient of aid
9under this Article on or after January 1, 1993, the Illinois
10Department shall reimburse ambulance service providers at
11rates calculated in accordance with this Section. It is the
12intent of the General Assembly to provide adequate
13reimbursement for ambulance services so as to ensure adequate
14access to services for recipients of aid under this Article and
15to provide appropriate incentives to ambulance service
16providers to provide services in an efficient and

 

 

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1cost-effective manner. Thus, it is the intent of the General
2Assembly that the Illinois Department implement a
3reimbursement system for ambulance services that, to the extent
4practicable and subject to the availability of funds
5appropriated by the General Assembly for this purpose, is
6consistent with the payment principles of Medicare. To ensure
7uniformity between the payment principles of Medicare and
8Medicaid, the Illinois Department shall follow, to the extent
9necessary and practicable and subject to the availability of
10funds appropriated by the General Assembly for this purpose,
11the statutes, laws, regulations, policies, procedures,
12principles, definitions, guidelines, and manuals used to
13determine the amounts paid to ambulance service providers under
14Title XVIII of the Social Security Act (Medicare).
15    (b) For ambulance services provided to a recipient of aid
16under this Article on or after January 1, 1996, the Illinois
17Department shall reimburse ambulance service providers based
18upon the actual distance traveled if a natural disaster,
19weather conditions, road repairs, or traffic congestion
20necessitates the use of a route other than the most direct
21route.
22    (c) For purposes of this Section, "ambulance services"
23includes medical transportation services provided by means of
24an ambulance, medi-car, service car, or taxi.
25    (c-1) For purposes of this Section, "ground ambulance
26service" means medical transportation services that are

 

 

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1described as ground ambulance services by the Centers for
2Medicare and Medicaid Services and provided in a vehicle that
3is licensed as an ambulance by the Illinois Department of
4Public Health pursuant to the Emergency Medical Services (EMS)
5Systems Act.
6    (c-2) For purposes of this Section, "ground ambulance
7service provider" means a vehicle service provider as described
8in the Emergency Medical Services (EMS) Systems Act that
9operates licensed ambulances for the purpose of providing
10emergency ambulance services, or non-emergency ambulance
11services, or both. For purposes of this Section, this includes
12both ambulance providers and ambulance suppliers as described
13by the Centers for Medicare and Medicaid Services.
14    (c-3) For purposes of this Section, "medi-car" means
15transportation services provided to a patient who is confined
16to a wheelchair and requires the use of a hydraulic or electric
17lift or ramp and wheelchair lockdown when the patient's
18condition does not require medical observation, medical
19supervision, medical equipment, the administration of
20medications, or the administration of oxygen.
21    (c-4) For purposes of this Section, "service car" means
22transportation services provided to a patient by a passenger
23vehicle where that patient does not require the specialized
24modes described in subsection (c-1) or (c-3).
25    (d) This Section does not prohibit separate billing by
26ambulance service providers for oxygen furnished while

 

 

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1providing advanced life support services.
2    (e) Beginning with services rendered on or after July 1,
32008, all providers of non-emergency medi-car and service car
4transportation must certify that the driver and employee
5attendant, as applicable, have completed a safety program
6approved by the Department to protect both the patient and the
7driver, prior to transporting a patient. The provider must
8maintain this certification in its records. The provider shall
9produce such documentation upon demand by the Department or its
10representative. Failure to produce documentation of such
11training shall result in recovery of any payments made by the
12Department for services rendered by a non-certified driver or
13employee attendant. Medi-car and service car providers must
14maintain legible documentation in their records of the driver
15and, as applicable, employee attendant that actually
16transported the patient. Providers must recertify all drivers
17and employee attendants every 3 years.
18    Notwithstanding the requirements above, any public
19transportation provider of medi-car and service car
20transportation that receives federal funding under 49 U.S.C.
215307 and 5311 need not certify its drivers and employee
22attendants under this Section, since safety training is already
23federally mandated.
24    (f) With respect to any policy or program administered by
25the Department or its agent regarding approval of non-emergency
26medical transportation by ground ambulance service providers,

 

 

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1including, but not limited to, the Non-Emergency
2Transportation Services Prior Approval Program (NETSPAP), the
3Department shall establish by rule a process by which ground
4ambulance service providers of non-emergency medical
5transportation may appeal any decision by the Department or its
6agent for which no denial was received prior to the time of
7transport that either (i) denies a request for approval for
8payment of non-emergency transportation by means of ground
9ambulance service or (ii) grants a request for approval of
10non-emergency transportation by means of ground ambulance
11service at a level of service that entitles the ground
12ambulance service provider to a lower level of compensation
13from the Department than the ground ambulance service provider
14would have received as compensation for the level of service
15requested. The rule shall be filed by December 15, 2012 and
16shall provide that, for any decision rendered by the Department
17or its agent on or after the date the rule takes effect, the
18ground ambulance service provider shall have 60 days from the
19date the decision is received to file an appeal. The rule
20established by the Department shall be, insofar as is
21practical, consistent with the Illinois Administrative
22Procedure Act. The Director's decision on an appeal under this
23Section shall be a final administrative decision subject to
24review under the Administrative Review Law.
25    (f-5) Beginning 90 days after July 20, 2012 (the effective
26date of Public Act 97-842), (i) no denial of a request for

 

 

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1approval for payment of non-emergency transportation by means
2of ground ambulance service, and (ii) no approval of
3non-emergency transportation by means of ground ambulance
4service at a level of service that entitles the ground
5ambulance service provider to a lower level of compensation
6from the Department than would have been received at the level
7of service submitted by the ground ambulance service provider,
8may be issued by the Department or its agent unless the
9Department has submitted the criteria for determining the
10appropriateness of the transport for first notice publication
11in the Illinois Register pursuant to Section 5-40 of the
12Illinois Administrative Procedure Act.
13    (g) Whenever a patient covered by a medical assistance
14program under this Code or by another medical program
15administered by the Department, including a patient covered
16under the State's Medicaid managed care program, is being
17transported from a facility and requires non-emergency
18transportation including ground ambulance, medi-car, or
19service car transportation, a Physician Certification
20Statement as described in this Section shall be required for
21each patient. Facilities shall develop procedures for a
22licensed medical professional to provide a written and signed
23Physician Certification Statement. The Physician Certification
24Statement shall specify the level of transportation services
25needed and complete a medical certification establishing the
26criteria for approval of non-emergency ambulance

 

 

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1transportation, as published by the Department of Healthcare
2and Family Services, that is met by the patient. This
3certification shall be completed prior to ordering the
4transportation service and prior to patient discharge. The
5Physician Certification Statement is not required prior to
6transport if a delay in transport can be expected to negatively
7affect the patient outcome.
8    The medical certification specifying the level and type of
9non-emergency transportation needed shall be in the form of the
10Physician Certification Statement on a standardized form
11prescribed by the Department of Healthcare and Family Services.
12Within 75 days after July 27, 2018 (the effective date of
13Public Act 100-646) this amendatory Act of the 100th General
14Assembly, the Department of Healthcare and Family Services
15shall develop a standardized form of the Physician
16Certification Statement specifying the level and type of
17transportation services needed in consultation with the
18Department of Public Health, Medicaid managed care
19organizations, a statewide association representing ambulance
20providers, a statewide association representing hospitals, 3
21statewide associations representing nursing homes, and other
22stakeholders. The Physician Certification Statement shall
23include, but is not limited to, the criteria necessary to
24demonstrate medical necessity for the level of transport needed
25as required by (i) the Department of Healthcare and Family
26Services and (ii) the federal Centers for Medicare and Medicaid

 

 

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1Services as outlined in the Centers for Medicare and Medicaid
2Services' Medicare Benefit Policy Manual, Pub. 100-02, Chap.
310, Sec. 10.2.1, et seq. The use of the Physician Certification
4Statement shall satisfy the obligations of hospitals under
5Section 6.22 of the Hospital Licensing Act and nursing homes
6under Section 2-217 of the Nursing Home Care Act.
7Implementation and acceptance of the Physician Certification
8Statement shall take place no later than 90 days after the
9issuance of the Physician Certification Statement by the
10Department of Healthcare and Family Services.
11    Pursuant to subsection (E) of Section 12-4.25 of this Code,
12the Department is entitled to recover overpayments paid to a
13provider or vendor, including, but not limited to, from the
14discharging physician, the discharging facility, and the
15ground ambulance service provider, in instances where a
16non-emergency ground ambulance service is rendered as the
17result of improper or false certification.
18    Beginning October 1, 2018, the Department of Healthcare and
19Family Services shall collect data from Medicaid managed care
20organizations and transportation brokers, including the
21Department's NETSPAP broker, regarding denials and appeals
22related to the missing or incomplete Physician Certification
23Statement forms and overall compliance with this subsection.
24The Department of Healthcare and Family Services shall publish
25quarterly results on its website within 15 days following the
26end of each quarter.

 

 

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1    (h) On and after July 1, 2012, the Department shall reduce
2any rate of reimbursement for services or other payments or
3alter any methodologies authorized by this Code to reduce any
4rate of reimbursement for services or other payments in
5accordance with Section 5-5e.
6    (i) On and after July 1, 2018, the Department shall
7increase the base rate of reimbursement for both base charges
8and mileage charges for ground ambulance service providers for
9medical transportation services provided by means of a ground
10ambulance to a level not lower than 112% of the base rate in
11effect as of June 30, 2018.
12    (j) On or before January 1, 2020, the Department of
13Healthcare and Family Services shall create a sustainable rate
14or rates of reimbursement for medi-car and service car services
15taking into account the labor, insurance, and fuel costs of
16providing such services. The rate or rates shall also take into
17account the difference in cost between bedside-to-bedside
18transport for long-term care facility residents and
19curbside-to-curbside transport for other beneficiaries. In
20order to ensure regional costs are considered in the new rate
21or rates of reimbursement, the Department shall consult at
22least one medi-car service provider from St. Clair, Sangamon,
23and Cook counties for the purpose of providing input in the
24construction of the new rate or rates of reimbursement. The new
25rate or rates of reimbursement must be greater than 3 times the
26rate or rates of reimbursement in effect on January 1, 2019.

 

 

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1(Source: P.A. 100-587, eff. 6-4-18; 100-646, eff. 7-27-18;
2revised 8-27-18.)".