101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB3027

 

Introduced , by Rep. Kathleen Willis

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.10 new

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the medical assistance program shall cover charges incurred, and anesthetics provided, in conjunction with dental care that is provided to an individual in a hospital or an ambulatory surgical treatment center if the individual is otherwise eligible for medical assistance and any of the following applies: (1) the individual has a medical condition that requires hospitalization or general anesthesia for dental care; or (2) the individual is a person with a disability. Defines "person with a disability" to mean a person, regardless of age, with a chronic disability if the chronic disability meets specified conditions. Provides that the medical assistance program shall cover charges incurred, and anesthetics provided by a dentist with a permit provided under the Illinois Dental Practice Act or by a physician licensed under the Medical Practice Act to practice medicine in all of its branches, in conjunction with dental care that is provided to an individual in a dental office, oral surgeon's office, hospital, or ambulatory surgical treatment center if the individual, regardless of age, is otherwise eligible for medical assistance and has been diagnosed with (i) an autism spectrum disorder as defined in the Autism Spectrum Disorders Reporting Act or (ii) a developmental disability. Defines "developmental disability". Requires the Department of Healthcare and Family Services to reimburse providers of services covered under the amendatory Act at the same rates as the Medicare program's rates for similar services.


LRB101 10853 KTG 56190 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB3027LRB101 10853 KTG 56190 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5adding Section 5-5.10 as follows:
 
6    (305 ILCS 5/5-5.10 new)
7    Sec. 5-5.10. Coverage for adjunctive services in dental
8care.
9    (a) As used in this Section:
10    "Ambulatory surgical treatment center" has the meaning
11given to that term in Section 3 of the Ambulatory Surgical
12Treatment Center Act.
13    "Person with a disability" means a person, regardless of
14age, with a chronic disability if the chronic disability meets
15all of the following conditions:
16        (1) It is attributable to a mental or physical
17    impairment or combination of mental and physical
18    impairments.
19        (2) It is likely to continue.
20        (3) It results in substantial functional limitations
21    in one or more of the following areas of major life
22    activity:
23            (A) self-care;

 

 

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1            (B) receptive and expressive language;
2            (C) learning;
3            (D) mobility;
4            (E) capacity for independent living; or
5            (F) economic self-sufficiency.
6    (b) The medical assistance program shall cover charges
7incurred, and anesthetics provided, in conjunction with dental
8care that is provided to an individual in a hospital or an
9ambulatory surgical treatment center if the individual is
10otherwise eligible for medical assistance and any of the
11following applies:
12        (1) the individual has a medical condition that
13    requires hospitalization or general anesthesia for dental
14    care; or
15        (2) the individual is a person with a disability.
16    (c) The medical assistance program shall cover charges
17incurred, and anesthetics provided by a dentist with a permit
18provided under Section 8.1 of the Illinois Dental Practice Act
19or by a physician licensed under the Medical Practice Act to
20practice medicine in all of its branches, in conjunction with
21dental care that is provided to an individual in a dental
22office, oral surgeon's office, hospital, or ambulatory
23surgical treatment center if the individual, regardless of age,
24is otherwise eligible for medical assistance and has been
25diagnosed with an autism spectrum disorder as defined in
26Section 10 of the Autism Spectrum Disorders Reporting Act or a

 

 

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1developmental disability.
2    As used in this subsection, "developmental disability"
3means a disability that is attributable to an intellectual
4disability or a related condition, if the related condition
5meets all of the following conditions:
6        (1) it is attributable to cerebral palsy, epilepsy, or
7    any other condition, other than mental illness, found to be
8    closely related to an intellectual disability because that
9    condition results in impairment of general intellectual
10    functioning or adaptive behavior similar to that of
11    individuals with an intellectual disability and requires
12    treatment or services similar to those required for those
13    individuals; for purposes of this definition, autism is
14    considered a related condition;
15        (2) it is manifested before the individual reaches age
16    22;
17        (3) it is likely to continue indefinitely; and
18        (4) it results in substantial functional limitations
19    in 3 or more of the following areas of major life activity:
20    self-care, language, learning, mobility, self-direction,
21    and capacity for independent living.
22    (d) The Department shall reimburse providers of services
23covered under this Section at the same rates as the Medicare
24program's rates for similar services.