Rep. Gregory Harris

Filed: 5/23/2020

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 1864

2    AMENDMENT NO. ______. Amend Senate Bill 1864, AS AMENDED,
3by replacing everything after the enacting clause with the
4following:
 
5
"Article 5. Health Care Affordability Act

 
6    Section 5-1. Short title. This Article may be cited as the
7Health Care Affordability Act. References in this Article to
8"this Act" mean this Article.
 
9    Section 5-5. Findings. The General Assembly finds that:
10        (1) The State is committed to improving the health and
11    well-being of Illinois residents and families.
12        (2) Illinois has over 835,000 uninsured residents,
13    with a total uninsured rate of 7.9%.
14        (3) 774,500 of Illinois' uninsured residents are below
15    400% of the federal poverty level, with higher uninsured

 

 

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1    rates of more than 13% below 250% of the federal poverty
2    level and an uninsured rate of 8.3% below 400% of the
3    federal poverty level.
4        (4) The cost of health insurance premiums remains a
5    barrier to obtaining health insurance coverage for many
6    Illinois residents and families.
7        (5) Many Illinois residents and families who have
8    health insurance cannot afford to use it due to high
9    deductibles and cost sharing.
10        (6) Improving health insurance affordability is key to
11    increasing health insurance coverage and access.
12        (7) Despite progress made under the Patient Protection
13    and Affordable Care Act, health insurance is still not
14    affordable enough for many Illinois residents and
15    families.
16        (8) Illinois has a lower uninsured rate than the
17    national average of 10.2%, but a higher uninsured rate
18    compared to states that have state-directed policies to
19    improve affordability, including Massachusetts with an
20    uninsured rate of 3.2%.
21        (9) Illinois has an opportunity to create a healthy
22    Illinois where health insurance coverage is more
23    affordable and accessible for all Illinois residents,
24    families, and small businesses.
 
25    Section 5-10. Feasibility study.

 

 

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1    (a) The Department of Healthcare and Family Services, in
2consultation with the Department of Insurance, shall oversee a
3feasibility study to explore options to make health insurance
4more affordable for low-income and middle-income residents.
5The study shall include policies targeted at increasing health
6care affordability and access, including policies being
7discussed in other states and nationally. The study shall
8follow the best practices of other states and include an
9Illinois-specific actuarial and economic analysis of
10demographic and market dynamics.
11    (b) The study shall produce cost estimates for the policies
12studied under subsection (a) along with the impact of the
13policies on health insurance affordability and access and the
14uninsured rates for low-income and middle-income residents,
15with break-out data by geography, race, ethnicity, and income
16level. The study shall evaluate how multiple policies
17implemented together affect costs and outcomes and how policies
18could be structured to leverage federal matching funds and
19federal pass-through awards.
20    (c) The Department of Healthcare and Family Services, in
21consultation with the Department of Insurance, shall develop
22and submit no later than February 28, 2021 a report to the
23General Assembly and the Governor concerning the design, costs,
24benefits, and implementation of State options to increase
25access to affordable health care coverage that leverage
26existing State infrastructure.
 

 

 

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1
Article 10. Kidney Disease Prevention and Education Task Force
2
Act

 
3    Section 10-1. Short title. This Article may be cited as the
4Kidney Disease Prevention and Education Task Force Act.
5References in this Article to "this Act" mean this Article.
 
6    Section 10-5. Findings. The General Assembly finds that:
7        (1) Chronic kidney disease is the 9th-leading cause of
8    death in the United States. An estimated 31 million people
9    in the United States have chronic kidney disease and over
10    1.12 million people in the State of Illinois are living
11    with the disease. Early chronic kidney disease has no signs
12    or symptoms and, without early detection, can progress to
13    kidney failure.
14        (2) If a person has high blood pressure, heart disease,
15    diabetes, or a family history of kidney failure, the risk
16    of kidney disease is greater. In Illinois, 13% of all
17    adults have diabetes, and 32% have high blood pressure. The
18    prevalence of diabetes, heart disease, and hypertension is
19    higher for African Americans, who develop kidney failure at
20    a rate of nearly 4 to 1 compared to Caucasians, while
21    Hispanics develop kidney failure at a rate of 2 to 1.
22    Almost half of the people waiting for a kidney in Illinois
23    identify as African American, but, in 2017, less than 10%

 

 

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1    of them received a kidney.
2        (3) Although dialysis is a life-extending treatment,
3    the best and most cost-effective treatment for kidney
4    failure is a kidney transplant. Currently, the wait in
5    Illinois for a deceased donor kidney is 5-7 years, and 13
6    people die while waiting every day.
7        (4) If chronic kidney disease is detected early and
8    managed appropriately, the individual can receive
9    treatment sooner to help protect the kidneys, the
10    deterioration in kidney function can be slowed or even
11    stopped, and the risk of associated cardiovascular
12    complications and other complications can be reduced.
13        (5) In light of the COVID-19 pandemic and the increased
14    risk of infection to patients with preexisting conditions,
15    it is imperative to provide those with kidney disease with
16    support.
 
17    Section 10-10. Kidney Disease Prevention and Education
18Task Force.
19    (a) There is hereby established the Kidney Disease
20Prevention and Education Task Force to work directly with
21educational institutions to create health education programs
22to increase awareness of and to examine chronic kidney disease,
23transplantations, living and deceased kidney donation, and the
24existing disparity in the rates of those afflicted between
25Caucasians and minorities.

 

 

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1    (b) The Task Force shall develop a sustainable plan to
2raise awareness about early detection, promote health equity,
3and reduce the burden of kidney disease throughout the State,
4which shall include an ongoing campaign that includes health
5education workshops and seminars, relevant research, and
6preventive screenings and that promotes social media campaigns
7and TV and radio commercials.
8    (c) Membership of the Task Force shall be as follows:
9        (1) one member of the Senate, appointed by the Senate
10    President, who shall serve as Co-Chair;
11        (2) one member of the House of Representatives,
12    appointed by the Speaker of the House, who shall serve as
13    Co-Chair;
14        (3) one member of the House of Representatives,
15    appointed by the Minority Leader of the House;
16        (4) one member of the Senate, appointed by the Senate
17    Minority Leader;
18        (5) one member representing the Department of Public
19    Health, appointed by the Governor;
20        (6) one member representing the Department of
21    Healthcare and Family Services, appointed by the Governor;
22        (7) one member representing a medical center in a
23    county with a population of more 3 million residents,
24    appointed by the Co-Chairs;
25        (8) one member representing a physician's association
26    in a county with a population of more than 3 million

 

 

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1    residents, appointed by the Co-Chairs;
2        (9) one member representing a not-for-profit organ
3    procurement organization, appointed by the Co-Chairs;
4        (10) one member representing a national nonprofit
5    research kidney organization in the State of Illinois,
6    appointed by the Co-Chairs; and
7        (11) the Secretary of State or his or her designee.
8    (d) Members of the Task Force shall serve without
9compensation.
10    (e) The Department of Public Health shall provide
11administrative support to the Task Force.
12    (f) The Task Force shall submit its final report to the
13General Assembly on or before December 31, 2021 and, upon the
14filing of its final report, is dissolved.
 
15    Section 10-15. Repeal. This Act is repealed on June 1,
162022.
 
17
Article 90. Amendatory Provisions

 
18    Section 90-5. The Freedom of Information Act is amended by
19changing Section 7.5 as follows:
 
20    (5 ILCS 140/7.5)
21    Sec. 7.5. Statutory exemptions. To the extent provided for
22by the statutes referenced below, the following shall be exempt

 

 

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1from inspection and copying:
2        (a) All information determined to be confidential
3    under Section 4002 of the Technology Advancement and
4    Development Act.
5        (b) Library circulation and order records identifying
6    library users with specific materials under the Library
7    Records Confidentiality Act.
8        (c) Applications, related documents, and medical
9    records received by the Experimental Organ Transplantation
10    Procedures Board and any and all documents or other records
11    prepared by the Experimental Organ Transplantation
12    Procedures Board or its staff relating to applications it
13    has received.
14        (d) Information and records held by the Department of
15    Public Health and its authorized representatives relating
16    to known or suspected cases of sexually transmissible
17    disease or any information the disclosure of which is
18    restricted under the Illinois Sexually Transmissible
19    Disease Control Act.
20        (e) Information the disclosure of which is exempted
21    under Section 30 of the Radon Industry Licensing Act.
22        (f) Firm performance evaluations under Section 55 of
23    the Architectural, Engineering, and Land Surveying
24    Qualifications Based Selection Act.
25        (g) Information the disclosure of which is restricted
26    and exempted under Section 50 of the Illinois Prepaid

 

 

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1    Tuition Act.
2        (h) Information the disclosure of which is exempted
3    under the State Officials and Employees Ethics Act, and
4    records of any lawfully created State or local inspector
5    general's office that would be exempt if created or
6    obtained by an Executive Inspector General's office under
7    that Act.
8        (i) Information contained in a local emergency energy
9    plan submitted to a municipality in accordance with a local
10    emergency energy plan ordinance that is adopted under
11    Section 11-21.5-5 of the Illinois Municipal Code.
12        (j) Information and data concerning the distribution
13    of surcharge moneys collected and remitted by carriers
14    under the Emergency Telephone System Act.
15        (k) Law enforcement officer identification information
16    or driver identification information compiled by a law
17    enforcement agency or the Department of Transportation
18    under Section 11-212 of the Illinois Vehicle Code.
19        (l) Records and information provided to a residential
20    health care facility resident sexual assault and death
21    review team or the Executive Council under the Abuse
22    Prevention Review Team Act.
23        (m) Information provided to the predatory lending
24    database created pursuant to Article 3 of the Residential
25    Real Property Disclosure Act, except to the extent
26    authorized under that Article.

 

 

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1        (n) Defense budgets and petitions for certification of
2    compensation and expenses for court appointed trial
3    counsel as provided under Sections 10 and 15 of the Capital
4    Crimes Litigation Act. This subsection (n) shall apply
5    until the conclusion of the trial of the case, even if the
6    prosecution chooses not to pursue the death penalty prior
7    to trial or sentencing.
8        (o) Information that is prohibited from being
9    disclosed under Section 4 of the Illinois Health and
10    Hazardous Substances Registry Act.
11        (p) Security portions of system safety program plans,
12    investigation reports, surveys, schedules, lists, data, or
13    information compiled, collected, or prepared by or for the
14    Regional Transportation Authority under Section 2.11 of
15    the Regional Transportation Authority Act or the St. Clair
16    County Transit District under the Bi-State Transit Safety
17    Act.
18        (q) Information prohibited from being disclosed by the
19    Personnel Record Review Act.
20        (r) Information prohibited from being disclosed by the
21    Illinois School Student Records Act.
22        (s) Information the disclosure of which is restricted
23    under Section 5-108 of the Public Utilities Act.
24        (t) All identified or deidentified health information
25    in the form of health data or medical records contained in,
26    stored in, submitted to, transferred by, or released from

 

 

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1    the Illinois Health Information Exchange, and identified
2    or deidentified health information in the form of health
3    data and medical records of the Illinois Health Information
4    Exchange in the possession of the Illinois Health
5    Information Exchange Office Authority due to its
6    administration of the Illinois Health Information
7    Exchange. The terms "identified" and "deidentified" shall
8    be given the same meaning as in the Health Insurance
9    Portability and Accountability Act of 1996, Public Law
10    104-191, or any subsequent amendments thereto, and any
11    regulations promulgated thereunder.
12        (u) Records and information provided to an independent
13    team of experts under the Developmental Disability and
14    Mental Health Safety Act (also known as Brian's Law).
15        (v) Names and information of people who have applied
16    for or received Firearm Owner's Identification Cards under
17    the Firearm Owners Identification Card Act or applied for
18    or received a concealed carry license under the Firearm
19    Concealed Carry Act, unless otherwise authorized by the
20    Firearm Concealed Carry Act; and databases under the
21    Firearm Concealed Carry Act, records of the Concealed Carry
22    Licensing Review Board under the Firearm Concealed Carry
23    Act, and law enforcement agency objections under the
24    Firearm Concealed Carry Act.
25        (w) Personally identifiable information which is
26    exempted from disclosure under subsection (g) of Section

 

 

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1    19.1 of the Toll Highway Act.
2        (x) Information which is exempted from disclosure
3    under Section 5-1014.3 of the Counties Code or Section
4    8-11-21 of the Illinois Municipal Code.
5        (y) Confidential information under the Adult
6    Protective Services Act and its predecessor enabling
7    statute, the Elder Abuse and Neglect Act, including
8    information about the identity and administrative finding
9    against any caregiver of a verified and substantiated
10    decision of abuse, neglect, or financial exploitation of an
11    eligible adult maintained in the Registry established
12    under Section 7.5 of the Adult Protective Services Act.
13        (z) Records and information provided to a fatality
14    review team or the Illinois Fatality Review Team Advisory
15    Council under Section 15 of the Adult Protective Services
16    Act.
17        (aa) Information which is exempted from disclosure
18    under Section 2.37 of the Wildlife Code.
19        (bb) Information which is or was prohibited from
20    disclosure by the Juvenile Court Act of 1987.
21        (cc) Recordings made under the Law Enforcement
22    Officer-Worn Body Camera Act, except to the extent
23    authorized under that Act.
24        (dd) Information that is prohibited from being
25    disclosed under Section 45 of the Condominium and Common
26    Interest Community Ombudsperson Act.

 

 

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1        (ee) Information that is exempted from disclosure
2    under Section 30.1 of the Pharmacy Practice Act.
3        (ff) Information that is exempted from disclosure
4    under the Revised Uniform Unclaimed Property Act.
5        (gg) Information that is prohibited from being
6    disclosed under Section 7-603.5 of the Illinois Vehicle
7    Code.
8        (hh) Records that are exempt from disclosure under
9    Section 1A-16.7 of the Election Code.
10        (ii) Information which is exempted from disclosure
11    under Section 2505-800 of the Department of Revenue Law of
12    the Civil Administrative Code of Illinois.
13        (jj) Information and reports that are required to be
14    submitted to the Department of Labor by registering day and
15    temporary labor service agencies but are exempt from
16    disclosure under subsection (a-1) of Section 45 of the Day
17    and Temporary Labor Services Act.
18        (kk) Information prohibited from disclosure under the
19    Seizure and Forfeiture Reporting Act.
20        (ll) Information the disclosure of which is restricted
21    and exempted under Section 5-30.8 of the Illinois Public
22    Aid Code.
23        (mm) Records that are exempt from disclosure under
24    Section 4.2 of the Crime Victims Compensation Act.
25        (nn) Information that is exempt from disclosure under
26    Section 70 of the Higher Education Student Assistance Act.

 

 

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1        (oo) Communications, notes, records, and reports
2    arising out of a peer support counseling session prohibited
3    from disclosure under the First Responders Suicide
4    Prevention Act.
5        (pp) Names and all identifying information relating to
6    an employee of an emergency services provider or law
7    enforcement agency under the First Responders Suicide
8    Prevention Act.
9        (qq) Information and records held by the Department of
10    Public Health and its authorized representatives collected
11    under the Reproductive Health Act.
12        (rr) Information that is exempt from disclosure under
13    the Cannabis Regulation and Tax Act.
14        (ss) Data reported by an employer to the Department of
15    Human Rights pursuant to Section 2-108 of the Illinois
16    Human Rights Act.
17        (tt) Recordings made under the Children's Advocacy
18    Center Act, except to the extent authorized under that Act.
19        (uu) Information that is exempt from disclosure under
20    Section 50 of the Sexual Assault Evidence Submission Act.
21        (vv) Information that is exempt from disclosure under
22    subsections (f) and (j) of Section 5-36 of the Illinois
23    Public Aid Code.
24        (ww) Information that is exempt from disclosure under
25    Section 16.8 of the State Treasurer Act.
26        (xx) Information that is exempt from disclosure or

 

 

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1    information that shall not be made public under the
2    Illinois Insurance Code.
3        (yy) (oo) Information prohibited from being disclosed
4    under the Illinois Educational Labor Relations Act.
5        (zz) (pp) Information prohibited from being disclosed
6    under the Illinois Public Labor Relations Act.
7        (aaa) (qq) Information prohibited from being disclosed
8    under Section 1-167 of the Illinois Pension Code.
9(Source: P.A. 100-20, eff. 7-1-17; 100-22, eff. 1-1-18;
10100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff.
118-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517,
12eff. 6-1-18; 100-646, eff. 7-27-18; 100-690, eff. 1-1-19;
13100-863, eff. 8-14-18; 100-887, eff. 8-14-18; 101-13, eff.
146-12-19; 101-27, eff. 6-25-19; 101-81, eff. 7-12-19; 101-221,
15eff. 1-1-20; 101-236, eff. 1-1-20; 101-375, eff. 8-16-19;
16101-377, eff. 8-16-19; 101-452, eff. 1-1-20; 101-466, eff.
171-1-20; 101-600, eff. 12-6-19; 101-620, eff 12-20-19; revised
181-6-20.)
 
19    Section 90-10. The Illinois Health Information Exchange
20and Technology Act is amended by changing Sections 10, 20, 25,
2130, 35, and 40, as follows:
 
22    (20 ILCS 3860/10)
23    (Section scheduled to be repealed on January 1, 2021)
24    Sec. 10. Creation of the Health Information Exchange Office

 

 

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1Authority. There is hereby created the Illinois Health
2Information Exchange Office ("Office") Authority
3("Authority"), which is hereby constituted as an
4instrumentality and an administrative agency of the State of
5Illinois.
6    As part of its program to promote, develop, and sustain
7health information exchange at the State level, the Office
8Authority shall do the following:
9        (1) Establish the Illinois Health Information Exchange
10    ("ILHIE"), to promote and facilitate the sharing of health
11    information among health care providers within Illinois
12    and in other states. ILHIE shall be an entity operated by
13    the Office Authority to serve as a State-level electronic
14    medical records exchange providing for the transfer of
15    health information, medical records, and other health data
16    in a secure environment for the benefit of patient care,
17    patient safety, reduction of duplicate medical tests,
18    reduction of administrative costs, and any other benefits
19    deemed appropriate by the Office Authority.
20        (2) Foster the widespread adoption of electronic
21    health records and participation in the ILHIE.
22(Source: P.A. 96-1331, eff. 7-27-10.)
 
23    (20 ILCS 3860/20)
24    (Section scheduled to be repealed on January 1, 2021)
25    Sec. 20. Powers and duties of the Illinois Health

 

 

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1Information Exchange Office Authority. The Office Authority
2has the following powers, together with all powers incidental
3or necessary to accomplish the purposes of this Act:
4        (1) The Office Authority shall create and administer
5    the ILHIE using information systems and processes that are
6    secure, are cost effective, and meet all other relevant
7    privacy and security requirements under State and federal
8    law.
9        (2) The Office Authority shall establish and adopt
10    standards and requirements for the use of health
11    information and the requirements for participation in the
12    ILHIE by persons or entities including, but not limited to,
13    health care providers, payors, and local health
14    information exchanges.
15        (3) The Office Authority shall establish minimum
16    standards for accessing the ILHIE to ensure that the
17    appropriate security and privacy protections apply to
18    health information, consistent with applicable federal and
19    State standards and laws. The Office Authority shall have
20    the power to suspend, limit, or terminate the right to
21    participate in the ILHIE for non-compliance or failure to
22    act, with respect to applicable standards and laws, in the
23    best interests of patients, users of the ILHIE, or the
24    public. The Office Authority may seek all remedies allowed
25    by law to address any violation of the terms of
26    participation in the ILHIE.

 

 

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1        (4) The Office Authority shall identify barriers to the
2    adoption of electronic health records systems, including
3    researching the rates and patterns of dissemination and use
4    of electronic health record systems throughout the State.
5    The Office Authority shall make the results of the research
6    available on the Department of Healthcare and Family
7    Services' website its website.
8        (5) The Office Authority shall prepare educational
9    materials and educate the general public on the benefits of
10    electronic health records, the ILHIE, and the safeguards
11    available to prevent unauthorized disclosure of health
12    information.
13        (6) The Office Authority may appoint or designate an
14    institutional review board in accordance with federal and
15    State law to review and approve requests for research in
16    order to ensure compliance with standards and patient
17    privacy and security protections as specified in paragraph
18    (3) of this Section.
19        (7) The Office Authority may enter into all contracts
20    and agreements necessary or incidental to the performance
21    of its powers under this Act. The Office's Authority's
22    expenditures of private funds are exempt from the Illinois
23    Procurement Code, pursuant to Section 1-10 of that Act.
24    Notwithstanding this exception, the Office Authority shall
25    comply with the Business Enterprise for Minorities, Women,
26    and Persons with Disabilities Act.

 

 

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1        (8) The Office Authority may solicit and accept grants,
2    loans, contributions, or appropriations from any public or
3    private source and may expend those moneys, through
4    contracts, grants, loans, or agreements, on activities it
5    considers suitable to the performance of its duties under
6    this Act.
7        (9) The Office Authority may determine, charge, and
8    collect any fees, charges, costs, and expenses from any
9    healthcare provider or entity in connection with its duties
10    under this Act. Moneys collected under this paragraph (9)
11    shall be deposited into the Health Information Exchange
12    Fund.
13        (10) The Office Authority may, under the direction of
14    the Executive Director, employ and discharge staff,
15    including administrative, technical, expert, professional,
16    and legal staff, as is necessary or convenient to carry out
17    the purposes of this Act and as authorized by the Personnel
18    Code. The Authority may establish and administer standards
19    of classification regarding compensation, benefits,
20    duties, performance, and tenure for that staff and may
21    enter into contracts of employment with members of that
22    staff for such periods and on such terms as the Authority
23    deems desirable. All employees of the Authority are exempt
24    from the Personnel Code as provided by Section 4 of the
25    Personnel Code.
26        (10.5) Staff employed by the Illinois Health

 

 

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1    Information Exchange Authority on the effective date of
2    this amendatory Act of the 101st General Assembly shall
3    transfer to the Office within the Department of Healthcare
4    and Family Services.
5        (10.6) The status and rights of employees transferring
6    from the Illinois Health Information Exchange Authority
7    under paragraph (10.5) shall not be affected by such
8    transfer except that, notwithstanding any other State law
9    to the contrary, those employees shall maintain their
10    seniority and their positions shall convert to titles of
11    comparable organizational level under the Personnel Code
12    and become subject to the Personnel Code. Other than the
13    changes described in this paragraph, the rights of
14    employees, the State of Illinois, and State agencies under
15    the Personnel Code or under any pension, retirement, or
16    annuity plan shall not be affected by this amendatory Act
17    of the 101st General Assembly. Transferring personnel
18    shall continue their service within the Office.
19        (11) The Office Authority shall consult and coordinate
20    with the Department of Public Health to further the
21    Office's Authority's collection of health information from
22    health care providers for public health purposes. The
23    collection of public health information shall include
24    identifiable information for use by the Office Authority or
25    other State agencies to comply with State and federal laws.
26    Any identifiable information so collected shall be

 

 

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1    privileged and confidential in accordance with Sections
2    8-2101, 8-2102, 8-2103, 8-2104, and 8-2105 of the Code of
3    Civil Procedure.
4        (12) All identified or deidentified health information
5    in the form of health data or medical records contained in,
6    stored in, submitted to, transferred by, or released from
7    the Illinois Health Information Exchange, and identified
8    or deidentified health information in the form of health
9    data and medical records of the Illinois Health Information
10    Exchange in the possession of the Illinois Health
11    Information Exchange Office Authority due to its
12    administration of the Illinois Health Information
13    Exchange, shall be exempt from inspection and copying under
14    the Freedom of Information Act. The terms "identified" and
15    "deidentified" shall be given the same meaning as in the
16    Health Insurance Portability and Accountability Act of
17    1996, Public Law 104-191, or any subsequent amendments
18    thereto, and any regulations promulgated thereunder.
19        (13) To address gaps in the adoption of, workforce
20    preparation for, and exchange of electronic health records
21    that result in regional and socioeconomic disparities in
22    the delivery of care, the Office Authority may evaluate
23    such gaps and provide resources as available, giving
24    priority to healthcare providers serving a significant
25    percentage of Medicaid or uninsured patients and in
26    medically underserved or rural areas.

 

 

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1        (14) The Office shall perform its duties under this Act
2    in consultation with the Office of the Governor and with
3    the Departments of Public Health, Insurance, and Human
4    Services.
5(Source: P.A. 99-642, eff. 7-28-16; 100-391, eff. 8-25-17.)
 
6    (20 ILCS 3860/25)
7    (Section scheduled to be repealed on January 1, 2021)
8    Sec. 25. Health Information Exchange Fund.
9    (a) The Health Information Exchange Fund (the "Fund") is
10created as a separate fund outside the State treasury. Moneys
11in the Fund are not subject to appropriation by the General
12Assembly. The State Treasurer shall be ex-officio custodian of
13the Fund. Revenues arising from the operation and
14administration of the Office Authority and the ILHIE shall be
15deposited into the Fund. Fees, charges, State and federal
16moneys, grants, donations, gifts, interest, or other moneys
17shall be deposited into the Fund. "Private funds" means gifts,
18donations, and private grants.
19    (b) The Office Authority is authorized to spend moneys in
20the Fund on activities suitable to the performance of its
21duties as provided in Section 20 of this Act and authorized by
22this Act. Disbursements may be made from the Fund for purposes
23related to the operations and functions of the Office Authority
24and the ILHIE.
25    (c) The Illinois General Assembly may appropriate moneys to

 

 

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1the Office Authority and the ILHIE, and those moneys shall be
2deposited into the Fund.
3    (d) The Fund is not subject to administrative charges or
4charge-backs, including but not limited to those authorized
5under Section 8h of the State Finance Act.
6    (e) The Office's Authority's accounts and books shall be
7set up and maintained in accordance with the Office of the
8Comptroller's requirements, and the Authority's Executive
9Director of the Department of Healthcare and Family Services
10shall be responsible for the approval of recording of receipts,
11approval of payments, and proper filing of required reports.
12The moneys held and made available by the Office Authority
13shall be subject to financial and compliance audits by the
14Auditor General in compliance with the Illinois State Auditing
15Act.
16(Source: P.A. 96-1331, eff. 7-27-10.)
 
17    (20 ILCS 3860/30)
18    (Section scheduled to be repealed on January 1, 2021)
19    Sec. 30. Participation in health information systems
20maintained by State agencies.
21    (a) By no later than January 1, 2015, each State agency
22that implements, acquires, or upgrades health information
23technology systems shall use health information technology
24systems and products that meet minimum standards adopted by the
25Office Authority for accessing the ILHIE. State agencies that

 

 

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1have health information which supports and develops the ILHIE
2shall provide access to patient-specific data to complete the
3patient record at the ILHIE. Notwithstanding any other
4provision of State law, the State agencies shall provide
5patient-specific data to the ILHIE.
6    (b) Participation in the ILHIE shall have no impact on the
7content of or use or disclosure of health information of
8patient participants that is held in locations other than the
9ILHIE. Nothing in this Act shall limit or change an entity's
10obligation to exchange health information in accordance with
11applicable federal and State laws and standards.
12(Source: P.A. 96-1331, eff. 7-27-10.)
 
13    (20 ILCS 3860/35)
14    (Section scheduled to be repealed on January 1, 2021)
15    Sec. 35. Illinois Administrative Procedure Act. The
16provisions of the Illinois Administrative Procedure Act are
17hereby expressly adopted and shall apply to all administrative
18rules and procedures of the Office Authority, except that
19Section 5-35 of the Illinois Administrative Procedure Act
20relating to procedures for rulemaking does not apply to the
21adoption of any rule required by federal law when the Office
22Authority is precluded by that law from exercising any
23discretion regarding that rule.
24(Source: P.A. 96-1331, eff. 7-27-10.)
 

 

 

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1    (20 ILCS 3860/40)
2    (Section scheduled to be repealed on January 1, 2021)
3    Sec. 40. Reliance on data. Any health care provider who
4relies in good faith upon any information provided through the
5ILHIE in his, her, or its treatment of a patient shall be
6immune from criminal or civil liability or professional
7discipline arising from any damages caused by such good faith
8reliance. This immunity does not apply to acts or omissions
9constituting gross negligence or reckless, wanton, or
10intentional misconduct. Notwithstanding this provision, the
11Office Authority does not waive any immunities provided under
12State or federal law.
13(Source: P.A. 98-1046, eff. 1-1-15.)
 
14    (20 ILCS 3860/15 rep.)
15    Section 90-15. The Illinois Health Information Exchange
16and Technology Act is amended by repealing Section 15.
 
17    Section 90-20. The Children's Health Insurance Program Act
18is amended by changing Section 7 and by adding Section 8 as
19follows:
 
20    (215 ILCS 106/7)
21    Sec. 7. Eligibility verification. Notwithstanding any
22other provision of this Act, with respect to applications for
23benefits provided under the Program, eligibility shall be

 

 

10100SB1864ham006- 26 -LRB101 10924 SMS 72418 a

1determined in a manner that ensures program integrity and that
2complies with federal law and regulations while minimizing
3unnecessary barriers to enrollment. To this end, as soon as
4practicable, and unless the Department receives written denial
5from the federal government, this Section shall be implemented:
6    (a) The Department of Healthcare and Family Services or its
7designees shall:
8        (1) By no later than July 1, 2011, require verification
9    of, at a minimum, one month's income from all sources
10    required for determining the eligibility of applicants to
11    the Program. Such verification shall take the form of pay
12    stubs, business or income and expense records for
13    self-employed persons, letters from employers, and any
14    other valid documentation of income including data
15    obtained electronically by the Department or its designees
16    from other sources as described in subsection (b) of this
17    Section. A month's income may be verified by a single pay
18    stub with the monthly income extrapolated from the time
19    period covered by the pay stub.
20        (2) By no later than October 1, 2011, require
21    verification of, at a minimum, one month's income from all
22    sources required for determining the continued eligibility
23    of recipients at their annual review of eligibility under
24    the Program. Such verification shall take the form of pay
25    stubs, business or income and expense records for
26    self-employed persons, letters from employers, and any

 

 

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1    other valid documentation of income including data
2    obtained electronically by the Department or its designees
3    from other sources as described in subsection (b) of this
4    Section. A month's income may be verified by a single pay
5    stub with the monthly income extrapolated from the time
6    period covered by the pay stub. The Department shall send a
7    notice to the recipient at least 60 days prior to the end
8    of the period of eligibility that informs them of the
9    requirements for continued eligibility. Information the
10    Department receives prior to the annual review, including
11    information available to the Department as a result of the
12    recipient's application for other non-health care
13    benefits, that is sufficient to make a determination of
14    continued eligibility for medical assistance or for
15    benefits provided under the Program may be reviewed and
16    verified, and subsequent action taken including client
17    notification of continued eligibility for medical
18    assistance or for benefits provided under the Program. The
19    date of client notification establishes the date for
20    subsequent annual eligibility reviews. If a recipient does
21    not fulfill the requirements for continued eligibility by
22    the deadline established in the notice, a notice of
23    cancellation shall be issued to the recipient and coverage
24    shall end no later than the last day of the month following
25    the last day of the eligibility period. A recipient's
26    eligibility may be reinstated without requiring a new

 

 

10100SB1864ham006- 28 -LRB101 10924 SMS 72418 a

1    application if the recipient fulfills the requirements for
2    continued eligibility prior to the end of the third month
3    following the last date of coverage (or longer period if
4    required by federal regulations). Nothing in this Section
5    shall prevent an individual whose coverage has been
6    cancelled from reapplying for health benefits at any time.
7        (3) By no later than July 1, 2011, require verification
8    of Illinois residency.
9    (b) The Department shall establish or continue cooperative
10arrangements with the Social Security Administration, the
11Illinois Secretary of State, the Department of Human Services,
12the Department of Revenue, the Department of Employment
13Security, and any other appropriate entity to gain electronic
14access, to the extent allowed by law, to information available
15to those entities that may be appropriate for electronically
16verifying any factor of eligibility for benefits under the
17Program. Data relevant to eligibility shall be provided for no
18other purpose than to verify the eligibility of new applicants
19or current recipients of health benefits under the Program.
20Data will be requested or provided for any new applicant or
21current recipient only insofar as that individual's
22circumstances are relevant to that individual's or another
23individual's eligibility.
24    (c) Within 90 days of the effective date of this amendatory
25Act of the 96th General Assembly, the Department of Healthcare
26and Family Services shall send notice to current recipients

 

 

10100SB1864ham006- 29 -LRB101 10924 SMS 72418 a

1informing them of the changes regarding their eligibility
2verification.
3(Source: P.A. 101-209, eff. 8-5-19.)
 
4    (215 ILCS 106/8 new)
5    Sec. 8. COVID-19 public health emergency. Notwithstanding
6any other provision of this Act, the Department may take
7necessary actions to address the COVID-19 public health
8emergency to the extent such actions are required, approved, or
9authorized by the United States Department of Health and Human
10Services, Centers for Medicare and Medicaid Services. Such
11actions may continue throughout the public health emergency and
12for up to 12 months after the period ends, and may include, but
13are not limited to: accepting an applicant's or recipient's
14attestation of income, incurred medical expenses, residency,
15and insured status when electronic verification is not
16available; eliminating resource tests for some eligibility
17determinations; suspending redeterminations; suspending
18changes that would adversely affect an applicant's or
19recipient's eligibility; phone or verbal approval by an
20applicant to submit an application in lieu of applicant
21signature; allowing adult presumptive eligibility; allowing
22presumptive eligibility for children, pregnant women, and
23adults as often as twice per calendar year; paying for
24additional services delivered by telehealth; and suspending
25premium and co-payment requirements.

 

 

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1    The Department's authority under this Section shall only
2extend to encompass, incorporate, or effectuate the terms,
3items, conditions, and other provisions approved, authorized,
4or required by the United States Department of Health and Human
5Services, Centers for Medicare and Medicaid Services, and shall
6not extend beyond the time of the COVID-19 public health
7emergency and up to 12 months after the period expires.
 
8    Section 90-25. The Covering ALL KIDS Health Insurance Act
9is amended by changing Section 7 and by adding Section 8 as
10follows:
 
11    (215 ILCS 170/7)
12    (Section scheduled to be repealed on October 1, 2024)
13    Sec. 7. Eligibility verification. Notwithstanding any
14other provision of this Act, with respect to applications for
15benefits provided under the Program, eligibility shall be
16determined in a manner that ensures program integrity and that
17complies with federal law and regulations while minimizing
18unnecessary barriers to enrollment. To this end, as soon as
19practicable, and unless the Department receives written denial
20from the federal government, this Section shall be implemented:
21    (a) The Department of Healthcare and Family Services or its
22designees shall:
23        (1) By July 1, 2011, require verification of, at a
24    minimum, one month's income from all sources required for

 

 

10100SB1864ham006- 31 -LRB101 10924 SMS 72418 a

1    determining the eligibility of applicants to the Program.
2    Such verification shall take the form of pay stubs,
3    business or income and expense records for self-employed
4    persons, letters from employers, and any other valid
5    documentation of income including data obtained
6    electronically by the Department or its designees from
7    other sources as described in subsection (b) of this
8    Section. A month's income may be verified by a single pay
9    stub with the monthly income extrapolated from the time
10    period covered by the pay stub.
11        (2) By October 1, 2011, require verification of, at a
12    minimum, one month's income from all sources required for
13    determining the continued eligibility of recipients at
14    their annual review of eligibility under the Program. Such
15    verification shall take the form of pay stubs, business or
16    income and expense records for self-employed persons,
17    letters from employers, and any other valid documentation
18    of income including data obtained electronically by the
19    Department or its designees from other sources as described
20    in subsection (b) of this Section. A month's income may be
21    verified by a single pay stub with the monthly income
22    extrapolated from the time period covered by the pay stub.
23    The Department shall send a notice to recipients at least
24    60 days prior to the end of their period of eligibility
25    that informs them of the requirements for continued
26    eligibility. Information the Department receives prior to

 

 

10100SB1864ham006- 32 -LRB101 10924 SMS 72418 a

1    the annual review, including information available to the
2    Department as a result of the recipient's application for
3    other non-health care benefits, that is sufficient to make
4    a determination of continued eligibility for benefits
5    provided under this Act, the Children's Health Insurance
6    Program Act, or Article V of the Illinois Public Aid Code
7    may be reviewed and verified, and subsequent action taken
8    including client notification of continued eligibility for
9    benefits provided under this Act, the Children's Health
10    Insurance Program Act, or Article V of the Illinois Public
11    Aid Code. The date of client notification establishes the
12    date for subsequent annual eligibility reviews. If a
13    recipient does not fulfill the requirements for continued
14    eligibility by the deadline established in the notice, a
15    notice of cancellation shall be issued to the recipient and
16    coverage shall end no later than the last day of the month
17    following the last day of the eligibility period. A
18    recipient's eligibility may be reinstated without
19    requiring a new application if the recipient fulfills the
20    requirements for continued eligibility prior to the end of
21    the third month following the last date of coverage (or
22    longer period if required by federal regulations). Nothing
23    in this Section shall prevent an individual whose coverage
24    has been cancelled from reapplying for health benefits at
25    any time.
26        (3) By July 1, 2011, require verification of Illinois

 

 

10100SB1864ham006- 33 -LRB101 10924 SMS 72418 a

1    residency.
2    (b) The Department shall establish or continue cooperative
3arrangements with the Social Security Administration, the
4Illinois Secretary of State, the Department of Human Services,
5the Department of Revenue, the Department of Employment
6Security, and any other appropriate entity to gain electronic
7access, to the extent allowed by law, to information available
8to those entities that may be appropriate for electronically
9verifying any factor of eligibility for benefits under the
10Program. Data relevant to eligibility shall be provided for no
11other purpose than to verify the eligibility of new applicants
12or current recipients of health benefits under the Program.
13Data will be requested or provided for any new applicant or
14current recipient only insofar as that individual's
15circumstances are relevant to that individual's or another
16individual's eligibility.
17    (c) Within 90 days of the effective date of this amendatory
18Act of the 96th General Assembly, the Department of Healthcare
19and Family Services shall send notice to current recipients
20informing them of the changes regarding their eligibility
21verification.
22(Source: P.A. 101-209, eff. 8-5-19.)
 
23    (215 ILCS 170/8 new)
24    Sec. 8. COVID-19 public health emergency. Notwithstanding
25any other provision of this Act, the Department may take

 

 

10100SB1864ham006- 34 -LRB101 10924 SMS 72418 a

1necessary actions to address the COVID-19 public health
2emergency to the extent such actions are required, approved, or
3authorized by the United States Department of Health and Human
4Services, Centers for Medicare and Medicaid Services. Such
5actions may continue throughout the public health emergency and
6for up to 12 months after the period ends, and may include, but
7are not limited to: accepting an applicant's or recipient's
8attestation of income, incurred medical expenses, residency,
9and insured status when electronic verification is not
10available; eliminating resource tests for some eligibility
11determinations; suspending redeterminations; suspending
12changes that would adversely affect an applicant's or
13recipient's eligibility; phone or verbal approval by an
14applicant to submit an application in lieu of applicant
15signature; allowing adult presumptive eligibility; allowing
16presumptive eligibility for children, pregnant women, and
17adults as often as twice per calendar year; paying for
18additional services delivered by telehealth; and suspending
19premium and co-payment requirements.
20    The Department's authority under this Section shall only
21extend to encompass, incorporate, or effectuate the terms,
22items, conditions, and other provisions approved, authorized,
23or required by the United States Department of Health and Human
24Services, Centers for Medicare and Medicaid Services, and shall
25not extend beyond the time of the COVID-19 public health
26emergency and up to 12 months after the period expires.
 

 

 

10100SB1864ham006- 35 -LRB101 10924 SMS 72418 a

1    Section 90-30. The Pharmacy Practice Act is amended by
2adding Section 39.5 as follows:
 
3    (225 ILCS 85/39.5 new)
4    Sec. 39.5. Emergency kits.
5    (a) As used in this Section:
6    "Emergency kit" means a kit containing drugs that may be
7required to meet the immediate therapeutic needs of a patient
8and that are not available from any other source in sufficient
9time to prevent the risk of harm to a patient by delay
10resulting from obtaining the drugs from another source. An
11automated dispensing and storage system may be used as an
12emergency kit.
13    "Licensed facility" means an entity licensed under the
14Nursing Home Care Act, the Hospital Licensing Act, or the
15University of Illinois Hospital Act or a facility licensed
16under the Illinois Department of Human Services, Division of
17Substance Use Prevention and Recovery, for the prevention,
18intervention, treatment, and recovery support of substance use
19disorders or certified by the Illinois Department of Human
20Services, Division of Mental Health for the treatment of mental
21health.
22    "Offsite institutional pharmacy" means: (1) a pharmacy
23that is not located in facilities it serves and whose primary
24purpose is to provide services to patients or residents of

 

 

10100SB1864ham006- 36 -LRB101 10924 SMS 72418 a

1facilities licensed under the Nursing Home Care Act, the
2Hospital Licensing Act, or the University of Illinois Hospital
3Act; and (2) a pharmacy that is not located in the facilities
4it serves and the facilities it serves are licensed under the
5Illinois Department of Human Services, Division of Substance
6Use Prevention and Recovery, for the prevention, intervention,
7treatment, and recovery support of substance use disorders or
8for the treatment of mental health.
9    (b) An offsite institutional pharmacy may supply emergency
10kits to a licensed facility.
 
11    Section 90-35. The Illinois Public Aid Code is amended by
12changing Sections 5-2, 5-4.2, 5-5e, 5-16.8, 5B-4, and 11-5.1
13and by adding Sections 5-1.5, 5-5.27 and 12-21.21 as follows:
 
14    (305 ILCS 5/5-1.5 new)
15    Sec. 5-1.5. COVID-19 public health emergency.
16Notwithstanding any other provision of Articles V, XI, and XII
17of this Code, the Department may take necessary actions to
18address the COVID-19 public health emergency to the extent such
19actions are required, approved, or authorized by the United
20States Department of Health and Human Services, Centers for
21Medicare and Medicaid Services. Such actions may continue
22throughout the public health emergency and for up to 12 months
23after the period ends, and may include, but are not limited to:
24accepting an applicant's or recipient's attestation of income,

 

 

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1incurred medical expenses, residency, and insured status when
2electronic verification is not available; eliminating resource
3tests for some eligibility determinations; suspending
4redeterminations; suspending changes that would adversely
5affect an applicant's or recipient's eligibility; phone or
6verbal approval by an applicant to submit an application in
7lieu of applicant signature; allowing adult presumptive
8eligibility; allowing presumptive eligibility for children,
9pregnant women, and adults as often as twice per calendar year;
10paying for additional services delivered by telehealth; and
11suspending premium and co-payment requirements.
12    The Department's authority under this Section shall only
13extend to encompass, incorporate, or effectuate the terms,
14items, conditions, and other provisions approved, authorized,
15or required by the United States Department of Health and Human
16Services, Centers for Medicare and Medicaid Services, and shall
17not extend beyond the time of the COVID-19 public health
18emergency and up to 12 months after the period expires.
 
19    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
20    Sec. 5-2. Classes of Persons Eligible.
21    Medical assistance under this Article shall be available to
22any of the following classes of persons in respect to whom a
23plan for coverage has been submitted to the Governor by the
24Illinois Department and approved by him. If changes made in
25this Section 5-2 require federal approval, they shall not take

 

 

10100SB1864ham006- 38 -LRB101 10924 SMS 72418 a

1effect until such approval has been received:
2        1. Recipients of basic maintenance grants under
3    Articles III and IV.
4        2. Beginning January 1, 2014, persons otherwise
5    eligible for basic maintenance under Article III,
6    excluding any eligibility requirements that are
7    inconsistent with any federal law or federal regulation, as
8    interpreted by the U.S. Department of Health and Human
9    Services, but who fail to qualify thereunder on the basis
10    of need, and who have insufficient income and resources to
11    meet the costs of necessary medical care, including but not
12    limited to the following:
13            (a) All persons otherwise eligible for basic
14        maintenance under Article III but who fail to qualify
15        under that Article on the basis of need and who meet
16        either of the following requirements:
17                (i) their income, as determined by the
18            Illinois Department in accordance with any federal
19            requirements, is equal to or less than 100% of the
20            federal poverty level; or
21                (ii) their income, after the deduction of
22            costs incurred for medical care and for other types
23            of remedial care, is equal to or less than 100% of
24            the federal poverty level.
25            (b) (Blank).
26        3. (Blank).

 

 

10100SB1864ham006- 39 -LRB101 10924 SMS 72418 a

1        4. Persons not eligible under any of the preceding
2    paragraphs who fall sick, are injured, or die, not having
3    sufficient money, property or other resources to meet the
4    costs of necessary medical care or funeral and burial
5    expenses.
6        5.(a) Beginning January 1, 2020, women during
7    pregnancy and during the 12-month period beginning on the
8    last day of the pregnancy, together with their infants,
9    whose income is at or below 200% of the federal poverty
10    level. Until September 30, 2019, or sooner if the
11    maintenance of effort requirements under the Patient
12    Protection and Affordable Care Act are eliminated or may be
13    waived before then, women during pregnancy and during the
14    12-month period beginning on the last day of the pregnancy,
15    whose countable monthly income, after the deduction of
16    costs incurred for medical care and for other types of
17    remedial care as specified in administrative rule, is equal
18    to or less than the Medical Assistance-No Grant(C)
19    (MANG(C)) Income Standard in effect on April 1, 2013 as set
20    forth in administrative rule.
21        (b) The plan for coverage shall provide ambulatory
22    prenatal care to pregnant women during a presumptive
23    eligibility period and establish an income eligibility
24    standard that is equal to 200% of the federal poverty
25    level, provided that costs incurred for medical care are
26    not taken into account in determining such income

 

 

10100SB1864ham006- 40 -LRB101 10924 SMS 72418 a

1    eligibility.
2        (c) The Illinois Department may conduct a
3    demonstration in at least one county that will provide
4    medical assistance to pregnant women, together with their
5    infants and children up to one year of age, where the
6    income eligibility standard is set up to 185% of the
7    nonfarm income official poverty line, as defined by the
8    federal Office of Management and Budget. The Illinois
9    Department shall seek and obtain necessary authorization
10    provided under federal law to implement such a
11    demonstration. Such demonstration may establish resource
12    standards that are not more restrictive than those
13    established under Article IV of this Code.
14        6. (a) Children younger than age 19 when countable
15    income is at or below 133% of the federal poverty level.
16    Until September 30, 2019, or sooner if the maintenance of
17    effort requirements under the Patient Protection and
18    Affordable Care Act are eliminated or may be waived before
19    then, children younger than age 19 whose countable monthly
20    income, after the deduction of costs incurred for medical
21    care and for other types of remedial care as specified in
22    administrative rule, is equal to or less than the Medical
23    Assistance-No Grant(C) (MANG(C)) Income Standard in effect
24    on April 1, 2013 as set forth in administrative rule.
25        (b) Children and youth who are under temporary custody
26    or guardianship of the Department of Children and Family

 

 

10100SB1864ham006- 41 -LRB101 10924 SMS 72418 a

1    Services or who receive financial assistance in support of
2    an adoption or guardianship placement from the Department
3    of Children and Family Services.
4        7. (Blank).
5        8. As required under federal law, persons who are
6    eligible for Transitional Medical Assistance as a result of
7    an increase in earnings or child or spousal support
8    received. The plan for coverage for this class of persons
9    shall:
10            (a) extend the medical assistance coverage to the
11        extent required by federal law; and
12            (b) offer persons who have initially received 6
13        months of the coverage provided in paragraph (a) above,
14        the option of receiving an additional 6 months of
15        coverage, subject to the following:
16                (i) such coverage shall be pursuant to
17            provisions of the federal Social Security Act;
18                (ii) such coverage shall include all services
19            covered under Illinois' State Medicaid Plan;
20                (iii) no premium shall be charged for such
21            coverage; and
22                (iv) such coverage shall be suspended in the
23            event of a person's failure without good cause to
24            file in a timely fashion reports required for this
25            coverage under the Social Security Act and
26            coverage shall be reinstated upon the filing of

 

 

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1            such reports if the person remains otherwise
2            eligible.
3        9. Persons with acquired immunodeficiency syndrome
4    (AIDS) or with AIDS-related conditions with respect to whom
5    there has been a determination that but for home or
6    community-based services such individuals would require
7    the level of care provided in an inpatient hospital,
8    skilled nursing facility or intermediate care facility the
9    cost of which is reimbursed under this Article. Assistance
10    shall be provided to such persons to the maximum extent
11    permitted under Title XIX of the Federal Social Security
12    Act.
13        10. Participants in the long-term care insurance
14    partnership program established under the Illinois
15    Long-Term Care Partnership Program Act who meet the
16    qualifications for protection of resources described in
17    Section 15 of that Act.
18        11. Persons with disabilities who are employed and
19    eligible for Medicaid, pursuant to Section
20    1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
21    subject to federal approval, persons with a medically
22    improved disability who are employed and eligible for
23    Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
24    the Social Security Act, as provided by the Illinois
25    Department by rule. In establishing eligibility standards
26    under this paragraph 11, the Department shall, subject to

 

 

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1    federal approval:
2            (a) set the income eligibility standard at not
3        lower than 350% of the federal poverty level;
4            (b) exempt retirement accounts that the person
5        cannot access without penalty before the age of 59 1/2,
6        and medical savings accounts established pursuant to
7        26 U.S.C. 220;
8            (c) allow non-exempt assets up to $25,000 as to
9        those assets accumulated during periods of eligibility
10        under this paragraph 11; and
11            (d) continue to apply subparagraphs (b) and (c) in
12        determining the eligibility of the person under this
13        Article even if the person loses eligibility under this
14        paragraph 11.
15        12. Subject to federal approval, persons who are
16    eligible for medical assistance coverage under applicable
17    provisions of the federal Social Security Act and the
18    federal Breast and Cervical Cancer Prevention and
19    Treatment Act of 2000. Those eligible persons are defined
20    to include, but not be limited to, the following persons:
21            (1) persons who have been screened for breast or
22        cervical cancer under the U.S. Centers for Disease
23        Control and Prevention Breast and Cervical Cancer
24        Program established under Title XV of the federal
25        Public Health Services Act in accordance with the
26        requirements of Section 1504 of that Act as

 

 

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1        administered by the Illinois Department of Public
2        Health; and
3            (2) persons whose screenings under the above
4        program were funded in whole or in part by funds
5        appropriated to the Illinois Department of Public
6        Health for breast or cervical cancer screening.
7        "Medical assistance" under this paragraph 12 shall be
8    identical to the benefits provided under the State's
9    approved plan under Title XIX of the Social Security Act.
10    The Department must request federal approval of the
11    coverage under this paragraph 12 within 30 days after the
12    effective date of this amendatory Act of the 92nd General
13    Assembly.
14        In addition to the persons who are eligible for medical
15    assistance pursuant to subparagraphs (1) and (2) of this
16    paragraph 12, and to be paid from funds appropriated to the
17    Department for its medical programs, any uninsured person
18    as defined by the Department in rules residing in Illinois
19    who is younger than 65 years of age, who has been screened
20    for breast and cervical cancer in accordance with standards
21    and procedures adopted by the Department of Public Health
22    for screening, and who is referred to the Department by the
23    Department of Public Health as being in need of treatment
24    for breast or cervical cancer is eligible for medical
25    assistance benefits that are consistent with the benefits
26    provided to those persons described in subparagraphs (1)

 

 

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1    and (2). Medical assistance coverage for the persons who
2    are eligible under the preceding sentence is not dependent
3    on federal approval, but federal moneys may be used to pay
4    for services provided under that coverage upon federal
5    approval.
6        13. Subject to appropriation and to federal approval,
7    persons living with HIV/AIDS who are not otherwise eligible
8    under this Article and who qualify for services covered
9    under Section 5-5.04 as provided by the Illinois Department
10    by rule.
11        14. Subject to the availability of funds for this
12    purpose, the Department may provide coverage under this
13    Article to persons who reside in Illinois who are not
14    eligible under any of the preceding paragraphs and who meet
15    the income guidelines of paragraph 2(a) of this Section and
16    (i) have an application for asylum pending before the
17    federal Department of Homeland Security or on appeal before
18    a court of competent jurisdiction and are represented
19    either by counsel or by an advocate accredited by the
20    federal Department of Homeland Security and employed by a
21    not-for-profit organization in regard to that application
22    or appeal, or (ii) are receiving services through a
23    federally funded torture treatment center. Medical
24    coverage under this paragraph 14 may be provided for up to
25    24 continuous months from the initial eligibility date so
26    long as an individual continues to satisfy the criteria of

 

 

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1    this paragraph 14. If an individual has an appeal pending
2    regarding an application for asylum before the Department
3    of Homeland Security, eligibility under this paragraph 14
4    may be extended until a final decision is rendered on the
5    appeal. The Department may adopt rules governing the
6    implementation of this paragraph 14.
7        15. Family Care Eligibility.
8            (a) On and after July 1, 2012, a parent or other
9        caretaker relative who is 19 years of age or older when
10        countable income is at or below 133% of the federal
11        poverty level. A person may not spend down to become
12        eligible under this paragraph 15.
13            (b) Eligibility shall be reviewed annually.
14            (c) (Blank).
15            (d) (Blank).
16            (e) (Blank).
17            (f) (Blank).
18            (g) (Blank).
19            (h) (Blank).
20            (i) Following termination of an individual's
21        coverage under this paragraph 15, the individual must
22        be determined eligible before the person can be
23        re-enrolled.
24        16. Subject to appropriation, uninsured persons who
25    are not otherwise eligible under this Section who have been
26    certified and referred by the Department of Public Health

 

 

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1    as having been screened and found to need diagnostic
2    evaluation or treatment, or both diagnostic evaluation and
3    treatment, for prostate or testicular cancer. For the
4    purposes of this paragraph 16, uninsured persons are those
5    who do not have creditable coverage, as defined under the
6    Health Insurance Portability and Accountability Act, or
7    have otherwise exhausted any insurance benefits they may
8    have had, for prostate or testicular cancer diagnostic
9    evaluation or treatment, or both diagnostic evaluation and
10    treatment. To be eligible, a person must furnish a Social
11    Security number. A person's assets are exempt from
12    consideration in determining eligibility under this
13    paragraph 16. Such persons shall be eligible for medical
14    assistance under this paragraph 16 for so long as they need
15    treatment for the cancer. A person shall be considered to
16    need treatment if, in the opinion of the person's treating
17    physician, the person requires therapy directed toward
18    cure or palliation of prostate or testicular cancer,
19    including recurrent metastatic cancer that is a known or
20    presumed complication of prostate or testicular cancer and
21    complications resulting from the treatment modalities
22    themselves. Persons who require only routine monitoring
23    services are not considered to need treatment. "Medical
24    assistance" under this paragraph 16 shall be identical to
25    the benefits provided under the State's approved plan under
26    Title XIX of the Social Security Act. Notwithstanding any

 

 

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1    other provision of law, the Department (i) does not have a
2    claim against the estate of a deceased recipient of
3    services under this paragraph 16 and (ii) does not have a
4    lien against any homestead property or other legal or
5    equitable real property interest owned by a recipient of
6    services under this paragraph 16.
7        17. Persons who, pursuant to a waiver approved by the
8    Secretary of the U.S. Department of Health and Human
9    Services, are eligible for medical assistance under Title
10    XIX or XXI of the federal Social Security Act.
11    Notwithstanding any other provision of this Code and
12    consistent with the terms of the approved waiver, the
13    Illinois Department, may by rule:
14            (a) Limit the geographic areas in which the waiver
15        program operates.
16            (b) Determine the scope, quantity, duration, and
17        quality, and the rate and method of reimbursement, of
18        the medical services to be provided, which may differ
19        from those for other classes of persons eligible for
20        assistance under this Article.
21            (c) Restrict the persons' freedom in choice of
22        providers.
23        18. Beginning January 1, 2014, persons aged 19 or
24    older, but younger than 65, who are not otherwise eligible
25    for medical assistance under this Section 5-2, who qualify
26    for medical assistance pursuant to 42 U.S.C.

 

 

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1    1396a(a)(10)(A)(i)(VIII) and applicable federal
2    regulations, and who have income at or below 133% of the
3    federal poverty level plus 5% for the applicable family
4    size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
5    applicable federal regulations. Persons eligible for
6    medical assistance under this paragraph 18 shall receive
7    coverage for the Health Benefits Service Package as that
8    term is defined in subsection (m) of Section 5-1.1 of this
9    Code. If Illinois' federal medical assistance percentage
10    (FMAP) is reduced below 90% for persons eligible for
11    medical assistance under this paragraph 18, eligibility
12    under this paragraph 18 shall cease no later than the end
13    of the third month following the month in which the
14    reduction in FMAP takes effect.
15        19. Beginning January 1, 2014, as required under 42
16    U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18
17    and younger than age 26 who are not otherwise eligible for
18    medical assistance under paragraphs (1) through (17) of
19    this Section who (i) were in foster care under the
20    responsibility of the State on the date of attaining age 18
21    or on the date of attaining age 21 when a court has
22    continued wardship for good cause as provided in Section
23    2-31 of the Juvenile Court Act of 1987 and (ii) received
24    medical assistance under the Illinois Title XIX State Plan
25    or waiver of such plan while in foster care.
26        20. Beginning January 1, 2018, persons who are

 

 

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1    foreign-born victims of human trafficking, torture, or
2    other serious crimes as defined in Section 2-19 of this
3    Code and their derivative family members if such persons:
4    (i) reside in Illinois; (ii) are not eligible under any of
5    the preceding paragraphs; (iii) meet the income guidelines
6    of subparagraph (a) of paragraph 2; and (iv) meet the
7    nonfinancial eligibility requirements of Sections 16-2,
8    16-3, and 16-5 of this Code. The Department may extend
9    medical assistance for persons who are foreign-born
10    victims of human trafficking, torture, or other serious
11    crimes whose medical assistance would be terminated
12    pursuant to subsection (b) of Section 16-5 if the
13    Department determines that the person, during the year of
14    initial eligibility (1) experienced a health crisis, (2)
15    has been unable, after reasonable attempts, to obtain
16    necessary information from a third party, or (3) has other
17    extenuating circumstances that prevented the person from
18    completing his or her application for status. The
19    Department may adopt any rules necessary to implement the
20    provisions of this paragraph.
21        21. Persons who are not otherwise eligible for medical
22    assistance under this Section who may qualify for medical
23    assistance pursuant to 42 U.S.C.
24    1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the
25    duration of any federal or State declared emergency due to
26    COVID-19. Medical assistance to persons eligible for

 

 

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1    medical assistance solely pursuant to this paragraph 21
2    shall be limited to any in vitro diagnostic product (and
3    the administration of such product) described in 42 U.S.C.
4    1396d(a)(3)(B) on or after March 18, 2020, any visit
5    described in 42 U.S.C. 1396o(a)(2)(G), or any other medical
6    assistance that may be federally authorized for this class
7    of persons. The Department may also cover treatment of
8    COVID-19 for this class of persons, or any similar category
9    of uninsured individuals, to the extent authorized under a
10    federally approved 1115 Waiver or other federal authority.
11    Notwithstanding the provisions of Section 1-11 of this
12    Code, due to the nature of the COVID-19 public health
13    emergency, the Department may cover and provide the medical
14    assistance described in this paragraph 21 to noncitizens
15    who would otherwise meet the eligibility requirements for
16    the class of persons described in this paragraph 21 for the
17    duration of the State emergency period.
18    In implementing the provisions of Public Act 96-20, the
19Department is authorized to adopt only those rules necessary,
20including emergency rules. Nothing in Public Act 96-20 permits
21the Department to adopt rules or issue a decision that expands
22eligibility for the FamilyCare Program to a person whose income
23exceeds 185% of the Federal Poverty Level as determined from
24time to time by the U.S. Department of Health and Human
25Services, unless the Department is provided with express
26statutory authority.

 

 

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1    The eligibility of any such person for medical assistance
2under this Article is not affected by the payment of any grant
3under the Senior Citizens and Persons with Disabilities
4Property Tax Relief Act or any distributions or items of income
5described under subparagraph (X) of paragraph (2) of subsection
6(a) of Section 203 of the Illinois Income Tax Act.
7    The Department shall by rule establish the amounts of
8assets to be disregarded in determining eligibility for medical
9assistance, which shall at a minimum equal the amounts to be
10disregarded under the Federal Supplemental Security Income
11Program. The amount of assets of a single person to be
12disregarded shall not be less than $2,000, and the amount of
13assets of a married couple to be disregarded shall not be less
14than $3,000.
15    To the extent permitted under federal law, any person found
16guilty of a second violation of Article VIIIA shall be
17ineligible for medical assistance under this Article, as
18provided in Section 8A-8.
19    The eligibility of any person for medical assistance under
20this Article shall not be affected by the receipt by the person
21of donations or benefits from fundraisers held for the person
22in cases of serious illness, as long as neither the person nor
23members of the person's family have actual control over the
24donations or benefits or the disbursement of the donations or
25benefits.
26    Notwithstanding any other provision of this Code, if the

 

 

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1United States Supreme Court holds Title II, Subtitle A, Section
22001(a) of Public Law 111-148 to be unconstitutional, or if a
3holding of Public Law 111-148 makes Medicaid eligibility
4allowed under Section 2001(a) inoperable, the State or a unit
5of local government shall be prohibited from enrolling
6individuals in the Medical Assistance Program as the result of
7federal approval of a State Medicaid waiver on or after the
8effective date of this amendatory Act of the 97th General
9Assembly, and any individuals enrolled in the Medical
10Assistance Program pursuant to eligibility permitted as a
11result of such a State Medicaid waiver shall become immediately
12ineligible.
13    Notwithstanding any other provision of this Code, if an Act
14of Congress that becomes a Public Law eliminates Section
152001(a) of Public Law 111-148, the State or a unit of local
16government shall be prohibited from enrolling individuals in
17the Medical Assistance Program as the result of federal
18approval of a State Medicaid waiver on or after the effective
19date of this amendatory Act of the 97th General Assembly, and
20any individuals enrolled in the Medical Assistance Program
21pursuant to eligibility permitted as a result of such a State
22Medicaid waiver shall become immediately ineligible.
23    Effective October 1, 2013, the determination of
24eligibility of persons who qualify under paragraphs 5, 6, 8,
2515, 17, and 18 of this Section shall comply with the
26requirements of 42 U.S.C. 1396a(e)(14) and applicable federal

 

 

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1regulations.
2    The Department of Healthcare and Family Services, the
3Department of Human Services, and the Illinois health insurance
4marketplace shall work cooperatively to assist persons who
5would otherwise lose health benefits as a result of changes
6made under this amendatory Act of the 98th General Assembly to
7transition to other health insurance coverage.
8(Source: P.A. 101-10, eff. 6-5-19.)
 
9    (305 ILCS 5/5-4.2)  (from Ch. 23, par. 5-4.2)
10    Sec. 5-4.2. Ambulance services payments.
11    (a) For ambulance services provided to a recipient of aid
12under this Article on or after January 1, 1993, the Illinois
13Department shall reimburse ambulance service providers at
14rates calculated in accordance with this Section. It is the
15intent of the General Assembly to provide adequate
16reimbursement for ambulance services so as to ensure adequate
17access to services for recipients of aid under this Article and
18to provide appropriate incentives to ambulance service
19providers to provide services in an efficient and
20cost-effective manner. Thus, it is the intent of the General
21Assembly that the Illinois Department implement a
22reimbursement system for ambulance services that, to the extent
23practicable and subject to the availability of funds
24appropriated by the General Assembly for this purpose, is
25consistent with the payment principles of Medicare. To ensure

 

 

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

 

 

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1service provider" means a vehicle service provider as described
2in the Emergency Medical Services (EMS) Systems Act that
3operates licensed ambulances for the purpose of providing
4emergency ambulance services, or non-emergency ambulance
5services, or both. For purposes of this Section, this includes
6both ambulance providers and ambulance suppliers as described
7by the Centers for Medicare and Medicaid Services.
8    (c-3) For purposes of this Section, "medi-car" means
9transportation services provided to a patient who is confined
10to a wheelchair and requires the use of a hydraulic or electric
11lift or ramp and wheelchair lockdown when the patient's
12condition does not require medical observation, medical
13supervision, medical equipment, the administration of
14medications, or the administration of oxygen.
15    (c-4) For purposes of this Section, "service car" means
16transportation services provided to a patient by a passenger
17vehicle where that patient does not require the specialized
18modes described in subsection (c-1) or (c-3).
19    (d) This Section does not prohibit separate billing by
20ambulance service providers for oxygen furnished while
21providing advanced life support services.
22    (e) Beginning with services rendered on or after July 1,
232008, all providers of non-emergency medi-car and service car
24transportation must certify that the driver and employee
25attendant, as applicable, have completed a safety program
26approved by the Department to protect both the patient and the

 

 

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1driver, prior to transporting a patient. The provider must
2maintain this certification in its records. The provider shall
3produce such documentation upon demand by the Department or its
4representative. Failure to produce documentation of such
5training shall result in recovery of any payments made by the
6Department for services rendered by a non-certified driver or
7employee attendant. Medi-car and service car providers must
8maintain legible documentation in their records of the driver
9and, as applicable, employee attendant that actually
10transported the patient. Providers must recertify all drivers
11and employee attendants every 3 years.
12    Notwithstanding the requirements above, any public
13transportation provider of medi-car and service car
14transportation that receives federal funding under 49 U.S.C.
155307 and 5311 need not certify its drivers and employee
16attendants under this Section, since safety training is already
17federally mandated.
18    (f) With respect to any policy or program administered by
19the Department or its agent regarding approval of non-emergency
20medical transportation by ground ambulance service providers,
21including, but not limited to, the Non-Emergency
22Transportation Services Prior Approval Program (NETSPAP), the
23Department shall establish by rule a process by which ground
24ambulance service providers of non-emergency medical
25transportation may appeal any decision by the Department or its
26agent for which no denial was received prior to the time of

 

 

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1transport that either (i) denies a request for approval for
2payment of non-emergency transportation by means of ground
3ambulance service or (ii) grants a request for approval of
4non-emergency transportation by means of ground ambulance
5service at a level of service that entitles the ground
6ambulance service provider to a lower level of compensation
7from the Department than the ground ambulance service provider
8would have received as compensation for the level of service
9requested. The rule shall be filed by December 15, 2012 and
10shall provide that, for any decision rendered by the Department
11or its agent on or after the date the rule takes effect, the
12ground ambulance service provider shall have 60 days from the
13date the decision is received to file an appeal. The rule
14established by the Department shall be, insofar as is
15practical, consistent with the Illinois Administrative
16Procedure Act. The Director's decision on an appeal under this
17Section shall be a final administrative decision subject to
18review under the Administrative Review Law.
19    (f-5) Beginning 90 days after July 20, 2012 (the effective
20date of Public Act 97-842), (i) no denial of a request for
21approval for payment of non-emergency transportation by means
22of ground ambulance service, and (ii) no approval of
23non-emergency transportation by means of ground ambulance
24service at a level of service that entitles the ground
25ambulance service provider to a lower level of compensation
26from the Department than would have been received at the level

 

 

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1of service submitted by the ground ambulance service provider,
2may be issued by the Department or its agent unless the
3Department has submitted the criteria for determining the
4appropriateness of the transport for first notice publication
5in the Illinois Register pursuant to Section 5-40 of the
6Illinois Administrative Procedure Act.
7    (g) Whenever a patient covered by a medical assistance
8program under this Code or by another medical program
9administered by the Department, including a patient covered
10under the State's Medicaid managed care program, is being
11transported from a facility and requires non-emergency
12transportation including ground ambulance, medi-car, or
13service car transportation, a Physician Certification
14Statement as described in this Section shall be required for
15each patient. Facilities shall develop procedures for a
16licensed medical professional to provide a written and signed
17Physician Certification Statement. The Physician Certification
18Statement shall specify the level of transportation services
19needed and complete a medical certification establishing the
20criteria for approval of non-emergency ambulance
21transportation, as published by the Department of Healthcare
22and Family Services, that is met by the patient. This
23certification shall be completed prior to ordering the
24transportation service and prior to patient discharge. The
25Physician Certification Statement is not required prior to
26transport if a delay in transport can be expected to negatively

 

 

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1affect the patient outcome. If the ground ambulance provider,
2medi-car provider, or service car provider is unable to obtain
3the required Physician Certification Statement within 10
4calendar days following the date of the service, the ground
5ambulance provider, medi-car provider, or service car provider
6must document its attempt to obtain the requested certification
7and may then submit the claim for payment. Acceptable
8documentation includes a signed return receipt from the U.S.
9Postal Service, facsimile receipt, email receipt, or other
10similar service that evidences that the ground ambulance
11provider, medi-car provider, or service car provider attempted
12to obtain the required Physician Certification Statement.
13    The medical certification specifying the level and type of
14non-emergency transportation needed shall be in the form of the
15Physician Certification Statement on a standardized form
16prescribed by the Department of Healthcare and Family Services.
17Within 75 days after July 27, 2018 (the effective date of
18Public Act 100-646), the Department of Healthcare and Family
19Services shall develop a standardized form of the Physician
20Certification Statement specifying the level and type of
21transportation services needed in consultation with the
22Department of Public Health, Medicaid managed care
23organizations, a statewide association representing ambulance
24providers, a statewide association representing hospitals, 3
25statewide associations representing nursing homes, and other
26stakeholders. The Physician Certification Statement shall

 

 

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1include, but is not limited to, the criteria necessary to
2demonstrate medical necessity for the level of transport needed
3as required by (i) the Department of Healthcare and Family
4Services and (ii) the federal Centers for Medicare and Medicaid
5Services as outlined in the Centers for Medicare and Medicaid
6Services' Medicare Benefit Policy Manual, Pub. 100-02, Chap.
710, Sec. 10.2.1, et seq. The use of the Physician Certification
8Statement shall satisfy the obligations of hospitals under
9Section 6.22 of the Hospital Licensing Act and nursing homes
10under Section 2-217 of the Nursing Home Care Act.
11Implementation and acceptance of the Physician Certification
12Statement shall take place no later than 90 days after the
13issuance of the Physician Certification Statement by the
14Department of Healthcare and Family Services.
15    Pursuant to subsection (E) of Section 12-4.25 of this Code,
16the Department is entitled to recover overpayments paid to a
17provider or vendor, including, but not limited to, from the
18discharging physician, the discharging facility, and the
19ground ambulance service provider, in instances where a
20non-emergency ground ambulance service is rendered as the
21result of improper or false certification.
22    Beginning October 1, 2018, the Department of Healthcare and
23Family Services shall collect data from Medicaid managed care
24organizations and transportation brokers, including the
25Department's NETSPAP broker, regarding denials and appeals
26related to the missing or incomplete Physician Certification

 

 

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1Statement forms and overall compliance with this subsection.
2The Department of Healthcare and Family Services shall publish
3quarterly results on its website within 15 days following the
4end of each quarter.
5    (h) On and after July 1, 2012, the Department shall reduce
6any rate of reimbursement for services or other payments or
7alter any methodologies authorized by this Code to reduce any
8rate of reimbursement for services or other payments in
9accordance with Section 5-5e.
10    (i) On and after July 1, 2018, the Department shall
11increase the base rate of reimbursement for both base charges
12and mileage charges for ground ambulance service providers for
13medical transportation services provided by means of a ground
14ambulance to a level not lower than 112% of the base rate in
15effect as of June 30, 2018.
16(Source: P.A. 100-587, eff. 6-4-18; 100-646, eff. 7-27-18;
17101-81, eff. 7-12-19.)
 
18    (305 ILCS 5/5-5.27 new)
19    Sec. 5-5.27. Coverage for clinical trials.
20    (a) The medical assistance program shall provide coverage
21for routine care costs that are incurred in the course of an
22approved clinical trial if the medical assistance program would
23provide coverage for the same routine care costs not incurred
24in a clinical trial. "Routine care cost" shall be defined by
25the Department by rule.

 

 

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1    (b) The coverage that must be provided under this Section
2is subject to the terms, conditions, restrictions, exclusions,
3and limitations that apply generally under the medical
4assistance program, including terms, conditions, restrictions,
5exclusions, or limitations that apply to health care services
6rendered by participating providers and nonparticipating
7providers.
8    (c) Implementation of this Section shall be contingent upon
9federal approval. Upon receipt of federal approval, if
10required, the Department shall adopt any rules necessary to
11implement this Section.
12    (d) As used in this Section:
13    "Approved clinical trial" means a phase I, II, III, or IV
14clinical trial involving the prevention, detection, or
15treatment of cancer or any other life-threatening disease or
16condition if one or more of the following conditions apply:
17        (1) the Department makes a determination that the study
18    or investigation is an approved clinical trial;
19        (2) the study or investigation is conducted under an
20    investigational new drug application or an investigational
21    device exemption reviewed by the federal Food and Drug
22    Administration;
23        (3) the study or investigation is a drug trial that is
24    exempt from having an investigational new drug application
25    or an investigational device exemption from the federal
26    Food and Drug Administration; or

 

 

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1        (4) the study or investigation is approved or funded
2    (which may include funding through in-kind contributions)
3    by:
4            (A) the National Institutes of Health;
5            (B) the Centers for Disease Control and
6        Prevention;
7            (C) the Agency for Healthcare Research and
8        Quality;
9            (D) the Patient-Centered Outcomes Research
10        Institute;
11            (E) the federal Centers for Medicare and Medicaid
12        Services;
13            (F) a cooperative group or center of any of the
14        entities described in subparagraphs (A) through (E) or
15        the United States Department of Defense or the United
16        States Department of Veterans Affairs;
17            (G) a qualified non-governmental research entity
18        identified in the guidelines issued by the National
19        Institutes of Health for center support grants; or
20            (H) the United States Department of Veterans
21        Affairs, the United States Department of Defense, or
22        the United States Department of Energy, provided that
23        review and approval of the study or investigation
24        occurs through a system of peer review that is
25        comparable to the peer review of studies performed by
26        the National Institutes of Health, including an

 

 

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1        unbiased review of the highest scientific standards by
2        qualified individuals who have no interest in the
3        outcome of the review.
4    "Care method" means the use of a particular drug or device
5in a particular manner.
6    "Life-threatening disease or condition" means a disease or
7condition from which the likelihood of death is probable unless
8the course of the disease or condition is interrupted.
 
9    (305 ILCS 5/5-5e)
10    Sec. 5-5e. Adjusted rates of reimbursement.
11    (a) Rates or payments for services in effect on June 30,
122012 shall be adjusted and services shall be affected as
13required by any other provision of Public Act 97-689. In
14addition, the Department shall do the following:
15        (1) Delink the per diem rate paid for supportive living
16    facility services from the per diem rate paid for nursing
17    facility services, effective for services provided on or
18    after May 1, 2011 and before July 1, 2019.
19        (2) Cease payment for bed reserves in nursing
20    facilities and specialized mental health rehabilitation
21    facilities; for purposes of therapeutic home visits for
22    individuals scoring as TBI on the MDS 3.0, beginning June
23    1, 2015, the Department shall approve payments for bed
24    reserves in nursing facilities and specialized mental
25    health rehabilitation facilities that have at least a 90%

 

 

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1    occupancy level and at least 80% of their residents are
2    Medicaid eligible. Payment shall be at a daily rate of 75%
3    of an individual's current Medicaid per diem and shall not
4    exceed 10 days in a calendar month.
5        (2.5) Cease payment for bed reserves for purposes of
6    inpatient hospitalizations to intermediate care facilities
7    for persons with developmental development disabilities,
8    except in the instance of residents who are under 21 years
9    of age.
10        (3) Cease payment of the $10 per day add-on payment to
11    nursing facilities for certain residents with
12    developmental disabilities.
13    (b) After the application of subsection (a),
14notwithstanding any other provision of this Code to the
15contrary and to the extent permitted by federal law, on and
16after July 1, 2012, the rates of reimbursement for services and
17other payments provided under this Code shall further be
18reduced as follows:
19        (1) Rates or payments for physician services, dental
20    services, or community health center services reimbursed
21    through an encounter rate, and services provided under the
22    Medicaid Rehabilitation Option of the Illinois Title XIX
23    State Plan shall not be further reduced, except as provided
24    in Section 5-5b.1.
25        (2) Rates or payments, or the portion thereof, paid to
26    a provider that is operated by a unit of local government

 

 

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1    or State University that provides the non-federal share of
2    such services shall not be further reduced, except as
3    provided in Section 5-5b.1.
4        (3) Rates or payments for hospital services delivered
5    by a hospital defined as a Safety-Net Hospital under
6    Section 5-5e.1 of this Code shall not be further reduced,
7    except as provided in Section 5-5b.1.
8        (4) Rates or payments for hospital services delivered
9    by a Critical Access Hospital, which is an Illinois
10    hospital designated as a critical care hospital by the
11    Department of Public Health in accordance with 42 CFR 485,
12    Subpart F, shall not be further reduced, except as provided
13    in Section 5-5b.1.
14        (5) Rates or payments for Nursing Facility Services
15    shall only be further adjusted pursuant to Section 5-5.2 of
16    this Code.
17        (6) Rates or payments for services delivered by long
18    term care facilities licensed under the ID/DD Community
19    Care Act or the MC/DD Act and developmental training
20    services shall not be further reduced.
21        (7) Rates or payments for services provided under
22    capitation rates shall be adjusted taking into
23    consideration the rates reduction and covered services
24    required by Public Act 97-689.
25        (8) For hospitals not previously described in this
26    subsection, the rates or payments for hospital services

 

 

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1    shall be further reduced by 3.5%, except for payments
2    authorized under Section 5A-12.4 of this Code.
3        (9) For all other rates or payments for services
4    delivered by providers not specifically referenced in
5    paragraphs (1) through (8), rates or payments shall be
6    further reduced by 2.7%.
7    (c) Any assessment imposed by this Code shall continue and
8nothing in this Section shall be construed to cause it to
9cease.
10    (d) Notwithstanding any other provision of this Code to the
11contrary, subject to federal approval under Title XIX of the
12Social Security Act, for dates of service on and after July 1,
132014, rates or payments for services provided for the purpose
14of transitioning children from a hospital to home placement or
15other appropriate setting by a children's community-based
16health care center authorized under the Alternative Health Care
17Delivery Act shall be $683 per day.
18    (e) (Blank) Notwithstanding any other provision of this
19Code to the contrary, subject to federal approval under Title
20XIX of the Social Security Act, for dates of service on and
21after July 1, 2014, rates or payments for home health visits
22shall be $72.
23    (f) (Blank) Notwithstanding any other provision of this
24Code to the contrary, subject to federal approval under Title
25XIX of the Social Security Act, for dates of service on and
26after July 1, 2014, rates or payments for the certified nursing

 

 

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1assistant component of the home health agency rate shall be
2$20.
3(Source: P.A. 101-10, eff. 6-5-19; revised 9-12-19.)
 
4    (305 ILCS 5/5-16.8)
5    Sec. 5-16.8. Required health benefits. The medical
6assistance program shall (i) provide the post-mastectomy care
7benefits required to be covered by a policy of accident and
8health insurance under Section 356t and the coverage required
9under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
10356z.29, and 356z.32, and 356z.33, 356z.34, and 356z.35 of the
11Illinois Insurance Code and (ii) be subject to the provisions
12of Sections 356z.19, 364.01, 370c, and 370c.1 of the Illinois
13Insurance Code.
14    The Department, by rule, shall adopt a model similar to the
15requirements of Section 356z.39 of the Illinois Insurance Code.
16    On and after July 1, 2012, the Department shall reduce any
17rate of reimbursement for services or other payments or alter
18any methodologies authorized by this Code to reduce any rate of
19reimbursement for services or other payments in accordance with
20Section 5-5e.
21    To ensure full access to the benefits set forth in this
22Section, on and after January 1, 2016, the Department shall
23ensure that provider and hospital reimbursement for
24post-mastectomy care benefits required under this Section are
25no lower than the Medicare reimbursement rate.

 

 

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1(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
2100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
37-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
4eff. 1-1-20; 101-574, eff. 1-1-20; revised 10-16-19.)
 
5    (305 ILCS 5/5B-4)  (from Ch. 23, par. 5B-4)
6    Sec. 5B-4. Payment of assessment; penalty.
7    (a) The assessment imposed by Section 5B-2 shall be due and
8payable monthly, on the last State business day of the month
9for occupied bed days reported for the preceding third month
10prior to the month in which the tax is payable and due. A
11facility that has delayed payment due to the State's failure to
12reimburse for services rendered may request an extension on the
13due date for payment pursuant to subsection (b) and shall pay
14the assessment within 30 days of reimbursement by the
15Department. The Illinois Department may provide that county
16nursing homes directed and maintained pursuant to Section
175-1005 of the Counties Code may meet their assessment
18obligation by certifying to the Illinois Department that county
19expenditures have been obligated for the operation of the
20county nursing home in an amount at least equal to the amount
21of the assessment.
22    (a-5) The Illinois Department shall provide for an
23electronic submission process for each long-term care facility
24to report at a minimum the number of occupied bed days of the
25long-term care facility for the reporting period and other

 

 

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1reasonable information the Illinois Department requires for
2the administration of its responsibilities under this Code.
3Beginning July 1, 2013, a separate electronic submission shall
4be completed for each long-term care facility in this State
5operated by a long-term care provider. The Illinois Department
6shall provide a self-reporting notice of the assessment form
7that the long-term care facility completes for the required
8period and submits with its assessment payment to the Illinois
9Department. shall prepare an assessment bill stating the amount
10due and payable each month and submit it to each long-term care
11facility via an electronic process. Each assessment payment
12shall be accompanied by a copy of the assessment bill sent to
13the long-term care facility by the Illinois Department. To the
14extent practicable, the Department shall coordinate the
15assessment reporting requirements with other reporting
16required of long-term care facilities.
17    (b) The Illinois Department is authorized to establish
18delayed payment schedules for long-term care providers that are
19unable to make assessment payments when due under this Section
20due to financial difficulties, as determined by the Illinois
21Department. The Illinois Department may not deny a request for
22delay of payment of the assessment imposed under this Article
23if the long-term care provider has not been paid for services
24provided during the month on which the assessment is levied or
25the Medicaid managed care organization has not been paid by the
26State.

 

 

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1    (c) If a long-term care provider fails to pay the full
2amount of an assessment payment when due (including any
3extensions granted under subsection (b)), there shall, unless
4waived by the Illinois Department for reasonable cause, be
5added to the assessment imposed by Section 5B-2 a penalty
6assessment equal to the lesser of (i) 5% of the amount of the
7assessment payment not paid on or before the due date plus 5%
8of the portion thereof remaining unpaid on the last day of each
9month thereafter or (ii) 100% of the assessment payment amount
10not paid on or before the due date. For purposes of this
11subsection, payments will be credited first to unpaid
12assessment payment amounts (rather than to penalty or
13interest), beginning with the most delinquent assessment
14payments. Payment cycles of longer than 60 days shall be one
15factor the Director takes into account in granting a waiver
16under this Section.
17    (c-5) If a long-term care facility fails to file its
18assessment bill with payment, there shall, unless waived by the
19Illinois Department for reasonable cause, be added to the
20assessment due a penalty assessment equal to 25% of the
21assessment due. After July 1, 2013, no penalty shall be
22assessed under this Section if the Illinois Department does not
23provide a process for the electronic submission of the
24information required by subsection (a-5).
25    (d) Nothing in this amendatory Act of 1993 shall be
26construed to prevent the Illinois Department from collecting

 

 

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1all amounts due under this Article pursuant to an assessment
2imposed before the effective date of this amendatory Act of
31993.
4    (e) Nothing in this amendatory Act of the 96th General
5Assembly shall be construed to prevent the Illinois Department
6from collecting all amounts due under this Code pursuant to an
7assessment, tax, fee, or penalty imposed before the effective
8date of this amendatory Act of the 96th General Assembly.
9    (f) No installment of the assessment imposed by Section
105B-2 shall be due and payable until after the Department
11notifies the long-term care providers, in writing, that the
12payment methodologies to long-term care providers required
13under Section 5-5.4 of this Code have been approved by the
14Centers for Medicare and Medicaid Services of the U.S.
15Department of Health and Human Services and the waivers under
1642 CFR 433.68 for the assessment imposed by this Section, if
17necessary, have been granted by the Centers for Medicare and
18Medicaid Services of the U.S. Department of Health and Human
19Services. Upon notification to the Department of approval of
20the payment methodologies required under Section 5-5.4 of this
21Code and the waivers granted under 42 CFR 433.68, all
22installments otherwise due under Section 5B-4 prior to the date
23of notification shall be due and payable to the Department upon
24written direction from the Department within 90 days after
25issuance by the Comptroller of the payments required under
26Section 5-5.4 of this Code.

 

 

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1(Source: P.A. 100-501, eff. 6-1-18.)
 
2    (305 ILCS 5/11-5.1)
3    Sec. 11-5.1. Eligibility verification. Notwithstanding any
4other provision of this Code, with respect to applications for
5medical assistance provided under Article V of this Code,
6eligibility shall be determined in a manner that ensures
7program integrity and complies with federal laws and
8regulations while minimizing unnecessary barriers to
9enrollment. To this end, as soon as practicable, and unless the
10Department receives written denial from the federal
11government, this Section shall be implemented:
12    (a) The Department of Healthcare and Family Services or its
13designees shall:
14        (1) By no later than July 1, 2011, require verification
15    of, at a minimum, one month's income from all sources
16    required for determining the eligibility of applicants for
17    medical assistance under this Code. Such verification
18    shall take the form of pay stubs, business or income and
19    expense records for self-employed persons, letters from
20    employers, and any other valid documentation of income
21    including data obtained electronically by the Department
22    or its designees from other sources as described in
23    subsection (b) of this Section. A month's income may be
24    verified by a single pay stub with the monthly income
25    extrapolated from the time period covered by the pay stub.

 

 

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1        (2) By no later than October 1, 2011, require
2    verification of, at a minimum, one month's income from all
3    sources required for determining the continued eligibility
4    of recipients at their annual review of eligibility for
5    medical assistance under this Code. Information the
6    Department receives prior to the annual review, including
7    information available to the Department as a result of the
8    recipient's application for other non-Medicaid benefits,
9    that is sufficient to make a determination of continued
10    Medicaid eligibility may be reviewed and verified, and
11    subsequent action taken including client notification of
12    continued Medicaid eligibility. The date of client
13    notification establishes the date for subsequent annual
14    Medicaid eligibility reviews. Such verification shall take
15    the form of pay stubs, business or income and expense
16    records for self-employed persons, letters from employers,
17    and any other valid documentation of income including data
18    obtained electronically by the Department or its designees
19    from other sources as described in subsection (b) of this
20    Section. A month's income may be verified by a single pay
21    stub with the monthly income extrapolated from the time
22    period covered by the pay stub. The Department shall send a
23    notice to recipients at least 60 days prior to the end of
24    their period of eligibility that informs them of the
25    requirements for continued eligibility. If a recipient
26    does not fulfill the requirements for continued

 

 

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1    eligibility by the deadline established in the notice a
2    notice of cancellation shall be issued to the recipient and
3    coverage shall end no later than the last day of the month
4    following the last day of the eligibility period. A
5    recipient's eligibility may be reinstated without
6    requiring a new application if the recipient fulfills the
7    requirements for continued eligibility prior to the end of
8    the third month following the last date of coverage (or
9    longer period if required by federal regulations). Nothing
10    in this Section shall prevent an individual whose coverage
11    has been cancelled from reapplying for health benefits at
12    any time.
13        (3) By no later than July 1, 2011, require verification
14    of Illinois residency.
15    The Department, with federal approval, may choose to adopt
16continuous financial eligibility for a full 12 months for
17adults on Medicaid.
18    (b) The Department shall establish or continue cooperative
19arrangements with the Social Security Administration, the
20Illinois Secretary of State, the Department of Human Services,
21the Department of Revenue, the Department of Employment
22Security, and any other appropriate entity to gain electronic
23access, to the extent allowed by law, to information available
24to those entities that may be appropriate for electronically
25verifying any factor of eligibility for benefits under the
26Program. Data relevant to eligibility shall be provided for no

 

 

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1other purpose than to verify the eligibility of new applicants
2or current recipients of health benefits under the Program.
3Data shall be requested or provided for any new applicant or
4current recipient only insofar as that individual's
5circumstances are relevant to that individual's or another
6individual's eligibility.
7    (c) Within 90 days of the effective date of this amendatory
8Act of the 96th General Assembly, the Department of Healthcare
9and Family Services shall send notice to current recipients
10informing them of the changes regarding their eligibility
11verification.
12    (d) As soon as practical if the data is reasonably
13available, but no later than January 1, 2017, the Department
14shall compile on a monthly basis data on eligibility
15redeterminations of beneficiaries of medical assistance
16provided under Article V of this Code. This data shall be
17posted on the Department's website, and data from prior months
18shall be retained and available on the Department's website.
19The data compiled and reported shall include the following:
20        (1) The total number of redetermination decisions made
21    in a month and, of that total number, the number of
22    decisions to continue or change benefits and the number of
23    decisions to cancel benefits.
24        (2) A breakdown of enrollee language preference for the
25    total number of redetermination decisions made in a month
26    and, of that total number, a breakdown of enrollee language

 

 

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1    preference for the number of decisions to continue or
2    change benefits, and a breakdown of enrollee language
3    preference for the number of decisions to cancel benefits.
4    The language breakdown shall include, at a minimum,
5    English, Spanish, and the next 4 most commonly used
6    languages.
7        (3) The percentage of cancellation decisions made in a
8    month due to each of the following:
9            (A) The beneficiary's ineligibility due to excess
10        income.
11            (B) The beneficiary's ineligibility due to not
12        being an Illinois resident.
13            (C) The beneficiary's ineligibility due to being
14        deceased.
15            (D) The beneficiary's request to cancel benefits.
16            (E) The beneficiary's lack of response after
17        notices mailed to the beneficiary are returned to the
18        Department as undeliverable by the United States
19        Postal Service.
20            (F) The beneficiary's lack of response to a request
21        for additional information when reliable information
22        in the beneficiary's account, or other more current
23        information, is unavailable to the Department to make a
24        decision on whether to continue benefits.
25            (G) Other reasons tracked by the Department for the
26        purpose of ensuring program integrity.

 

 

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1        (4) If a vendor is utilized to provide services in
2    support of the Department's redetermination decision
3    process, the total number of redetermination decisions
4    made in a month and, of that total number, the number of
5    decisions to continue or change benefits, and the number of
6    decisions to cancel benefits (i) with the involvement of
7    the vendor and (ii) without the involvement of the vendor.
8        (5) Of the total number of benefit cancellations in a
9    month, the number of beneficiaries who return from
10    cancellation within one month, the number of beneficiaries
11    who return from cancellation within 2 months, and the
12    number of beneficiaries who return from cancellation
13    within 3 months. Of the number of beneficiaries who return
14    from cancellation within 3 months, the percentage of those
15    cancellations due to each of the reasons listed under
16    paragraph (3) of this subsection.
17    (e) The Department shall conduct a complete review of the
18Medicaid redetermination process in order to identify changes
19that can increase the use of ex parte redetermination
20processing. This review shall be completed within 90 days after
21the effective date of this amendatory Act of the 101st General
22Assembly. Within 90 days of completion of the review, the
23Department shall seek written federal approval of policy
24changes the review recommended and implement once approved. The
25review shall specifically include, but not be limited to, use
26of ex parte redeterminations of the following populations:

 

 

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1        (1) Recipients of developmental disabilities services.
2        (2) Recipients of benefits under the State's Aid to the
3    Aged, Blind, or Disabled program.
4        (3) Recipients of Medicaid long-term care services and
5    supports, including waiver services.
6        (4) All Modified Adjusted Gross Income (MAGI)
7    populations.
8        (5) Populations with no verifiable income.
9        (6) Self-employed people.
10    The report shall also outline populations and
11circumstances in which an ex parte redetermination is not a
12recommended option.
13    (f) The Department shall explore and implement, as
14practical and technologically possible, roles that
15stakeholders outside State agencies can play to assist in
16expediting eligibility determinations and redeterminations
17within 24 months after the effective date of this amendatory
18Act of the 101st General Assembly. Such practical roles to be
19explored to expedite the eligibility determination processes
20shall include the implementation of hospital presumptive
21eligibility, as authorized by the Patient Protection and
22Affordable Care Act.
23    (g) The Department or its designee shall seek federal
24approval to enhance the reasonable compatibility standard from
255% to 10%.
26    (h) Reporting. The Department of Healthcare and Family

 

 

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1Services and the Department of Human Services shall publish
2quarterly reports on their progress in implementing policies
3and practices pursuant to this Section as modified by this
4amendatory Act of the 101st General Assembly.
5        (1) The reports shall include, but not be limited to,
6    the following:
7            (A) Medical application processing, including a
8        breakdown of the number of MAGI, non-MAGI, long-term
9        care, and other medical cases pending for various
10        incremental time frames between 0 to 181 or more days.
11            (B) Medical redeterminations completed, including:
12        (i) a breakdown of the number of households that were
13        redetermined ex parte and those that were not; (ii) the
14        reasons households were not redetermined ex parte; and
15        (iii) the relative percentages of these reasons.
16            (C) A narrative discussion on issues identified in
17        the functioning of the State's Integrated Eligibility
18        System and progress on addressing those issues, as well
19        as progress on implementing strategies to address
20        eligibility backlogs, including expanding ex parte
21        determinations to ensure timely eligibility
22        determinations and renewals.
23        (2) Initial reports shall be issued within 90 days
24    after the effective date of this amendatory Act of the
25    101st General Assembly.
26        (3) All reports shall be published on the Department's

 

 

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1    website.
2(Source: P.A. 101-209, eff. 8-5-19.)
 
3    (305 ILCS 5/12-21.21 new)
4    Sec. 12-21.21. Federal waiver or State Plan amendment. The
5Department of Healthcare and Family Services and the Department
6of Human Services shall jointly submit the necessary
7application to the federal Centers for Medicare and Medicaid
8Services for a waiver or State Plan amendment to allow remote
9monitoring and support services as a waiver-reimbursable
10service for persons with intellectual and developmental
11disabilities. The application shall be submitted no later than
12January 1, 2021.
13    No later than July 1, 2021, the Department of Human
14Services shall adopt rules to allow remote monitoring and
15support services at community-integrated living arrangements.
 
16    Section 90-40. The Medical Patient Rights Act is amended by
17changing Section 3 as follows:
 
18    (410 ILCS 50/3)  (from Ch. 111 1/2, par. 5403)
19    Sec. 3. The following rights are hereby established:
20    (a) The right of each patient to care consistent with sound
21nursing and medical practices, to be informed of the name of
22the physician responsible for coordinating his or her care, to
23receive information concerning his or her condition and

 

 

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1proposed treatment, to refuse any treatment to the extent
2permitted by law, and to privacy and confidentiality of records
3except as otherwise provided by law.
4    (b) The right of each patient, regardless of source of
5payment, to examine and receive a reasonable explanation of his
6total bill for services rendered by his physician or health
7care provider, including the itemized charges for specific
8services received. Each physician or health care provider shall
9be responsible only for a reasonable explanation of those
10specific services provided by such physician or health care
11provider.
12    (c) In the event an insurance company or health services
13corporation cancels or refuses to renew an individual policy or
14plan, the insured patient shall be entitled to timely, prior
15notice of the termination of such policy or plan.
16    An insurance company or health services corporation that
17requires any insured patient or applicant for new or continued
18insurance or coverage to be tested for infection with human
19immunodeficiency virus (HIV) or any other identified causative
20agent of acquired immunodeficiency syndrome (AIDS) shall (1)
21give the patient or applicant prior written notice of such
22requirement, (2) proceed with such testing only upon the
23written authorization of the applicant or patient, and (3) keep
24the results of such testing confidential. Notice of an adverse
25underwriting or coverage decision may be given to any
26appropriately interested party, but the insurer may only

 

 

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1disclose the test result itself to a physician designated by
2the applicant or patient, and any such disclosure shall be in a
3manner that assures confidentiality.
4    The Department of Insurance shall enforce the provisions of
5this subsection.
6    (d) The right of each patient to privacy and
7confidentiality in health care. Each physician, health care
8provider, health services corporation and insurance company
9shall refrain from disclosing the nature or details of services
10provided to patients, except that such information may be
11disclosed: (1) to the patient, (2) to the party making
12treatment decisions if the patient is incapable of making
13decisions regarding the health services provided, (3) for
14treatment in accordance with 45 CFR 164.501 and 164.506, (4)
15for payment in accordance with 45 CFR 164.501 and 164.506, (5)
16to those parties responsible for peer review, utilization
17review, and quality assurance, (6) for health care operations
18in accordance with 45 CFR 164.501 and 164.506, (7) to those
19parties required to be notified under the Abused and Neglected
20Child Reporting Act or the Illinois Sexually Transmissible
21Disease Control Act, or (8) as otherwise permitted, authorized,
22or required by State or federal law. This right may be waived
23in writing by the patient or the patient's guardian or legal
24representative, but a physician or other health care provider
25may not condition the provision of services on the patient's,
26guardian's, or legal representative's agreement to sign such a

 

 

10100SB1864ham006- 85 -LRB101 10924 SMS 72418 a

1waiver. In the interest of public health, safety, and welfare,
2patient information, including, but not limited to, health
3information, demographic information, and information about
4the services provided to patients, may be transmitted to or
5through a health information exchange, as that term is defined
6in Section 2 of the Mental Health and Developmental
7Disabilities Confidentiality Act, in accordance with the
8disclosures permitted pursuant to this Section. Patients shall
9be provided the opportunity to opt out of their health
10information being transmitted to or through a health
11information exchange in accordance with the regulations,
12standards, or contractual obligations adopted by the Illinois
13Health Information Exchange Office Authority in accordance
14with Section 9.6 of the Mental Health and Developmental
15Disabilities Confidentiality Act, Section 9.6 of the AIDS
16Confidentiality Act, or Section 31.8 of the Genetic Information
17Privacy Act, as applicable. In the case of a patient choosing
18to opt out of having his or her information available on an
19HIE, nothing in this Act shall cause the physician or health
20care provider to be liable for the release of a patient's
21health information by other entities that may possess such
22information, including, but not limited to, other health
23professionals, providers, laboratories, pharmacies, hospitals,
24ambulatory surgical centers, and nursing homes.
25(Source: P.A. 98-1046, eff. 1-1-15.)
 

 

 

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1    Section 90-45. The Genetic Information Privacy Act is
2amended by changing Section 10 as follows:
 
3    (410 ILCS 513/10)
4    Sec. 10. Definitions. As used in this Act:
5    "Office Authority" means the Illinois Health Information
6Exchange Office Authority established pursuant to the Illinois
7Health Information Exchange and Technology Act.
8    "Business associate" has the meaning ascribed to it under
9HIPAA, as specified in 45 CFR 160.103.
10    "Covered entity" has the meaning ascribed to it under
11HIPAA, as specified in 45 CFR 160.103.
12    "De-identified information" means health information that
13is not individually identifiable as described under HIPAA, as
14specified in 45 CFR 164.514(b).
15    "Disclosure" has the meaning ascribed to it under HIPAA, as
16specified in 45 CFR 160.103.
17    "Employer" means the State of Illinois, any unit of local
18government, and any board, commission, department,
19institution, or school district, any party to a public
20contract, any joint apprenticeship or training committee
21within the State, and every other person employing employees
22within the State.
23    "Employment agency" means both public and private
24employment agencies and any person, labor organization, or
25labor union having a hiring hall or hiring office regularly

 

 

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1undertaking, with or without compensation, to procure
2opportunities to work, or to procure, recruit, refer, or place
3employees.
4    "Family member" means, with respect to an individual, (i)
5the spouse of the individual; (ii) a dependent child of the
6individual, including a child who is born to or placed for
7adoption with the individual; (iii) any other person qualifying
8as a covered dependent under a managed care plan; and (iv) all
9other individuals related by blood or law to the individual or
10the spouse or child described in subsections (i) through (iii)
11of this definition.
12    "Genetic information" has the meaning ascribed to it under
13HIPAA, as specified in 45 CFR 160.103.
14    "Genetic monitoring" means the periodic examination of
15employees to evaluate acquired modifications to their genetic
16material, such as chromosomal damage or evidence of increased
17occurrence of mutations that may have developed in the course
18of employment due to exposure to toxic substances in the
19workplace in order to identify, evaluate, and respond to
20effects of or control adverse environmental exposures in the
21workplace.
22    "Genetic services" has the meaning ascribed to it under
23HIPAA, as specified in 45 CFR 160.103.
24    "Genetic testing" and "genetic test" have the meaning
25ascribed to "genetic test" under HIPAA, as specified in 45 CFR
26160.103. "Genetic testing" includes direct-to-consumer

 

 

10100SB1864ham006- 88 -LRB101 10924 SMS 72418 a

1commercial genetic testing.
2    "Health care operations" has the meaning ascribed to it
3under HIPAA, as specified in 45 CFR 164.501.
4    "Health care professional" means (i) a licensed physician,
5(ii) a licensed physician assistant, (iii) a licensed advanced
6practice registered nurse, (iv) a licensed dentist, (v) a
7licensed podiatrist, (vi) a licensed genetic counselor, or
8(vii) an individual certified to provide genetic testing by a
9state or local public health department.
10    "Health care provider" has the meaning ascribed to it under
11HIPAA, as specified in 45 CFR 160.103.
12    "Health facility" means a hospital, blood bank, blood
13center, sperm bank, or other health care institution, including
14any "health facility" as that term is defined in the Illinois
15Finance Authority Act.
16    "Health information exchange" or "HIE" means a health
17information exchange or health information organization that
18exchanges health information electronically that (i) is
19established pursuant to the Illinois Health Information
20Exchange and Technology Act, or any subsequent amendments
21thereto, and any administrative rules promulgated thereunder;
22(ii) has established a data sharing arrangement with the Office
23Authority; or (iii) as of August 16, 2013, was designated by
24the Illinois Health Information Exchange Authority (now
25Office) Board as a member of, or was represented on, the
26Authority Board's Regional Health Information Exchange

 

 

10100SB1864ham006- 89 -LRB101 10924 SMS 72418 a

1Workgroup; provided that such designation shall not require the
2establishment of a data sharing arrangement or other
3participation with the Illinois Health Information Exchange or
4the payment of any fee. In certain circumstances, in accordance
5with HIPAA, an HIE will be a business associate.
6    "Health oversight agency" has the meaning ascribed to it
7under HIPAA, as specified in 45 CFR 164.501.
8    "HIPAA" means the Health Insurance Portability and
9Accountability Act of 1996, Public Law 104-191, as amended by
10the Health Information Technology for Economic and Clinical
11Health Act of 2009, Public Law 111-05, and any subsequent
12amendments thereto and any regulations promulgated thereunder.
13    "Insurer" means (i) an entity that is subject to the
14jurisdiction of the Director of Insurance and (ii) a managed
15care plan.
16    "Labor organization" includes any organization, labor
17union, craft union, or any voluntary unincorporated
18association designed to further the cause of the rights of
19union labor that is constituted for the purpose, in whole or in
20part, of collective bargaining or of dealing with employers
21concerning grievances, terms or conditions of employment, or
22apprenticeships or applications for apprenticeships, or of
23other mutual aid or protection in connection with employment,
24including apprenticeships or applications for apprenticeships.
25    "Licensing agency" means a board, commission, committee,
26council, department, or officers, except a judicial officer, in

 

 

10100SB1864ham006- 90 -LRB101 10924 SMS 72418 a

1this State or any political subdivision authorized to grant,
2deny, renew, revoke, suspend, annul, withdraw, or amend a
3license or certificate of registration.
4    "Limited data set" has the meaning ascribed to it under
5HIPAA, as described in 45 CFR 164.514(e)(2).
6    "Managed care plan" means a plan that establishes,
7operates, or maintains a network of health care providers that
8have entered into agreements with the plan to provide health
9care services to enrollees where the plan has the ultimate and
10direct contractual obligation to the enrollee to arrange for
11the provision of or pay for services through:
12        (1) organizational arrangements for ongoing quality
13    assurance, utilization review programs, or dispute
14    resolution; or
15        (2) financial incentives for persons enrolled in the
16    plan to use the participating providers and procedures
17    covered by the plan.
18    A managed care plan may be established or operated by any
19entity including a licensed insurance company, hospital or
20medical service plan, health maintenance organization, limited
21health service organization, preferred provider organization,
22third party administrator, or an employer or employee
23organization.
24    "Minimum necessary" means HIPAA's standard for using,
25disclosing, and requesting protected health information found
26in 45 CFR 164.502(b) and 164.514(d).

 

 

10100SB1864ham006- 91 -LRB101 10924 SMS 72418 a

1    "Nontherapeutic purpose" means a purpose that is not
2intended to improve or preserve the life or health of the
3individual whom the information concerns.
4    "Organized health care arrangement" has the meaning
5ascribed to it under HIPAA, as specified in 45 CFR 160.103.
6    "Patient safety activities" has the meaning ascribed to it
7under 42 CFR 3.20.
8    "Payment" has the meaning ascribed to it under HIPAA, as
9specified in 45 CFR 164.501.
10    "Person" includes any natural person, partnership,
11association, joint venture, trust, governmental entity, public
12or private corporation, health facility, or other legal entity.
13    "Protected health information" has the meaning ascribed to
14it under HIPAA, as specified in 45 CFR 164.103.
15    "Research" has the meaning ascribed to it under HIPAA, as
16specified in 45 CFR 164.501.
17    "State agency" means an instrumentality of the State of
18Illinois and any instrumentality of another state which
19pursuant to applicable law or a written undertaking with an
20instrumentality of the State of Illinois is bound to protect
21the privacy of genetic information of Illinois persons.
22    "Treatment" has the meaning ascribed to it under HIPAA, as
23specified in 45 CFR 164.501.
24    "Use" has the meaning ascribed to it under HIPAA, as
25specified in 45 CFR 160.103, where context dictates.
26(Source: P.A. 100-513, eff. 1-1-18; 101-132, eff. 1-1-20.)
 

 

 

10100SB1864ham006- 92 -LRB101 10924 SMS 72418 a

1    Section 90-50. The Mental Health and Developmental
2Disabilities Confidentiality Act is amended by changing
3Sections 2, 9.5, 9.6, 9.8, 9.9, and 9.11 as follows:
 
4    (740 ILCS 110/2)  (from Ch. 91 1/2, par. 802)
5    Sec. 2. The terms used in this Act, unless the context
6requires otherwise, have the meanings ascribed to them in this
7Section.
8    "Agent" means a person who has been legally appointed as an
9individual's agent under a power of attorney for health care or
10for property.
11    "Business associate" has the meaning ascribed to it under
12HIPAA, as specified in 45 CFR 160.103.
13    "Confidential communication" or "communication" means any
14communication made by a recipient or other person to a
15therapist or to or in the presence of other persons during or
16in connection with providing mental health or developmental
17disability services to a recipient. Communication includes
18information which indicates that a person is a recipient.
19"Communication" does not include information that has been
20de-identified in accordance with HIPAA, as specified in 45 CFR
21164.514.
22    "Covered entity" has the meaning ascribed to it under
23HIPAA, as specified in 45 CFR 160.103.
24    "Guardian" means a legally appointed guardian or

 

 

10100SB1864ham006- 93 -LRB101 10924 SMS 72418 a

1conservator of the person.
2    "Health information exchange" or "HIE" means a health
3information exchange or health information organization that
4oversees and governs the electronic exchange of health
5information that (i) is established pursuant to the Illinois
6Health Information Exchange and Technology Act, or any
7subsequent amendments thereto, and any administrative rules
8promulgated thereunder; or (ii) has established a data sharing
9arrangement with the Illinois Health Information Exchange; or
10(iii) as of the effective date of this amendatory Act of the
1198th General Assembly, was designated by the Illinois Health
12Information Exchange Office Authority Board as a member of, or
13was represented on, the Office Authority Board's Regional
14Health Information Exchange Workgroup; provided that such
15designation shall not require the establishment of a data
16sharing arrangement or other participation with the Illinois
17Health Information Exchange or the payment of any fee.
18    "HIE purposes" means those uses and disclosures (as those
19terms are defined under HIPAA, as specified in 45 CFR 160.103)
20for activities of an HIE: (i) set forth in the Illinois Health
21Information Exchange and Technology Act or any subsequent
22amendments thereto and any administrative rules promulgated
23thereunder; or (ii) which are permitted under federal law.
24    "HIPAA" means the Health Insurance Portability and
25Accountability Act of 1996, Public Law 104-191, and any
26subsequent amendments thereto and any regulations promulgated

 

 

10100SB1864ham006- 94 -LRB101 10924 SMS 72418 a

1thereunder, including the Security Rule, as specified in 45 CFR
2164.302-18, and the Privacy Rule, as specified in 45 CFR
3164.500-34.
4    "Integrated health system" means an organization with a
5system of care which incorporates physical and behavioral
6healthcare and includes care delivered in an inpatient and
7outpatient setting.
8    "Interdisciplinary team" means a group of persons
9representing different clinical disciplines, such as medicine,
10nursing, social work, and psychology, providing and
11coordinating the care and treatment for a recipient of mental
12health or developmental disability services. The group may be
13composed of individuals employed by one provider or multiple
14providers.
15    "Mental health or developmental disabilities services" or
16"services" includes but is not limited to examination,
17diagnosis, evaluation, treatment, training, pharmaceuticals,
18aftercare, habilitation or rehabilitation.
19    "Personal notes" means:
20        (i) information disclosed to the therapist in
21    confidence by other persons on condition that such
22    information would never be disclosed to the recipient or
23    other persons;
24        (ii) information disclosed to the therapist by the
25    recipient which would be injurious to the recipient's
26    relationships to other persons, and

 

 

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1        (iii) the therapist's speculations, impressions,
2    hunches, and reminders.
3    "Parent" means a parent or, in the absence of a parent or
4guardian, a person in loco parentis.
5    "Recipient" means a person who is receiving or has received
6mental health or developmental disabilities services.
7    "Record" means any record kept by a therapist or by an
8agency in the course of providing mental health or
9developmental disabilities service to a recipient concerning
10the recipient and the services provided. "Records" includes all
11records maintained by a court that have been created in
12connection with, in preparation for, or as a result of the
13filing of any petition or certificate under Chapter II, Chapter
14III, or Chapter IV of the Mental Health and Developmental
15Disabilities Code and includes the petitions, certificates,
16dispositional reports, treatment plans, and reports of
17diagnostic evaluations and of hearings under Article VIII of
18Chapter III or under Article V of Chapter IV of that Code.
19Record does not include the therapist's personal notes, if such
20notes are kept in the therapist's sole possession for his own
21personal use and are not disclosed to any other person, except
22the therapist's supervisor, consulting therapist or attorney.
23If at any time such notes are disclosed, they shall be
24considered part of the recipient's record for purposes of this
25Act. "Record" does not include information that has been
26de-identified in accordance with HIPAA, as specified in 45 CFR

 

 

10100SB1864ham006- 96 -LRB101 10924 SMS 72418 a

1164.514. "Record" does not include a reference to the receipt
2of mental health or developmental disabilities services noted
3during a patient history and physical or other summary of care.
4    "Record custodian" means a person responsible for
5maintaining a recipient's record.
6    "Therapist" means a psychiatrist, physician, psychologist,
7social worker, or nurse providing mental health or
8developmental disabilities services or any other person not
9prohibited by law from providing such services or from holding
10himself out as a therapist if the recipient reasonably believes
11that such person is permitted to do so. Therapist includes any
12successor of the therapist.
13    "Therapeutic relationship" means the receipt by a
14recipient of mental health or developmental disabilities
15services from a therapist. "Therapeutic relationship" does not
16include independent evaluations for a purpose other than the
17provision of mental health or developmental disabilities
18services.
19(Source: P.A. 98-378, eff. 8-16-13; 99-28, eff. 1-1-16.)
 
20    (740 ILCS 110/9.5)
21    Sec. 9.5. Use and disclosure of information to an HIE.
22    (a) An HIE, person, therapist, facility, agency,
23interdisciplinary team, integrated health system, business
24associate, or covered entity may, without a recipient's
25consent, use or disclose information from a recipient's record

 

 

10100SB1864ham006- 97 -LRB101 10924 SMS 72418 a

1in connection with an HIE, including disclosure to the Illinois
2Health Information Exchange Office Authority, an HIE, or the
3business associate of either. An HIE and its business associate
4may, without a recipient's consent, use or disclose and
5re-disclose such information for HIE purposes or for such other
6purposes as are specifically allowed under this Act.
7    (b) As used in this Section:
8        (1) "facility" means a developmental disability
9    facility as defined in Section 1-107 of the Mental Health
10    and Developmental Disabilities Code or a mental health
11    facility as defined in Section 1-114 of the Mental Health
12    and Developmental Disabilities Code; and
13        (2) the terms "disclosure" and "use" have the meanings
14    ascribed to them under HIPAA, as specified in 45 CFR
15    160.103.
16(Source: P.A. 98-378, eff. 8-16-13.)
 
17    (740 ILCS 110/9.6)
18    Sec. 9.6. HIE opt-out. The Illinois Health Information
19Exchange Office Authority shall, through appropriate rules,
20standards, or contractual obligations, which shall be binding
21upon any HIE, as defined under Section 2, require that
22participants of such HIE provide each recipient whose record is
23accessible through the health information exchange the
24reasonable opportunity to expressly decline the further
25disclosure of the record by the health information exchange to

 

 

10100SB1864ham006- 98 -LRB101 10924 SMS 72418 a

1third parties, except to the extent permitted by law such as
2for purposes of public health reporting. These rules,
3standards, or contractual obligations shall permit a recipient
4to revoke a prior decision to opt-out or a decision not to
5opt-out. These rules, standards, or contractual obligations
6shall provide for written notice of a recipient's right to
7opt-out which directs the recipient to a health information
8exchange website containing (i) an explanation of the purposes
9of the health information exchange; and (ii) audio, visual, and
10written instructions on how to opt-out of participation in
11whole or in part to the extent possible. These rules,
12standards, or contractual obligations shall be reviewed
13annually and updated as the technical options develop. The
14recipient shall be provided meaningful disclosure regarding
15the health information exchange, and the recipient's decision
16whether to opt-out should be obtained without undue inducement
17or any element of force, fraud, deceit, duress, or other form
18of constraint or coercion. To the extent that HIPAA, as
19specified in 45 CFR 164.508(b)(4), prohibits a covered entity
20from conditioning the provision of its services upon an
21individual's provision of an authorization, an HIE participant
22shall not condition the provision of its services upon a
23recipient's decision to opt-out of further disclosure of the
24record by an HIE to third parties. The Illinois Health
25Information Exchange Office Authority shall, through
26appropriate rules, standards, or contractual obligations,

 

 

10100SB1864ham006- 99 -LRB101 10924 SMS 72418 a

1which shall be binding upon any HIE, as defined under Section
22, give consideration to the format and content of the
3meaningful disclosure and the availability to recipients of
4information regarding an HIE and the rights of recipients under
5this Section to expressly decline the further disclosure of the
6record by an HIE to third parties. The Illinois Health
7Information Exchange Office Authority shall also give annual
8consideration to enable a recipient to expressly decline the
9further disclosure by an HIE to third parties of selected
10portions of the recipient's record while permitting disclosure
11of the recipient's remaining patient health information. In
12establishing rules, standards, or contractual obligations
13binding upon HIEs under this Section to give effect to
14recipient disclosure preferences, the Illinois Health
15Information Exchange Office Authority in its discretion may
16consider the extent to which relevant health information
17technologies reasonably available to therapists and HIEs in
18this State reasonably enable the effective segmentation of
19specific information within a recipient's electronic medical
20record and reasonably enable the effective exclusion of
21specific information from disclosure by an HIE to third
22parties, as well as the availability of sufficient
23authoritative clinical guidance to enable the practical
24application of such technologies to effect recipient
25disclosure preferences. The provisions of this Section 9.6
26shall not apply to the secure electronic transmission of data

 

 

10100SB1864ham006- 100 -LRB101 10924 SMS 72418 a

1which is point-to-point communication directed by the data
2custodian. Any rules or standards promulgated under this
3Section which apply to HIEs shall be limited to that subject
4matter required by this Section and shall not include any
5requirement that an HIE enter a data sharing arrangement or
6otherwise participate with the Illinois Health Information
7Exchange. In connection with its annual consideration
8regarding the issue of segmentation of information within a
9medical record and prior to the adoption of any rules or
10standards regarding that issue, the Office Authority Board
11shall consider information provided by affected persons or
12organizations regarding the feasibility, availability, cost,
13reliability, and interoperability of any technology or process
14under consideration by the Board. Nothing in this Act shall be
15construed to limit the authority of the Illinois Health
16Information Exchange Office Authority to impose limits or
17conditions on consent for disclosures to or through any HIE, as
18defined under Section 2, which are more restrictive than the
19requirements under this Act or under HIPAA.
20(Source: P.A. 98-378, eff. 8-16-13.)
 
21    (740 ILCS 110/9.8)
22    Sec. 9.8. Business associates. An HIE, person, therapist,
23facility, agency, interdisciplinary team, integrated health
24system, business associate, covered entity, the Illinois
25Health Information Exchange Office Authority, or entity

 

 

10100SB1864ham006- 101 -LRB101 10924 SMS 72418 a

1facilitating the establishment or operation of an HIE may,
2without a recipient's consent, utilize the services of and
3disclose information from a recipient's record to a business
4associate, as defined by and in accordance with the
5requirements set forth under HIPAA. As used in this Section,
6the term "disclosure" has the meaning ascribed to it by HIPAA,
7as specified in 45 CFR 160.103.
8(Source: P.A. 98-378, eff. 8-16-13.)
 
9    (740 ILCS 110/9.9)
10    Sec. 9.9. Record locator service.
11    (a) An HIE, person, therapist, facility, agency,
12interdisciplinary team, integrated health system, business
13associate, covered entity, the Illinois Health Information
14Exchange Office Authority, or entity facilitating the
15establishment or operation of an HIE may, without a recipient's
16consent, disclose the existence of a recipient's record to a
17record locator service, master patient index, or other
18directory or services necessary to support and enable the
19establishment and operation of an HIE.
20    (b) As used in this Section:
21        (1) the term "disclosure" has the meaning ascribed to
22    it under HIPAA, as specified in 45 CFR 160.103; and
23        (2) "facility" means a developmental disability
24    facility as defined in Section 1-107 of the Mental Health
25    and Developmental Disabilities Code or a mental health

 

 

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1    facility as defined in Section 1-114 of the Mental Health
2    and Developmental Disabilities Code.
3(Source: P.A. 98-378, eff. 8-16-13.)
 
4    (740 ILCS 110/9.11)
5    Sec. 9.11. Establishment and disclosure of limited data
6sets and de-identified information.
7    (a) An HIE, person, therapist, facility, agency,
8interdisciplinary team, integrated health system, business
9associate, covered entity, the Illinois Health Information
10Exchange Office Authority, or entity facilitating the
11establishment or operation of an HIE may, without a recipient's
12consent, use information from a recipient's record to
13establish, or disclose such information to a business associate
14to establish, and further disclose information from a
15recipient's record as part of a limited data set as defined by
16and in accordance with the requirements set forth under HIPAA,
17as specified in 45 CFR 164.514(e). An HIE, person, therapist,
18facility, agency, interdisciplinary team, integrated health
19system, business associate, covered entity, the Illinois
20Health Information Exchange Office Authority, or entity
21facilitating the establishment or operation of an HIE may,
22without a recipient's consent, use information from a
23recipient's record or disclose information from a recipient's
24record to a business associate to de-identity the information
25in accordance with HIPAA, as specified in 45 CFR 164.514.

 

 

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1    (b) As used in this Section:
2        (1) the terms "disclosure" and "use" shall have the
3    meanings ascribed to them by HIPAA, as specified in 45 CFR
4    160.103; and
5        (2) "facility" means a developmental disability
6    facility as defined in Section 1-107 of the Mental Health
7    and Developmental Disabilities Code or a mental health
8    facility as defined in Section 1-114 of the Mental Health
9    and Developmental Disabilities Code.
10(Source: P.A. 98-378, eff. 8-16-13.)
 
11
Article 99. Effective Date

 
12    Section 99-99. Effective date. This Act takes effect upon
13becoming law.".