101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB1909

 

Introduced 2/15/2019, by Sen. Cristina Castro

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Illinois Insurance Code. Requires certain group health insurance policies and other specified policies to provide coverage of medically necessary treatment for postpartum complications as determined by the woman's treating physician. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act. Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Adds provisions regarding birthing facilities and neonatal and maternal care designations. Amends the Department of Human Services Act. Provides that the Department of Human Services may establish the Nurse-Family Partnership Pilot Program. Amends the Illinois Public Aid Code. Provides that women during pregnancy and during a 12-month (rather than 60-day) period are eligible for medical assistance. Provides that otherwise eligible women shall receive coverage for doula services, perinatal depression screenings, and other services. Provides that the Department of Children and Family Services shall seek approval of a State Plan amendment to expand coverage for family planning services to women whose income is at or below 200% of the federal poverty level. Makes other changes. Amends the Adoption Act. Removes a rebuttable presumption regarding a parent's unfitness if, at birth, the urine, blood, or meconium of the parent's child contains any amount of specified controlled substances. Makes conforming changes to the Abused and Neglected Child Reporting Act and the Juvenile Court Act of 1987. Effective immediately.


LRB101 09278 CPF 54372 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB1909LRB101 09278 CPF 54372 b

1    AN ACT concerning health.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. This Act may be referred to as the Improving
5Health Care for Pregnant and Postpartum Individuals Act.
 
6    Section 5. The State Employees Group Insurance Act of 1971
7is amended by changing Section 6.11 as follows:
 
8    (5 ILCS 375/6.11)
9    (Text of Section before amendment by P.A. 100-1170)
10    Sec. 6.11. Required health benefits; Illinois Insurance
11Code requirements. The program of health benefits shall provide
12the post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t of
14the Illinois Insurance Code. The program of health benefits
15shall provide the coverage required under Sections 356g,
16356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
17356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
18356z.14, 356z.15, 356z.17, 356z.22, 356z.25, and 356z.26, and
19356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code.
20The program of health benefits must comply with Sections
21155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 of the
22Illinois Insurance Code. The Department of Insurance shall

 

 

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1enforce the requirements of this Section.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
9100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
101-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
111-8-19.)
 
12    (Text of Section after amendment by P.A. 100-1170)
13    Sec. 6.11. Required health benefits; Illinois Insurance
14Code requirements. The program of health benefits shall provide
15the post-mastectomy care benefits required to be covered by a
16policy of accident and health insurance under Section 356t of
17the Illinois Insurance Code. The program of health benefits
18shall provide the coverage required under Sections 356g,
19356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
20356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
21356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29,
22and 356z.32, and 356z.33 of the Illinois Insurance Code. The
23program of health benefits must comply with Sections 155.22a,
24155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
25Insurance Code. The Department of Insurance shall enforce the

 

 

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1requirements of this Section with respect to Sections 370c and
2370c.1 of the Illinois Insurance Code; all other requirements
3of this Section shall be enforced by the Department of Central
4Management Services.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
12100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
131-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19;
14100-1170, eff. 6-1-19.)
 
15    Section 10. The Department of Human Services Act is amended
16by adding Section 10-24 as follows:
 
17    (20 ILCS 1305/10-24 new)
18    Sec. 10-24. Nurse-Family Partnership Pilot Program.
19Subject to the availability of funds provided for this purpose
20by public or private sources, the Department may, in its
21discretion, establish an evidence-based, voluntary, nurse home
22visitation program that improves the health and well-being of
23low-income, first-time pregnant women and their children. The
24program shall be known as the Nurse-Family Partnership Pilot

 

 

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1Program and shall include, but not be limited to, the following
2components:
3        (1) Eligibility criteria. Program participants must be
4    first-time pregnant women who have yet to reach the 28th
5    week of pregnancy and who are eligible for medical
6    assistance under Article V of the Illinois Public Aid Code.
7        (2) Maternal health education. Registered nurses shall
8    make home visits to program participants and shall provide
9    education, support, and guidance regarding pregnancy and
10    maternal health, child health and development, parenting,
11    the mother's life course development, and instruction on
12    how to identify and use family and community supports.
13        (3) Pre-natal and post-natal care. Home visits to
14    program participants shall begin before their 28th week of
15    pregnancy and shall continue on a weekly or biweekly basis
16    until their children reach the age of 2.
 
17    Section 15. The Department of Public Health Powers and
18Duties Law of the Civil Administrative Code of Illinois is
19amended by adding Section 2310-455 as follows:
 
20    (20 ILCS 2310/2310-455 new)
21    Sec. 2310-455. Birthing facilities; neonatal and maternal
22care designations.
23    (a) In this Section, "birthing facility" means: (1) a
24hospital, as defined in the Hospital Licensing Act, with more

 

 

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1than one licensed obstetric bed or a neonatal intensive care
2unit; (2) a hospital operated by a State university; or (3) a
3birth center, as defined in the Alternative Health Care
4Delivery Act.
5    (b) Every birthing facility shall, at a minimum, have an
6obstetric hemorrhage protocol and conduct a drill or simulation
7of the protocol. Every contracted provider who may encounter a
8pregnant woman shall participate in the drill or simulation on
9a regular basis.
10    (c) After holding multiple public hearings in diverse
11geographic regions of the State and seeking broad public and
12stakeholder input, the Department shall establish criteria for
13levels of neonatal care designations and levels of maternal
14care designations for birthing facilities. The levels
15developed under this Section shall be based upon:
16        (1) the most current published version of the "Levels
17    of Neonatal Care" developed by the American Academy of
18    Pediatrics;
19        (2) the most current published version of the "Levels
20    of Maternal Care" developed by the American Congress of
21    Obstetricians and Gynecologists and the Society for
22    Maternal-Fetal Medicine; and
23        (3) necessary variance when considering the geographic
24    and varied needs of citizens of this State.
25    (d) Nothing in this Section shall be construed in any way
26to modify or expand the licensure of any health care

 

 

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1professional.
2    (e) Nothing in this Section shall be construed in any way
3to require a patient to be transferred to a different facility.
4    (f) The Department shall adopt rules to implement the
5provisions of this Section no later than January 1, 2021. These
6rules shall be limited to those necessary for the establishment
7of levels of neonatal care designations and levels of maternal
8care designations for birthing facilities under subsection (c)
9of this Section.
10    (g) Beginning January 1, 2022, a birthing facility shall
11report to the Department its appropriate level of neonatal care
12designation and maternal care designation as determined by the
13criteria outlined under subsection (c) of this Section.
 
14    Section 20. The Counties Code is amended by changing
15Section 5-1069.3 as follows:
 
16    (55 ILCS 5/5-1069.3)
17    Sec. 5-1069.3. Required health benefits. If a county,
18including a home rule county, is a self-insurer for purposes of
19providing health insurance coverage for its employees, the
20coverage shall include coverage for the post-mastectomy care
21benefits required to be covered by a policy of accident and
22health insurance under Section 356t and the coverage required
23under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
24356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,

 

 

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1356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and 356z.29,
2356z.32, and 356z.33 of the Illinois Insurance Code. The
3coverage shall comply with Sections 155.22a, 355b, 356z.19, and
4370c of the Illinois Insurance Code. The Department of
5Insurance shall enforce the requirements of this Section. The
6requirement that health benefits be covered as provided in this
7Section is an exclusive power and function of the State and is
8a denial and limitation under Article VII, Section 6,
9subsection (h) of the Illinois Constitution. A home rule county
10to which this Section applies must comply with every provision
11of this Section.
12    Rulemaking authority to implement Public Act 95-1045, if
13any, is conditioned on the rules being adopted in accordance
14with all provisions of the Illinois Administrative Procedure
15Act and all rules and procedures of the Joint Committee on
16Administrative Rules; any purported rule not so adopted, for
17whatever reason, is unauthorized.
18(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
19100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
201-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
2110-3-18.)
 
22    Section 25. The Illinois Municipal Code is amended by
23changing Section 10-4-2.3 as follows:
 
24    (65 ILCS 5/10-4-2.3)

 

 

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1    Sec. 10-4-2.3. Required health benefits. If a
2municipality, including a home rule municipality, is a
3self-insurer for purposes of providing health insurance
4coverage for its employees, the coverage shall include coverage
5for the post-mastectomy care benefits required to be covered by
6a policy of accident and health insurance under Section 356t
7and the coverage required under Sections 356g, 356g.5,
8356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
9356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
10and 356z.26, and 356z.29, 356z.32, and 356z.33 of the Illinois
11Insurance Code. The coverage shall comply with Sections
12155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
13Code. The Department of Insurance shall enforce the
14requirements of this Section. The requirement that health
15benefits be covered as provided in this is an exclusive power
16and function of the State and is a denial and limitation under
17Article VII, Section 6, subsection (h) of the Illinois
18Constitution. A home rule municipality to which this Section
19applies must comply with every provision of this Section.
20    Rulemaking authority to implement Public Act 95-1045, if
21any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for
25whatever reason, is unauthorized.
26(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;

 

 

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1100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
21-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
310-4-18.)
 
4    Section 30. The School Code is amended by changing Section
510-22.3f as follows:
 
6    (105 ILCS 5/10-22.3f)
7    Sec. 10-22.3f. Required health benefits. Insurance
8protection and benefits for employees shall provide the
9post-mastectomy care benefits required to be covered by a
10policy of accident and health insurance under Section 356t and
11the coverage required under Sections 356g, 356g.5, 356g.5-1,
12356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
13356z.13, 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and
14356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code.
15Insurance policies shall comply with Section 356z.19 of the
16Illinois Insurance Code. The coverage shall comply with
17Sections 155.22a, 355b, and 370c of the Illinois Insurance
18Code. The Department of Insurance shall enforce the
19requirements of this Section.
20    Rulemaking authority to implement Public Act 95-1045, if
21any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
3100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
41-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
5    Section 35. The Illinois Insurance Code is amended by
6adding Section 356z.33 as follows:
 
7    (215 ILCS 5/356z.33 new)
8    Sec. 356z.33. Pregnancy and postpartum coverage.
9    (a) A group health insurance policy, individual health
10policy, group policy of accident and health insurance, group
11health benefit plan, qualified health plan that is offered
12through the health insurance marketplace, small employer group
13health plan, or large employer group health plan that is
14amended, delivered, issued, executed, or renewed in this State
15or approved for issuance or renewal in this State on or after
16the effective date of this amendatory Act of the 101st General
17Assembly shall provide coverage of medically necessary
18treatment for postpartum complications as determined by the
19woman's treating physician, including, but not limited to,
20infection, depression, and hemorrhaging, up to one year after
21the woman has given birth to a child.
22    (b) A group health insurance policy, individual health
23policy, group policy of accident and health insurance, group
24health benefit plan, qualified health plan that is offered

 

 

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1through the health insurance marketplace, small employer group
2health plan, or large employer group health plan that is
3amended, delivered, issued, executed, or renewed in this State
4or approved for issuance or renewal in this State on or after
5the effective date of this amendatory Act of the 101st General
6Assembly shall provide unlimited benefits for inpatient and
7outpatient treatment of mental, emotional, nervous, or
8substance use disorder or conditions at in-network facilities
9for a pregnant or postpartum woman up to one year after giving
10birth to a child. The services for the treatment of mental,
11emotional, nervous, or substance use disorder or condition
12shall be prescribed by a licensed physician, licensed
13psychologist, licensed psychiatrist, or licensed advanced
14practice registered nurse and provided by licensed health care
15professionals or licensed or certified mental, emotional,
16nervous, or substance use disorder or conditions providers in
17licensed, certified, or otherwise State-approved facilities.
18    As used in this subsection (b), "provider" includes
19licensed physicians, licensed psychologists, licensed
20psychiatrists, licensed advanced practice registered nurses,
21and licensed and certified mental, emotional, nervous, and
22substance use disorder and conditions providers.
23    Benefits under this subsection (b) shall be as follows:
24        (1) The benefits provided for treatment services for
25    the first 180 days per plan year of inpatient and
26    outpatient treatment of mental, emotional, nervous, or

 

 

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1    substance use disorder or conditions shall be provided when
2    determined medically necessary by the covered pregnant or
3    postpartum woman's provider without the imposition of any
4    prior authorization or other prospective utilization
5    review requirements. The facility or provider shall notify
6    the insurer of both the admission and the initial treatment
7    plan within 48 hours after admission or initiation of
8    treatment. If there is no in-network facility immediately
9    available for the covered pregnant or postpartum woman, the
10    insurer shall provide necessary exceptions to its network
11    to ensure admission and treatment with a provider or at a
12    treatment facility within 24 hours.
13        (2) The benefits for the first 28 days of an inpatient
14    stay, detoxification/withdrawal management, partial
15    hospitalization, intensive outpatient treatment, and
16    outpatient treatment during each plan year shall be
17    provided without any retrospective review or concurrent
18    review of medical necessity, and medical necessity shall be
19    as determined solely by the covered pregnant or postpartum
20    woman's provider.
21        (3) The benefits for days 29 and thereafter of
22    inpatient care, detoxification/withdrawal management,
23    partial hospitalization, intensive outpatient treatment,
24    and outpatient treatment shall be subject to concurrent
25    review as defined in the Health Carrier External Review
26    Act. A request for approval of inpatient care,

 

 

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1    detoxification/withdrawal management, partial
2    hospitalization, intensive outpatient treatment, and
3    outpatient treatment beyond the first 28 days shall be
4    submitted for concurrent review before the expiration of
5    the initial 28-day period. A request for approval of
6    inpatient care, detoxification/withdrawal management,
7    partial hospitalization, intensive outpatient treatment,
8    and outpatient treatment beyond any period that is approved
9    under concurrent review shall be submitted within the
10    period that was previously approved. No insurer shall
11    initiate concurrent review more frequently than at 2-week
12    intervals. If an insurer determines that continued
13    inpatient care, detoxification/withdrawal management,
14    partial hospitalization, intensive outpatient treatment,
15    or outpatient treatment in a facility is no longer
16    medically necessary, the insurer shall, within 24 hours,
17    provide written notice to the covered pregnant or
18    postpartum woman and the covered pregnant or postpartum
19    woman's provider of its decision and the right to file an
20    expedited internal appeal of the determination. The
21    insurer shall review and make a determination with respect
22    to the internal appeal within 24 hours and communicate such
23    determination to the covered pregnant or postpartum woman
24    and the covered pregnant or postpartum woman's provider. If
25    the determination is to uphold the denial, the covered
26    pregnant or postpartum woman and the covered pregnant or

 

 

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1    postpartum woman's provider have the right to file an
2    expedited external appeal. An independent utilization
3    review organization shall make a determination within 24
4    hours. If the insurer's determination is upheld and it is
5    determined continued inpatient care,
6    detoxification/withdrawal management, partial
7    hospitalization, intensive outpatient treatment, or
8    outpatient treatment is not medically necessary, the
9    insurer shall remain responsible to provide benefits for
10    the inpatient care, detoxification/withdrawal management,
11    partial hospitalization, intensive outpatient treatment,
12    or outpatient treatment through the day following the date
13    the determination is made and the covered pregnant or
14    postpartum woman shall only be responsible for any
15    applicable copayment, deductible, and coinsurance for the
16    stay through that date as applicable under the policy. The
17    covered pregnant or postpartum woman shall not be
18    discharged or released from the inpatient facility,
19    detoxification/withdrawal management, partial
20    hospitalization, intensive outpatient treatment, or
21    outpatient treatment until all internal appeals and
22    independent utilization review organization appeals are
23    exhausted.
24        (4) The benefits for outpatient prescription drugs to
25    treat mental, emotional, nervous, or substance use
26    disorder or conditions shall be provided when determined

 

 

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1    medically necessary by the covered pregnant or postpartum
2    woman's provider with prescriptive authority, without the
3    imposition of any prior authorization or other prospective
4    utilization management requirements.
5        (5) The first 180 days per plan year of benefits shall
6    be computed based on inpatient days. One or more unused
7    inpatient days may be exchanged for 2 outpatient visits.
8    All extended outpatient services, such as partial
9    hospitalization and intensive outpatient, shall be deemed
10    inpatient days for the purpose of the visit to day exchange
11    provided in this subsection (b).
12        (6) Except as otherwise stated in this subsection (b),
13    the benefits and cost-sharing shall be provided to the same
14    extent as for any other medical condition covered under the
15    policy.
16        (7) The benefits required by this subsection (b) are to
17    be provided to all covered pregnant or postpartum woman
18    with a diagnosis of mental, emotional, nervous, or
19    substance use disorder or conditions. The presence of
20    additional related or unrelated diagnoses shall not be a
21    basis to reduce or deny the benefits required by this
22    subsection (b).
23    (c) A group health insurance policy, individual health
24policy, group policy of accident and health insurance, group
25health benefit plan, qualified health plan that is offered
26through the health insurance marketplace, small employer group

 

 

SB1909- 16 -LRB101 09278 CPF 54372 b

1health plan, or large employer group health plan that is
2amended, delivered, issued, executed, or renewed in this State
3or approved for issuance or renewal in this State on or after
4the effective date of this amendatory Act of the 101st General
5Assembly shall provide coverage for case management and
6outreach for a postpartum woman that had a high-risk pregnancy.
7The coverage under this subsection (c) shall take into
8consideration the cultural differences of the covered
9postpartum woman in case coordination. As used in this
10subsection (c), "high-risk pregnancy" means a pregnancy in
11which the mother or baby is at increased risk for poor health
12or complications during pregnancy or childbirth.
 
13    Section 40. The Health Maintenance Organization Act is
14amended by changing Section 5-3 as follows:
 
15    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
16    Sec. 5-3. Insurance Code provisions.
17    (a) Health Maintenance Organizations shall be subject to
18the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
19141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
20154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
21355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
22356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
23356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
24356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33,

 

 

SB1909- 17 -LRB101 09278 CPF 54372 b

1364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d,
2368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2,
3409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
4Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
5XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
6    (b) For purposes of the Illinois Insurance Code, except for
7Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
8Maintenance Organizations in the following categories are
9deemed to be "domestic companies":
10        (1) a corporation authorized under the Dental Service
11    Plan Act or the Voluntary Health Services Plans Act;
12        (2) a corporation organized under the laws of this
13    State; or
14        (3) a corporation organized under the laws of another
15    state, 30% or more of the enrollees of which are residents
16    of this State, except a corporation subject to
17    substantially the same requirements in its state of
18    organization as is a "domestic company" under Article VIII
19    1/2 of the Illinois Insurance Code.
20    (c) In considering the merger, consolidation, or other
21acquisition of control of a Health Maintenance Organization
22pursuant to Article VIII 1/2 of the Illinois Insurance Code,
23        (1) the Director shall give primary consideration to
24    the continuation of benefits to enrollees and the financial
25    conditions of the acquired Health Maintenance Organization
26    after the merger, consolidation, or other acquisition of

 

 

SB1909- 18 -LRB101 09278 CPF 54372 b

1    control takes effect;
2        (2)(i) the criteria specified in subsection (1)(b) of
3    Section 131.8 of the Illinois Insurance Code shall not
4    apply and (ii) the Director, in making his determination
5    with respect to the merger, consolidation, or other
6    acquisition of control, need not take into account the
7    effect on competition of the merger, consolidation, or
8    other acquisition of control;
9        (3) the Director shall have the power to require the
10    following information:
11            (A) certification by an independent actuary of the
12        adequacy of the reserves of the Health Maintenance
13        Organization sought to be acquired;
14            (B) pro forma financial statements reflecting the
15        combined balance sheets of the acquiring company and
16        the Health Maintenance Organization sought to be
17        acquired as of the end of the preceding year and as of
18        a date 90 days prior to the acquisition, as well as pro
19        forma financial statements reflecting projected
20        combined operation for a period of 2 years;
21            (C) a pro forma business plan detailing an
22        acquiring party's plans with respect to the operation
23        of the Health Maintenance Organization sought to be
24        acquired for a period of not less than 3 years; and
25            (D) such other information as the Director shall
26        require.

 

 

SB1909- 19 -LRB101 09278 CPF 54372 b

1    (d) The provisions of Article VIII 1/2 of the Illinois
2Insurance Code and this Section 5-3 shall apply to the sale by
3any health maintenance organization of greater than 10% of its
4enrollee population (including without limitation the health
5maintenance organization's right, title, and interest in and to
6its health care certificates).
7    (e) In considering any management contract or service
8agreement subject to Section 141.1 of the Illinois Insurance
9Code, the Director (i) shall, in addition to the criteria
10specified in Section 141.2 of the Illinois Insurance Code, take
11into account the effect of the management contract or service
12agreement on the continuation of benefits to enrollees and the
13financial condition of the health maintenance organization to
14be managed or serviced, and (ii) need not take into account the
15effect of the management contract or service agreement on
16competition.
17    (f) Except for small employer groups as defined in the
18Small Employer Rating, Renewability and Portability Health
19Insurance Act and except for medicare supplement policies as
20defined in Section 363 of the Illinois Insurance Code, a Health
21Maintenance Organization may by contract agree with a group or
22other enrollment unit to effect refunds or charge additional
23premiums under the following terms and conditions:
24        (i) the amount of, and other terms and conditions with
25    respect to, the refund or additional premium are set forth
26    in the group or enrollment unit contract agreed in advance

 

 

SB1909- 20 -LRB101 09278 CPF 54372 b

1    of the period for which a refund is to be paid or
2    additional premium is to be charged (which period shall not
3    be less than one year); and
4        (ii) the amount of the refund or additional premium
5    shall not exceed 20% of the Health Maintenance
6    Organization's profitable or unprofitable experience with
7    respect to the group or other enrollment unit for the
8    period (and, for purposes of a refund or additional
9    premium, the profitable or unprofitable experience shall
10    be calculated taking into account a pro rata share of the
11    Health Maintenance Organization's administrative and
12    marketing expenses, but shall not include any refund to be
13    made or additional premium to be paid pursuant to this
14    subsection (f)). The Health Maintenance Organization and
15    the group or enrollment unit may agree that the profitable
16    or unprofitable experience may be calculated taking into
17    account the refund period and the immediately preceding 2
18    plan years.
19    The Health Maintenance Organization shall include a
20statement in the evidence of coverage issued to each enrollee
21describing the possibility of a refund or additional premium,
22and upon request of any group or enrollment unit, provide to
23the group or enrollment unit a description of the method used
24to calculate (1) the Health Maintenance Organization's
25profitable experience with respect to the group or enrollment
26unit and the resulting refund to the group or enrollment unit

 

 

SB1909- 21 -LRB101 09278 CPF 54372 b

1or (2) the Health Maintenance Organization's unprofitable
2experience with respect to the group or enrollment unit and the
3resulting additional premium to be paid by the group or
4enrollment unit.
5    In no event shall the Illinois Health Maintenance
6Organization Guaranty Association be liable to pay any
7contractual obligation of an insolvent organization to pay any
8refund authorized under this Section.
9    (g) Rulemaking authority to implement Public Act 95-1045,
10if any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17;
16100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1026, eff.
178-22-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
1810-4-18.)
 
19    Section 45. The Voluntary Health Services Plans Act is
20amended by changing Section 10 as follows:
 
21    (215 ILCS 165/10)  (from Ch. 32, par. 604)
22    Sec. 10. Application of Insurance Code provisions. Health
23services plan corporations and all persons interested therein
24or dealing therewith shall be subject to the provisions of

 

 

SB1909- 22 -LRB101 09278 CPF 54372 b

1Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
2143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
3356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
4356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
5356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
6356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
7356z.32, 356z.33, 364.01, 367.2, 368a, 401, 401.1, 402, 403,
8403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
9Section 367 of the Illinois Insurance Code.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
17100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
181-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
19    Section 50. The Illinois Public Aid Code is amended by
20changing Sections 5-2, 5-5, and 5-5.24 and by adding Section
215-5.27 as follows:
 
22    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
23    Sec. 5-2. Classes of Persons Eligible.
24    Medical assistance under this Article shall be available to

 

 

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

 

 

SB1909- 24 -LRB101 09278 CPF 54372 b

1            of remedial care, is equal to or less than 100% of
2            the federal poverty level.
3            (b) (Blank).
4        3. (Blank).
5        4. Persons not eligible under any of the preceding
6    paragraphs who fall sick, are injured, or die, not having
7    sufficient money, property or other resources to meet the
8    costs of necessary medical care or funeral and burial
9    expenses.
10        5.(a) Women during pregnancy and during the 12-month
11    60-day period beginning on the last day of the pregnancy,
12    together with their infants, whose income is at or below
13    200% of the federal poverty level. Until September 30,
14    2019, or sooner if the maintenance of effort requirements
15    under the Patient Protection and Affordable Care Act are
16    eliminated or may be waived before then, women during
17    pregnancy and during the 12-month 60-day period beginning
18    on the last day of the pregnancy, whose countable monthly
19    income, after the deduction of costs incurred for medical
20    care and for other types of remedial care as specified in
21    administrative rule, is equal to or less than the Medical
22    Assistance-No Grant(C) (MANG(C)) Income Standard in effect
23    on April 1, 2013 as set forth in administrative rule.
24        (b) The plan for coverage shall provide ambulatory
25    prenatal care to pregnant women during a presumptive
26    eligibility period and establish an income eligibility

 

 

SB1909- 25 -LRB101 09278 CPF 54372 b

1    standard that is equal to 200% of the federal poverty
2    level, provided that costs incurred for medical care are
3    not taken into account in determining such income
4    eligibility.
5        (c) The Illinois Department may conduct a
6    demonstration in at least one county that will provide
7    medical assistance to pregnant women, together with their
8    infants and children up to one year of age, where the
9    income eligibility standard is set up to 185% of the
10    nonfarm income official poverty line, as defined by the
11    federal Office of Management and Budget. The Illinois
12    Department shall seek and obtain necessary authorization
13    provided under federal law to implement such a
14    demonstration. Such demonstration may establish resource
15    standards that are not more restrictive than those
16    established under Article IV of this Code.
17        6. (a) Children younger than age 19 when countable
18    income is at or below 133% of the federal poverty level.
19    Until September 30, 2019, or sooner if the maintenance of
20    effort requirements under the Patient Protection and
21    Affordable Care Act are eliminated or may be waived before
22    then, children younger than age 19 whose countable monthly
23    income, after the deduction of costs incurred for medical
24    care and for other types of remedial care as specified in
25    administrative rule, is equal to or less than the Medical
26    Assistance-No Grant(C) (MANG(C)) Income Standard in effect

 

 

SB1909- 26 -LRB101 09278 CPF 54372 b

1    on April 1, 2013 as set forth in administrative rule.
2        (b) Children and youth who are under temporary custody
3    or guardianship of the Department of Children and Family
4    Services or who receive financial assistance in support of
5    an adoption or guardianship placement from the Department
6    of Children and Family Services.
7        7. (Blank).
8        8. As required under federal law, persons who are
9    eligible for Transitional Medical Assistance as a result of
10    an increase in earnings or child or spousal support
11    received. The plan for coverage for this class of persons
12    shall:
13            (a) extend the medical assistance coverage to the
14        extent required by federal law; and
15            (b) offer persons who have initially received 6
16        months of the coverage provided in paragraph (a) above,
17        the option of receiving an additional 6 months of
18        coverage, subject to the following:
19                (i) such coverage shall be pursuant to
20            provisions of the federal Social Security Act;
21                (ii) such coverage shall include all services
22            covered under Illinois' State Medicaid Plan;
23                (iii) no premium shall be charged for such
24            coverage; and
25                (iv) such coverage shall be suspended in the
26            event of a person's failure without good cause to

 

 

SB1909- 27 -LRB101 09278 CPF 54372 b

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

 

 

SB1909- 28 -LRB101 09278 CPF 54372 b

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

 

 

SB1909- 29 -LRB101 09278 CPF 54372 b

1        Program established under Title XV of the federal
2        Public Health Services Act in accordance with the
3        requirements of Section 1504 of that Act as
4        administered by the Illinois Department of Public
5        Health; and
6            (2) persons whose screenings under the above
7        program were funded in whole or in part by funds
8        appropriated to the Illinois Department of Public
9        Health for breast or cervical cancer screening.
10        "Medical assistance" under this paragraph 12 shall be
11    identical to the benefits provided under the State's
12    approved plan under Title XIX of the Social Security Act.
13    The Department must request federal approval of the
14    coverage under this paragraph 12 within 30 days after the
15    effective date of this amendatory Act of the 92nd General
16    Assembly.
17        In addition to the persons who are eligible for medical
18    assistance pursuant to subparagraphs (1) and (2) of this
19    paragraph 12, and to be paid from funds appropriated to the
20    Department for its medical programs, any uninsured person
21    as defined by the Department in rules residing in Illinois
22    who is younger than 65 years of age, who has been screened
23    for breast and cervical cancer in accordance with standards
24    and procedures adopted by the Department of Public Health
25    for screening, and who is referred to the Department by the
26    Department of Public Health as being in need of treatment

 

 

SB1909- 30 -LRB101 09278 CPF 54372 b

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

 

 

SB1909- 31 -LRB101 09278 CPF 54372 b

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

 

 

SB1909- 32 -LRB101 09278 CPF 54372 b

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

 

 

SB1909- 33 -LRB101 09278 CPF 54372 b

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

 

 

SB1909- 34 -LRB101 09278 CPF 54372 b

1    older, but younger than 65, who are not otherwise eligible
2    for medical assistance under this Section 5-2, who qualify
3    for medical assistance pursuant to 42 U.S.C.
4    1396a(a)(10)(A)(i)(VIII) and applicable federal
5    regulations, and who have income at or below 133% of the
6    federal poverty level plus 5% for the applicable family
7    size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
8    applicable federal regulations. Persons eligible for
9    medical assistance under this paragraph 18 shall receive
10    coverage for the Health Benefits Service Package as that
11    term is defined in subsection (m) of Section 5-1.1 of this
12    Code. If Illinois' federal medical assistance percentage
13    (FMAP) is reduced below 90% for persons eligible for
14    medical assistance under this paragraph 18, eligibility
15    under this paragraph 18 shall cease no later than the end
16    of the third month following the month in which the
17    reduction in FMAP takes effect.
18        19. Beginning January 1, 2014, as required under 42
19    U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18
20    and younger than age 26 who are not otherwise eligible for
21    medical assistance under paragraphs (1) through (17) of
22    this Section who (i) were in foster care under the
23    responsibility of the State on the date of attaining age 18
24    or on the date of attaining age 21 when a court has
25    continued wardship for good cause as provided in Section
26    2-31 of the Juvenile Court Act of 1987 and (ii) received

 

 

SB1909- 35 -LRB101 09278 CPF 54372 b

1    medical assistance under the Illinois Title XIX State Plan
2    or waiver of such plan while in foster care.
3        20. Beginning January 1, 2018, persons who are
4    foreign-born victims of human trafficking, torture, or
5    other serious crimes as defined in Section 2-19 of this
6    Code and their derivative family members if such persons:
7    (i) reside in Illinois; (ii) are not eligible under any of
8    the preceding paragraphs; (iii) meet the income guidelines
9    of subparagraph (a) of paragraph 2; and (iv) meet the
10    nonfinancial eligibility requirements of Sections 16-2,
11    16-3, and 16-5 of this Code. The Department may extend
12    medical assistance for persons who are foreign-born
13    victims of human trafficking, torture, or other serious
14    crimes whose medical assistance would be terminated
15    pursuant to subsection (b) of Section 16-5 if the
16    Department determines that the person, during the year of
17    initial eligibility (1) experienced a health crisis, (2)
18    has been unable, after reasonable attempts, to obtain
19    necessary information from a third party, or (3) has other
20    extenuating circumstances that prevented the person from
21    completing his or her application for status. The
22    Department may adopt any rules necessary to implement the
23    provisions of this paragraph.
24    In implementing the provisions of Public Act 96-20, the
25Department is authorized to adopt only those rules necessary,
26including emergency rules. Nothing in Public Act 96-20 permits

 

 

SB1909- 36 -LRB101 09278 CPF 54372 b

1the Department to adopt rules or issue a decision that expands
2eligibility for the FamilyCare Program to a person whose income
3exceeds 185% of the Federal Poverty Level as determined from
4time to time by the U.S. Department of Health and Human
5Services, unless the Department is provided with express
6statutory authority.
7    The eligibility of any such person for medical assistance
8under this Article is not affected by the payment of any grant
9under the Senior Citizens and Persons with Disabilities
10Property Tax Relief Act or any distributions or items of income
11described under subparagraph (X) of paragraph (2) of subsection
12(a) of Section 203 of the Illinois Income Tax Act.
13    The Department shall by rule establish the amounts of
14assets to be disregarded in determining eligibility for medical
15assistance, which shall at a minimum equal the amounts to be
16disregarded under the Federal Supplemental Security Income
17Program. The amount of assets of a single person to be
18disregarded shall not be less than $2,000, and the amount of
19assets of a married couple to be disregarded shall not be less
20than $3,000.
21    To the extent permitted under federal law, any person found
22guilty of a second violation of Article VIIIA shall be
23ineligible for medical assistance under this Article, as
24provided in Section 8A-8.
25    The eligibility of any person for medical assistance under
26this Article shall not be affected by the receipt by the person

 

 

SB1909- 37 -LRB101 09278 CPF 54372 b

1of donations or benefits from fundraisers held for the person
2in cases of serious illness, as long as neither the person nor
3members of the person's family have actual control over the
4donations or benefits or the disbursement of the donations or
5benefits.
6    Notwithstanding any other provision of this Code, if the
7United States Supreme Court holds Title II, Subtitle A, Section
82001(a) of Public Law 111-148 to be unconstitutional, or if a
9holding of Public Law 111-148 makes Medicaid eligibility
10allowed under Section 2001(a) inoperable, the State or a unit
11of local government shall be prohibited from enrolling
12individuals in the Medical Assistance Program as the result of
13federal approval of a State Medicaid waiver on or after the
14effective date of this amendatory Act of the 97th General
15Assembly, and any individuals enrolled in the Medical
16Assistance Program pursuant to eligibility permitted as a
17result of such a State Medicaid waiver shall become immediately
18ineligible.
19    Notwithstanding any other provision of this Code, if an Act
20of Congress that becomes a Public Law eliminates Section
212001(a) of Public Law 111-148, the State or a unit of local
22government shall be prohibited from enrolling individuals in
23the Medical Assistance Program as the result of federal
24approval of a State Medicaid waiver on or after the effective
25date of this amendatory Act of the 97th General Assembly, and
26any individuals enrolled in the Medical Assistance Program

 

 

SB1909- 38 -LRB101 09278 CPF 54372 b

1pursuant to eligibility permitted as a result of such a State
2Medicaid waiver shall become immediately ineligible.
3    Effective October 1, 2013, the determination of
4eligibility of persons who qualify under paragraphs 5, 6, 8,
515, 17, and 18 of this Section shall comply with the
6requirements of 42 U.S.C. 1396a(e)(14) and applicable federal
7regulations.
8    The Department of Healthcare and Family Services, the
9Department of Human Services, and the Illinois health insurance
10marketplace shall work cooperatively to assist persons who
11would otherwise lose health benefits as a result of changes
12made under this amendatory Act of the 98th General Assembly to
13transition to other health insurance coverage.
14(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;
1599-143, eff. 7-27-15; 99-870, eff. 8-22-16.)
 
16    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
17    Sec. 5-5. Medical services. The Illinois Department, by
18rule, shall determine the quantity and quality of and the rate
19of reimbursement for the medical assistance for which payment
20will be authorized, and the medical services to be provided,
21which may include all or part of the following: (1) inpatient
22hospital services; (2) outpatient hospital services; (3) other
23laboratory and X-ray services; (4) skilled nursing home
24services; (5) physicians' services whether furnished in the
25office, the patient's home, a hospital, a skilled nursing home,

 

 

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

 

 

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1(15) medical treatment of sexual assault survivors, as defined
2in Section 1a of the Sexual Assault Survivors Emergency
3Treatment Act, for injuries sustained as a result of the sexual
4assault, including examinations and laboratory tests to
5discover evidence which may be used in criminal proceedings
6arising from the sexual assault; (16) the diagnosis and
7treatment of sickle cell anemia; and (17) any other medical
8care, and any other type of remedial care recognized under the
9laws of this State. The term "any other type of remedial care"
10shall include nursing care and nursing home service for persons
11who rely on treatment by spiritual means alone through prayer
12for healing.
13    Notwithstanding any other provision of this Section, a
14comprehensive tobacco use cessation program that includes
15purchasing prescription drugs or prescription medical devices
16approved by the Food and Drug Administration shall be covered
17under the medical assistance program under this Article for
18persons who are otherwise eligible for assistance under this
19Article.
20    Notwithstanding any other provision of this Code,
21reproductive health care that is otherwise legal in Illinois
22shall be covered under the medical assistance program for
23persons who are otherwise eligible for medical assistance under
24this Article.
25    Notwithstanding any other provision of this Code, the
26Illinois Department may not require, as a condition of payment

 

 

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1for any laboratory test authorized under this Article, that a
2physician's handwritten signature appear on the laboratory
3test order form. The Illinois Department may, however, impose
4other appropriate requirements regarding laboratory test order
5documentation.
6    Upon receipt of federal approval of an amendment to the
7Illinois Title XIX State Plan for this purpose, the Department
8shall authorize the Chicago Public Schools (CPS) to procure a
9vendor or vendors to manufacture eyeglasses for individuals
10enrolled in a school within the CPS system. CPS shall ensure
11that its vendor or vendors are enrolled as providers in the
12medical assistance program and in any capitated Medicaid
13managed care entity (MCE) serving individuals enrolled in a
14school within the CPS system. Under any contract procured under
15this provision, the vendor or vendors must serve only
16individuals enrolled in a school within the CPS system. Claims
17for services provided by CPS's vendor or vendors to recipients
18of benefits in the medical assistance program under this Code,
19the Children's Health Insurance Program, or the Covering ALL
20KIDS Health Insurance Program shall be submitted to the
21Department or the MCE in which the individual is enrolled for
22payment and shall be reimbursed at the Department's or the
23MCE's established rates or rate methodologies for eyeglasses.
24    On and after July 1, 2012, the Department of Healthcare and
25Family Services may provide the following services to persons
26eligible for assistance under this Article who are

 

 

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1participating in education, training or employment programs
2operated by the Department of Human Services as successor to
3the Department of Public Aid:
4        (1) dental services provided by or under the
5    supervision of a dentist; and
6        (2) eyeglasses prescribed by a physician skilled in the
7    diseases of the eye, or by an optometrist, whichever the
8    person may select.
9    On and after July 1, 2018, the Department of Healthcare and
10Family Services shall provide dental services to any adult who
11is otherwise eligible for assistance under the medical
12assistance program. As used in this paragraph, "dental
13services" means diagnostic, preventative, restorative, or
14corrective procedures, including procedures and services for
15the prevention and treatment of periodontal disease and dental
16caries disease, provided by an individual who is licensed to
17practice dentistry or dental surgery or who is under the
18supervision of a dentist in the practice of his or her
19profession.
20    On and after July 1, 2018, targeted dental services, as set
21forth in Exhibit D of the Consent Decree entered by the United
22States District Court for the Northern District of Illinois,
23Eastern Division, in the matter of Memisovski v. Maram, Case
24No. 92 C 1982, that are provided to adults under the medical
25assistance program shall be established at no less than the
26rates set forth in the "New Rate" column in Exhibit D of the

 

 

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

 

 

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1    The Illinois Department shall authorize the provision of,
2and shall authorize payment for, screening by low-dose
3mammography for the presence of occult breast cancer for women
435 years of age or older who are eligible for medical
5assistance under this Article, as follows:
6        (A) A baseline mammogram for women 35 to 39 years of
7    age.
8        (B) An annual mammogram for women 40 years of age or
9    older.
10        (C) A mammogram at the age and intervals considered
11    medically necessary by the woman's health care provider for
12    women under 40 years of age and having a family history of
13    breast cancer, prior personal history of breast cancer,
14    positive genetic testing, or other risk factors.
15        (D) A comprehensive ultrasound screening and MRI of an
16    entire breast or breasts if a mammogram demonstrates
17    heterogeneous or dense breast tissue, when medically
18    necessary as determined by a physician licensed to practice
19    medicine in all of its branches.
20        (E) A screening MRI when medically necessary, as
21    determined by a physician licensed to practice medicine in
22    all of its branches.
23    All screenings shall include a physical breast exam,
24instruction on self-examination and information regarding the
25frequency of self-examination and its value as a preventative
26tool. For purposes of this Section, "low-dose mammography"

 

 

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

 

 

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

 

 

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1qualified health centers and other encounter-rate clinics.
2These clinics or centers may also collaborate with other
3hospital-based mammography facilities. By January 1, 2016, the
4Department shall report to the General Assembly on the status
5of the provision set forth in this paragraph.
6    The Department shall establish a methodology to remind
7women who are age-appropriate for screening mammography, but
8who have not received a mammogram within the previous 18
9months, of the importance and benefit of screening mammography.
10The Department shall work with experts in breast cancer
11outreach and patient navigation to optimize these reminders and
12shall establish a methodology for evaluating their
13effectiveness and modifying the methodology based on the
14evaluation.
15    The Department shall establish a performance goal for
16primary care providers with respect to their female patients
17over age 40 receiving an annual mammogram. This performance
18goal shall be used to provide additional reimbursement in the
19form of a quality performance bonus to primary care providers
20who meet that goal.
21    The Department shall devise a means of case-managing or
22patient navigation for beneficiaries diagnosed with breast
23cancer. This program shall initially operate as a pilot program
24in areas of the State with the highest incidence of mortality
25related to breast cancer. At least one pilot program site shall
26be in the metropolitan Chicago area and at least one site shall

 

 

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1be outside the metropolitan Chicago area. On or after July 1,
22016, the pilot program shall be expanded to include one site
3in western Illinois, one site in southern Illinois, one site in
4central Illinois, and 4 sites within metropolitan Chicago. An
5evaluation of the pilot program shall be carried out measuring
6health outcomes and cost of care for those served by the pilot
7program compared to similarly situated patients who are not
8served by the pilot program.
9    The Department shall require all networks of care to
10develop a means either internally or by contract with experts
11in navigation and community outreach to navigate cancer
12patients to comprehensive care in a timely fashion. The
13Department shall require all networks of care to include access
14for patients diagnosed with cancer to at least one academic
15commission on cancer-accredited cancer program as an
16in-network covered benefit.
17    On or after July 1, 2019, women who are otherwise eligible
18for medical assistance under this Article shall receive
19coverage for doula services by a certified doula during their
20pregnancy and during the 12-month period beginning on the last
21day of their pregnancy. As used in this paragraph, "certified
22doula" means an individual who has received a certification to
23perform doula services from the International Childbirth
24Education Association, the Doulas of North America, the
25Association of Labor Assistants and Childbirth Educators,
26BirthWorks, the Childbirth and Postpartum Professional

 

 

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1Association, Childbirth International, the International
2Center for Traditional Childbearing, or Commonsense Childbirth
3Inc. As used in this paragraph, "doula services" means
4continuous personal, non-medical emotional and physical
5support throughout labor and birth, and intermittently during
6the prenatal and postpartum periods.
7    On or after July 1, 2019, women who are otherwise eligible
8for medical assistance under this Article shall receive
9coverage for perinatal depression screenings for the 12-month
10period beginning on the last day of their pregnancy. Medical
11assistance coverage under this paragraph shall be conditioned
12on the use of a screening instrument approved by the
13Department.
14    Any medical or health care provider shall immediately
15recommend, to any pregnant woman who is being provided prenatal
16services and is suspected of having a substance use disorder as
17defined in the Substance Use Disorder Act, referral to a local
18substance use disorder treatment program licensed by the
19Department of Human Services or to a licensed hospital which
20provides substance abuse treatment services. The Department of
21Healthcare and Family Services shall assure coverage for the
22cost of treatment of the drug abuse or addiction for pregnant
23recipients in accordance with the Illinois Medicaid Program in
24conjunction with the Department of Human Services.
25    All medical providers providing medical assistance to
26pregnant women under this Code shall receive information from

 

 

SB1909- 50 -LRB101 09278 CPF 54372 b

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

 

 

SB1909- 51 -LRB101 09278 CPF 54372 b

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

 

 

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1        (3) Persons receiving medical services through
2    Partnerships may receive medical and case management
3    services above the level usually offered through the
4    medical assistance program.
5    Medical providers shall be required to meet certain
6qualifications to participate in Partnerships to ensure the
7delivery of high quality medical services. These
8qualifications shall be determined by rule of the Illinois
9Department and may be higher than qualifications for
10participation in the medical assistance program. Partnership
11sponsors may prescribe reasonable additional qualifications
12for participation by medical providers, only with the prior
13written approval of the Illinois Department.
14    Nothing in this Section shall limit the free choice of
15practitioners, hospitals, and other providers of medical
16services by clients. In order to ensure patient freedom of
17choice, the Illinois Department shall immediately promulgate
18all rules and take all other necessary actions so that provided
19services may be accessed from therapeutically certified
20optometrists to the full extent of the Illinois Optometric
21Practice Act of 1987 without discriminating between service
22providers.
23    The Department shall apply for a waiver from the United
24States Health Care Financing Administration to allow for the
25implementation of Partnerships under this Section.
26    The Illinois Department shall require health care

 

 

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1providers to maintain records that document the medical care
2and services provided to recipients of Medical Assistance under
3this Article. Such records must be retained for a period of not
4less than 6 years from the date of service or as provided by
5applicable State law, whichever period is longer, except that
6if an audit is initiated within the required retention period
7then the records must be retained until the audit is completed
8and every exception is resolved. The Illinois Department shall
9require health care providers to make available, when
10authorized by the patient, in writing, the medical records in a
11timely fashion to other health care providers who are treating
12or serving persons eligible for Medical Assistance under this
13Article. All dispensers of medical services shall be required
14to maintain and retain business and professional records
15sufficient to fully and accurately document the nature, scope,
16details and receipt of the health care provided to persons
17eligible for medical assistance under this Code, in accordance
18with regulations promulgated by the Illinois Department. The
19rules and regulations shall require that proof of the receipt
20of prescription drugs, dentures, prosthetic devices and
21eyeglasses by eligible persons under this Section accompany
22each claim for reimbursement submitted by the dispenser of such
23medical services. No such claims for reimbursement shall be
24approved for payment by the Illinois Department without such
25proof of receipt, unless the Illinois Department shall have put
26into effect and shall be operating a system of post-payment

 

 

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1audit and review which shall, on a sampling basis, be deemed
2adequate by the Illinois Department to assure that such drugs,
3dentures, prosthetic devices and eyeglasses for which payment
4is being made are actually being received by eligible
5recipients. Within 90 days after September 16, 1984 (the
6effective date of Public Act 83-1439), the Illinois Department
7shall establish a current list of acquisition costs for all
8prosthetic devices and any other items recognized as medical
9equipment and supplies reimbursable under this Article and
10shall update such list on a quarterly basis, except that the
11acquisition costs of all prescription drugs shall be updated no
12less frequently than every 30 days as required by Section
135-5.12.
14    Notwithstanding any other law to the contrary, the Illinois
15Department shall, within 365 days after July 22, 2013 (the
16effective date of Public Act 98-104), establish procedures to
17permit skilled care facilities licensed under the Nursing Home
18Care Act to submit monthly billing claims for reimbursement
19purposes. Following development of these procedures, the
20Department shall, by July 1, 2016, test the viability of the
21new system and implement any necessary operational or
22structural changes to its information technology platforms in
23order to allow for the direct acceptance and payment of nursing
24home claims.
25    Notwithstanding any other law to the contrary, the Illinois
26Department shall, within 365 days after August 15, 2014 (the

 

 

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

 

 

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1period and shall be conditional for one year. During the period
2of conditional enrollment, the Department may terminate the
3vendor's eligibility to participate in, or may disenroll the
4vendor from, the medical assistance program without cause.
5Unless otherwise specified, such termination of eligibility or
6disenrollment is not subject to the Department's hearing
7process. However, a disenrolled vendor may reapply without
8penalty.
9    The Department has the discretion to limit the conditional
10enrollment period for vendors based upon category of risk of
11the vendor.
12    Prior to enrollment and during the conditional enrollment
13period in the medical assistance program, all vendors shall be
14subject to enhanced oversight, screening, and review based on
15the risk of fraud, waste, and abuse that is posed by the
16category of risk of the vendor. The Illinois Department shall
17establish the procedures for oversight, screening, and review,
18which may include, but need not be limited to: criminal and
19financial background checks; fingerprinting; license,
20certification, and authorization verifications; unscheduled or
21unannounced site visits; database checks; prepayment audit
22reviews; audits; payment caps; payment suspensions; and other
23screening as required by federal or State law.
24    The Department shall define or specify the following: (i)
25by provider notice, the "category of risk of the vendor" for
26each type of vendor, which shall take into account the level of

 

 

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

 

 

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1        (4) In the case of a provider operated by a unit of
2    local government with a population exceeding 3,000,000
3    when local government funds finance federal participation
4    for claims payments.
5    For claims for services rendered during a period for which
6a recipient received retroactive eligibility, claims must be
7filed within 180 days after the Department determines the
8applicant is eligible. For claims for which the Illinois
9Department is not the primary payer, claims must be submitted
10to the Illinois Department within 180 days after the final
11adjudication by the primary payer.
12    In the case of long term care facilities, within 45
13calendar days of receipt by the facility of required
14prescreening information, new admissions with associated
15admission documents shall be submitted through the Medical
16Electronic Data Interchange (MEDI) or the Recipient
17Eligibility Verification (REV) System or shall be submitted
18directly to the Department of Human Services using required
19admission forms. Effective September 1, 2014, admission
20documents, including all prescreening information, must be
21submitted through MEDI or REV. Confirmation numbers assigned to
22an accepted transaction shall be retained by a facility to
23verify timely submittal. Once an admission transaction has been
24completed, all resubmitted claims following prior rejection
25are subject to receipt no later than 180 days after the
26admission transaction has been completed.

 

 

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

 

 

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

 

 

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1limited to, the following services: (1) immediate repair or
2replacement of such devices by recipients; and (2) rental,
3lease, purchase or lease-purchase of durable medical equipment
4in a cost-effective manner, taking into consideration the
5recipient's medical prognosis, the extent of the recipient's
6needs, and the requirements and costs for maintaining such
7equipment. Subject to prior approval, such rules shall enable a
8recipient to temporarily acquire and use alternative or
9substitute devices or equipment pending repairs or
10replacements of any device or equipment previously authorized
11for such recipient by the Department. Notwithstanding any
12provision of Section 5-5f to the contrary, the Department may,
13by rule, exempt certain replacement wheelchair parts from prior
14approval and, for wheelchairs, wheelchair parts, wheelchair
15accessories, and related seating and positioning items,
16determine the wholesale price by methods other than actual
17acquisition costs.
18    The Department shall require, by rule, all providers of
19durable medical equipment to be accredited by an accreditation
20organization approved by the federal Centers for Medicare and
21Medicaid Services and recognized by the Department in order to
22bill the Department for providing durable medical equipment to
23recipients. No later than 15 months after the effective date of
24the rule adopted pursuant to this paragraph, all providers must
25meet the accreditation requirement.
26    In order to promote environmental responsibility, meet the

 

 

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1needs of recipients and enrollees, and achieve significant cost
2savings, the Department, or a managed care organization under
3contract with the Department, may provide recipients or managed
4care enrollees who have a prescription or Certificate of
5Medical Necessity access to refurbished durable medical
6equipment under this Section (excluding prosthetic and
7orthotic devices as defined in the Orthotics, Prosthetics, and
8Pedorthics Practice Act and complex rehabilitation technology
9products and associated services) through the State's
10assistive technology program's reutilization program, using
11staff with the Assistive Technology Professional (ATP)
12Certification if the refurbished durable medical equipment:
13(i) is available; (ii) is less expensive, including shipping
14costs, than new durable medical equipment of the same type;
15(iii) is able to withstand at least 3 years of use; (iv) is
16cleaned, disinfected, sterilized, and safe in accordance with
17federal Food and Drug Administration regulations and guidance
18governing the reprocessing of medical devices in health care
19settings; and (v) equally meets the needs of the recipient or
20enrollee. The reutilization program shall confirm that the
21recipient or enrollee is not already in receipt of same or
22similar equipment from another service provider, and that the
23refurbished durable medical equipment equally meets the needs
24of the recipient or enrollee. Nothing in this paragraph shall
25be construed to limit recipient or enrollee choice to obtain
26new durable medical equipment or place any additional prior

 

 

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

 

 

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

 

 

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1include suggested legislation for consideration by the General
2Assembly. The requirement for reporting to the General Assembly
3shall be satisfied by filing copies of the report as required
4by Section 3.1 of the General Assembly Organization Act, and
5filing such additional copies with the State Government Report
6Distribution Center for the General Assembly as is required
7under paragraph (t) of Section 7 of the State Library Act.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14    On and after July 1, 2012, the Department shall reduce any
15rate of reimbursement for services or other payments or alter
16any methodologies authorized by this Code to reduce any rate of
17reimbursement for services or other payments in accordance with
18Section 5-5e.
19    Because kidney transplantation can be an appropriate,
20cost-effective alternative to renal dialysis when medically
21necessary and notwithstanding the provisions of Section 1-11 of
22this Code, beginning October 1, 2014, the Department shall
23cover kidney transplantation for noncitizens with end-stage
24renal disease who are not eligible for comprehensive medical
25benefits, who meet the residency requirements of Section 5-3 of
26this Code, and who would otherwise meet the financial

 

 

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

 

 

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1means a drug that binds to opioid receptors and blocks or
2inhibits the effect of opioids acting on those receptors,
3including, but not limited to, naloxone hydrochloride or any
4other similarly acting drug approved by the U.S. Food and Drug
5Administration.
6    Upon federal approval, the Department shall provide
7coverage and reimbursement for all drugs that are approved for
8marketing by the federal Food and Drug Administration and that
9are recommended by the federal Public Health Service or the
10United States Centers for Disease Control and Prevention for
11pre-exposure prophylaxis and related pre-exposure prophylaxis
12services, including, but not limited to, HIV and sexually
13transmitted infection screening, treatment for sexually
14transmitted infections, medical monitoring, assorted labs, and
15counseling to reduce the likelihood of HIV infection among
16individuals who are not infected with HIV but who are at high
17risk of HIV infection.
18    A federally qualified health center, as defined in Section
191905(l)(2)(B) of the federal Social Security Act, shall be
20reimbursed by the Department in accordance with the federally
21qualified health center's encounter rate for services provided
22to medical assistance recipients that are performed by a dental
23hygienist, as defined under the Illinois Dental Practice Act,
24working under the general supervision of a dentist and employed
25by a federally qualified health center.
26    Notwithstanding any other provision of this Code, the

 

 

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1Illinois Department shall authorize licensed dietitian
2nutritionists and certified diabetes educators to counsel
3senior diabetes patients in the senior diabetes patients' homes
4to remove the hurdle of transportation for senior diabetes
5patients to receive treatment.
6    The Department shall seek approval of a State Plan
7amendment to expand coverage for family planning services to
8women whose income is at or below 200% of the federal poverty
9level.
10(Source: P.A. 99-78, eff. 7-20-15; 99-180, eff. 7-29-15;
1199-236, eff. 8-3-15; 99-407 (see Section 20 of P.A. 99-588 for
12the effective date of P.A. 99-407); 99-433, eff. 8-21-15;
1399-480, eff. 9-9-15; 99-588, eff. 7-20-16; 99-642, eff.
147-28-16; 99-772, eff. 1-1-17; 99-895, eff. 1-1-17; 100-201,
15eff. 8-18-17; 100-395, eff. 1-1-18; 100-449, eff. 1-1-18;
16100-538, eff. 1-1-18; 100-587, eff. 6-4-18; 100-759, eff.
171-1-19; 100-863, eff. 8-14-18; 100-974, eff. 8-19-18;
18100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19; 100-1148, eff.
1912-10-18.)
 
20    (305 ILCS 5/5-5.24)
21    Sec. 5-5.24. Prenatal and perinatal care. The Department of
22Healthcare and Family Services may provide reimbursement under
23this Article for all prenatal and perinatal health care
24services that are provided for the purpose of preventing
25low-birthweight infants, reducing the need for neonatal

 

 

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1intensive care hospital services, and promoting perinatal and
2maternal health. These services may include comprehensive risk
3assessments for pregnant women, women with infants, and
4infants, lactation counseling, nutrition counseling,
5childbirth support, psychosocial counseling, treatment and
6prevention of periodontal disease, language translation, nurse
7home visitation, and other support services that have been
8proven to improve birth and maternal health outcomes. The
9Department shall maximize the use of preventive prenatal and
10perinatal health care services consistent with federal
11statutes, rules, and regulations. The Department of Public Aid
12(now Department of Healthcare and Family Services) shall
13develop a plan for prenatal and perinatal preventive health
14care and shall present the plan to the General Assembly by
15January 1, 2004. On or before January 1, 2006 and every 2 years
16thereafter, the Department shall report to the General Assembly
17concerning the effectiveness of prenatal and perinatal health
18care services reimbursed under this Section in preventing
19low-birthweight infants and reducing the need for neonatal
20intensive care hospital services. Each such report shall
21include an evaluation of how the ratio of expenditures for
22treating low-birthweight infants compared with the investment
23in promoting healthy births and infants in local community
24areas throughout Illinois relates to healthy infant
25development in those areas.
26    On and after July 1, 2012, the Department shall reduce any

 

 

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1rate of reimbursement for services or other payments or alter
2any methodologies authorized by this Code to reduce any rate of
3reimbursement for services or other payments in accordance with
4Section 5-5e.
5(Source: P.A. 97-689, eff. 6-14-12.)
 
6    Section 55. The Abused and Neglected Child Reporting Act is
7amended by changing Section 3 as follows:
 
8    (325 ILCS 5/3)  (from Ch. 23, par. 2053)
9    Sec. 3. As used in this Act unless the context otherwise
10requires:
11    "Adult resident" means any person between 18 and 22 years
12of age who resides in any facility licensed by the Department
13under the Child Care Act of 1969. For purposes of this Act, the
14criteria set forth in the definitions of "abused child" and
15"neglected child" shall be used in determining whether an adult
16resident is abused or neglected.
17    "Agency" means a child care facility licensed under Section
182.05 or Section 2.06 of the Child Care Act of 1969 and includes
19a transitional living program that accepts children and adult
20residents for placement who are in the guardianship of the
21Department.
22    "Blatant disregard" means an incident where the real,
23significant, and imminent risk of harm would be so obvious to a
24reasonable parent or caretaker that it is unlikely that a

 

 

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1reasonable parent or caretaker would have exposed the child to
2the danger without exercising precautionary measures to
3protect the child from harm. With respect to a person working
4at an agency in his or her professional capacity with a child
5or adult resident, "blatant disregard" includes a failure by
6the person to perform job responsibilities intended to protect
7the child's or adult resident's health, physical well-being, or
8welfare, and, when viewed in light of the surrounding
9circumstances, evidence exists that would cause a reasonable
10person to believe that the child was neglected. With respect to
11an agency, "blatant disregard" includes a failure to implement
12practices that ensure the health, physical well-being, or
13welfare of the children and adult residents residing in the
14facility.
15    "Child" means any person under the age of 18 years, unless
16legally emancipated by reason of marriage or entry into a
17branch of the United States armed services.
18    "Department" means Department of Children and Family
19Services.
20    "Local law enforcement agency" means the police of a city,
21town, village or other incorporated area or the sheriff of an
22unincorporated area or any sworn officer of the Illinois
23Department of State Police.
24    "Abused child" means a child whose parent or immediate
25family member, or any person responsible for the child's
26welfare, or any individual residing in the same home as the

 

 

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1child, or a paramour of the child's parent:
2        (a) inflicts, causes to be inflicted, or allows to be
3    inflicted upon such child physical injury, by other than
4    accidental means, which causes death, disfigurement,
5    impairment of physical or emotional health, or loss or
6    impairment of any bodily function;
7        (b) creates a substantial risk of physical injury to
8    such child by other than accidental means which would be
9    likely to cause death, disfigurement, impairment of
10    physical or emotional health, or loss or impairment of any
11    bodily function;
12        (c) commits or allows to be committed any sex offense
13    against such child, as such sex offenses are defined in the
14    Criminal Code of 2012 or in the Wrongs to Children Act, and
15    extending those definitions of sex offenses to include
16    children under 18 years of age;
17        (d) commits or allows to be committed an act or acts of
18    torture upon such child;
19        (e) inflicts excessive corporal punishment or, in the
20    case of a person working for an agency who is prohibited
21    from using corporal punishment, inflicts corporal
22    punishment upon a child or adult resident with whom the
23    person is working in his or her professional capacity;
24        (f) commits or allows to be committed the offense of
25    female genital mutilation, as defined in Section 12-34 of
26    the Criminal Code of 2012, against the child;

 

 

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1        (g) causes to be sold, transferred, distributed, or
2    given to such child under 18 years of age, a controlled
3    substance as defined in Section 102 of the Illinois
4    Controlled Substances Act in violation of Article IV of the
5    Illinois Controlled Substances Act or in violation of the
6    Methamphetamine Control and Community Protection Act,
7    except for controlled substances that are prescribed in
8    accordance with Article III of the Illinois Controlled
9    Substances Act and are dispensed to such child in a manner
10    that substantially complies with the prescription; or
11        (h) commits or allows to be committed the offense of
12    involuntary servitude, involuntary sexual servitude of a
13    minor, or trafficking in persons as defined in Section 10-9
14    of the Criminal Code of 2012 against the child.
15    A child shall not be considered abused for the sole reason
16that the child has been relinquished in accordance with the
17Abandoned Newborn Infant Protection Act.
18    "Neglected child" means any child who is not receiving the
19proper or necessary nourishment or medically indicated
20treatment including food or care not provided solely on the
21basis of the present or anticipated mental or physical
22impairment as determined by a physician acting alone or in
23consultation with other physicians or otherwise is not
24receiving the proper or necessary support or medical or other
25remedial care recognized under State law as necessary for a
26child's well-being, or other care necessary for his or her

 

 

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1well-being, including adequate food, clothing and shelter; or
2who is subjected to an environment which is injurious insofar
3as (i) the child's environment creates a likelihood of harm to
4the child's health, physical well-being, or welfare and (ii)
5the likely harm to the child is the result of a blatant
6disregard of parent, caretaker, or agency responsibilities; or
7who is abandoned by his or her parents or other person
8responsible for the child's welfare without a proper plan of
9care; or who has been provided with interim crisis intervention
10services under Section 3-5 of the Juvenile Court Act of 1987
11and whose parent, guardian, or custodian refuses to permit the
12child to return home and no other living arrangement agreeable
13to the parent, guardian, or custodian can be made, and the
14parent, guardian, or custodian has not made any other
15appropriate living arrangement for the child; or who is a
16newborn infant whose blood, urine, or meconium contains any
17amount of a controlled substance as defined in subsection (f)
18of Section 102 of the Illinois Controlled Substances Act or a
19metabolite thereof, with the exception of a controlled
20substance or metabolite thereof whose presence in the newborn
21infant is the result of medical treatment administered to the
22mother or the newborn infant. A child shall not be considered
23neglected for the sole reason that the child's parent or other
24person responsible for his or her welfare has left the child in
25the care of an adult relative for any period of time. A child
26shall not be considered neglected for the sole reason that the

 

 

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1child has been relinquished in accordance with the Abandoned
2Newborn Infant Protection Act. A child shall not be considered
3neglected or abused for the sole reason that such child's
4parent or other person responsible for his or her welfare
5depends upon spiritual means through prayer alone for the
6treatment or cure of disease or remedial care as provided under
7Section 4 of this Act. A child shall not be considered
8neglected or abused solely because the child is not attending
9school in accordance with the requirements of Article 26 of The
10School Code, as amended.
11    "Child Protective Service Unit" means certain specialized
12State employees of the Department assigned by the Director to
13perform the duties and responsibilities as provided under
14Section 7.2 of this Act.
15    "Near fatality" means an act that, as certified by a
16physician, places the child in serious or critical condition,
17including acts of great bodily harm inflicted upon children
18under 13 years of age, and as otherwise defined by Department
19rule.
20    "Great bodily harm" includes bodily injury which creates a
21high probability of death, or which causes serious permanent
22disfigurement, or which causes a permanent or protracted loss
23or impairment of the function of any bodily member or organ, or
24other serious bodily harm.
25    "Person responsible for the child's welfare" means the
26child's parent; guardian; foster parent; relative caregiver;

 

 

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1any person responsible for the child's welfare in a public or
2private residential agency or institution; any person
3responsible for the child's welfare within a public or private
4profit or not for profit child care facility; or any other
5person responsible for the child's welfare at the time of the
6alleged abuse or neglect, including any person that is the
7custodian of a child under 18 years of age who commits or
8allows to be committed, against the child, the offense of
9involuntary servitude, involuntary sexual servitude of a
10minor, or trafficking in persons for forced labor or services,
11as provided in Section 10-9 of the Criminal Code of 2012, or
12any person who came to know the child through an official
13capacity or position of trust, including but not limited to
14health care professionals, educational personnel, recreational
15supervisors, members of the clergy, and volunteers or support
16personnel in any setting where children may be subject to abuse
17or neglect.
18    "Temporary protective custody" means custody within a
19hospital or other medical facility or a place previously
20designated for such custody by the Department, subject to
21review by the Court, including a licensed foster home, group
22home, or other institution; but such place shall not be a jail
23or other place for the detention of criminal or juvenile
24offenders.
25    "An unfounded report" means any report made under this Act
26for which it is determined after an investigation that no

 

 

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1credible evidence of abuse or neglect exists.
2    "An indicated report" means a report made under this Act if
3an investigation determines that credible evidence of the
4alleged abuse or neglect exists.
5    "An undetermined report" means any report made under this
6Act in which it was not possible to initiate or complete an
7investigation on the basis of information provided to the
8Department.
9    "Subject of report" means any child reported to the central
10register of child abuse and neglect established under Section
117.7 of this Act as an alleged victim of child abuse or neglect
12and the parent or guardian of the alleged victim or other
13person responsible for the alleged victim's welfare who is
14named in the report or added to the report as an alleged
15perpetrator of child abuse or neglect.
16    "Perpetrator" means a person who, as a result of
17investigation, has been determined by the Department to have
18caused child abuse or neglect.
19    "Member of the clergy" means a clergyman or practitioner of
20any religious denomination accredited by the religious body to
21which he or she belongs.
22(Source: P.A. 99-350, eff. 6-1-16; 100-733, eff. 1-1-19.)
 
23    Section 60. The Juvenile Court Act of 1987 is amended by
24changing Sections 2-3 and 2-18 as follows:
 

 

 

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1    (705 ILCS 405/2-3)  (from Ch. 37, par. 802-3)
2    Sec. 2-3. Neglected or abused minor.
3    (1) Those who are neglected include:
4        (a) any minor under 18 years of age who is not
5    receiving the proper or necessary support, education as
6    required by law, or medical or other remedial care
7    recognized under State law as necessary for a minor's
8    well-being, or other care necessary for his or her
9    well-being, including adequate food, clothing and shelter,
10    or who is abandoned by his or her parent or parents or
11    other person or persons responsible for the minor's
12    welfare, except that a minor shall not be considered
13    neglected for the sole reason that the minor's parent or
14    parents or other person or persons responsible for the
15    minor's welfare have left the minor in the care of an adult
16    relative for any period of time, who the parent or parents
17    or other person responsible for the minor's welfare know is
18    both a mentally capable adult relative and physically
19    capable adult relative, as defined by this Act; or
20        (b) any minor under 18 years of age whose environment
21    is injurious to his or her welfare; or
22        (c) (blank); or any newborn infant whose blood, urine,
23    or meconium contains any amount of a controlled substance
24    as defined in subsection (f) of Section 102 of the Illinois
25    Controlled Substances Act, as now or hereafter amended, or
26    a metabolite of a controlled substance, with the exception

 

 

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1    of controlled substances or metabolites of such
2    substances, the presence of which in the newborn infant is
3    the result of medical treatment administered to the mother
4    or the newborn infant; or
5        (d) any minor under the age of 14 years whose parent or
6    other person responsible for the minor's welfare leaves the
7    minor without supervision for an unreasonable period of
8    time without regard for the mental or physical health,
9    safety, or welfare of that minor; or
10        (e) any minor who has been provided with interim crisis
11    intervention services under Section 3-5 of this Act and
12    whose parent, guardian, or custodian refuses to permit the
13    minor to return home unless the minor is an immediate
14    physical danger to himself, herself, or others living in
15    the home.
16    Whether the minor was left without regard for the mental or
17physical health, safety, or welfare of that minor or the period
18of time was unreasonable shall be determined by considering the
19following factors, including but not limited to:
20        (1) the age of the minor;
21        (2) the number of minors left at the location;
22        (3) special needs of the minor, including whether the
23    minor is a person with a physical or mental disability, or
24    otherwise in need of ongoing prescribed medical treatment
25    such as periodic doses of insulin or other medications;
26        (4) the duration of time in which the minor was left

 

 

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1    without supervision;
2        (5) the condition and location of the place where the
3    minor was left without supervision;
4        (6) the time of day or night when the minor was left
5    without supervision;
6        (7) the weather conditions, including whether the
7    minor was left in a location with adequate protection from
8    the natural elements such as adequate heat or light;
9        (8) the location of the parent or guardian at the time
10    the minor was left without supervision, the physical
11    distance the minor was from the parent or guardian at the
12    time the minor was without supervision;
13        (9) whether the minor's movement was restricted, or the
14    minor was otherwise locked within a room or other
15    structure;
16        (10) whether the minor was given a phone number of a
17    person or location to call in the event of an emergency and
18    whether the minor was capable of making an emergency call;
19        (11) whether there was food and other provision left
20    for the minor;
21        (12) whether any of the conduct is attributable to
22    economic hardship or illness and the parent, guardian or
23    other person having physical custody or control of the
24    child made a good faith effort to provide for the health
25    and safety of the minor;
26        (13) the age and physical and mental capabilities of

 

 

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1    the person or persons who provided supervision for the
2    minor;
3        (14) whether the minor was left under the supervision
4    of another person;
5        (15) any other factor that would endanger the health
6    and safety of that particular minor.
7    A minor shall not be considered neglected for the sole
8reason that the minor has been relinquished in accordance with
9the Abandoned Newborn Infant Protection Act.
10    (2) Those who are abused include any minor under 18 years
11of age whose parent or immediate family member, or any person
12responsible for the minor's welfare, or any person who is in
13the same family or household as the minor, or any individual
14residing in the same home as the minor, or a paramour of the
15minor's parent:
16        (i) inflicts, causes to be inflicted, or allows to be
17    inflicted upon such minor physical injury, by other than
18    accidental means, which causes death, disfigurement,
19    impairment of physical or emotional health, or loss or
20    impairment of any bodily function;
21        (ii) creates a substantial risk of physical injury to
22    such minor by other than accidental means which would be
23    likely to cause death, disfigurement, impairment of
24    emotional health, or loss or impairment of any bodily
25    function;
26        (iii) commits or allows to be committed any sex offense

 

 

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1    against such minor, as such sex offenses are defined in the
2    Criminal Code of 1961 or the Criminal Code of 2012, or in
3    the Wrongs to Children Act, and extending those definitions
4    of sex offenses to include minors under 18 years of age;
5        (iv) commits or allows to be committed an act or acts
6    of torture upon such minor;
7        (v) inflicts excessive corporal punishment;
8        (vi) commits or allows to be committed the offense of
9    involuntary servitude, involuntary sexual servitude of a
10    minor, or trafficking in persons as defined in Section 10-9
11    of the Criminal Code of 1961 or the Criminal Code of 2012,
12    upon such minor; or
13        (vii) allows, encourages or requires a minor to commit
14    any act of prostitution, as defined in the Criminal Code of
15    1961 or the Criminal Code of 2012, and extending those
16    definitions to include minors under 18 years of age.
17    A minor shall not be considered abused for the sole reason
18that the minor has been relinquished in accordance with the
19Abandoned Newborn Infant Protection Act.
20    (3) This Section does not apply to a minor who would be
21included herein solely for the purpose of qualifying for
22financial assistance for himself, his parents, guardian or
23custodian.
24(Source: P.A. 99-143, eff. 7-27-15.)
 
25    (705 ILCS 405/2-18)  (from Ch. 37, par. 802-18)

 

 

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1    Sec. 2-18. Evidence.
2    (1) At the adjudicatory hearing, the court shall first
3consider only the question whether the minor is abused,
4neglected or dependent. The standard of proof and the rules of
5evidence in the nature of civil proceedings in this State are
6applicable to proceedings under this Article. If the petition
7also seeks the appointment of a guardian of the person with
8power to consent to adoption of the minor under Section 2-29,
9the court may also consider legally admissible evidence at the
10adjudicatory hearing that one or more grounds of unfitness
11exists under subdivision D of Section 1 of the Adoption Act.
12    (2) In any hearing under this Act, the following shall
13constitute prima facie evidence of abuse or neglect, as the
14case may be:
15        (a) proof that a minor has a medical diagnosis of
16    battered child syndrome is prima facie evidence of abuse;
17        (b) proof that a minor has a medical diagnosis of
18    failure to thrive syndrome is prima facie evidence of
19    neglect;
20        (c) proof that a minor has a medical diagnosis of fetal
21    alcohol syndrome is prima facie evidence of neglect;
22        (d) proof that a minor has a medical diagnosis at birth
23    of withdrawal symptoms from narcotics or barbiturates is
24    prima facie evidence of neglect;
25        (e) proof of injuries sustained by a minor or of the
26    condition of a minor of such a nature as would ordinarily

 

 

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1    not be sustained or exist except by reason of the acts or
2    omissions of the parent, custodian or guardian of such
3    minor shall be prima facie evidence of abuse or neglect, as
4    the case may be;
5        (f) proof that a parent, custodian or guardian of a
6    minor repeatedly used a drug, to the extent that it has or
7    would ordinarily have the effect of producing in the user a
8    substantial state of stupor, unconsciousness,
9    intoxication, hallucination, disorientation or
10    incompetence, or a substantial impairment of judgment, or a
11    substantial manifestation of irrationality, shall be prima
12    facie evidence of neglect;
13        (g) proof that a parent, custodian, or guardian of a
14    minor repeatedly used a controlled substance, as defined in
15    subsection (f) of Section 102 of the Illinois Controlled
16    Substances Act, in the presence of the minor or a sibling
17    of the minor is prima facie evidence of neglect. "Repeated
18    use", for the purpose of this subsection, means more than
19    one use of a controlled substance as defined in subsection
20    (f) of Section 102 of the Illinois Controlled Substances
21    Act;
22        (h) (blank); proof that a newborn infant's blood,
23    urine, or meconium contains any amount of a controlled
24    substance as defined in subsection (f) of Section 102 of
25    the Illinois Controlled Substances Act, or a metabolite of
26    a controlled substance, with the exception of controlled

 

 

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1    substances or metabolites of those substances, the
2    presence of which is the result of medical treatment
3    administered to the mother or the newborn, is prime facie
4    evidence of neglect;
5        (i) proof that a minor was present in a structure or
6    vehicle in which the minor's parent, custodian, or guardian
7    was involved in the manufacture of methamphetamine
8    constitutes prima facie evidence of abuse and neglect;
9        (j) proof that a parent, custodian, or guardian of a
10    minor allows, encourages, or requires a minor to perform,
11    offer, or agree to perform any act of sexual penetration as
12    defined in Section 11-0.1 of the Criminal Code of 2012 for
13    any money, property, token, object, or article or anything
14    of value, or any touching or fondling of the sex organs of
15    one person by another person, for any money, property,
16    token, object, or article or anything of value, for the
17    purpose of sexual arousal or gratification, constitutes
18    prima facie evidence of abuse and neglect;
19        (k) proof that a parent, custodian, or guardian of a
20    minor commits or allows to be committed the offense of
21    involuntary servitude, involuntary sexual servitude of a
22    minor, or trafficking in persons as defined in Section 10-9
23    of the Criminal Code of 1961 or the Criminal Code of 2012,
24    upon such minor, constitutes prima facie evidence of abuse
25    and neglect.
26    (3) In any hearing under this Act, proof of the abuse,

 

 

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1neglect or dependency of one minor shall be admissible evidence
2on the issue of the abuse, neglect or dependency of any other
3minor for whom the respondent is responsible.
4    (4) (a) Any writing, record, photograph or x-ray of any
5hospital or public or private agency, whether in the form of an
6entry in a book or otherwise, made as a memorandum or record of
7any condition, act, transaction, occurrence or event relating
8to a minor in an abuse, neglect or dependency proceeding, shall
9be admissible in evidence as proof of that condition, act,
10transaction, occurrence or event, if the court finds that the
11document was made in the regular course of the business of the
12hospital or agency and that it was in the regular course of
13such business to make it, at the time of the act, transaction,
14occurrence or event, or within a reasonable time thereafter. A
15certification by the head or responsible employee of the
16hospital or agency that the writing, record, photograph or
17x-ray is the full and complete record of the condition, act,
18transaction, occurrence or event and that it satisfies the
19conditions of this paragraph shall be prima facie evidence of
20the facts contained in such certification. A certification by
21someone other than the head of the hospital or agency shall be
22accompanied by a photocopy of a delegation of authority signed
23by both the head of the hospital or agency and by such other
24employee. All other circumstances of the making of the
25memorandum, record, photograph or x-ray, including lack of
26personal knowledge of the maker, may be proved to affect the

 

 

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1weight to be accorded such evidence, but shall not affect its
2admissibility.
3    (b) Any indicated report filed pursuant to the Abused and
4Neglected Child Reporting Act shall be admissible in evidence.
5    (c) Previous statements made by the minor relating to any
6allegations of abuse or neglect shall be admissible in
7evidence. However, no such statement, if uncorroborated and not
8subject to cross-examination, shall be sufficient in itself to
9support a finding of abuse or neglect.
10    (d) There shall be a rebuttable presumption that a minor is
11competent to testify in abuse or neglect proceedings. The court
12shall determine how much weight to give to the minor's
13testimony, and may allow the minor to testify in chambers with
14only the court, the court reporter and attorneys for the
15parties present.
16    (e) The privileged character of communication between any
17professional person and patient or client, except privilege
18between attorney and client, shall not apply to proceedings
19subject to this Article.
20    (f) Proof of the impairment of emotional health or
21impairment of mental or emotional condition as a result of the
22failure of the respondent to exercise a minimum degree of care
23toward a minor may include competent opinion or expert
24testimony, and may include proof that such impairment lessened
25during a period when the minor was in the care, custody or
26supervision of a person or agency other than the respondent.

 

 

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1    (5) In any hearing under this Act alleging neglect for
2failure to provide education as required by law under
3subsection (1) of Section 2-3, proof that a minor under 13
4years of age who is subject to compulsory school attendance
5under the School Code is a chronic truant as defined under the
6School Code shall be prima facie evidence of neglect by the
7parent or guardian in any hearing under this Act and proof that
8a minor who is 13 years of age or older who is subject to
9compulsory school attendance under the School Code is a chronic
10truant shall raise a rebuttable presumption of neglect by the
11parent or guardian. This subsection (5) shall not apply in
12counties with 2,000,000 or more inhabitants.
13    (6) In any hearing under this Act, the court may take
14judicial notice of prior sworn testimony or evidence admitted
15in prior proceedings involving the same minor if (a) the
16parties were either represented by counsel at such prior
17proceedings or the right to counsel was knowingly waived and
18(b) the taking of judicial notice would not result in admitting
19hearsay evidence at a hearing where it would otherwise be
20prohibited.
21(Source: P.A. 96-1464, eff. 8-20-10; 97-897, eff. 1-1-13;
2297-1150, eff. 1-25-13.)
 
23    Section 65. The Adoption Act is amended by changing Section
241 as follows:
 

 

 

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1    (750 ILCS 50/1)  (from Ch. 40, par. 1501)
2    Sec. 1. Definitions. When used in this Act, unless the
3context otherwise requires:
4    A. "Child" means a person under legal age subject to
5adoption under this Act.
6    B. "Related child" means a child subject to adoption where
7either or both of the adopting parents stands in any of the
8following relationships to the child by blood, marriage,
9adoption, or civil union: parent, grand-parent,
10great-grandparent, brother, sister, step-parent,
11step-grandparent, step-brother, step-sister, uncle, aunt,
12great-uncle, great-aunt, first cousin, or second cousin. A
13person is related to the child as a first cousin or second
14cousin if they are both related to the same ancestor as either
15grandchild or great-grandchild. A child whose parent has
16executed a consent to adoption, a surrender, or a waiver
17pursuant to Section 10 of this Act or whose parent has signed a
18denial of paternity pursuant to Section 12 of the Vital Records
19Act or Section 12a of this Act, or whose parent has had his or
20her parental rights terminated, is not a related child to that
21person, unless (1) the consent is determined to be void or is
22void pursuant to subsection O of Section 10 of this Act; or (2)
23the parent of the child executed a consent to adoption by a
24specified person or persons pursuant to subsection A-1 of
25Section 10 of this Act and a court of competent jurisdiction
26finds that such consent is void; or (3) the order terminating

 

 

SB1909- 90 -LRB101 09278 CPF 54372 b

1the parental rights of the parent is vacated by a court of
2competent jurisdiction.
3    C. "Agency" for the purpose of this Act means a public
4child welfare agency or a licensed child welfare agency.
5    D. "Unfit person" means any person whom the court shall
6find to be unfit to have a child, without regard to the
7likelihood that the child will be placed for adoption. The
8grounds of unfitness are any one or more of the following,
9except that a person shall not be considered an unfit person
10for the sole reason that the person has relinquished a child in
11accordance with the Abandoned Newborn Infant Protection Act:
12        (a) Abandonment of the child.
13        (a-1) Abandonment of a newborn infant in a hospital.
14        (a-2) Abandonment of a newborn infant in any setting
15    where the evidence suggests that the parent intended to
16    relinquish his or her parental rights.
17        (b) Failure to maintain a reasonable degree of
18    interest, concern or responsibility as to the child's
19    welfare.
20        (c) Desertion of the child for more than 3 months next
21    preceding the commencement of the Adoption proceeding.
22        (d) Substantial neglect of the child if continuous or
23    repeated.
24        (d-1) Substantial neglect, if continuous or repeated,
25    of any child residing in the household which resulted in
26    the death of that child.

 

 

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1        (e) Extreme or repeated cruelty to the child.
2        (f) There is a rebuttable presumption, which can be
3    overcome only by clear and convincing evidence, that a
4    parent is unfit if:
5            (1) Two or more findings of physical abuse have
6        been entered regarding any children under Section 2-21
7        of the Juvenile Court Act of 1987, the most recent of
8        which was determined by the juvenile court hearing the
9        matter to be supported by clear and convincing
10        evidence; or
11            (2) The parent has been convicted or found not
12        guilty by reason of insanity and the conviction or
13        finding resulted from the death of any child by
14        physical abuse; or
15            (3) There is a finding of physical child abuse
16        resulting from the death of any child under Section
17        2-21 of the Juvenile Court Act of 1987.
18        No conviction or finding of delinquency pursuant to
19    Article V of the Juvenile Court Act of 1987 shall be
20    considered a criminal conviction for the purpose of
21    applying any presumption under this item (f).
22        (g) Failure to protect the child from conditions within
23    his environment injurious to the child's welfare.
24        (h) Other neglect of, or misconduct toward the child;
25    provided that in making a finding of unfitness the court
26    hearing the adoption proceeding shall not be bound by any

 

 

SB1909- 92 -LRB101 09278 CPF 54372 b

1    previous finding, order or judgment affecting or
2    determining the rights of the parents toward the child
3    sought to be adopted in any other proceeding except such
4    proceedings terminating parental rights as shall be had
5    under either this Act, the Juvenile Court Act or the
6    Juvenile Court Act of 1987.
7        (i) Depravity. Conviction of any one of the following
8    crimes shall create a presumption that a parent is depraved
9    which can be overcome only by clear and convincing
10    evidence: (1) first degree murder in violation of paragraph
11    1 or 2 of subsection (a) of Section 9-1 of the Criminal
12    Code of 1961 or the Criminal Code of 2012 or conviction of
13    second degree murder in violation of subsection (a) of
14    Section 9-2 of the Criminal Code of 1961 or the Criminal
15    Code of 2012 of a parent of the child to be adopted; (2)
16    first degree murder or second degree murder of any child in
17    violation of the Criminal Code of 1961 or the Criminal Code
18    of 2012; (3) attempt or conspiracy to commit first degree
19    murder or second degree murder of any child in violation of
20    the Criminal Code of 1961 or the Criminal Code of 2012; (4)
21    solicitation to commit murder of any child, solicitation to
22    commit murder of any child for hire, or solicitation to
23    commit second degree murder of any child in violation of
24    the Criminal Code of 1961 or the Criminal Code of 2012; (5)
25    predatory criminal sexual assault of a child in violation
26    of Section 11-1.40 or 12-14.1 of the Criminal Code of 1961

 

 

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1    or the Criminal Code of 2012; (6) heinous battery of any
2    child in violation of the Criminal Code of 1961; or (7)
3    aggravated battery of any child in violation of the
4    Criminal Code of 1961 or the Criminal Code of 2012.
5        There is a rebuttable presumption that a parent is
6    depraved if the parent has been criminally convicted of at
7    least 3 felonies under the laws of this State or any other
8    state, or under federal law, or the criminal laws of any
9    United States territory; and at least one of these
10    convictions took place within 5 years of the filing of the
11    petition or motion seeking termination of parental rights.
12        There is a rebuttable presumption that a parent is
13    depraved if that parent has been criminally convicted of
14    either first or second degree murder of any person as
15    defined in the Criminal Code of 1961 or the Criminal Code
16    of 2012 within 10 years of the filing date of the petition
17    or motion to terminate parental rights.
18        No conviction or finding of delinquency pursuant to
19    Article 5 of the Juvenile Court Act of 1987 shall be
20    considered a criminal conviction for the purpose of
21    applying any presumption under this item (i).
22        (j) Open and notorious adultery or fornication.
23        (j-1) (Blank).
24        (k) Habitual drunkenness or addiction to drugs, other
25    than those prescribed by a physician, for at least one year
26    immediately prior to the commencement of the unfitness

 

 

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1    proceeding.
2        There is a rebuttable presumption that a parent is
3    unfit under this subsection with respect to any child to
4    which that parent gives birth where there is a confirmed
5    test result that at birth the child's blood, urine, or
6    meconium contained any amount of a controlled substance as
7    defined in subsection (f) of Section 102 of the Illinois
8    Controlled Substances Act or metabolites of such
9    substances, the presence of which in the newborn infant was
10    not the result of medical treatment administered to the
11    mother or the newborn infant; and the biological mother of
12    this child is the biological mother of at least one other
13    child who was adjudicated a neglected minor under
14    subsection (c) of Section 2-3 of the Juvenile Court Act of
15    1987.
16        (l) Failure to demonstrate a reasonable degree of
17    interest, concern or responsibility as to the welfare of a
18    new born child during the first 30 days after its birth.
19        (m) Failure by a parent (i) to make reasonable efforts
20    to correct the conditions that were the basis for the
21    removal of the child from the parent during any 9-month
22    period following the adjudication of neglected or abused
23    minor under Section 2-3 of the Juvenile Court Act of 1987
24    or dependent minor under Section 2-4 of that Act, or (ii)
25    to make reasonable progress toward the return of the child
26    to the parent during any 9-month period following the

 

 

SB1909- 95 -LRB101 09278 CPF 54372 b

1    adjudication of neglected or abused minor under Section 2-3
2    of the Juvenile Court Act of 1987 or dependent minor under
3    Section 2-4 of that Act. If a service plan has been
4    established as required under Section 8.2 of the Abused and
5    Neglected Child Reporting Act to correct the conditions
6    that were the basis for the removal of the child from the
7    parent and if those services were available, then, for
8    purposes of this Act, "failure to make reasonable progress
9    toward the return of the child to the parent" includes the
10    parent's failure to substantially fulfill his or her
11    obligations under the service plan and correct the
12    conditions that brought the child into care during any
13    9-month period following the adjudication under Section
14    2-3 or 2-4 of the Juvenile Court Act of 1987.
15    Notwithstanding any other provision, when a petition or
16    motion seeks to terminate parental rights on the basis of
17    item (ii) of this subsection (m), the petitioner shall file
18    with the court and serve on the parties a pleading that
19    specifies the 9-month period or periods relied on. The
20    pleading shall be filed and served on the parties no later
21    than 3 weeks before the date set by the court for closure
22    of discovery, and the allegations in the pleading shall be
23    treated as incorporated into the petition or motion.
24    Failure of a respondent to file a written denial of the
25    allegations in the pleading shall not be treated as an
26    admission that the allegations are true.

 

 

SB1909- 96 -LRB101 09278 CPF 54372 b

1        (m-1) (Blank).
2        (n) Evidence of intent to forgo his or her parental
3    rights, whether or not the child is a ward of the court,
4    (1) as manifested by his or her failure for a period of 12
5    months: (i) to visit the child, (ii) to communicate with
6    the child or agency, although able to do so and not
7    prevented from doing so by an agency or by court order, or
8    (iii) to maintain contact with or plan for the future of
9    the child, although physically able to do so, or (2) as
10    manifested by the father's failure, where he and the mother
11    of the child were unmarried to each other at the time of
12    the child's birth, (i) to commence legal proceedings to
13    establish his paternity under the Illinois Parentage Act of
14    1984, the Illinois Parentage Act of 2015, or the law of the
15    jurisdiction of the child's birth within 30 days of being
16    informed, pursuant to Section 12a of this Act, that he is
17    the father or the likely father of the child or, after
18    being so informed where the child is not yet born, within
19    30 days of the child's birth, or (ii) to make a good faith
20    effort to pay a reasonable amount of the expenses related
21    to the birth of the child and to provide a reasonable
22    amount for the financial support of the child, the court to
23    consider in its determination all relevant circumstances,
24    including the financial condition of both parents;
25    provided that the ground for termination provided in this
26    subparagraph (n)(2)(ii) shall only be available where the

 

 

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1    petition is brought by the mother or the husband of the
2    mother.
3        Contact or communication by a parent with his or her
4    child that does not demonstrate affection and concern does
5    not constitute reasonable contact and planning under
6    subdivision (n). In the absence of evidence to the
7    contrary, the ability to visit, communicate, maintain
8    contact, pay expenses and plan for the future shall be
9    presumed. The subjective intent of the parent, whether
10    expressed or otherwise, unsupported by evidence of the
11    foregoing parental acts manifesting that intent, shall not
12    preclude a determination that the parent has intended to
13    forgo his or her parental rights. In making this
14    determination, the court may consider but shall not require
15    a showing of diligent efforts by an authorized agency to
16    encourage the parent to perform the acts specified in
17    subdivision (n).
18        It shall be an affirmative defense to any allegation
19    under paragraph (2) of this subsection that the father's
20    failure was due to circumstances beyond his control or to
21    impediments created by the mother or any other person
22    having legal custody. Proof of that fact need only be by a
23    preponderance of the evidence.
24        (o) Repeated or continuous failure by the parents,
25    although physically and financially able, to provide the
26    child with adequate food, clothing, or shelter.

 

 

SB1909- 98 -LRB101 09278 CPF 54372 b

1        (p) Inability to discharge parental responsibilities
2    supported by competent evidence from a psychiatrist,
3    licensed clinical social worker, or clinical psychologist
4    of mental impairment, mental illness or an intellectual
5    disability as defined in Section 1-116 of the Mental Health
6    and Developmental Disabilities Code, or developmental
7    disability as defined in Section 1-106 of that Code, and
8    there is sufficient justification to believe that the
9    inability to discharge parental responsibilities shall
10    extend beyond a reasonable time period. However, this
11    subdivision (p) shall not be construed so as to permit a
12    licensed clinical social worker to conduct any medical
13    diagnosis to determine mental illness or mental
14    impairment.
15        (q) (Blank).
16        (r) The child is in the temporary custody or
17    guardianship of the Department of Children and Family
18    Services, the parent is incarcerated as a result of
19    criminal conviction at the time the petition or motion for
20    termination of parental rights is filed, prior to
21    incarceration the parent had little or no contact with the
22    child or provided little or no support for the child, and
23    the parent's incarceration will prevent the parent from
24    discharging his or her parental responsibilities for the
25    child for a period in excess of 2 years after the filing of
26    the petition or motion for termination of parental rights.

 

 

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1        (s) The child is in the temporary custody or
2    guardianship of the Department of Children and Family
3    Services, the parent is incarcerated at the time the
4    petition or motion for termination of parental rights is
5    filed, the parent has been repeatedly incarcerated as a
6    result of criminal convictions, and the parent's repeated
7    incarceration has prevented the parent from discharging
8    his or her parental responsibilities for the child.
9        (t) A finding that at birth the child's blood, urine,
10    or meconium contained any amount of a controlled substance
11    as defined in subsection (f) of Section 102 of the Illinois
12    Controlled Substances Act, or a metabolite of a controlled
13    substance, with the exception of controlled substances or
14    metabolites of such substances, the presence of which in
15    the newborn infant was the result of medical treatment
16    administered to the mother or the newborn infant, and that
17    the biological mother of this child is the biological
18    mother of at least one other child who was adjudicated a
19    neglected minor under subsection (c) of Section 2-3 of the
20    Juvenile Court Act of 1987, after which the biological
21    mother had the opportunity to enroll in and participate in
22    a clinically appropriate substance abuse counseling,
23    treatment, and rehabilitation program.
24    E. "Parent" means a person who is the legal mother or legal
25father of the child as defined in subsection X or Y of this
26Section. For the purpose of this Act, a parent who has executed

 

 

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1a consent to adoption, a surrender, or a waiver pursuant to
2Section 10 of this Act, who has signed a Denial of Paternity
3pursuant to Section 12 of the Vital Records Act or Section 12a
4of this Act, or whose parental rights have been terminated by a
5court, is not a parent of the child who was the subject of the
6consent, surrender, waiver, or denial unless (1) the consent is
7void pursuant to subsection O of Section 10 of this Act; or (2)
8the person executed a consent to adoption by a specified person
9or persons pursuant to subsection A-1 of Section 10 of this Act
10and a court of competent jurisdiction finds that the consent is
11void; or (3) the order terminating the parental rights of the
12person is vacated by a court of competent jurisdiction.
13    F. A person is available for adoption when the person is:
14        (a) a child who has been surrendered for adoption to an
15    agency and to whose adoption the agency has thereafter
16    consented;
17        (b) a child to whose adoption a person authorized by
18    law, other than his parents, has consented, or to whose
19    adoption no consent is required pursuant to Section 8 of
20    this Act;
21        (c) a child who is in the custody of persons who intend
22    to adopt him through placement made by his parents;
23        (c-1) a child for whom a parent has signed a specific
24    consent pursuant to subsection O of Section 10;
25        (d) an adult who meets the conditions set forth in
26    Section 3 of this Act; or

 

 

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1        (e) a child who has been relinquished as defined in
2    Section 10 of the Abandoned Newborn Infant Protection Act.
3    A person who would otherwise be available for adoption
4shall not be deemed unavailable for adoption solely by reason
5of his or her death.
6    G. The singular includes the plural and the plural includes
7the singular and the "male" includes the "female", as the
8context of this Act may require.
9    H. (Blank).
10    I. "Habitual residence" has the meaning ascribed to it in
11the federal Intercountry Adoption Act of 2000 and regulations
12promulgated thereunder.
13    J. "Immediate relatives" means the biological parents, the
14parents of the biological parents and siblings of the
15biological parents.
16    K. "Intercountry adoption" is a process by which a child
17from a country other than the United States is adopted by
18persons who are habitual residents of the United States, or the
19child is a habitual resident of the United States who is
20adopted by persons who are habitual residents of a country
21other than the United States.
22    L. (Blank).
23    M. "Interstate Compact on the Placement of Children" is a
24law enacted by all states and certain territories for the
25purpose of establishing uniform procedures for handling the
26interstate placement of children in foster homes, adoptive

 

 

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1homes, or other child care facilities.
2    N. (Blank).
3    O. "Preadoption requirements" means any conditions or
4standards established by the laws or administrative rules of
5this State that must be met by a prospective adoptive parent
6prior to the placement of a child in an adoptive home.
7    P. "Abused child" means a child whose parent or immediate
8family member, or any person responsible for the child's
9welfare, or any individual residing in the same home as the
10child, or a paramour of the child's parent:
11        (a) inflicts, causes to be inflicted, or allows to be
12    inflicted upon the child physical injury, by other than
13    accidental means, that causes death, disfigurement,
14    impairment of physical or emotional health, or loss or
15    impairment of any bodily function;
16        (b) creates a substantial risk of physical injury to
17    the child by other than accidental means which would be
18    likely to cause death, disfigurement, impairment of
19    physical or emotional health, or loss or impairment of any
20    bodily function;
21        (c) commits or allows to be committed any sex offense
22    against the child, as sex offenses are defined in the
23    Criminal Code of 2012 and extending those definitions of
24    sex offenses to include children under 18 years of age;
25        (d) commits or allows to be committed an act or acts of
26    torture upon the child; or

 

 

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1        (e) inflicts excessive corporal punishment.
2    Q. "Neglected child" means any child whose parent or other
3person responsible for the child's welfare withholds or denies
4nourishment or medically indicated treatment including food or
5care denied solely on the basis of the present or anticipated
6mental or physical impairment as determined by a physician
7acting alone or in consultation with other physicians or
8otherwise does not provide the proper or necessary support,
9education as required by law, or medical or other remedial care
10recognized under State law as necessary for a child's
11well-being, or other care necessary for his or her well-being,
12including adequate food, clothing and shelter; or who is
13abandoned by his or her parents or other person responsible for
14the child's welfare.
15    A child shall not be considered neglected or abused for the
16sole reason that the child's parent or other person responsible
17for his or her welfare depends upon spiritual means through
18prayer alone for the treatment or cure of disease or remedial
19care as provided under Section 4 of the Abused and Neglected
20Child Reporting Act. A child shall not be considered neglected
21or abused for the sole reason that the child's parent or other
22person responsible for the child's welfare failed to vaccinate,
23delayed vaccination, or refused vaccination for the child due
24to a waiver on religious or medical grounds as permitted by
25law.
26    R. "Putative father" means a man who may be a child's

 

 

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1father, but who (1) is not married to the child's mother on or
2before the date that the child was or is to be born and (2) has
3not established paternity of the child in a court proceeding
4before the filing of a petition for the adoption of the child.
5The term includes a male who is less than 18 years of age.
6"Putative father" does not mean a man who is the child's father
7as a result of criminal sexual abuse or assault as defined
8under Article 11 of the Criminal Code of 2012.
9    S. "Standby adoption" means an adoption in which a parent
10consents to custody and termination of parental rights to
11become effective upon the occurrence of a future event, which
12is either the death of the parent or the request of the parent
13for the entry of a final judgment of adoption.
14    T. (Blank).
15    T-5. "Biological parent", "birth parent", or "natural
16parent" of a child are interchangeable terms that mean a person
17who is biologically or genetically related to that child as a
18parent.
19    U. "Interstate adoption" means the placement of a minor
20child with a prospective adoptive parent for the purpose of
21pursuing an adoption for that child that is subject to the
22provisions of the Interstate Compact on Placement of Children.
23    V. (Blank).
24    W. (Blank).
25    X. "Legal father" of a child means a man who is recognized
26as or presumed to be that child's father:

 

 

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1        (1) because of his marriage to or civil union with the
2    child's parent at the time of the child's birth or within
3    300 days prior to that child's birth, unless he signed a
4    denial of paternity pursuant to Section 12 of the Vital
5    Records Act or a waiver pursuant to Section 10 of this Act;
6    or
7        (2) because his paternity of the child has been
8    established pursuant to the Illinois Parentage Act, the
9    Illinois Parentage Act of 1984, or the Gestational
10    Surrogacy Act; or
11        (3) because he is listed as the child's father or
12    parent on the child's birth certificate, unless he is
13    otherwise determined by an administrative or judicial
14    proceeding not to be the parent of the child or unless he
15    rescinds his acknowledgment of paternity pursuant to the
16    Illinois Parentage Act of 1984; or
17        (4) because his paternity or adoption of the child has
18    been established by a court of competent jurisdiction.
19    The definition in this subsection X shall not be construed
20to provide greater or lesser rights as to the number of parents
21who can be named on a final judgment order of adoption or
22Illinois birth certificate that otherwise exist under Illinois
23law.
24    Y. "Legal mother" of a child means a woman who is
25recognized as or presumed to be that child's mother:
26        (1) because she gave birth to the child except as

 

 

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1    provided in the Gestational Surrogacy Act; or
2        (2) because her maternity of the child has been
3    established pursuant to the Illinois Parentage Act of 1984
4    or the Gestational Surrogacy Act; or
5        (3) because her maternity or adoption of the child has
6    been established by a court of competent jurisdiction; or
7        (4) because of her marriage to or civil union with the
8    child's other parent at the time of the child's birth or
9    within 300 days prior to the time of birth; or
10        (5) because she is listed as the child's mother or
11    parent on the child's birth certificate unless she is
12    otherwise determined by an administrative or judicial
13    proceeding not to be the parent of the child.
14    The definition in this subsection Y shall not be construed
15to provide greater or lesser rights as to the number of parents
16who can be named on a final judgment order of adoption or
17Illinois birth certificate that otherwise exist under Illinois
18law.
19    Z. "Department" means the Illinois Department of Children
20and Family Services.
21    AA. "Placement disruption" means a circumstance where the
22child is removed from an adoptive placement before the adoption
23is finalized.
24    BB. "Secondary placement" means a placement, including but
25not limited to the placement of a youth in care as defined in
26Section 4d of the Children and Family Services Act, that occurs

 

 

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1after a placement disruption or an adoption dissolution.
2"Secondary placement" does not mean secondary placements
3arising due to the death of the adoptive parent of the child.
4    CC. "Adoption dissolution" means a circumstance where the
5child is removed from an adoptive placement after the adoption
6is finalized.
7    DD. "Unregulated placement" means the secondary placement
8of a child that occurs without the oversight of the courts, the
9Department, or a licensed child welfare agency.
10    EE. "Post-placement and post-adoption support services"
11means support services for placed or adopted children and
12families that include, but are not limited to, counseling for
13emotional, behavioral, or developmental needs.
14(Source: P.A. 99-49, eff. 7-15-15; 99-85, eff. 1-1-16; 99-642,
15eff. 7-28-16; 99-836, eff. 1-1-17; 100-159, eff. 8-18-17.)
 
16    Section 95. No acceleration or delay. Where this Act makes
17changes in a statute that is represented in this Act by text
18that is not yet or no longer in effect (for example, a Section
19represented by multiple versions), the use of that text does
20not accelerate or delay the taking effect of (i) the changes
21made by this Act or (ii) provisions derived from any other
22Public Act.
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    5 ILCS 375/6.11
4    20 ILCS 1305/10-24 new
5    20 ILCS 2310/2310-455 new
6    55 ILCS 5/5-1069.3
7    65 ILCS 5/10-4-2.3
8    105 ILCS 5/10-22.3f
9    215 ILCS 5/356z.33 new
10    215 ILCS 125/5-3from Ch. 111 1/2, par. 1411.2
11    215 ILCS 165/10from Ch. 32, par. 604
12    305 ILCS 5/5-2from Ch. 23, par. 5-2
13    305 ILCS 5/5-5from Ch. 23, par. 5-5
14    305 ILCS 5/5-5.24
15    325 ILCS 5/3from Ch. 23, par. 2053
16    705 ILCS 405/2-3from Ch. 37, par. 802-3
17    705 ILCS 405/2-18from Ch. 37, par. 802-18
18    750 ILCS 50/1from Ch. 40, par. 1501