State of Illinois
2023 and 2024


Introduced 2/17/2023, by Rep. Bradley Fritts


5 ILCS 375/6  from Ch. 127, par. 526
5 ILCS 375/6.1  from Ch. 127, par. 526.1
305 ILCS 5/5-5  from Ch. 23, par. 5-5
305 ILCS 5/5-8  from Ch. 23, par. 5-8
305 ILCS 5/5-9  from Ch. 23, par. 5-9
305 ILCS 5/6-1  from Ch. 23, par. 6-1
410 ILCS 230/4-100  from Ch. 111 1/2, par. 4604-100

    Amends the State Employees Group Insurance Act of 1971, the Illinois Public Aid Code, and the Problem Pregnancy Health Services and Care Act. Restores language that existed before the amendment of those Acts by Public Act 100-538.

LRB103 30309 LNS 56737 b





HB3547LRB103 30309 LNS 56737 b

1    AN ACT concerning abortion.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Sections 6 and 6.1 as follows:
6    (5 ILCS 375/6)  (from Ch. 127, par. 526)
7    Sec. 6. Program of health benefits.
8    (a) The program of health benefits shall provide for
9protection against the financial costs of health care expenses
10incurred in and out of hospital including basic
11hospital-surgical-medical coverages. The program may include,
12but shall not be limited to, such supplemental coverages as
13out-patient diagnostic X-ray and laboratory expenses,
14prescription drugs, dental services, hearing evaluations,
15hearing aids, the dispensing and fitting of hearing aids, and
16similar group benefits as are now or may become available.
17However, nothing in this Act shall be construed to permit, on
18or after July 1, 1980, the non-contributory portion of any
19such program to include the expenses of obtaining an abortion,
20induced miscarriage or induced premature birth unless, in the
21opinion of a physician, such procedures are necessary for the
22preservation of the life of the woman seeking such treatment,
23or except an induced premature birth intended to produce a



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1live viable child and such procedure is necessary for the
2health of the mother or the unborn child. The program may also
3include coverage for those who rely on treatment by prayer or
4spiritual means alone for healing in accordance with the
5tenets and practice of a recognized religious denomination.
6    The program of health benefits shall be designed by the
7Director (1) to provide a reasonable relationship between the
8benefits to be included and the expected distribution of
9expenses of each such type to be incurred by the covered
10members and dependents, (2) to specify, as covered benefits
11and as optional benefits, the medical services of
12practitioners in all categories licensed under the Medical
13Practice Act of 1987, (3) to include reasonable controls,
14which may include deductible and co-insurance provisions,
15applicable to some or all of the benefits, or a coordination of
16benefits provision, to prevent or minimize unnecessary
17utilization of the various hospital, surgical and medical
18expenses to be provided and to provide reasonable assurance of
19stability of the program, and (4) to provide benefits to the
20extent possible to members throughout the State, wherever
21located, on an equitable basis. Notwithstanding any other
22provision of this Section or Act, for all members or
23dependents who are eligible for benefits under Social Security
24or the Railroad Retirement system or who had sufficient
25Medicare-covered government employment, the Department shall
26reduce benefits which would otherwise be paid by Medicare, by



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1the amount of benefits for which the member or dependents are
2eligible under Medicare, except that such reduction in
3benefits shall apply only to those members or dependents who
4(1) first become eligible for such medicare coverage on or
5after the effective date of this amendatory Act of 1992; or (2)
6are Medicare-eligible members or dependents of a local
7government unit which began participation in the program on or
8after July 1, 1992; or (3) remain eligible for but no longer
9receive Medicare coverage which they had been receiving on or
10after the effective date of this amendatory Act of 1992.
11    Notwithstanding any other provisions of this Act, where a
12covered member or dependents are eligible for benefits under
13the federal Medicare health insurance program (Title XVIII of
14the Social Security Act as added by Public Law 89-97, 89th
15Congress), benefits paid under the State of Illinois program
16or plan will be reduced by the amount of benefits paid by
17Medicare. For members or dependents who are eligible for
18benefits under Social Security or the Railroad Retirement
19system or who had sufficient Medicare-covered government
20employment, benefits shall be reduced by the amount for which
21the member or dependent is eligible under Medicare, except
22that such reduction in benefits shall apply only to those
23members or dependents who (1) first become eligible for such
24Medicare coverage on or after the effective date of this
25amendatory Act of 1992; or (2) are Medicare-eligible members
26or dependents of a local government unit which began



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1participation in the program on or after July 1, 1992; or (3)
2remain eligible for, but no longer receive Medicare coverage
3which they had been receiving on or after the effective date of
4this amendatory Act of 1992. Premiums may be adjusted, where
5applicable, to an amount deemed by the Director to be
6reasonably consistent with any reduction of benefits.
7    (b) A member, not otherwise covered by this Act, who has
8retired as a participating member under Article 2 of the
9Illinois Pension Code but is ineligible for the retirement
10annuity under Section 2-119 of the Illinois Pension Code,
11shall pay the premiums for coverage, not exceeding the amount
12paid by the State for the non-contributory coverage for other
13members, under the group health benefits program under this
14Act. The Director shall determine the premiums to be paid by a
15member under this subsection (b).
16(Source: P.A. 100-538, eff. 1-1-18.)
17    (5 ILCS 375/6.1)  (from Ch. 127, par. 526.1)
18    Sec. 6.1. The program of health benefits may offer as an
19alternative, available on an optional basis, coverage through
20health maintenance organizations or other managed care
21programs. That part of the premium for such coverage which is
22in excess of the amount which would otherwise be paid by the
23State for the program of health benefits shall be paid by the
24member who elects such alternative coverage and shall be
25collected as provided for premiums for other optional



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2    However, nothing in this Act shall be construed to permit,
3after the effective date of this amendatory Act of 1983, the
4noncontributory portion of any such program to include the
5expenses of obtaining an abortion, induced miscarriage or
6induced premature birth unless, in the opinion of a physician,
7such procedures are necessary for the preservation of the life
8of the woman seeking such treatment, or except an induced
9premature birth intended to produce a live viable child and
10such procedure is necessary for the health of the mother or her
11unborn child.
12(Source: P.A. 102-19, eff. 7-1-21.)
13    Section 10. The Illinois Public Aid Code is amended by
14changing Sections 5-5, 5-8, 5-9, and 6-1 as follows:
15    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
16    Sec. 5-5. Medical services. The Illinois Department, by
17rule, shall determine the quantity and quality of and the rate
18of reimbursement for the medical assistance for which payment
19will be authorized, and the medical services to be provided,
20which may include all or part of the following: (1) inpatient
21hospital services; (2) outpatient hospital services; (3) other
22laboratory and X-ray services; (4) skilled nursing home
23services; (5) physicians' services whether furnished in the
24office, the patient's home, a hospital, a skilled nursing



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1home, or elsewhere; (6) medical care, or any other type of
2remedial care furnished by licensed practitioners; (7) home
3health care services; (8) private duty nursing service; (9)
4clinic services; (10) dental services, including prevention
5and treatment of periodontal disease and dental caries disease
6for pregnant individuals, provided by an individual licensed
7to practice dentistry or dental surgery; for purposes of this
8item (10), "dental services" means diagnostic, preventive, or
9corrective procedures provided by or under the supervision of
10a dentist in the practice of his or her profession; (11)
11physical therapy and related services; (12) prescribed drugs,
12dentures, and prosthetic devices; and eyeglasses prescribed by
13a physician skilled in the diseases of the eye, or by an
14optometrist, whichever the person may select; (13) other
15diagnostic, screening, preventive, and rehabilitative
16services, including to ensure that the individual's need for
17intervention or treatment of mental disorders or substance use
18disorders or co-occurring mental health and substance use
19disorders is determined using a uniform screening, assessment,
20and evaluation 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
4sexual assault, 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; (16.5) services performed by
8a chiropractic physician licensed under the Medical Practice
9Act of 1987 and acting within the scope of his or her license,
10including, but not limited to, chiropractic manipulative
11treatment; and (17) any other medical care, and any other type
12of remedial care recognized under the laws of this State, but
13not including abortions, or induced miscarriages or premature
14births, unless, in the opinion of a physician, such procedures
15are necessary for the preservation of the life of the woman
16seeking such treatment, or except an induced premature birth
17intended to produce a live viable child and such procedure is
18necessary for the health of the mother or her unborn child. The
19Illinois Department, by rule, shall prohibit any physician
20from providing medical assistance to anyone eligible therefor
21under this Code where such physician has been found guilty of
22performing an abortion procedure in a willful and wanton
23manner upon a woman who was not pregnant at the time such
24abortion procedure was performed. The term "any other type of
25remedial care" shall include nursing care and nursing home
26service for persons who rely on treatment by spiritual means



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1alone through prayer for healing.
2    Notwithstanding any other provision of this Section, a
3comprehensive tobacco use cessation program that includes
4purchasing prescription drugs or prescription medical devices
5approved by the Food and Drug Administration shall be covered
6under the medical assistance program under this Article for
7persons who are otherwise eligible for assistance under this
9    Notwithstanding any other provision of this Code,
10reproductive health care that is otherwise legal in Illinois
11shall be covered under the medical assistance program for
12persons who are otherwise eligible for medical assistance
13under this Article.
14    Notwithstanding any other provision of this Section, all
15tobacco cessation medications approved by the United States
16Food and Drug Administration and all individual and group
17tobacco cessation counseling services and telephone-based
18counseling services and tobacco cessation medications provided
19through the Illinois Tobacco Quitline shall be covered under
20the medical assistance program for persons who are otherwise
21eligible for assistance under this Article. The Department
22shall comply with all federal requirements necessary to obtain
23federal financial participation, as specified in 42 CFR
24433.15(b)(7), for telephone-based counseling services provided
25through the Illinois Tobacco Quitline, including, but not
26limited to: (i) entering into a memorandum of understanding or



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1interagency agreement with the Department of Public Health, as
2administrator of the Illinois Tobacco Quitline; and (ii)
3developing a cost allocation plan for Medicaid-allowable
4Illinois Tobacco Quitline services in accordance with 45 CFR
595.507. The Department shall submit the memorandum of
6understanding or interagency agreement, the cost allocation
7plan, and all other necessary documentation to the Centers for
8Medicare and Medicaid Services for review and approval.
9Coverage under this paragraph shall be contingent upon federal
11    Notwithstanding any other provision of this Code, the
12Illinois Department may not require, as a condition of payment
13for any laboratory test authorized under this Article, that a
14physician's handwritten signature appear on the laboratory
15test order form. The Illinois Department may, however, impose
16other appropriate requirements regarding laboratory test order
18    Upon receipt of federal approval of an amendment to the
19Illinois Title XIX State Plan for this purpose, the Department
20shall authorize the Chicago Public Schools (CPS) to procure a
21vendor or vendors to manufacture eyeglasses for individuals
22enrolled in a school within the CPS system. CPS shall ensure
23that its vendor or vendors are enrolled as providers in the
24medical assistance program and in any capitated Medicaid
25managed care entity (MCE) serving individuals enrolled in a
26school within the CPS system. Under any contract procured



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1under this provision, the vendor or vendors must serve only
2individuals enrolled in a school within the CPS system. Claims
3for services provided by CPS's vendor or vendors to recipients
4of benefits in the medical assistance program under this Code,
5the Children's Health Insurance Program, or the Covering ALL
6KIDS Health Insurance Program shall be submitted to the
7Department or the MCE in which the individual is enrolled for
8payment and shall be reimbursed at the Department's or the
9MCE's established rates or rate methodologies for eyeglasses.
10    On and after July 1, 2012, the Department of Healthcare
11and Family Services may provide the following services to
12persons eligible for assistance under this Article who are
13participating in education, training or employment programs
14operated by the Department of Human Services as successor to
15the Department of Public Aid:
16        (1) dental services provided by or under the
17    supervision of a dentist; and
18        (2) eyeglasses prescribed by a physician skilled in
19    the diseases of the eye, or by an optometrist, whichever
20    the person may select.
21    On and after July 1, 2018, the Department of Healthcare
22and Family Services shall provide dental services to any adult
23who is otherwise eligible for assistance under the medical
24assistance program. As used in this paragraph, "dental
25services" means diagnostic, preventative, restorative, or
26corrective procedures, including procedures and services for



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1the prevention and treatment of periodontal disease and dental
2caries disease, provided by an individual who is licensed to
3practice dentistry or dental surgery or who is under the
4supervision of a dentist in the practice of his or her
6    On and after July 1, 2018, targeted dental services, as
7set forth in Exhibit D of the Consent Decree entered by the
8United States District Court for the Northern District of
9Illinois, Eastern Division, in the matter of Memisovski v.
10Maram, Case No. 92 C 1982, that are provided to adults under
11the medical assistance program shall be established at no less
12than the rates set forth in the "New Rate" column in Exhibit D
13of the Consent Decree for targeted dental services that are
14provided to persons under the age of 18 under the medical
15assistance program.
16    Notwithstanding any other provision of this Code and
17subject to federal approval, the Department may adopt rules to
18allow a dentist who is volunteering his or her service at no
19cost to render dental services through an enrolled
20not-for-profit health clinic without the dentist personally
21enrolling as a participating provider in the medical
22assistance program. A not-for-profit health clinic shall
23include a public health clinic or Federally Qualified Health
24Center or other enrolled provider, as determined by the
25Department, through which dental services covered under this
26Section are performed. The Department shall establish a



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1process for payment of claims for reimbursement for covered
2dental services rendered under this provision.
3    On and after January 1, 2022, the Department of Healthcare
4and Family Services shall administer and regulate a
5school-based dental program that allows for the out-of-office
6delivery of preventative dental services in a school setting
7to children under 19 years of age. The Department shall
8establish, by rule, guidelines for participation by providers
9and set requirements for follow-up referral care based on the
10requirements established in the Dental Office Reference Manual
11published by the Department that establishes the requirements
12for dentists participating in the All Kids Dental School
13Program. Every effort shall be made by the Department when
14developing the program requirements to consider the different
15geographic differences of both urban and rural areas of the
16State for initial treatment and necessary follow-up care. No
17provider shall be charged a fee by any unit of local government
18to participate in the school-based dental program administered
19by the Department. Nothing in this paragraph shall be
20construed to limit or preempt a home rule unit's or school
21district's authority to establish, change, or administer a
22school-based dental program in addition to, or independent of,
23the school-based dental program administered by the
25    The Illinois Department, by rule, may distinguish and
26classify the medical services to be provided only in



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1accordance with the classes of persons designated in Section
3    The Department of Healthcare and Family Services must
4provide coverage and reimbursement for amino acid-based
5elemental formulas, regardless of delivery method, for the
6diagnosis and treatment of (i) eosinophilic disorders and (ii)
7short bowel syndrome when the prescribing physician has issued
8a written order stating that the amino acid-based elemental
9formula is medically necessary.
10    The Illinois Department shall authorize the provision of,
11and shall authorize payment for, screening by low-dose
12mammography for the presence of occult breast cancer for
13individuals 35 years of age or older who are eligible for
14medical assistance under this Article, as follows:
15        (A) A baseline mammogram for individuals 35 to 39
16    years of age.
17        (B) An annual mammogram for individuals 40 years of
18    age or older.
19        (C) A mammogram at the age and intervals considered
20    medically necessary by the individual's health care
21    provider for individuals under 40 years of age and having
22    a family history of breast cancer, prior personal history
23    of breast cancer, positive genetic testing, or other risk
24    factors.
25        (D) A comprehensive ultrasound screening and MRI of an
26    entire breast or breasts if a mammogram demonstrates



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1    heterogeneous or dense breast tissue or when medically
2    necessary as determined by a physician licensed to
3    practice medicine in all of its branches.
4        (E) A screening MRI when medically necessary, as
5    determined by a physician licensed to practice medicine in
6    all of its branches.
7        (F) A diagnostic mammogram when medically necessary,
8    as determined by a physician licensed to practice medicine
9    in all its branches, advanced practice registered nurse,
10    or physician assistant.
11    The Department shall not impose a deductible, coinsurance,
12copayment, or any other cost-sharing requirement on the
13coverage provided under this paragraph; except that this
14sentence does not apply to coverage of diagnostic mammograms
15to the extent such coverage would disqualify a high-deductible
16health plan from eligibility for a health savings account
17pursuant to Section 223 of the Internal Revenue Code (26
18U.S.C. 223).
19    All screenings shall include a physical breast exam,
20instruction on self-examination and information regarding the
21frequency of self-examination and its value as a preventative
23     For purposes of this Section:
24    "Diagnostic mammogram" means a mammogram obtained using
25diagnostic mammography.
26    "Diagnostic mammography" means a method of screening that



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1is designed to evaluate an abnormality in a breast, including
2an abnormality seen or suspected on a screening mammogram or a
3subjective or objective abnormality otherwise detected in the
5    "Low-dose mammography" means the x-ray examination of the
6breast using equipment dedicated specifically for mammography,
7including the x-ray tube, filter, compression device, and
8image receptor, with an average radiation exposure delivery of
9less than one rad per breast for 2 views of an average size
10breast. The term also includes digital mammography and
11includes breast tomosynthesis.
12    "Breast tomosynthesis" means a radiologic procedure that
13involves the acquisition of projection images over the
14stationary breast to produce cross-sectional digital
15three-dimensional images of the breast.
16    If, at any time, the Secretary of the United States
17Department of Health and Human Services, or its successor
18agency, promulgates rules or regulations to be published in
19the Federal Register or publishes a comment in the Federal
20Register or issues an opinion, guidance, or other action that
21would require the State, pursuant to any provision of the
22Patient Protection and Affordable Care Act (Public Law
23111-148), including, but not limited to, 42 U.S.C.
2418031(d)(3)(B) or any successor provision, to defray the cost
25of any coverage for breast tomosynthesis outlined in this
26paragraph, then the requirement that an insurer cover breast



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1tomosynthesis is inoperative other than any such coverage
2authorized under Section 1902 of the Social Security Act, 42
3U.S.C. 1396a, and the State shall not assume any obligation
4for the cost of coverage for breast tomosynthesis set forth in
5this paragraph.
6    On and after January 1, 2016, the Department shall ensure
7that all networks of care for adult clients of the Department
8include access to at least one breast imaging Center of
9Imaging Excellence as certified by the American College of
11    On and after January 1, 2012, providers participating in a
12quality improvement program approved by the Department shall
13be reimbursed for screening and diagnostic mammography at the
14same rate as the Medicare program's rates, including the
15increased reimbursement for digital mammography and, after
16January 1, 2023 (the effective date of Public Act 102-1018)
17this amendatory Act of the 102nd General Assembly, breast
19    The Department shall convene an expert panel including
20representatives of hospitals, free-standing mammography
21facilities, and doctors, including radiologists, to establish
22quality standards for mammography.
23    On and after January 1, 2017, providers participating in a
24breast cancer treatment quality improvement program approved
25by the Department shall be reimbursed for breast cancer
26treatment at a rate that is no lower than 95% of the Medicare



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1program's rates for the data elements included in the breast
2cancer treatment quality program.
3    The Department shall convene an expert panel, including
4representatives of hospitals, free-standing breast cancer
5treatment centers, breast cancer quality organizations, and
6doctors, including breast surgeons, reconstructive breast
7surgeons, oncologists, and primary care providers to establish
8quality standards for breast cancer treatment.
9    Subject to federal approval, the Department shall
10establish a rate methodology for mammography at federally
11qualified health centers and other encounter-rate clinics.
12These clinics or centers may also collaborate with other
13hospital-based mammography facilities. By January 1, 2016, the
14Department shall report to the General Assembly on the status
15of the provision set forth in this paragraph.
16    The Department shall establish a methodology to remind
17individuals who are age-appropriate for screening mammography,
18but who have not received a mammogram within the previous 18
19months, of the importance and benefit of screening
20mammography. The Department shall work with experts in breast
21cancer outreach and patient navigation to optimize these
22reminders and shall establish a methodology for evaluating
23their effectiveness and modifying the methodology based on the
25    The Department shall establish a performance goal for
26primary care providers with respect to their female patients



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1over age 40 receiving an annual mammogram. This performance
2goal shall be used to provide additional reimbursement in the
3form of a quality performance bonus to primary care providers
4who meet that goal.
5    The Department shall devise a means of case-managing or
6patient navigation for beneficiaries diagnosed with breast
7cancer. This program shall initially operate as a pilot
8program in areas of the State with the highest incidence of
9mortality related to breast cancer. At least one pilot program
10site shall be in the metropolitan Chicago area and at least one
11site shall be outside the metropolitan Chicago area. On or
12after July 1, 2016, the pilot program shall be expanded to
13include one site in western Illinois, one site in southern
14Illinois, one site in central Illinois, and 4 sites within
15metropolitan Chicago. An evaluation of the pilot program shall
16be carried out measuring health outcomes and cost of care for
17those served by the pilot program compared to similarly
18situated patients who are not served by the pilot program.
19    The Department shall require all networks of care to
20develop a means either internally or by contract with experts
21in navigation and community outreach to navigate cancer
22patients to comprehensive care in a timely fashion. The
23Department shall require all networks of care to include
24access for patients diagnosed with cancer to at least one
25academic commission on cancer-accredited cancer program as an
26in-network covered benefit.



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1    The Department shall provide coverage and reimbursement
2for a human papillomavirus (HPV) vaccine that is approved for
3marketing by the federal Food and Drug Administration for all
4persons between the ages of 9 and 45 and persons of the age of
546 and above who have been diagnosed with cervical dysplasia
6with a high risk of recurrence or progression. The Department
7shall disallow any preauthorization requirements for the
8administration of the human papillomavirus (HPV) vaccine.
9    On or after July 1, 2022, individuals who are otherwise
10eligible for medical assistance under this Article shall
11receive coverage for perinatal depression screenings for the
1212-month period beginning on the last day of their pregnancy.
13Medical assistance coverage under this paragraph shall be
14conditioned on the use of a screening instrument approved by
15the Department.
16    Any medical or health care provider shall immediately
17recommend, to any pregnant individual who is being provided
18prenatal services and is suspected of having a substance use
19disorder as defined in the Substance Use Disorder Act,
20referral to a local substance use disorder treatment program
21licensed by the Department of Human Services or to a licensed
22hospital which provides substance abuse treatment services.
23The Department of Healthcare and Family Services shall assure
24coverage for the cost of treatment of the drug abuse or
25addiction for pregnant recipients in accordance with the
26Illinois Medicaid Program in conjunction with the Department



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



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



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



HB3547- 23 -LRB103 30309 LNS 56737 b

1service providers.
2    The Department shall apply for a waiver from the United
3States Health Care Financing Administration to allow for the
4implementation of Partnerships under this Section.
5    The Illinois Department shall require health care
6providers to maintain records that document the medical care
7and services provided to recipients of Medical Assistance
8under this Article. Such records must be retained for a period
9of not less than 6 years from the date of service or as
10provided by applicable State law, whichever period is longer,
11except that if an audit is initiated within the required
12retention period then the records must be retained until the
13audit is completed and every exception is resolved. The
14Illinois Department shall require health care providers to
15make available, when authorized by the patient, in writing,
16the medical records in a timely fashion to other health care
17providers who are treating or serving persons eligible for
18Medical Assistance under this Article. All dispensers of
19medical services shall be required to maintain and retain
20business and professional records sufficient to fully and
21accurately document the nature, scope, details and receipt of
22the health care provided to persons eligible for medical
23assistance under this Code, in accordance with regulations
24promulgated by the Illinois Department. The rules and
25regulations shall require that proof of the receipt of
26prescription drugs, dentures, prosthetic devices and



HB3547- 24 -LRB103 30309 LNS 56737 b

1eyeglasses by eligible persons under this Section accompany
2each claim for reimbursement submitted by the dispenser of
3such medical services. No such claims for reimbursement shall
4be approved for payment by the Illinois Department without
5such proof of receipt, unless the Illinois Department shall
6have put into effect and shall be operating a system of
7post-payment audit and review which shall, on a sampling
8basis, be deemed adequate by the Illinois Department to assure
9that such drugs, dentures, prosthetic devices and eyeglasses
10for which payment is being made are actually being received by
11eligible recipients. Within 90 days after September 16, 1984
12(the effective date of Public Act 83-1439), the Illinois
13Department shall establish a current list of acquisition costs
14for all prosthetic devices and any other items recognized as
15medical equipment and supplies reimbursable under this Article
16and shall update such list on a quarterly basis, except that
17the acquisition costs of all prescription drugs shall be
18updated no less frequently than every 30 days as required by
19Section 5-5.12.
20    The rules and regulations of the Illinois Department shall
21require that a written statement including the required
22opinion of a physician shall accompany any claim for
23reimbursement for abortions, or induced miscarriages or
24premature births. This statement shall indicate what
25procedures were used in providing such medical services.
26    Notwithstanding any other law to the contrary, the



HB3547- 25 -LRB103 30309 LNS 56737 b

1Illinois Department shall, within 365 days after July 22, 2013
2(the effective date of Public Act 98-104), establish
3procedures to permit skilled care facilities licensed under
4the Nursing Home Care Act to submit monthly billing claims for
5reimbursement purposes. Following development of these
6procedures, the Department shall, by July 1, 2016, test the
7viability of the new system and implement any necessary
8operational or structural changes to its information
9technology platforms in order to allow for the direct
10acceptance and payment of nursing home claims.
11    Notwithstanding any other law to the contrary, the
12Illinois Department shall, within 365 days after August 15,
132014 (the effective date of Public Act 98-963), establish
14procedures to permit ID/DD facilities licensed under the ID/DD
15Community Care Act and MC/DD facilities licensed under the
16MC/DD Act to submit monthly billing claims for reimbursement
17purposes. Following development of these procedures, the
18Department shall have an additional 365 days to test the
19viability of the new system and to ensure that any necessary
20operational or structural changes to its information
21technology platforms are implemented.
22    The Illinois Department shall require all dispensers of
23medical services, other than an individual practitioner or
24group of practitioners, desiring to participate in the Medical
25Assistance program established under this Article to disclose
26all financial, beneficial, ownership, equity, surety or other



HB3547- 26 -LRB103 30309 LNS 56737 b

1interests in any and all firms, corporations, partnerships,
2associations, business enterprises, joint ventures, agencies,
3institutions or other legal entities providing any form of
4health care services in this State under this Article.
5    The Illinois Department may require that all dispensers of
6medical services desiring to participate in the medical
7assistance program established under this Article disclose,
8under such terms and conditions as the Illinois Department may
9by rule establish, all inquiries from clients and attorneys
10regarding medical bills paid by the Illinois Department, which
11inquiries could indicate potential existence of claims or
12liens for the Illinois Department.
13    Enrollment of a vendor shall be subject to a provisional
14period and shall be conditional for one year. During the
15period of conditional enrollment, the Department may terminate
16the vendor's eligibility to participate in, or may disenroll
17the vendor from, the medical assistance program without cause.
18Unless otherwise specified, such termination of eligibility or
19disenrollment is not subject to the Department's hearing
20process. However, a disenrolled vendor may reapply without
22    The Department has the discretion to limit the conditional
23enrollment period for vendors based upon the category of risk
24of the vendor.
25    Prior to enrollment and during the conditional enrollment
26period in the medical assistance program, all vendors shall be



HB3547- 27 -LRB103 30309 LNS 56737 b

1subject to enhanced oversight, screening, and review based on
2the risk of fraud, waste, and abuse that is posed by the
3category of risk of the vendor. The Illinois Department shall
4establish the procedures for oversight, screening, and review,
5which may include, but need not be limited to: criminal and
6financial background checks; fingerprinting; license,
7certification, and authorization verifications; unscheduled or
8unannounced site visits; database checks; prepayment audit
9reviews; audits; payment caps; payment suspensions; and other
10screening as required by federal or State law.
11    The Department shall define or specify the following: (i)
12by provider notice, the "category of risk of the vendor" for
13each type of vendor, which shall take into account the level of
14screening applicable to a particular category of vendor under
15federal law and regulations; (ii) by rule or provider notice,
16the maximum length of the conditional enrollment period for
17each category of risk of the vendor; and (iii) by rule, the
18hearing rights, if any, afforded to a vendor in each category
19of risk of the vendor that is terminated or disenrolled during
20the conditional enrollment period.
21    To be eligible for payment consideration, a vendor's
22payment claim or bill, either as an initial claim or as a
23resubmitted claim following prior rejection, must be received
24by the Illinois Department, or its fiscal intermediary, no
25later than 180 days after the latest date on the claim on which
26medical goods or services were provided, with the following



HB3547- 28 -LRB103 30309 LNS 56737 b

2        (1) In the case of a provider whose enrollment is in
3    process by the Illinois Department, the 180-day period
4    shall not begin until the date on the written notice from
5    the Illinois Department that the provider enrollment is
6    complete.
7        (2) In the case of errors attributable to the Illinois
8    Department or any of its claims processing intermediaries
9    which result in an inability to receive, process, or
10    adjudicate a claim, the 180-day period shall not begin
11    until the provider has been notified of the error.
12        (3) In the case of a provider for whom the Illinois
13    Department initiates the monthly billing process.
14        (4) In the case of a provider operated by a unit of
15    local government with a population exceeding 3,000,000
16    when local government funds finance federal participation
17    for claims payments.
18    For claims for services rendered during a period for which
19a recipient received retroactive eligibility, claims must be
20filed within 180 days after the Department determines the
21applicant is eligible. For claims for which the Illinois
22Department is not the primary payer, claims must be submitted
23to the Illinois Department within 180 days after the final
24adjudication by the primary payer.
25    In the case of long term care facilities, within 120
26calendar days of receipt by the facility of required



HB3547- 29 -LRB103 30309 LNS 56737 b

1prescreening information, new admissions with associated
2admission documents shall be submitted through the Medical
3Electronic Data Interchange (MEDI) or the Recipient
4Eligibility Verification (REV) System or shall be submitted
5directly to the Department of Human Services using required
6admission forms. Effective September 1, 2014, admission
7documents, including all prescreening information, must be
8submitted through MEDI or REV. Confirmation numbers assigned
9to an accepted transaction shall be retained by a facility to
10verify timely submittal. Once an admission transaction has
11been completed, all resubmitted claims following prior
12rejection are subject to receipt no later than 180 days after
13the admission transaction has been completed.
14    Claims that are not submitted and received in compliance
15with the foregoing requirements shall not be eligible for
16payment under the medical assistance program, and the State
17shall have no liability for payment of those claims.
18    To the extent consistent with applicable information and
19privacy, security, and disclosure laws, State and federal
20agencies and departments shall provide the Illinois Department
21access to confidential and other information and data
22necessary to perform eligibility and payment verifications and
23other Illinois Department functions. This includes, but is not
24limited to: information pertaining to licensure;
25certification; earnings; immigration status; citizenship; wage
26reporting; unearned and earned income; pension income;



HB3547- 30 -LRB103 30309 LNS 56737 b

1employment; supplemental security income; social security
2numbers; National Provider Identifier (NPI) numbers; the
3National Practitioner Data Bank (NPDB); program and agency
4exclusions; taxpayer identification numbers; tax delinquency;
5corporate information; and death records.
6    The Illinois Department shall enter into agreements with
7State agencies and departments, and is authorized to enter
8into agreements with federal agencies and departments, under
9which such agencies and departments shall share data necessary
10for medical assistance program integrity functions and
11oversight. The Illinois Department shall develop, in
12cooperation with other State departments and agencies, and in
13compliance with applicable federal laws and regulations,
14appropriate and effective methods to share such data. At a
15minimum, and to the extent necessary to provide data sharing,
16the Illinois Department shall enter into agreements with State
17agencies and departments, and is authorized to enter into
18agreements with federal agencies and departments, including,
19but not limited to: the Secretary of State; the Department of
20Revenue; the Department of Public Health; the Department of
21Human Services; and the Department of Financial and
22Professional Regulation.
23    Beginning in fiscal year 2013, the Illinois Department
24shall set forth a request for information to identify the
25benefits of a pre-payment, post-adjudication, and post-edit
26claims system with the goals of streamlining claims processing



HB3547- 31 -LRB103 30309 LNS 56737 b

1and provider reimbursement, reducing the number of pending or
2rejected claims, and helping to ensure a more transparent
3adjudication process through the utilization of: (i) provider
4data verification and provider screening technology; and (ii)
5clinical code editing; and (iii) pre-pay, pre-adjudicated pre-
6or post-adjudicated predictive modeling with an integrated
7case management system with link analysis. Such a request for
8information shall not be considered as a request for proposal
9or as an obligation on the part of the Illinois Department to
10take any action or acquire any products or services.
11    The Illinois Department shall establish policies,
12procedures, standards and criteria by rule for the
13acquisition, repair and replacement of orthotic and prosthetic
14devices and durable medical equipment. Such rules shall
15provide, but not be limited to, the following services: (1)
16immediate repair or replacement of such devices by recipients;
17and (2) rental, lease, purchase or lease-purchase of durable
18medical equipment in a cost-effective manner, taking into
19consideration the recipient's medical prognosis, the extent of
20the recipient's needs, and the requirements and costs for
21maintaining such equipment. Subject to prior approval, such
22rules shall enable a recipient to temporarily acquire and use
23alternative or substitute devices or equipment pending repairs
24or replacements of any device or equipment previously
25authorized for such recipient by the Department.
26Notwithstanding any provision of Section 5-5f to the contrary,



HB3547- 32 -LRB103 30309 LNS 56737 b

1the Department may, by rule, exempt certain replacement
2wheelchair parts from prior approval and, for wheelchairs,
3wheelchair parts, wheelchair accessories, and related seating
4and positioning items, determine the wholesale price by
5methods other than actual acquisition costs.
6    The Department shall require, by rule, all providers of
7durable medical equipment to be accredited by an accreditation
8organization approved by the federal Centers for Medicare and
9Medicaid Services and recognized by the Department in order to
10bill the Department for providing durable medical equipment to
11recipients. No later than 15 months after the effective date
12of the rule adopted pursuant to this paragraph, all providers
13must meet the accreditation requirement.
14    In order to promote environmental responsibility, meet the
15needs of recipients and enrollees, and achieve significant
16cost savings, the Department, or a managed care organization
17under contract with the Department, may provide recipients or
18managed care enrollees who have a prescription or Certificate
19of Medical Necessity access to refurbished durable medical
20equipment under this Section (excluding prosthetic and
21orthotic devices as defined in the Orthotics, Prosthetics, and
22Pedorthics Practice Act and complex rehabilitation technology
23products and associated services) through the State's
24assistive technology program's reutilization program, using
25staff with the Assistive Technology Professional (ATP)
26Certification if the refurbished durable medical equipment:



HB3547- 33 -LRB103 30309 LNS 56737 b

1(i) is available; (ii) is less expensive, including shipping
2costs, than new durable medical equipment of the same type;
3(iii) is able to withstand at least 3 years of use; (iv) is
4cleaned, disinfected, sterilized, and safe in accordance with
5federal Food and Drug Administration regulations and guidance
6governing the reprocessing of medical devices in health care
7settings; and (v) equally meets the needs of the recipient or
8enrollee. The reutilization program shall confirm that the
9recipient or enrollee is not already in receipt of the same or
10similar equipment from another service provider, and that the
11refurbished durable medical equipment equally meets the needs
12of the recipient or enrollee. Nothing in this paragraph shall
13be construed to limit recipient or enrollee choice to obtain
14new durable medical equipment or place any additional prior
15authorization conditions on enrollees of managed care
17    The Department shall execute, relative to the nursing home
18prescreening project, written inter-agency agreements with the
19Department of Human Services and the Department on Aging, to
20effect the following: (i) intake procedures and common
21eligibility criteria for those persons who are receiving
22non-institutional services; and (ii) the establishment and
23development of non-institutional services in areas of the
24State where they are not currently available or are
25undeveloped; and (iii) notwithstanding any other provision of
26law, subject to federal approval, on and after July 1, 2012, an



HB3547- 34 -LRB103 30309 LNS 56737 b

1increase in the determination of need (DON) scores from 29 to
237 for applicants for institutional and home and
3community-based long term care; if and only if federal
4approval is not granted, the Department may, in conjunction
5with other affected agencies, implement utilization controls
6or changes in benefit packages to effectuate a similar savings
7amount for this population; and (iv) no later than July 1,
82013, minimum level of care eligibility criteria for
9institutional and home and community-based long term care; and
10(v) no later than October 1, 2013, establish procedures to
11permit long term care providers access to eligibility scores
12for individuals with an admission date who are seeking or
13receiving services from the long term care provider. In order
14to select the minimum level of care eligibility criteria, the
15Governor shall establish a workgroup that includes affected
16agency representatives and stakeholders representing the
17institutional and home and community-based long term care
18interests. This Section shall not restrict the Department from
19implementing lower level of care eligibility criteria for
20community-based services in circumstances where federal
21approval has been granted.
22    The Illinois Department shall develop and operate, in
23cooperation with other State Departments and agencies and in
24compliance with applicable federal laws and regulations,
25appropriate and effective systems of health care evaluation
26and programs for monitoring of utilization of health care



HB3547- 35 -LRB103 30309 LNS 56737 b

1services and facilities, as it affects persons eligible for
2medical assistance under this Code.
3    The Illinois Department shall report annually to the
4General Assembly, no later than the second Friday in April of
51979 and each year thereafter, in regard to:
6        (a) actual statistics and trends in utilization of
7    medical services by public aid recipients;
8        (b) actual statistics and trends in the provision of
9    the various medical services by medical vendors;
10        (c) current rate structures and proposed changes in
11    those rate structures for the various medical vendors; and
12        (d) efforts at utilization review and control by the
13    Illinois Department.
14    The period covered by each report shall be the 3 years
15ending on the June 30 prior to the report. The report shall
16include suggested legislation for consideration by the General
17Assembly. The requirement for reporting to the General
18Assembly shall be satisfied by filing copies of the report as
19required by Section 3.1 of the General Assembly Organization
20Act, and filing such additional copies with the State
21Government Report Distribution Center for the General Assembly
22as is required under paragraph (t) of Section 7 of the State
23Library Act.
24    Rulemaking authority to implement Public Act 95-1045, if
25any, is conditioned on the rules being adopted in accordance
26with all provisions of the Illinois Administrative Procedure



HB3547- 36 -LRB103 30309 LNS 56737 b

1Act and all rules and procedures of the Joint Committee on
2Administrative Rules; any purported rule not so adopted, for
3whatever reason, is unauthorized.
4    On and after July 1, 2012, the Department shall reduce any
5rate of reimbursement for services or other payments or alter
6any methodologies authorized by this Code to reduce any rate
7of reimbursement for services or other payments in accordance
8with Section 5-5e.
9    Because kidney transplantation can be an appropriate,
10cost-effective alternative to renal dialysis when medically
11necessary and notwithstanding the provisions of Section 1-11
12of this Code, beginning October 1, 2014, the Department shall
13cover kidney transplantation for noncitizens with end-stage
14renal disease who are not eligible for comprehensive medical
15benefits, who meet the residency requirements of Section 5-3
16of this Code, and who would otherwise meet the financial
17requirements of the appropriate class of eligible persons
18under Section 5-2 of this Code. To qualify for coverage of
19kidney transplantation, such person must be receiving
20emergency renal dialysis services covered by the Department.
21Providers under this Section shall be prior approved and
22certified by the Department to perform kidney transplantation
23and the services under this Section shall be limited to
24services associated with kidney transplantation.
25    Notwithstanding any other provision of this Code to the
26contrary, on or after July 1, 2015, all FDA approved forms of



HB3547- 37 -LRB103 30309 LNS 56737 b

1medication assisted treatment prescribed for the treatment of
2alcohol dependence or treatment of opioid dependence shall be
3covered under both fee for service and managed care medical
4assistance programs for persons who are otherwise eligible for
5medical assistance under this Article and shall not be subject
6to any (1) utilization control, other than those established
7under the American Society of Addiction Medicine patient
8placement criteria, (2) prior authorization mandate, or (3)
9lifetime restriction limit mandate.
10    On or after July 1, 2015, opioid antagonists prescribed
11for the treatment of an opioid overdose, including the
12medication product, administration devices, and any pharmacy
13fees or hospital fees related to the dispensing, distribution,
14and administration of the opioid antagonist, shall be covered
15under the medical assistance program for persons who are
16otherwise eligible for medical assistance under this Article.
17As used in this Section, "opioid antagonist" means a drug that
18binds to opioid receptors and blocks or inhibits the effect of
19opioids acting on those receptors, including, but not limited
20to, naloxone hydrochloride or any other similarly acting drug
21approved by the U.S. Food and Drug Administration. The
22Department shall not impose a copayment on the coverage
23provided for naloxone hydrochloride under the medical
24assistance program.
25    Upon federal approval, the Department shall provide
26coverage and reimbursement for all drugs that are approved for



HB3547- 38 -LRB103 30309 LNS 56737 b

1marketing by the federal Food and Drug Administration and that
2are recommended by the federal Public Health Service or the
3United States Centers for Disease Control and Prevention for
4pre-exposure prophylaxis and related pre-exposure prophylaxis
5services, including, but not limited to, HIV and sexually
6transmitted infection screening, treatment for sexually
7transmitted infections, medical monitoring, assorted labs, and
8counseling to reduce the likelihood of HIV infection among
9individuals who are not infected with HIV but who are at high
10risk of HIV infection.
11    A federally qualified health center, as defined in Section
121905(l)(2)(B) of the federal Social Security Act, shall be
13reimbursed by the Department in accordance with the federally
14qualified health center's encounter rate for services provided
15to medical assistance recipients that are performed by a
16dental hygienist, as defined under the Illinois Dental
17Practice Act, working under the general supervision of a
18dentist and employed by a federally qualified health center.
19    Within 90 days after October 8, 2021 (the effective date
20of Public Act 102-665), the Department shall seek federal
21approval of a State Plan amendment to expand coverage for
22family planning services that includes presumptive eligibility
23to individuals whose income is at or below 208% of the federal
24poverty level. Coverage under this Section shall be effective
25beginning no later than December 1, 2022.
26    Subject to approval by the federal Centers for Medicare



HB3547- 39 -LRB103 30309 LNS 56737 b

1and Medicaid Services of a Title XIX State Plan amendment
2electing the Program of All-Inclusive Care for the Elderly
3(PACE) as a State Medicaid option, as provided for by Subtitle
4I (commencing with Section 4801) of Title IV of the Balanced
5Budget Act of 1997 (Public Law 105-33) and Part 460
6(commencing with Section 460.2) of Subchapter E of Title 42 of
7the Code of Federal Regulations, PACE program services shall
8become a covered benefit of the medical assistance program,
9subject to criteria established in accordance with all
10applicable laws.
11    Notwithstanding any other provision of this Code,
12community-based pediatric palliative care from a trained
13interdisciplinary team shall be covered under the medical
14assistance program as provided in Section 15 of the Pediatric
15Palliative Care Act.
16    Notwithstanding any other provision of this Code, within
1712 months after June 2, 2022 (the effective date of Public Act
18102-1037) this amendatory Act of the 102nd General Assembly
19and subject to federal approval, acupuncture services
20performed by an acupuncturist licensed under the Acupuncture
21Practice Act who is acting within the scope of his or her
22license shall be covered under the medical assistance program.
23The Department shall apply for any federal waiver or State
24Plan amendment, if required, to implement this paragraph. The
25Department may adopt any rules, including standards and
26criteria, necessary to implement this paragraph.



HB3547- 40 -LRB103 30309 LNS 56737 b

1(Source: P.A. 101-209, eff. 8-5-19; 101-580, eff. 1-1-20;
2102-43, Article 30, Section 30-5, eff. 7-6-21; 102-43, Article
335, Section 35-5, eff. 7-6-21; 102-43, Article 55, Section
455-5, eff. 7-6-21; 102-95, eff. 1-1-22; 102-123, eff. 1-1-22;
5102-558, eff. 8-20-21; 102-598, eff. 1-1-22; 102-655, eff.
61-1-22; 102-665, eff. 10-8-21; 102-813, eff. 5-13-22;
7102-1018, eff. 1-1-23; 102-1037, eff. 6-2-22; 102-1038 eff.
81-1-23; revised 2-5-23.)
9    (305 ILCS 5/5-8)  (from Ch. 23, par. 5-8)
10    Sec. 5-8. Practitioners. In supplying medical assistance,
11the Illinois Department may provide for the legally authorized
12services of (i) persons licensed under the Medical Practice
13Act of 1987, as amended, except as hereafter in this Section
14stated, whether under a general or limited license, (ii)
15persons licensed under the Nurse Practice Act as advanced
16practice registered nurses, regardless of whether or not the
17persons have written collaborative agreements, (iii) persons
18licensed or registered under other laws of this State to
19provide dental, medical, pharmaceutical, optometric,
20podiatric, or nursing services, or other remedial care
21recognized under State law, (iv) persons licensed under other
22laws of this State as a clinical social worker, and (v) persons
23licensed under other laws of this State as physician
24assistants. The Department shall adopt rules, no later than 90
25days after January 1, 2017 (the effective date of Public Act



HB3547- 41 -LRB103 30309 LNS 56737 b

199-621), for the legally authorized services of persons
2licensed under other laws of this State as a clinical social
3worker. The Department may not provide for legally authorized
4services of any physician who has been convicted of having
5performed an abortion procedure in a willful and wanton manner
6on a woman who was not pregnant at the time such abortion
7procedure was performed. The Department shall provide for the
8legally authorized services of persons licensed under the
9Professional Counselor and Clinical Professional Counselor
10Licensing and Practice Act as clinical professional counselors
11and for the legally authorized services of persons licensed
12under the Marriage and Family Therapy Licensing Act as
13marriage and family therapists. The utilization of the
14services of persons engaged in the treatment or care of the
15sick, which persons are not required to be licensed or
16registered under the laws of this State, is not prohibited by
17this Section.
18(Source: P.A. 102-43, eff. 7-6-21.)
19    (305 ILCS 5/5-9)  (from Ch. 23, par. 5-9)
20    Sec. 5-9. Choice of medical dispensers. Applicants and
21recipients shall be entitled to free choice of those qualified
22practitioners, hospitals, nursing homes, and other dispensers
23of medical services meeting the requirements and complying
24with the rules and regulations of the Illinois Department.
25However, the Director of Healthcare and Family Services may,



HB3547- 42 -LRB103 30309 LNS 56737 b

1after providing reasonable notice and opportunity for hearing,
2deny, suspend or terminate any otherwise qualified person,
3firm, corporation, association, agency, institution, or other
4legal entity, from participation as a vendor of goods or
5services under the medical assistance program authorized by
6this Article if the Director finds such vendor of medical
7services in violation of this Act or the policy or rules and
8regulations issued pursuant to this Act. Any physician who has
9been convicted of performing an abortion procedure in a
10willful and wanton manner upon a woman who was not pregnant at
11the time such abortion procedure was performed shall be
12automatically removed from the list of physicians qualified to
13participate as a vendor of medical services under the medical
14assistance program authorized by this Article.
15(Source: P.A. 100-538, eff. 1-1-18.)
16    (305 ILCS 5/6-1)  (from Ch. 23, par. 6-1)
17    Sec. 6-1. Eligibility requirements. Financial aid in
18meeting basic maintenance requirements shall be given under
19this Article to or in behalf of persons who meet the
20eligibility conditions of Sections 6-1.1 through 6-1.10. In
21addition, each unit of local government subject to this
22Article shall provide persons receiving financial aid in
23meeting basic maintenance requirements with financial aid for
24either (a) necessary treatment, care, and supplies required
25because of illness or disability, or (b) acute medical



HB3547- 43 -LRB103 30309 LNS 56737 b

1treatment, care, and supplies only. If a local governmental
2unit elects to provide financial aid for acute medical
3treatment, care, and supplies only, the general types of acute
4medical treatment, care, and supplies for which financial aid
5is provided shall be specified in the general assistance rules
6of the local governmental unit, which rules shall provide that
7financial aid is provided, at a minimum, for acute medical
8treatment, care, or supplies necessitated by a medical
9condition for which prior approval or authorization of medical
10treatment, care, or supplies is not required by the general
11assistance rules of the Illinois Department. Nothing in this
12Article shall be construed to permit the granting of financial
13aid where the purpose of such aid is to obtain an abortion,
14induced miscarriage, or induced premature birth unless, in the
15opinion of a physician, such procedures are necessary for the
16preservation of the life of the woman seeking such treatment,
17or except an induced premature birth intended to produce a
18live viable child and such procedure is necessary for the
19health of the mother or her unborn child.
20(Source: P.A. 100-538, eff. 1-1-18.)
21    Section 15. The Problem Pregnancy Health Services and Care
22Act is amended by changing Section 4-100 as follows:
23    (410 ILCS 230/4-100)  (from Ch. 111 1/2, par. 4604-100)
24    Sec. 4-100. The Department may make grants to nonprofit



HB3547- 44 -LRB103 30309 LNS 56737 b

1agencies and organizations which do not use such grants to
2refer or counsel for, or perform, abortions and which
3coordinate and establish linkages among services that will
4further the purposes of this Act and, where appropriate, will
5provide, supplement, or improve the quality of such services.
6(Source: P.A. 100-538, eff. 1-1-18.)