HB0486 Enrolled LRB093 05218 AMC 05278 b

1     AN ACT concerning health care for women.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Hospital Licensing Act is amended by adding
5 Section 11.5 as follows:
 
6     (210 ILCS 85/11.5 new)
7     Sec. 11.5. Uniform standards of obstetrical care
8 regardless of ability to pay.
9     (a) No hospital may promulgate policies or implement
10 practices that determine differing standards of obstetrical
11 care based upon a patient's source of payment or ability to pay
12 for medical services.
13     (b) Each hospital shall develop a written policy statement
14 reflecting the requirements of subsection (a) and shall post
15 written notices of this policy in the obstetrical admitting
16 areas of the hospital by July 1, 2004. Notices posted pursuant
17 to this Section shall be posted in the predominant language or
18 languages spoken in the hospital's service area.
 
19     Section 15. The Illinois Public Aid Code is amended by
20 changing Section 5-5 and adding Section 5-16.7a as follows:
 
21     (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
22     Sec. 5-5. Medical services. The Illinois Department, by
23 rule, shall determine the quantity and quality of and the rate
24 of reimbursement for the medical assistance for which payment
25 will be authorized, and the medical services to be provided,
26 which may include all or part of the following: (1) inpatient
27 hospital services; (2) outpatient hospital services; (3) other
28 laboratory and X-ray services; (4) skilled nursing home
29 services; (5) physicians' services whether furnished in the
30 office, the patient's home, a hospital, a skilled nursing home,

 

 

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1 or elsewhere; (6) medical care, or any other type of remedial
2 care furnished by licensed practitioners; (7) home health care
3 services; (8) private duty nursing service; (9) clinic
4 services; (10) dental services, including prevention and
5 treatment of periodontal disease and dental caries disease for
6 pregnant women; (11) physical therapy and related services;
7 (12) prescribed drugs, dentures, and prosthetic devices; and
8 eyeglasses prescribed by a physician skilled in the diseases of
9 the eye, or by an optometrist, whichever the person may select;
10 (13) other diagnostic, screening, preventive, and
11 rehabilitative services; (14) transportation and such other
12 expenses as may be necessary; (15) medical treatment of sexual
13 assault survivors, as defined in Section 1a of the Sexual
14 Assault Survivors Emergency Treatment Act, for injuries
15 sustained as a result of the sexual assault, including
16 examinations and laboratory tests to discover evidence which
17 may be used in criminal proceedings arising from the sexual
18 assault; (16) the diagnosis and treatment of sickle cell
19 anemia; and (17) any other medical care, and any other type of
20 remedial care recognized under the laws of this State, but not
21 including abortions, or induced miscarriages or premature
22 births, unless, in the opinion of a physician, such procedures
23 are necessary for the preservation of the life of the woman
24 seeking such treatment, or except an induced premature birth
25 intended to produce a live viable child and such procedure is
26 necessary for the health of the mother or her unborn child. The
27 Illinois Department, by rule, shall prohibit any physician from
28 providing medical assistance to anyone eligible therefor under
29 this Code where such physician has been found guilty of
30 performing an abortion procedure in a wilful and wanton manner
31 upon a woman who was not pregnant at the time such abortion
32 procedure was performed. The term "any other type of remedial
33 care" shall include nursing care and nursing home service for
34 persons who rely on treatment by spiritual means alone through
35 prayer for healing.
36     Notwithstanding any other provision of this Section, a

 

 

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1 comprehensive tobacco use cessation program that includes
2 purchasing prescription drugs or prescription medical devices
3 approved by the Food and Drug administration shall be covered
4 under the medical assistance program under this Article for
5 persons who are otherwise eligible for assistance under this
6 Article.
7     Notwithstanding any other provision of this Code, the
8 Illinois Department may not require, as a condition of payment
9 for any laboratory test authorized under this Article, that a
10 physician's handwritten signature appear on the laboratory
11 test order form. The Illinois Department may, however, impose
12 other appropriate requirements regarding laboratory test order
13 documentation.
14     The Illinois Department of Public Aid shall provide the
15 following services to persons eligible for assistance under
16 this Article who are participating in education, training or
17 employment programs operated by the Department of Human
18 Services as successor to the Department of Public Aid:
19         (1) dental services, which shall include but not be
20     limited to prosthodontics; and
21         (2) eyeglasses prescribed by a physician skilled in the
22     diseases of the eye, or by an optometrist, whichever the
23     person may select.
24     The Illinois Department, by rule, may distinguish and
25 classify the medical services to be provided only in accordance
26 with the classes of persons designated in Section 5-2.
27     The Illinois Department shall authorize the provision of,
28 and shall authorize payment for, screening by low-dose
29 mammography for the presence of occult breast cancer for women
30 35 years of age or older who are eligible for medical
31 assistance under this Article, as follows: a baseline mammogram
32 for women 35 to 39 years of age and an annual mammogram for
33 women 40 years of age or older. All screenings shall include a
34 physical breast exam, instruction on self-examination and
35 information regarding the frequency of self-examination and
36 its value as a preventative tool. As used in this Section,

 

 

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1 "low-dose mammography" means the x-ray examination of the
2 breast using equipment dedicated specifically for mammography,
3 including the x-ray tube, filter, compression device, image
4 receptor, and cassettes, with an average radiation exposure
5 delivery of less than one rad mid-breast, with 2 views for each
6 breast.
7     Any medical or health care provider shall immediately
8 recommend, to any pregnant woman who is being provided prenatal
9 services and is suspected of drug abuse or is addicted as
10 defined in the Alcoholism and Other Drug Abuse and Dependency
11 Act, referral to a local substance abuse treatment provider
12 licensed by the Department of Human Services or to a licensed
13 hospital which provides substance abuse treatment services.
14 The Department of Public Aid shall assure coverage for the cost
15 of treatment of the drug abuse or addiction for pregnant
16 recipients in accordance with the Illinois Medicaid Program in
17 conjunction with the Department of Human Services.
18     All medical providers providing medical assistance to
19 pregnant women under this Code shall receive information from
20 the Department on the availability of services under the Drug
21 Free Families with a Future or any comparable program providing
22 case management services for addicted women, including
23 information on appropriate referrals for other social services
24 that may be needed by addicted women in addition to treatment
25 for addiction.
26     The Illinois Department, in cooperation with the
27 Departments of Human Services (as successor to the Department
28 of Alcoholism and Substance Abuse) and Public Health, through a
29 public awareness campaign, may provide information concerning
30 treatment for alcoholism and drug abuse and addiction, prenatal
31 health care, and other pertinent programs directed at reducing
32 the number of drug-affected infants born to recipients of
33 medical assistance.
34     Neither the Illinois Department of Public Aid nor the
35 Department of Human Services shall sanction the recipient
36 solely on the basis of her substance abuse.

 

 

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1     The Illinois Department shall establish such regulations
2 governing the dispensing of health services under this Article
3 as it shall deem appropriate. The Department should seek the
4 advice of formal professional advisory committees appointed by
5 the Director of the Illinois Department for the purpose of
6 providing regular advice on policy and administrative matters,
7 information dissemination and educational activities for
8 medical and health care providers, and consistency in
9 procedures to the Illinois Department.
10     The Illinois Department may develop and contract with
11 Partnerships of medical providers to arrange medical services
12 for persons eligible under Section 5-2 of this Code.
13 Implementation of this Section may be by demonstration projects
14 in certain geographic areas. The Partnership shall be
15 represented by a sponsor organization. The Department, by rule,
16 shall develop qualifications for sponsors of Partnerships.
17 Nothing in this Section shall be construed to require that the
18 sponsor organization be a medical organization.
19     The sponsor must negotiate formal written contracts with
20 medical providers for physician services, inpatient and
21 outpatient hospital care, home health services, treatment for
22 alcoholism and substance abuse, and other services determined
23 necessary by the Illinois Department by rule for delivery by
24 Partnerships. Physician services must include prenatal and
25 obstetrical care. The Illinois Department shall reimburse
26 medical services delivered by Partnership providers to clients
27 in target areas according to provisions of this Article and the
28 Illinois Health Finance Reform Act, except that:
29         (1) Physicians participating in a Partnership and
30     providing certain services, which shall be determined by
31     the Illinois Department, to persons in areas covered by the
32     Partnership may receive an additional surcharge for such
33     services.
34         (2) The Department may elect to consider and negotiate
35     financial incentives to encourage the development of
36     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
6 qualifications to participate in Partnerships to ensure the
7 delivery of high quality medical services. These
8 qualifications shall be determined by rule of the Illinois
9 Department and may be higher than qualifications for
10 participation in the medical assistance program. Partnership
11 sponsors may prescribe reasonable additional qualifications
12 for participation by medical providers, only with the prior
13 written approval of the Illinois Department.
14     Nothing in this Section shall limit the free choice of
15 practitioners, hospitals, and other providers of medical
16 services by clients. In order to ensure patient freedom of
17 choice, the Illinois Department shall immediately promulgate
18 all rules and take all other necessary actions so that provided
19 services may be accessed from therapeutically certified
20 optometrists to the full extent of the Illinois Optometric
21 Practice Act of 1987 without discriminating between service
22 providers.
23     The Department shall apply for a waiver from the United
24 States Health Care Financing Administration to allow for the
25 implementation of Partnerships under this Section.
26     The Illinois Department shall require health care
27 providers to maintain records that document the medical care
28 and services provided to recipients of Medical Assistance under
29 this Article. The Illinois Department shall require health care
30 providers to make available, when authorized by the patient, in
31 writing, the medical records in a timely fashion to other
32 health care providers who are treating or serving persons
33 eligible for Medical Assistance under this Article. All
34 dispensers of medical services shall be required to maintain
35 and retain business and professional records sufficient to
36 fully and accurately document the nature, scope, details and

 

 

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1 receipt of the health care provided to persons eligible for
2 medical assistance under this Code, in accordance with
3 regulations promulgated by the Illinois Department. The rules
4 and regulations shall require that proof of the receipt of
5 prescription drugs, dentures, prosthetic devices and
6 eyeglasses by eligible persons under this Section accompany
7 each claim for reimbursement submitted by the dispenser of such
8 medical services. No such claims for reimbursement shall be
9 approved for payment by the Illinois Department without such
10 proof of receipt, unless the Illinois Department shall have put
11 into effect and shall be operating a system of post-payment
12 audit and review which shall, on a sampling basis, be deemed
13 adequate by the Illinois Department to assure that such drugs,
14 dentures, prosthetic devices and eyeglasses for which payment
15 is being made are actually being received by eligible
16 recipients. Within 90 days after the effective date of this
17 amendatory Act of 1984, the Illinois Department shall establish
18 a current list of acquisition costs for all prosthetic devices
19 and any other items recognized as medical equipment and
20 supplies reimbursable under this Article and shall update such
21 list on a quarterly basis, except that the acquisition costs of
22 all prescription drugs shall be updated no less frequently than
23 every 30 days as required by Section 5-5.12.
24     The rules and regulations of the Illinois Department shall
25 require that a written statement including the required opinion
26 of a physician shall accompany any claim for reimbursement for
27 abortions, or induced miscarriages or premature births. This
28 statement shall indicate what procedures were used in providing
29 such medical services.
30     The Illinois Department shall require all dispensers of
31 medical services, other than an individual practitioner or
32 group of practitioners, desiring to participate in the Medical
33 Assistance program established under this Article to disclose
34 all financial, beneficial, ownership, equity, surety or other
35 interests in any and all firms, corporations, partnerships,
36 associations, business enterprises, joint ventures, agencies,

 

 

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1 institutions or other legal entities providing any form of
2 health care services in this State under this Article.
3     The Illinois Department may require that all dispensers of
4 medical services desiring to participate in the medical
5 assistance program established under this Article disclose,
6 under such terms and conditions as the Illinois Department may
7 by rule establish, all inquiries from clients and attorneys
8 regarding medical bills paid by the Illinois Department, which
9 inquiries could indicate potential existence of claims or liens
10 for the Illinois Department.
11     Enrollment of a vendor that provides non-emergency medical
12 transportation, defined by the Department by rule, shall be
13 conditional for 180 days. During that time, the Department of
14 Public Aid may terminate the vendor's eligibility to
15 participate in the medical assistance program without cause.
16 That termination of eligibility is not subject to the
17 Department's hearing process.
18     The Illinois Department shall establish policies,
19 procedures, standards and criteria by rule for the acquisition,
20 repair and replacement of orthotic and prosthetic devices and
21 durable medical equipment. Such rules shall provide, but not be
22 limited to, the following services: (1) immediate repair or
23 replacement of such devices by recipients without medical
24 authorization; and (2) rental, lease, purchase or
25 lease-purchase of durable medical equipment in a
26 cost-effective manner, taking into consideration the
27 recipient's medical prognosis, the extent of the recipient's
28 needs, and the requirements and costs for maintaining such
29 equipment. Such rules shall enable a recipient to temporarily
30 acquire and use alternative or substitute devices or equipment
31 pending repairs or replacements of any device or equipment
32 previously authorized for such recipient by the Department.
33 Rules under clause (2) above shall not provide for purchase or
34 lease-purchase of durable medical equipment or supplies used
35 for the purpose of oxygen delivery and respiratory care.
36     The Department shall execute, relative to the nursing home

 

 

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1 prescreening project, written inter-agency agreements with the
2 Department of Human Services and the Department on Aging, to
3 effect the following: (i) intake procedures and common
4 eligibility criteria for those persons who are receiving
5 non-institutional services; and (ii) the establishment and
6 development of non-institutional services in areas of the State
7 where they are not currently available or are undeveloped.
8     The Illinois Department shall develop and operate, in
9 cooperation with other State Departments and agencies and in
10 compliance with applicable federal laws and regulations,
11 appropriate and effective systems of health care evaluation and
12 programs for monitoring of utilization of health care services
13 and facilities, as it affects persons eligible for medical
14 assistance under this Code.
15     The Illinois Department shall report annually to the
16 General Assembly, no later than the second Friday in April of
17 1979 and each year thereafter, in regard to:
18         (a) actual statistics and trends in utilization of
19     medical services by public aid recipients;
20         (b) actual statistics and trends in the provision of
21     the various medical services by medical vendors;
22         (c) current rate structures and proposed changes in
23     those rate structures for the various medical vendors; and
24         (d) efforts at utilization review and control by the
25     Illinois Department.
26     The period covered by each report shall be the 3 years
27 ending on the June 30 prior to the report. The report shall
28 include suggested legislation for consideration by the General
29 Assembly. The filing of one copy of the report with the
30 Speaker, one copy with the Minority Leader and one copy with
31 the Clerk of the House of Representatives, one copy with the
32 President, one copy with the Minority Leader and one copy with
33 the Secretary of the Senate, one copy with the Legislative
34 Research Unit, and such additional copies with the State
35 Government Report Distribution Center for the General Assembly
36 as is required under paragraph (t) of Section 7 of the State

 

 

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1 Library Act shall be deemed sufficient to comply with this
2 Section.
3 (Source: P.A. 92-16, eff. 6-28-01; 92-651, eff. 7-11-02;
4 92-789, eff. 8-6-02; 93-632, eff. 2-1-04.)
 
5     (305 ILCS 5/5-16.7a new)
6     Sec. 5-16.7a. Reimbursement for epidural anesthesia
7 services. In addition to other procedures authorized by the
8 Department under this Code, the Department shall provide
9 reimbursement to medical providers for epidural anesthesia
10 services when ordered by the attending practitioner at the time
11 of delivery.
 
12     Section 99. Effective date. This Act takes effect upon
13 becoming law.