Rep. Elizabeth Hernandez

Filed: 5/30/2008

 

 


 

 


 
09500SB2348ham004 LRB095 15983 DRJ 51766 a

1
AMENDMENT TO SENATE BILL 2348

2     AMENDMENT NO. ______. Amend Senate Bill 2348 by replacing
3 everything after the enacting clause with the following:
 
 
4     "Section 5. The Illinois Public Aid Code is amended by
5 changing Sections 5-2 and 5-5 as follows:
 
6     (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
7     Sec. 5-2. Classes of Persons Eligible. Medical assistance
8 under this Article shall be available to any of the following
9 classes of persons in respect to whom a plan for coverage has
10 been submitted to the Governor by the Illinois Department and
11 approved by him:
12         1. Recipients of basic maintenance grants under
13     Articles III and IV.
14         2. Persons otherwise eligible for basic maintenance
15     under Articles III and IV but who fail to qualify

 

 

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1     thereunder on the basis of need, and who have insufficient
2     income and resources to meet the costs of necessary medical
3     care, including but not limited to the following:
4             (a) All persons otherwise eligible for basic
5         maintenance under Article III but who fail to qualify
6         under that Article on the basis of need and who meet
7         either of the following requirements:
8                 (i) their income, as determined by the
9             Illinois Department in accordance with any federal
10             requirements, is equal to or less than 70% in
11             fiscal year 2001, equal to or less than 85% in
12             fiscal year 2002 and until a date to be determined
13             by the Department by rule, and equal to or less
14             than 100% beginning on the date determined by the
15             Department by rule, of the nonfarm income official
16             poverty line, as defined by the federal Office of
17             Management and Budget and revised annually in
18             accordance with Section 673(2) of the Omnibus
19             Budget Reconciliation Act of 1981, applicable to
20             families of the same size; or
21                 (ii) their income, after the deduction of
22             costs incurred for medical care and for other types
23             of remedial care, is equal to or less than 70% in
24             fiscal year 2001, equal to or less than 85% in
25             fiscal year 2002 and until a date to be determined
26             by the Department by rule, and equal to or less

 

 

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1             than 100% beginning on the date determined by the
2             Department by rule, of the nonfarm income official
3             poverty line, as defined in item (i) of this
4             subparagraph (a).
5             (b) All persons who would be determined eligible
6         for such basic maintenance under Article IV by
7         disregarding the maximum earned income permitted by
8         federal law.
9         3. Persons who would otherwise qualify for Aid to the
10     Medically Indigent under Article VII.
11         4. Persons not eligible under any of the preceding
12     paragraphs who fall sick, are injured, or die, not having
13     sufficient money, property or other resources to meet the
14     costs of necessary medical care or funeral and burial
15     expenses.
16         5.(a) Women during pregnancy, after the fact of
17     pregnancy has been determined by medical diagnosis, and
18     during the 60-day period beginning on the last day of the
19     pregnancy, together with their infants and children born
20     after September 30, 1983, whose income and resources are
21     insufficient to meet the costs of necessary medical care to
22     the maximum extent possible under Title XIX of the Federal
23     Social Security Act.
24         (b) The Illinois Department and the Governor shall
25     provide a plan for coverage of the persons eligible under
26     paragraph 5(a) by April 1, 1990. Such plan shall provide

 

 

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1     ambulatory prenatal care to pregnant women during a
2     presumptive eligibility period and establish an income
3     eligibility standard that is equal to 133% of the nonfarm
4     income official poverty line, as defined by the federal
5     Office of Management and Budget and revised annually in
6     accordance with Section 673(2) of the Omnibus Budget
7     Reconciliation Act of 1981, applicable to families of the
8     same size, provided that costs incurred for medical care
9     are not taken into account in determining such income
10     eligibility.
11         (c) The Illinois Department may conduct a
12     demonstration in at least one county that will provide
13     medical assistance to pregnant women, together with their
14     infants and children up to one year of age, where the
15     income eligibility standard is set up to 185% of the
16     nonfarm income official poverty line, as defined by the
17     federal Office of Management and Budget. The Illinois
18     Department shall seek and obtain necessary authorization
19     provided under federal law to implement such a
20     demonstration. Such demonstration may establish resource
21     standards that are not more restrictive than those
22     established under Article IV of this Code.
23         6. Persons under the age of 18 who fail to qualify as
24     dependent under Article IV and who have insufficient income
25     and resources to meet the costs of necessary medical care
26     to the maximum extent permitted under Title XIX of the

 

 

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1     Federal Social Security Act.
2         7. Persons who are under 21 years of age and would
3     qualify as disabled as defined under the Federal
4     Supplemental Security Income Program, provided medical
5     service for such persons would be eligible for Federal
6     Financial Participation, and provided the Illinois
7     Department determines that:
8             (a) the person requires a level of care provided by
9         a hospital, skilled nursing facility, or intermediate
10         care facility, as determined by a physician licensed to
11         practice medicine in all its branches;
12             (b) it is appropriate to provide such care outside
13         of an institution, as determined by a physician
14         licensed to practice medicine in all its branches;
15             (c) the estimated amount which would be expended
16         for care outside the institution is not greater than
17         the estimated amount which would be expended in an
18         institution.
19         8. Persons who become ineligible for basic maintenance
20     assistance under Article IV of this Code in programs
21     administered by the Illinois Department due to employment
22     earnings and persons in assistance units comprised of
23     adults and children who become ineligible for basic
24     maintenance assistance under Article VI of this Code due to
25     employment earnings. The plan for coverage for this class
26     of persons shall:

 

 

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1             (a) extend the medical assistance coverage for up
2         to 12 months following termination of basic
3         maintenance assistance; and
4             (b) offer persons who have initially received 6
5         months of the coverage provided in paragraph (a) above,
6         the option of receiving an additional 6 months of
7         coverage, subject to the following:
8                 (i) such coverage shall be pursuant to
9             provisions of the federal Social Security Act;
10                 (ii) such coverage shall include all services
11             covered while the person was eligible for basic
12             maintenance assistance;
13                 (iii) no premium shall be charged for such
14             coverage; and
15                 (iv) such coverage shall be suspended in the
16             event of a person's failure without good cause to
17             file in a timely fashion reports required for this
18             coverage under the Social Security Act and
19             coverage shall be reinstated upon the filing of
20             such reports if the person remains otherwise
21             eligible.
22         9. Persons with acquired immunodeficiency syndrome
23     (AIDS) or with AIDS-related conditions with respect to whom
24     there has been a determination that but for home or
25     community-based services such individuals would require
26     the level of care provided in an inpatient hospital,

 

 

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1     skilled nursing facility or intermediate care facility the
2     cost of which is reimbursed under this Article. Assistance
3     shall be provided to such persons to the maximum extent
4     permitted under Title XIX of the Federal Social Security
5     Act.
6         10. Participants in the long-term care insurance
7     partnership program established under the Illinois
8     Long-Term Care Partnership Program Act Partnership for
9     Long-Term Care Act who meet the qualifications for
10     protection of resources described in Section 15 25 of that
11     Act.
12         11. Persons with disabilities who are employed and
13     eligible for Medicaid, pursuant to Section
14     1902(a)(10)(A)(ii)(xv) of the Social Security Act, as
15     provided by the Illinois Department by rule. In
16     establishing eligibility standards under this paragraph
17     11, the Department shall, subject to federal approval:
18             (a) set the income eligibility standard at not
19         lower than 350% of the federal poverty level;
20             (b) exempt retirement accounts that the person
21         cannot access without penalty before the age of 59 1/2,
22         and medical savings accounts established pursuant to
23         26 U.S.C. 220;
24             (c) allow non-exempt assets up to $25,000 as to
25         those assets accumulated during periods of eligibility
26         under this paragraph 11; and

 

 

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1             (d) continue to apply subparagraphs (b) and (c) in
2         determining the eligibility of the person under this
3         Article even if the person loses eligibility under this
4         paragraph 11.
5         12. Subject to federal approval, persons who are
6     eligible for medical assistance coverage under applicable
7     provisions of the federal Social Security Act and the
8     federal Breast and Cervical Cancer Prevention and
9     Treatment Act of 2000. Those eligible persons are defined
10     to include, but not be limited to, the following persons:
11             (1) persons who have been screened for breast or
12         cervical cancer under the U.S. Centers for Disease
13         Control and Prevention Breast and Cervical Cancer
14         Program established under Title XV of the federal
15         Public Health Services Act in accordance with the
16         requirements of Section 1504 of that Act as
17         administered by the Illinois Department of Public
18         Health; and
19             (2) persons whose screenings under the above
20         program were funded in whole or in part by funds
21         appropriated to the Illinois Department of Public
22         Health for breast or cervical cancer screening.
23         "Medical assistance" under this paragraph 12 shall be
24     identical to the benefits provided under the State's
25     approved plan under Title XIX of the Social Security Act.
26     The Department must request federal approval of the

 

 

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1     coverage under this paragraph 12 within 30 days after the
2     effective date of this amendatory Act of the 92nd General
3     Assembly.
4         13. Subject to appropriation and to federal approval,
5     persons living with HIV/AIDS who are not otherwise eligible
6     under this Article and who qualify for services covered
7     under Section 5-5.04 as provided by the Illinois Department
8     by rule.
9         14. Subject to the availability of funds for this
10     purpose, the Department may provide coverage under this
11     Article to persons who reside in Illinois who are not
12     eligible under any of the preceding paragraphs and who meet
13     the income guidelines of paragraph 2(a) of this Section and
14     (i) have an application for asylum pending before the
15     federal Department of Homeland Security or on appeal before
16     a court of competent jurisdiction and are represented
17     either by counsel or by an advocate accredited by the
18     federal Department of Homeland Security and employed by a
19     not-for-profit organization in regard to that application
20     or appeal, or (ii) are receiving services through a
21     federally funded torture treatment center. Medical
22     coverage under this paragraph 14 may be provided for up to
23     24 continuous months from the initial eligibility date so
24     long as an individual continues to satisfy the criteria of
25     this paragraph 14. If an individual has an appeal pending
26     regarding an application for asylum before the Department

 

 

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1     of Homeland Security, eligibility under this paragraph 14
2     may be extended until a final decision is rendered on the
3     appeal. The Department may adopt rules governing the
4     implementation of this paragraph 14.
5         15. Subject to federal approval, persons with
6     medically improved disability who are employed or eligible
7     for Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi)
8     of the Social Security Act that meet applicable eligibility
9     standards established in paragraph 11. The Department may
10     not otherwise adopt any rule to implement this paragraph.
11     The Illinois Department and the Governor shall provide a
12 plan for coverage of the persons eligible under paragraph 7 as
13 soon as possible after July 1, 1984.
14     The eligibility of any such person for medical assistance
15 under this Article is not affected by the payment of any grant
16 under the Senior Citizens and Disabled Persons Property Tax
17 Relief and Pharmaceutical Assistance Act or any distributions
18 or items of income described under subparagraph (X) of
19 paragraph (2) of subsection (a) of Section 203 of the Illinois
20 Income Tax Act. The Department shall by rule establish the
21 amounts of assets to be disregarded in determining eligibility
22 for medical assistance, which shall at a minimum equal the
23 amounts to be disregarded under the Federal Supplemental
24 Security Income Program. The amount of assets of a single
25 person to be disregarded shall not be less than $2,000, and the
26 amount of assets of a married couple to be disregarded shall

 

 

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1 not be less than $3,000.
2     To the extent permitted under federal law, any person found
3 guilty of a second violation of Article VIIIA shall be
4 ineligible for medical assistance under this Article, as
5 provided in Section 8A-8.
6     The eligibility of any person for medical assistance under
7 this Article shall not be affected by the receipt by the person
8 of donations or benefits from fundraisers held for the person
9 in cases of serious illness, as long as neither the person nor
10 members of the person's family have actual control over the
11 donations or benefits or the disbursement of the donations or
12 benefits.
13 (Source: P.A. 94-629, eff. 1-1-06; 94-1043, eff. 7-24-06;
14 95-546, eff. 8-29-07; revised 1-22-08.)
 
15     (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
16     Sec. 5-5. Medical services. The Illinois Department, by
17 rule, shall determine the quantity and quality of and the rate
18 of reimbursement for the medical assistance for which payment
19 will be authorized, and the medical services to be provided,
20 which may include all or part of the following: (1) inpatient
21 hospital services; (2) outpatient hospital services; (3) other
22 laboratory and X-ray services; (4) skilled nursing home
23 services; (5) physicians' services whether furnished in the
24 office, the patient's home, a hospital, a skilled nursing home,
25 or elsewhere; (6) medical care, or any other type of remedial

 

 

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1 care furnished by licensed practitioners; (7) home health care
2 services; (8) private duty nursing service; (9) clinic
3 services; (10) dental services, including prevention and
4 treatment of periodontal disease and dental caries disease for
5 pregnant women; (11) physical therapy and related services;
6 (12) prescribed drugs, dentures, and prosthetic devices; and
7 eyeglasses prescribed by a physician skilled in the diseases of
8 the eye, or by an optometrist, whichever the person may select;
9 (13) other diagnostic, screening, preventive, and
10 rehabilitative services; (14) transportation and such other
11 expenses as may be necessary; (15) medical treatment of sexual
12 assault survivors, as defined in Section 1a of the Sexual
13 Assault Survivors Emergency Treatment Act, for injuries
14 sustained as a result of the sexual assault, including
15 examinations and laboratory tests to discover evidence which
16 may be used in criminal proceedings arising from the sexual
17 assault; (16) the diagnosis and treatment of sickle cell
18 anemia; and (17) any other medical care, and any other type of
19 remedial care recognized under the laws of this State, but not
20 including abortions, or induced miscarriages or premature
21 births, unless, in the opinion of a physician, such procedures
22 are necessary for the preservation of the life of the woman
23 seeking such treatment, or except an induced premature birth
24 intended to produce a live viable child and such procedure is
25 necessary for the health of the mother or her unborn child. The
26 Illinois Department, by rule, shall prohibit any physician from

 

 

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1 providing medical assistance to anyone eligible therefor under
2 this Code where such physician has been found guilty of
3 performing an abortion procedure in a wilful and wanton manner
4 upon a woman who was not pregnant at the time such abortion
5 procedure was performed. The term "any other type of remedial
6 care" shall include nursing care and nursing home service for
7 persons who rely on treatment by spiritual means alone through
8 prayer for healing.
9     Notwithstanding any other provision of this Section, a
10 comprehensive tobacco use cessation program that includes
11 purchasing prescription drugs or prescription medical devices
12 approved by the Food and Drug administration shall be covered
13 under the medical assistance program under this Article for
14 persons who are otherwise eligible for assistance under this
15 Article.
16     Notwithstanding any other provision of this Code, the
17 Illinois Department may not require, as a condition of payment
18 for any laboratory test authorized under this Article, that a
19 physician's handwritten signature appear on the laboratory
20 test order form. The Illinois Department may, however, impose
21 other appropriate requirements regarding laboratory test order
22 documentation.
23     The Department of Healthcare and Family Services shall
24 provide the following services to persons eligible for
25 assistance under this Article who are participating in
26 education, training or employment programs operated by the

 

 

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1 Department of Human Services as successor to the Department of
2 Public Aid:
3         (1) dental services, which shall include but not be
4     limited to prosthodontics; and
5         (2) eyeglasses prescribed by a physician skilled in the
6     diseases of the eye, or by an optometrist, whichever the
7     person may select.
8     The Illinois Department, by rule, may distinguish and
9 classify the medical services to be provided only in accordance
10 with the classes of persons designated in Section 5-2.
11     The Department of Healthcare and Family Services must
12 provide coverage and reimbursement for amino acid-based
13 elemental formulas, regardless of delivery method, for the
14 diagnosis and treatment of (i) eosinophilic disorders and (ii)
15 short bowel syndrome when the prescribing physician has issued
16 a written order stating that the amino acid-based elemental
17 formula is medically necessary.
18     The Illinois Department shall authorize the provision of,
19 and shall authorize payment for, screening by low-dose
20 mammography for the presence of occult breast cancer for women
21 35 years of age or older who are eligible for medical
22 assistance under this Article, as follows: a baseline mammogram
23 for women 35 to 39 years of age and an annual mammogram for
24 women 40 years of age or older. All screenings shall include a
25 physical breast exam, instruction on self-examination and
26 information regarding the frequency of self-examination and

 

 

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1 its value as a preventative tool. As used in this Section,
2 "low-dose mammography" means the x-ray examination of the
3 breast using equipment dedicated specifically for mammography,
4 including the x-ray tube, filter, compression device, image
5 receptor, and cassettes, with an average radiation exposure
6 delivery of less than one rad mid-breast, with 2 views for each
7 breast.
8     Any medical or health care provider shall immediately
9 recommend, to any pregnant woman who is being provided prenatal
10 services and is suspected of drug abuse or is addicted as
11 defined in the Alcoholism and Other Drug Abuse and Dependency
12 Act, referral to a local substance abuse treatment provider
13 licensed by the Department of Human Services or to a licensed
14 hospital which provides substance abuse treatment services.
15 The Department of Healthcare and Family Services shall assure
16 coverage for the cost of treatment of the drug abuse or
17 addiction for pregnant recipients in accordance with the
18 Illinois Medicaid Program in conjunction with the Department of
19 Human Services.
20     All medical providers providing medical assistance to
21 pregnant women under this Code shall receive information from
22 the Department on the availability of services under the Drug
23 Free Families with a Future or any comparable program providing
24 case management services for addicted women, including
25 information on appropriate referrals for other social services
26 that may be needed by addicted women in addition to treatment

 

 

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

 

 

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1 under Article 24 of the Illinois Pension Code. A medical or
2 health care provider who elects to participate in that Plan
3 shall, for purposes of that participation, be deemed an
4 "employee" as defined in Section 24-102 of the Illinois Pension
5 Code. A medical or health care provider who elects to
6 participate in the Plan does not have a cause of action against
7 the State for any damages allegedly suffered by the provider as
8 a result of any delay by the State in crediting the amount of
9 any contribution to the provider's Plan account.
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

 

 

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1 in target areas according to provisions of this Article and the
2 Illinois Health Finance Reform Act, except that:
3         (1) Physicians participating in a Partnership and
4     providing certain services, which shall be determined by
5     the Illinois Department, to persons in areas covered by the
6     Partnership may receive an additional surcharge for such
7     services.
8         (2) The Department may elect to consider and negotiate
9     financial incentives to encourage the development of
10     Partnerships and the efficient delivery of medical care.
11         (3) Persons receiving medical services through
12     Partnerships may receive medical and case management
13     services above the level usually offered through the
14     medical assistance program.
15     Medical providers shall be required to meet certain
16 qualifications to participate in Partnerships to ensure the
17 delivery of high quality medical services. These
18 qualifications shall be determined by rule of the Illinois
19 Department and may be higher than qualifications for
20 participation in the medical assistance program. Partnership
21 sponsors may prescribe reasonable additional qualifications
22 for participation by medical providers, only with the prior
23 written approval of the Illinois Department.
24     Nothing in this Section shall limit the free choice of
25 practitioners, hospitals, and other providers of medical
26 services by clients. In order to ensure patient freedom of

 

 

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1 choice, the Illinois Department shall immediately promulgate
2 all rules and take all other necessary actions so that provided
3 services may be accessed from therapeutically certified
4 optometrists to the full extent of the Illinois Optometric
5 Practice Act of 1987 without discriminating between service
6 providers.
7     The Department shall apply for a waiver from the United
8 States Health Care Financing Administration to allow for the
9 implementation of Partnerships under this Section.
10     The Illinois Department shall require health care
11 providers to maintain records that document the medical care
12 and services provided to recipients of Medical Assistance under
13 this Article. The Illinois Department shall require health care
14 providers to make available, when authorized by the patient, in
15 writing, the medical records in a timely fashion to other
16 health care providers who are treating or serving persons
17 eligible for Medical Assistance under this Article. All
18 dispensers of medical services shall be required to maintain
19 and retain business and professional records sufficient to
20 fully and accurately document the nature, scope, details and
21 receipt of the health care provided to persons eligible for
22 medical assistance under this Code, in accordance with
23 regulations promulgated by the Illinois Department. The rules
24 and regulations shall require that proof of the receipt of
25 prescription drugs, dentures, prosthetic devices and
26 eyeglasses by eligible persons under this Section accompany

 

 

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

 

 

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1 Assistance program established under this Article to disclose
2 all financial, beneficial, ownership, equity, surety or other
3 interests in any and all firms, corporations, partnerships,
4 associations, business enterprises, joint ventures, agencies,
5 institutions or other legal entities providing any form of
6 health care services in this State under this Article.
7     The Illinois Department may require that all dispensers of
8 medical services desiring to participate in the medical
9 assistance program established under this Article disclose,
10 under such terms and conditions as the Illinois Department may
11 by rule establish, all inquiries from clients and attorneys
12 regarding medical bills paid by the Illinois Department, which
13 inquiries could indicate potential existence of claims or liens
14 for the Illinois Department.
15     Enrollment of a vendor that provides non-emergency medical
16 transportation, defined by the Department by rule, shall be
17 conditional for 180 days. During that time, the Department of
18 Healthcare and Family Services may terminate the vendor's
19 eligibility to participate in the medical assistance program
20 without cause. That termination of eligibility is not subject
21 to the Department's hearing process.
22     The Illinois Department shall establish policies,
23 procedures, standards and criteria by rule for the acquisition,
24 repair and replacement of orthotic and prosthetic devices and
25 durable medical equipment. Such rules shall provide, but not be
26 limited to, the following services: (1) immediate repair or

 

 

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1 replacement of such devices by recipients without medical
2 authorization; and (2) rental, lease, purchase or
3 lease-purchase of durable medical equipment in a
4 cost-effective manner, taking into consideration the
5 recipient's medical prognosis, the extent of the recipient's
6 needs, and the requirements and costs for maintaining such
7 equipment. Such rules shall enable a recipient to temporarily
8 acquire and use alternative or substitute devices or equipment
9 pending repairs or replacements of any device or equipment
10 previously authorized for such recipient by the Department.
11     The Department shall execute, relative to the nursing home
12 prescreening project, written inter-agency agreements with the
13 Department of Human Services and the Department on Aging, to
14 effect the following: (i) intake procedures and common
15 eligibility criteria for those persons who are receiving
16 non-institutional services; and (ii) the establishment and
17 development of non-institutional services in areas of the State
18 where they are not currently available or are undeveloped.
19     The Illinois Department shall develop and operate, in
20 cooperation with other State Departments and agencies and in
21 compliance with applicable federal laws and regulations,
22 appropriate and effective systems of health care evaluation and
23 programs for monitoring of utilization of health care services
24 and facilities, as it affects persons eligible for medical
25 assistance under this Code.
26     The Illinois Department shall report annually to the

 

 

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1 General Assembly, no later than the second Friday in April of
2 1979 and each year thereafter, in regard to:
3         (a) actual statistics and trends in utilization of
4     medical services by public aid recipients;
5         (b) actual statistics and trends in the provision of
6     the various medical services by medical vendors;
7         (c) current rate structures and proposed changes in
8     those rate structures for the various medical vendors; and
9         (d) efforts at utilization review and control by the
10     Illinois Department.
11     The period covered by each report shall be the 3 years
12 ending on the June 30 prior to the report. The report shall
13 include suggested legislation for consideration by the General
14 Assembly. The filing of one copy of the report with the
15 Speaker, one copy with the Minority Leader and one copy with
16 the Clerk of the House of Representatives, one copy with the
17 President, one copy with the Minority Leader and one copy with
18 the Secretary of the Senate, one copy with the Legislative
19 Research Unit, and such additional copies with the State
20 Government Report Distribution Center for the General Assembly
21 as is required under paragraph (t) of Section 7 of the State
22 Library Act shall be deemed sufficient to comply with this
23 Section.
24 (Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07.)".