97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB3547

 

Introduced 2/24/2011, by Rep. Mary E. Flowers

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/8A-3.5a new

    Amends the Public Assistance Fraud Article of the Illinois Public Aid Code. Provides that providers and suppliers of healthcare services under the State's medical assistance program shall be screened by the Department of Healthcare and Family Services prior to being accepted by the State as service providers. Contains provisions concerning screening measures; payment audits; and mandatory compliance plans.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5adding Section 8A-3.5a as follows:
 
6    (305 ILCS 5/8A-3.5a new)
7    Sec. 8A-3.5a. Medical assistance abuse and waste;
8screening measures for providers and suppliers.
9    (a) Providers and suppliers of healthcare services under
10the State's medical assistance program shall be screened by the
11Department of Healthcare and Family Services prior to being
12accepted by the State as service providers. Screening measures,
13the cost of which may be covered by charging application fees,
14shall include, but not be limited to:
15        (1) Application of accreditation standards.
16        (2) Proof of business integrity.
17        (3) Full disclosure of ownership and business
18    interests.
19        (4) An initial provisional period with enhanced
20    oversight.
21        (5) Onsite verification.
22        (6) Periodic recertification.
23    (b) Medical assistance payments to providers and suppliers

 

 

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1of healthcare services under the medical assistance program
2shall be reviewed and audited at regular intervals to ensure
3that payments are linked to changes in the marketplace, medical
4practice, and medical technology to avoid wasteful
5overspending and ensure appropriate payments for the items and
6services covered. The appropriate oversight agencies for the
7State shall utilize information technology, including
8databases that are coordinated with other relevant databases,
9and claims-processing mechanisms that are effective in
10detecting improper claims before they are paid.
11    (c) Each provider and supplier of healthcare services under
12the medical assistance program shall file a mandatory written
13compliance plan as a condition of participation in the program.
14The compliance plan shall list and describe in writing the
15policies and procedures that will be implemented to ensure
16compliance with federal and State regulations and other
17requirements designed to control fraud, waste, and abuse,
18including procedures to protect the anonymity of complainants
19and to protect whistleblowers from retaliation. Each provider
20and supplier of healthcare services under the medical
21assistance program shall designate a compliance officer and a
22compliance committee to monitor the compliance plan, and shall
23establish a mechanism, such as an anonymous and confidential
24hotline, to receive, record, and respond to compliance
25questions.
26    (d) Each provider and supplier of healthcare services under

 

 

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1the medical assistance program, and the appropriate oversight
2agencies of the State, shall respond swiftly to detected
3frauds, promptly remedy program vulnerabilities, and impose
4sufficient punishment to deter fraud by medical assistance
5providers and suppliers.