Rep. Lou Lang

Filed: 10/26/2011





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2    AMENDMENT NO. ______. Amend Senate Bill 769, AS AMENDED, by
3replacing everything after the enacting clause with the
5    "Section 5. The Illinois Public Aid Code is amended by
6changing Section 5-4.2 as follows:
7    (305 ILCS 5/5-4.2)  (from Ch. 23, par. 5-4.2)
8    Sec. 5-4.2. Ambulance services payments.
9    (a) For ambulance services provided to a recipient of aid
10under this Article on or after January 1, 1993, the Illinois
11Department shall reimburse ambulance service providers at
12rates calculated in accordance with this Section. It is the
13intent of the General Assembly to provide adequate
14reimbursement for ambulance services so as to ensure adequate
15access to services for recipients of aid under this Article and
16to provide appropriate incentives to ambulance service



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1providers to provide services in an efficient and
2cost-effective manner. Thus, it is the intent of the General
3Assembly that the Illinois Department implement a
4reimbursement system for ambulance services that, to the extent
5practicable and subject to the availability of funds
6appropriated by the General Assembly for this purpose, is
7consistent with the payment principles of Medicare. To ensure
8uniformity between the payment principles of Medicare and
9Medicaid, the Illinois Department shall follow, to the extent
10necessary and practicable and subject to the availability of
11funds appropriated by the General Assembly for this purpose,
12the statutes, laws, regulations, policies, procedures,
13principles, definitions, guidelines, and manuals used to
14determine the amounts paid to ambulance service providers under
15Title XVIII of the Social Security Act (Medicare).
16    (b) For ambulance services provided to a recipient of aid
17under this Article on or after January 1, 1996, the Illinois
18Department shall reimburse ambulance service providers based
19upon the actual distance traveled if a natural disaster,
20weather conditions, road repairs, or traffic congestion
21necessitates the use of a route other than the most direct
23    (b-1) Beginning with dates of service on or after July 1,
242011, the Department shall by rule establish reimburse rates
25for licensed ground ambulance providers at 90% of the 2011
26Medicare emergency services base mileage rate, excluding any



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1adjustment for rural/urban pickup differences, for loaded
2miles for approved non-emergency services and 50% of the 2011
3Medicare emergency services base mileage rate, excluding any
4adjustment for rural/urban pickup differences, for loaded
5miles for approved emergency services.
6    (c) For purposes of this Section, "ambulance services"
7includes medical transportation services provided by means of
8an ambulance, medi-car, service car, or taxi.
9    (c-1) For purposes of this Section, "ground ambulance
10service" means medical transportation services that are
11described as ground ambulance services by the Centers for
12Medicare and Medicaid Services and provided in a vehicle that
13is licensed as an ambulance by the Illinois Department of
14Public Health pursuant to the Emergency Medical Services (EMS)
15Systems Act.
16    (c-2) For purposes of this Section, "ground ambulance
17service provider" means a vehicle service provider as described
18in the Emergency Medical Services (EMS) Systems Act that
19operates licensed ambulances for the purpose of providing
20emergency ambulance services, or non-emergency ambulance
21services, or both. For purposes of this Section, this includes
22both ambulance providers and ambulance suppliers as described
23by the Centers for Medicare and Medicaid Services.
24    (d) This Section does not prohibit separate billing by
25ambulance service providers for oxygen furnished while
26providing advanced life support services.



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1    (e) Beginning with services rendered on or after July 1,
22008, all providers of non-emergency medi-car and service car
3transportation must certify that the driver and employee
4attendant, as applicable, have completed a safety program
5approved by the Department to protect both the patient and the
6driver, prior to transporting a patient. The provider must
7maintain this certification in its records. The provider shall
8produce such documentation upon demand by the Department or its
9representative. Failure to produce documentation of such
10training shall result in recovery of any payments made by the
11Department for services rendered by a non-certified driver or
12employee attendant. Medi-car and service car providers must
13maintain legible documentation in their records of the driver
14and, as applicable, employee attendant that actually
15transported the patient. Providers must recertify all drivers
16and employee attendants every 3 years.
17    Notwithstanding the requirements above, any public
18transportation provider of medi-car and service car
19transportation that receives federal funding under 49 U.S.C.
205307 and 5311 need not certify its drivers and employee
21attendants under this Section, since safety training is already
22federally mandated.
23    (f) With respect to any policy or program administered by
24the Department or its agent regarding approval of non-emergency
25medical transportation by ground ambulance service providers,
26including, but not limited to, the Non-Emergency



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1Transportation Services Prior Approval Program (NETSPAP), the
2Department shall establish by rule a process by which ground
3ambulance service providers of non-emergency medical
4transportation may appeal any decision by the Department or its
5agent for which no denial was received prior to the time of
6transport that either (i) denies a request for approval for
7payment of non-emergency transportation by means of ground
8ambulance service or (ii) grants a request for approval of
9non-emergency transportation by means of ground ambulance
10service at a level of service that entitles the ground
11ambulance service provider to a lower level of compensation
12from the Department than the ground ambulance service provider
13would have received as compensation for the level of service
14requested. The rule shall be established within 12 months after
15the effective date of this amendatory Act of the 97th General
16Assembly and shall provide that, for any decision rendered by
17the Department or its agent on or after the date the rule takes
18effect, the ground ambulance service provider shall have 60
19days from the date the decision is received to file an appeal.
20The rule established by the Department shall be, insofar as is
21practical, consistent with the Illinois Administrative
22Procedure Act. The Director's decision on an appeal under this
23Section shall be a final administrative decision subject to
24review under the Administrative Review Law.
25(Source: P.A. 97-584, eff. 8-26-11.)



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1    Section 99. Effective date. This Act takes effect upon
2becoming law.".