98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB1208

 

Introduced , by Rep. Mary E. Flowers

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5f

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Exempts pregnant women, persons who are classified as mentally or developmentally disabled, persons who are aged, blind, or disabled, and persons who are being treated at a dental school as part of the clinical education process for dental students from a provision limiting adult dental services to emergencies. Effective immediately.


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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
5changing Section 5-5f as follows:
 
6    (305 ILCS 5/5-5f)
7    Sec. 5-5f. Elimination and limitations of medical
8assistance services. Notwithstanding any other provision of
9this Code to the contrary, on and after July 1, 2012:
10    (a) The following services shall no longer be a covered
11service available under this Code: group psychotherapy for
12residents of any facility licensed under the Nursing Home Care
13Act or the Specialized Mental Health Rehabilitation Act; and
14adult chiropractic services.
15    (b) The Department shall place the following limitations on
16services: (i) the Department shall limit adult eyeglasses to
17one pair every 2 years; (ii) the Department shall set an annual
18limit of a maximum of 20 visits for each of the following
19services: adult speech, hearing, and language therapy
20services, adult occupational therapy services, and physical
21therapy services; (iii) the Department shall limit podiatry
22services to individuals with diabetes; (iv) the Department
23shall pay for caesarean sections at the normal vaginal delivery

 

 

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1rate unless a caesarean section was medically necessary; (v)
2the Department shall limit adult dental services to
3emergencies, except that this limitation shall not apply to
4pregnant women, persons who are classified as mentally or
5developmentally disabled, persons who are aged, blind, or
6disabled, or persons who are being treated at a dental school
7as part of the clinical education process for dental students;
8and (vi) effective July 1, 2012, the Department shall place
9limitations and require concurrent review on every inpatient
10detoxification stay to prevent repeat admissions to any
11hospital for detoxification within 60 days of a previous
12inpatient detoxification stay. The Department shall convene a
13workgroup of hospitals, substance abuse providers, care
14coordination entities, managed care plans, and other
15stakeholders to develop recommendations for quality standards,
16diversion to other settings, and admission criteria for
17patients who need inpatient detoxification.
18    (c) The Department shall require prior approval of the
19following services: wheelchair repairs, regardless of the cost
20of the repairs, coronary artery bypass graft, and bariatric
21surgery consistent with Medicare standards concerning patient
22responsibility. The wholesale cost of power wheelchairs shall
23be actual acquisition cost including all discounts.
24    (d) The Department shall establish benchmarks for
25hospitals to measure and align payments to reduce potentially
26preventable hospital readmissions, inpatient complications,

 

 

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1and unnecessary emergency room visits. In doing so, the
2Department shall consider items, including, but not limited to,
3historic and current acuity of care and historic and current
4trends in readmission. The Department shall publish
5provider-specific historical readmission data and anticipated
6potentially preventable targets 60 days prior to the start of
7the program. In the instance of readmissions, the Department
8shall adopt policies and rates of reimbursement for services
9and other payments provided under this Code to ensure that, by
10June 30, 2013, expenditures to hospitals are reduced by, at a
11minimum, $40,000,000.
12    (e) The Department shall establish utilization controls
13for the hospice program such that it shall not pay for other
14care services when an individual is in hospice.
15    (f) For home health services, the Department shall require
16Medicare certification of providers participating in the
17program, implement the Medicare face-to-face encounter rule,
18and limit services to post-hospitalization. The Department
19shall require providers to implement auditable electronic
20service verification based on global positioning systems or
21other cost-effective technology.
22    (g) For the Home Services Program operated by the
23Department of Human Services and the Community Care Program
24operated by the Department on Aging, the Department of Human
25Services, in cooperation with the Department on Aging, shall
26implement an electronic service verification based on global

 

 

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1positioning systems or other cost-effective technology.
2    (h) The Department shall not pay for hospital admissions
3when the claim indicates a hospital acquired condition that
4would cause Medicare to reduce its payment on the claim had the
5claim been submitted to Medicare, nor shall the Department pay
6for hospital admissions where a Medicare identified "never
7event" occurred.
8    (i) The Department shall implement cost savings
9initiatives for advanced imaging services, cardiac imaging
10services, pain management services, and back surgery. Such
11initiatives shall be designed to achieve annual costs savings.
12(Source: P.A. 97-689, eff. 6-14-12.)
 
13    Section 99. Effective date. This Act takes effect upon
14becoming law.