Illinois General Assembly - Full Text of SB1777
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Full Text of SB1777  101st General Assembly




State of Illinois
2019 and 2020


Introduced 2/15/2019, by Sen. Dan McConchie


New Act
5 ILCS 375/6  from Ch. 127, par. 526
5 ILCS 375/6.1  from Ch. 127, par. 526.1
305 ILCS 5/5-5  from Ch. 23, par. 5-5
305 ILCS 5/6-1  from Ch. 23, par. 6-1
410 ILCS 230/4-100  from Ch. 111 1/2, par. 4604-100

    Creates the No Taxpayer Funding for Abortion Act. Provides that neither the State nor any of its subdivisions may authorize the use of, appropriate, or expend funds to pay for an abortion or to cover any part of the costs of a health plan that includes coverage of abortion or to provide or refer for an abortion, unless a woman who suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death if an abortion is not performed. Amends the State Employees Group Insurance Act of 1971 and the Illinois Public Aid Code. Excludes from the programs of health benefits and services authorized under those Acts coverage for elective abortions as provided in the No Taxpayer Funding for Abortion Act. Amends the Problem Pregnancy Health Services and Care Act. Permits the Department of Human Services to make grants to nonprofit agencies and organizations that do not use those grants to refer or counsel for, or perform, abortions. Contains provisions regarding applicability and preempts home rule. Effective June 1, 2019.

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SB1777LRB101 07357 KTG 56289 b

1    AN ACT concerning abortion.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Short title. This Act may be cited as the No
5Taxpayer Funding for Abortion Act.
6    Section 5. Use of funds to pay for abortions prohibited;
7exceptions. Notwithstanding any other provision of law,
8neither the State nor any of its subdivisions may authorize the
9use of, appropriate, or expend any funds to pay for any
10abortion or to cover any part of the costs of any health plan
11that includes coverage of abortion or to provide or refer for
12any abortion, except in the case where a woman suffers from a
13physical disorder, physical injury, or physical illness that
14would, as certified by a physician, place the woman in danger
15of death unless an abortion is performed, including a
16life-endangering physical condition caused by or arising from
17the pregnancy itself, or in such other circumstances as
18required by federal law.
19    Section 900. The State Employees Group Insurance Act of
201971 is amended by changing Sections 6 and 6.1 as follows:
21    (5 ILCS 375/6)  (from Ch. 127, par. 526)



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1    Sec. 6. Program of health benefits.
2    (a) The program of health benefits shall provide for
3protection against the financial costs of health care expenses
4incurred in and out of hospital including basic
5hospital-surgical-medical coverages. The program may include,
6but shall not be limited to, such supplemental coverages as
7out-patient diagnostic X-ray and laboratory expenses,
8prescription drugs, dental services, hearing evaluations,
9hearing aids, the dispensing and fitting of hearing aids, and
10similar group benefits as are now or may become available,
11except as provided in the No Taxpayer Funding for Abortion Act.
12The program may also include coverage for those who rely on
13treatment by prayer or spiritual means alone for healing in
14accordance with the tenets and practice of a recognized
15religious denomination.
16    The program of health benefits shall be designed by the
17Director (1) to provide a reasonable relationship between the
18benefits to be included and the expected distribution of
19expenses of each such type to be incurred by the covered
20members and dependents, (2) to specify, as covered benefits and
21as optional benefits, the medical services of practitioners in
22all categories licensed under the Medical Practice Act of 1987,
23(3) to include reasonable controls, which may include
24deductible and co-insurance provisions, applicable to some or
25all of the benefits, or a coordination of benefits provision,
26to prevent or minimize unnecessary utilization of the various



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1hospital, surgical and medical expenses to be provided and to
2provide reasonable assurance of stability of the program, and
3(4) to provide benefits to the extent possible to members
4throughout the State, wherever located, on an equitable basis.
5Notwithstanding any other provision of this Section or Act, for
6all members or dependents who are eligible for benefits under
7Social Security or the Railroad Retirement system or who had
8sufficient Medicare-covered government employment, the
9Department shall reduce benefits which would otherwise be paid
10by Medicare, by the amount of benefits for which the member or
11dependents are eligible under Medicare, except that such
12reduction in benefits shall apply only to those members or
13dependents who (1) first become eligible for such medicare
14coverage on or after the effective date of this amendatory Act
15of 1992; or (2) are Medicare-eligible members or dependents of
16a local government unit which began participation in the
17program on or after July 1, 1992; or (3) remain eligible for
18but no longer receive Medicare coverage which they had been
19receiving on or after the effective date of this amendatory Act
20of 1992.
21    Notwithstanding any other provisions of this Act, where a
22covered member or dependents are eligible for benefits under
23the federal Medicare health insurance program (Title XVIII of
24the Social Security Act as added by Public Law 89-97, 89th
25Congress), benefits paid under the State of Illinois program or
26plan will be reduced by the amount of benefits paid by



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1Medicare. For members or dependents who are eligible for
2benefits under Social Security or the Railroad Retirement
3system or who had sufficient Medicare-covered government
4employment, benefits shall be reduced by the amount for which
5the member or dependent is eligible under Medicare, except that
6such reduction in benefits shall apply only to those members or
7dependents who (1) first become eligible for such Medicare
8coverage on or after the effective date of this amendatory Act
9of 1992; or (2) are Medicare-eligible members or dependents of
10a local government unit which began participation in the
11program on or after July 1, 1992; or (3) remain eligible for,
12but no longer receive Medicare coverage which they had been
13receiving on or after the effective date of this amendatory Act
14of 1992. Premiums may be adjusted, where applicable, to an
15amount deemed by the Director to be reasonably consistent with
16any reduction of benefits.
17    (b) A member, not otherwise covered by this Act, who has
18retired as a participating member under Article 2 of the
19Illinois Pension Code but is ineligible for the retirement
20annuity under Section 2-119 of the Illinois Pension Code, shall
21pay the premiums for coverage, not exceeding the amount paid by
22the State for the non-contributory coverage for other members,
23under the group health benefits program under this Act. The
24Director shall determine the premiums to be paid by a member
25under this subsection (b).
26(Source: P.A. 100-538, eff. 1-1-18.)



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1    (5 ILCS 375/6.1)  (from Ch. 127, par. 526.1)
2    Sec. 6.1. The program of health benefits may offer as an
3alternative, available on an optional basis, coverage through
4health maintenance organizations. That part of the premium for
5such coverage which is in excess of the amount which would
6otherwise be paid by the State for the program of health
7benefits shall be paid by the member who elects such
8alternative coverage and shall be collected as provided for
9premiums for other optional coverages, except as provided in
10the No Taxpayer Funding for Abortion Act.
11(Source: P.A. 100-538, eff. 1-1-18.)
12    Section 905. The Illinois Public Aid Code is amended by
13changing Sections 5-5 and 6-1 as follows:
14    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
15    Sec. 5-5. Medical services. The Illinois Department, by
16rule, shall determine the quantity and quality of and the rate
17of reimbursement for the medical assistance for which payment
18will be authorized, and the medical services to be provided,
19which may include all or part of the following: (1) inpatient
20hospital services; (2) outpatient hospital services; (3) other
21laboratory and X-ray services; (4) skilled nursing home
22services; (5) physicians' services whether furnished in the
23office, the patient's home, a hospital, a skilled nursing home,



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1or elsewhere; (6) medical care, or any other type of remedial
2care furnished by licensed practitioners; (7) home health care
3services; (8) private duty nursing service; (9) clinic
4services; (10) dental services, including prevention and
5treatment of periodontal disease and dental caries disease for
6pregnant women, provided by an individual licensed to practice
7dentistry or dental surgery; for purposes of this item (10),
8"dental services" means diagnostic, preventive, or corrective
9procedures provided by or under the supervision of a dentist in
10the practice of his or her profession; (11) physical therapy
11and related services; (12) prescribed drugs, dentures, and
12prosthetic devices; and eyeglasses prescribed by a physician
13skilled in the diseases of the eye, or by an optometrist,
14whichever the person may select; (13) other diagnostic,
15screening, preventive, and rehabilitative services, including
16to ensure that the individual's need for intervention or
17treatment of mental disorders or substance use disorders or
18co-occurring mental health and substance use disorders is
19determined using a uniform screening, assessment, and
20evaluation process inclusive of criteria, for children and
21adults; for purposes of this item (13), a uniform screening,
22assessment, and evaluation process refers to a process that
23includes an appropriate evaluation and, as warranted, a
24referral; "uniform" does not mean the use of a singular
25instrument, tool, or process that all must utilize; (14)
26transportation and such other expenses as may be necessary;



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1(15) medical treatment of sexual assault survivors, as defined
2in Section 1a of the Sexual Assault Survivors Emergency
3Treatment Act, for injuries sustained as a result of the sexual
4assault, including examinations and laboratory tests to
5discover evidence which may be used in criminal proceedings
6arising from the sexual assault; (16) the diagnosis and
7treatment of sickle cell anemia; and (17) any other medical
8care, and any other type of remedial care recognized under the
9laws of this State, except as provided in the No Taxpayer
10Funding for Abortion Act. The term "any other type of remedial
11care" shall include nursing care and nursing home service for
12persons who rely on treatment by spiritual means alone through
13prayer for healing.
14    Notwithstanding any other provision of this Section, a
15comprehensive tobacco use cessation program that includes
16purchasing prescription drugs or prescription medical devices
17approved by the Food and Drug Administration shall be covered
18under the medical assistance program under this Article for
19persons who are otherwise eligible for assistance under this
21    Notwithstanding any other provision of this Code,
22reproductive health care that is otherwise legal in Illinois
23shall be covered under the medical assistance program for
24persons who are otherwise eligible for medical assistance under
25this Article, except as provided in the No Taxpayer Funding for
26Abortion Act.



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1    Notwithstanding any other provision of this Code, the
2Illinois Department may not require, as a condition of payment
3for any laboratory test authorized under this Article, that a
4physician's handwritten signature appear on the laboratory
5test order form. The Illinois Department may, however, impose
6other appropriate requirements regarding laboratory test order
8    Upon receipt of federal approval of an amendment to the
9Illinois Title XIX State Plan for this purpose, the Department
10shall authorize the Chicago Public Schools (CPS) to procure a
11vendor or vendors to manufacture eyeglasses for individuals
12enrolled in a school within the CPS system. CPS shall ensure
13that its vendor or vendors are enrolled as providers in the
14medical assistance program and in any capitated Medicaid
15managed care entity (MCE) serving individuals enrolled in a
16school within the CPS system. Under any contract procured under
17this provision, the vendor or vendors must serve only
18individuals enrolled in a school within the CPS system. Claims
19for services provided by CPS's vendor or vendors to recipients
20of benefits in the medical assistance program under this Code,
21the Children's Health Insurance Program, or the Covering ALL
22KIDS Health Insurance Program shall be submitted to the
23Department or the MCE in which the individual is enrolled for
24payment and shall be reimbursed at the Department's or the
25MCE's established rates or rate methodologies for eyeglasses.
26    On and after July 1, 2012, the Department of Healthcare and



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1Family Services may provide the following services to persons
2eligible for assistance under this Article who are
3participating in education, training or employment programs
4operated by the Department of Human Services as successor to
5the Department of Public Aid:
6        (1) dental services provided by or under the
7    supervision of a dentist; and
8        (2) eyeglasses prescribed by a physician skilled in the
9    diseases of the eye, or by an optometrist, whichever the
10    person may select.
11    On and after July 1, 2018, the Department of Healthcare and
12Family Services shall provide dental services to any adult who
13is otherwise eligible for assistance under the medical
14assistance program. As used in this paragraph, "dental
15services" means diagnostic, preventative, restorative, or
16corrective procedures, including procedures and services for
17the prevention and treatment of periodontal disease and dental
18caries disease, provided by an individual who is licensed to
19practice dentistry or dental surgery or who is under the
20supervision of a dentist in the practice of his or her
22    On and after July 1, 2018, targeted dental services, as set
23forth in Exhibit D of the Consent Decree entered by the United
24States District Court for the Northern District of Illinois,
25Eastern Division, in the matter of Memisovski v. Maram, Case
26No. 92 C 1982, that are provided to adults under the medical



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1assistance program shall be established at no less than the
2rates set forth in the "New Rate" column in Exhibit D of the
3Consent Decree for targeted dental services that are provided
4to persons under the age of 18 under the medical assistance
6    Notwithstanding any other provision of this Code and
7subject to federal approval, the Department may adopt rules to
8allow a dentist who is volunteering his or her service at no
9cost to render dental services through an enrolled
10not-for-profit health clinic without the dentist personally
11enrolling as a participating provider in the medical assistance
12program. A not-for-profit health clinic shall include a public
13health clinic or Federally Qualified Health Center or other
14enrolled provider, as determined by the Department, through
15which dental services covered under this Section are performed.
16The Department shall establish a process for payment of claims
17for reimbursement for covered dental services rendered under
18this provision.
19    The Illinois Department, by rule, may distinguish and
20classify the medical services to be provided only in accordance
21with the classes of persons designated in Section 5-2.
22    The Department of Healthcare and Family Services must
23provide coverage and reimbursement for amino acid-based
24elemental formulas, regardless of delivery method, for the
25diagnosis and treatment of (i) eosinophilic disorders and (ii)
26short bowel syndrome when the prescribing physician has issued



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1a written order stating that the amino acid-based elemental
2formula is medically necessary.
3    The Illinois Department shall authorize the provision of,
4and shall authorize payment for, screening by low-dose
5mammography for the presence of occult breast cancer for women
635 years of age or older who are eligible for medical
7assistance under this Article, as follows:
8        (A) A baseline mammogram for women 35 to 39 years of
9    age.
10        (B) An annual mammogram for women 40 years of age or
11    older.
12        (C) A mammogram at the age and intervals considered
13    medically necessary by the woman's health care provider for
14    women under 40 years of age and having a family history of
15    breast cancer, prior personal history of breast cancer,
16    positive genetic testing, or other risk factors.
17        (D) A comprehensive ultrasound screening and MRI of an
18    entire breast or breasts if a mammogram demonstrates
19    heterogeneous or dense breast tissue, when medically
20    necessary as determined by a physician licensed to practice
21    medicine in all of its branches.
22        (E) A screening MRI when medically necessary, as
23    determined by a physician licensed to practice medicine in
24    all of its branches.
25    All screenings shall include a physical breast exam,
26instruction on self-examination and information regarding the



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1frequency of self-examination and its value as a preventative
2tool. For purposes of this Section, "low-dose mammography"
3means the x-ray examination of the breast using equipment
4dedicated specifically for mammography, including the x-ray
5tube, filter, compression device, and image receptor, with an
6average radiation exposure delivery of less than one rad per
7breast for 2 views of an average size breast. The term also
8includes digital mammography and includes breast
9tomosynthesis. As used in this Section, the term "breast
10tomosynthesis" means a radiologic procedure that involves the
11acquisition of projection images over the stationary breast to
12produce cross-sectional digital three-dimensional images of
13the breast. If, at any time, the Secretary of the United States
14Department of Health and Human Services, or its successor
15agency, promulgates rules or regulations to be published in the
16Federal Register or publishes a comment in the Federal Register
17or issues an opinion, guidance, or other action that would
18require the State, pursuant to any provision of the Patient
19Protection and Affordable Care Act (Public Law 111-148),
20including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
21successor provision, to defray the cost of any coverage for
22breast tomosynthesis outlined in this paragraph, then the
23requirement that an insurer cover breast tomosynthesis is
24inoperative other than any such coverage authorized under
25Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and
26the State shall not assume any obligation for the cost of



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1coverage for breast tomosynthesis set forth in this paragraph.
2    On and after January 1, 2016, the Department shall ensure
3that all networks of care for adult clients of the Department
4include access to at least one breast imaging Center of Imaging
5Excellence as certified by the American College of Radiology.
6    On and after January 1, 2012, providers participating in a
7quality improvement program approved by the Department shall be
8reimbursed for screening and diagnostic mammography at the same
9rate as the Medicare program's rates, including the increased
10reimbursement for digital mammography.
11    The Department shall convene an expert panel including
12representatives of hospitals, free-standing mammography
13facilities, and doctors, including radiologists, to establish
14quality standards for mammography.
15    On and after January 1, 2017, providers participating in a
16breast cancer treatment quality improvement program approved
17by the Department shall be reimbursed for breast cancer
18treatment at a rate that is no lower than 95% of the Medicare
19program's rates for the data elements included in the breast
20cancer treatment quality program.
21    The Department shall convene an expert panel, including
22representatives of hospitals, free-standing breast cancer
23treatment centers, breast cancer quality organizations, and
24doctors, including breast surgeons, reconstructive breast
25surgeons, oncologists, and primary care providers to establish
26quality standards for breast cancer treatment.



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1    Subject to federal approval, the Department shall
2establish a rate methodology for mammography at federally
3qualified health centers and other encounter-rate clinics.
4These clinics or centers may also collaborate with other
5hospital-based mammography facilities. By January 1, 2016, the
6Department shall report to the General Assembly on the status
7of the provision set forth in this paragraph.
8    The Department shall establish a methodology to remind
9women who are age-appropriate for screening mammography, but
10who have not received a mammogram within the previous 18
11months, of the importance and benefit of screening mammography.
12The Department shall work with experts in breast cancer
13outreach and patient navigation to optimize these reminders and
14shall establish a methodology for evaluating their
15effectiveness and modifying the methodology based on the
17    The Department shall establish a performance goal for
18primary care providers with respect to their female patients
19over age 40 receiving an annual mammogram. This performance
20goal shall be used to provide additional reimbursement in the
21form of a quality performance bonus to primary care providers
22who meet that goal.
23    The Department shall devise a means of case-managing or
24patient navigation for beneficiaries diagnosed with breast
25cancer. This program shall initially operate as a pilot program
26in areas of the State with the highest incidence of mortality



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1related to breast cancer. At least one pilot program site shall
2be in the metropolitan Chicago area and at least one site shall
3be outside the metropolitan Chicago area. On or after July 1,
42016, the pilot program shall be expanded to include one site
5in western Illinois, one site in southern Illinois, one site in
6central Illinois, and 4 sites within metropolitan Chicago. An
7evaluation of the pilot program shall be carried out measuring
8health outcomes and cost of care for those served by the pilot
9program compared to similarly situated patients who are not
10served by the pilot program.
11    The Department shall require all networks of care to
12develop a means either internally or by contract with experts
13in navigation and community outreach to navigate cancer
14patients to comprehensive care in a timely fashion. The
15Department shall require all networks of care to include access
16for patients diagnosed with cancer to at least one academic
17commission on cancer-accredited cancer program as an
18in-network covered benefit.
19    Any medical or health care provider shall immediately
20recommend, to any pregnant woman who is being provided prenatal
21services and is suspected of having a substance use disorder as
22defined in the Substance Use Disorder Act, referral to a local
23substance use disorder treatment program licensed by the
24Department of Human Services or to a licensed hospital which
25provides substance abuse treatment services. The Department of
26Healthcare and Family Services shall assure coverage for the



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1cost of treatment of the drug abuse or addiction for pregnant
2recipients in accordance with the Illinois Medicaid Program in
3conjunction with the Department of Human Services.
4    All medical providers providing medical assistance to
5pregnant women under this Code shall receive information from
6the Department on the availability of services under any
7program providing case management services for addicted women,
8including information on appropriate referrals for other
9social services that may be needed by addicted women in
10addition to treatment for addiction.
11    The Illinois Department, in cooperation with the
12Departments of Human Services (as successor to the Department
13of Alcoholism and Substance Abuse) and Public Health, through a
14public awareness campaign, may provide information concerning
15treatment for alcoholism and drug abuse and addiction, prenatal
16health care, and other pertinent programs directed at reducing
17the number of drug-affected infants born to recipients of
18medical assistance.
19    Neither the Department of Healthcare and Family Services
20nor the Department of Human Services shall sanction the
21recipient solely on the basis of her substance abuse.
22    The Illinois Department shall establish such regulations
23governing the dispensing of health services under this Article
24as it shall deem appropriate. The Department should seek the
25advice of formal professional advisory committees appointed by
26the Director of the Illinois Department for the purpose of



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1providing regular advice on policy and administrative matters,
2information dissemination and educational activities for
3medical and health care providers, and consistency in
4procedures to the Illinois Department.
5    The Illinois Department may develop and contract with
6Partnerships of medical providers to arrange medical services
7for persons eligible under Section 5-2 of this Code.
8Implementation of this Section may be by demonstration projects
9in certain geographic areas. The Partnership shall be
10represented by a sponsor organization. The Department, by rule,
11shall develop qualifications for sponsors of Partnerships.
12Nothing in this Section shall be construed to require that the
13sponsor organization be a medical organization.
14    The sponsor must negotiate formal written contracts with
15medical providers for physician services, inpatient and
16outpatient hospital care, home health services, treatment for
17alcoholism and substance abuse, and other services determined
18necessary by the Illinois Department by rule for delivery by
19Partnerships. Physician services must include prenatal and
20obstetrical care. The Illinois Department shall reimburse
21medical services delivered by Partnership providers to clients
22in target areas according to provisions of this Article and the
23Illinois Health Finance Reform Act, except that:
24        (1) Physicians participating in a Partnership and
25    providing certain services, which shall be determined by
26    the Illinois Department, to persons in areas covered by the



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1    Partnership may receive an additional surcharge for such
2    services.
3        (2) The Department may elect to consider and negotiate
4    financial incentives to encourage the development of
5    Partnerships and the efficient delivery of medical care.
6        (3) Persons receiving medical services through
7    Partnerships may receive medical and case management
8    services above the level usually offered through the
9    medical assistance program.
10    Medical providers shall be required to meet certain
11qualifications to participate in Partnerships to ensure the
12delivery of high quality medical services. These
13qualifications shall be determined by rule of the Illinois
14Department and may be higher than qualifications for
15participation in the medical assistance program. Partnership
16sponsors may prescribe reasonable additional qualifications
17for participation by medical providers, only with the prior
18written approval of the Illinois Department.
19    Nothing in this Section shall limit the free choice of
20practitioners, hospitals, and other providers of medical
21services by clients. In order to ensure patient freedom of
22choice, the Illinois Department shall immediately promulgate
23all rules and take all other necessary actions so that provided
24services may be accessed from therapeutically certified
25optometrists to the full extent of the Illinois Optometric
26Practice Act of 1987 without discriminating between service



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2    The Department shall apply for a waiver from the United
3States Health Care Financing Administration to allow for the
4implementation of Partnerships under this Section.
5    The Illinois Department shall require health care
6providers to maintain records that document the medical care
7and services provided to recipients of Medical Assistance under
8this Article. Such records must be retained for a period of not
9less than 6 years from the date of service or as provided by
10applicable State law, whichever period is longer, except that
11if an audit is initiated within the required retention period
12then the records must be retained until the audit is completed
13and every exception is resolved. The Illinois Department shall
14require health care providers to make available, when
15authorized by the patient, in writing, the medical records in a
16timely fashion to other health care providers who are treating
17or serving persons eligible for Medical Assistance under this
18Article. All dispensers of medical services shall be required
19to maintain and retain business and professional records
20sufficient to fully and accurately document the nature, scope,
21details and receipt of the health care provided to persons
22eligible for medical assistance under this Code, in accordance
23with regulations promulgated by the Illinois Department. The
24rules and regulations shall require that proof of the receipt
25of prescription drugs, dentures, prosthetic devices and
26eyeglasses by eligible persons under this Section accompany



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1each claim for reimbursement submitted by the dispenser of such
2medical services. No such claims for reimbursement shall be
3approved for payment by the Illinois Department without such
4proof of receipt, unless the Illinois Department shall have put
5into effect and shall be operating a system of post-payment
6audit and review which shall, on a sampling basis, be deemed
7adequate by the Illinois Department to assure that such drugs,
8dentures, prosthetic devices and eyeglasses for which payment
9is being made are actually being received by eligible
10recipients. Within 90 days after September 16, 1984 (the
11effective date of Public Act 83-1439), the Illinois Department
12shall establish a current list of acquisition costs for all
13prosthetic devices and any other items recognized as medical
14equipment and supplies reimbursable under this Article and
15shall update such list on a quarterly basis, except that the
16acquisition costs of all prescription drugs shall be updated no
17less frequently than every 30 days as required by Section
19    Notwithstanding any other law to the contrary, the Illinois
20Department shall, within 365 days after July 22, 2013 (the
21effective date of Public Act 98-104), establish procedures to
22permit skilled care facilities licensed under the Nursing Home
23Care Act to submit monthly billing claims for reimbursement
24purposes. Following development of these procedures, the
25Department shall, by July 1, 2016, test the viability of the
26new system and implement any necessary operational or



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1structural changes to its information technology platforms in
2order to allow for the direct acceptance and payment of nursing
3home claims.
4    Notwithstanding any other law to the contrary, the Illinois
5Department shall, within 365 days after August 15, 2014 (the
6effective date of Public Act 98-963), establish procedures to
7permit ID/DD facilities licensed under the ID/DD Community Care
8Act and MC/DD facilities licensed under the MC/DD Act to submit
9monthly billing claims for reimbursement purposes. Following
10development of these procedures, the Department shall have an
11additional 365 days to test the viability of the new system and
12to ensure that any necessary operational or structural changes
13to its information technology platforms are implemented.
14    The Illinois Department shall require all dispensers of
15medical services, other than an individual practitioner or
16group of practitioners, desiring to participate in the Medical
17Assistance program established under this Article to disclose
18all financial, beneficial, ownership, equity, surety or other
19interests in any and all firms, corporations, partnerships,
20associations, business enterprises, joint ventures, agencies,
21institutions or other legal entities providing any form of
22health care services in this State under this Article.
23    The Illinois Department may require that all dispensers of
24medical services desiring to participate in the medical
25assistance program established under this Article disclose,
26under such terms and conditions as the Illinois Department may



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1by rule establish, all inquiries from clients and attorneys
2regarding medical bills paid by the Illinois Department, which
3inquiries could indicate potential existence of claims or liens
4for the Illinois Department.
5    Enrollment of a vendor shall be subject to a provisional
6period and shall be conditional for one year. During the period
7of conditional enrollment, the Department may terminate the
8vendor's eligibility to participate in, or may disenroll the
9vendor from, the medical assistance program without cause.
10Unless otherwise specified, such termination of eligibility or
11disenrollment is not subject to the Department's hearing
12process. However, a disenrolled vendor may reapply without
14    The Department has the discretion to limit the conditional
15enrollment period for vendors based upon category of risk of
16the vendor.
17    Prior to enrollment and during the conditional enrollment
18period in the medical assistance program, all vendors shall be
19subject to enhanced oversight, screening, and review based on
20the risk of fraud, waste, and abuse that is posed by the
21category of risk of the vendor. The Illinois Department shall
22establish the procedures for oversight, screening, and review,
23which may include, but need not be limited to: criminal and
24financial background checks; fingerprinting; license,
25certification, and authorization verifications; unscheduled or
26unannounced site visits; database checks; prepayment audit



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1reviews; audits; payment caps; payment suspensions; and other
2screening as required by federal or State law.
3    The Department shall define or specify the following: (i)
4by provider notice, the "category of risk of the vendor" for
5each type of vendor, which shall take into account the level of
6screening applicable to a particular category of vendor under
7federal law and regulations; (ii) by rule or provider notice,
8the maximum length of the conditional enrollment period for
9each category of risk of the vendor; and (iii) by rule, the
10hearing rights, if any, afforded to a vendor in each category
11of risk of the vendor that is terminated or disenrolled during
12the conditional enrollment period.
13    To be eligible for payment consideration, a vendor's
14payment claim or bill, either as an initial claim or as a
15resubmitted claim following prior rejection, must be received
16by the Illinois Department, or its fiscal intermediary, no
17later than 180 days after the latest date on the claim on which
18medical goods or services were provided, with the following
20        (1) In the case of a provider whose enrollment is in
21    process by the Illinois Department, the 180-day period
22    shall not begin until the date on the written notice from
23    the Illinois Department that the provider enrollment is
24    complete.
25        (2) In the case of errors attributable to the Illinois
26    Department or any of its claims processing intermediaries



SB1777- 24 -LRB101 07357 KTG 56289 b

1    which result in an inability to receive, process, or
2    adjudicate a claim, the 180-day period shall not begin
3    until the provider has been notified of the error.
4        (3) In the case of a provider for whom the Illinois
5    Department initiates the monthly billing process.
6        (4) In the case of a provider operated by a unit of
7    local government with a population exceeding 3,000,000
8    when local government funds finance federal participation
9    for claims payments.
10    For claims for services rendered during a period for which
11a recipient received retroactive eligibility, claims must be
12filed within 180 days after the Department determines the
13applicant is eligible. For claims for which the Illinois
14Department is not the primary payer, claims must be submitted
15to the Illinois Department within 180 days after the final
16adjudication by the primary payer.
17    In the case of long term care facilities, within 45
18calendar days of receipt by the facility of required
19prescreening information, new admissions with associated
20admission documents shall be submitted through the Medical
21Electronic Data Interchange (MEDI) or the Recipient
22Eligibility Verification (REV) System or shall be submitted
23directly to the Department of Human Services using required
24admission forms. Effective September 1, 2014, admission
25documents, including all prescreening information, must be
26submitted through MEDI or REV. Confirmation numbers assigned to



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1an accepted transaction shall be retained by a facility to
2verify timely submittal. Once an admission transaction has been
3completed, all resubmitted claims following prior rejection
4are subject to receipt no later than 180 days after the
5admission transaction has been completed.
6    Claims that are not submitted and received in compliance
7with the foregoing requirements shall not be eligible for
8payment under the medical assistance program, and the State
9shall have no liability for payment of those claims.
10    To the extent consistent with applicable information and
11privacy, security, and disclosure laws, State and federal
12agencies and departments shall provide the Illinois Department
13access to confidential and other information and data necessary
14to perform eligibility and payment verifications and other
15Illinois Department functions. This includes, but is not
16limited to: information pertaining to licensure;
17certification; earnings; immigration status; citizenship; wage
18reporting; unearned and earned income; pension income;
19employment; supplemental security income; social security
20numbers; National Provider Identifier (NPI) numbers; the
21National Practitioner Data Bank (NPDB); program and agency
22exclusions; taxpayer identification numbers; tax delinquency;
23corporate information; and death records.
24    The Illinois Department shall enter into agreements with
25State agencies and departments, and is authorized to enter into
26agreements with federal agencies and departments, under which



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1such agencies and departments shall share data necessary for
2medical assistance program integrity functions and oversight.
3The Illinois Department shall develop, in cooperation with
4other State departments and agencies, and in compliance with
5applicable federal laws and regulations, appropriate and
6effective methods to share such data. At a minimum, and to the
7extent necessary to provide data sharing, the Illinois
8Department shall enter into agreements with State agencies and
9departments, and is authorized to enter into agreements with
10federal agencies and departments, including but not limited to:
11the Secretary of State; the Department of Revenue; the
12Department of Public Health; the Department of Human Services;
13and the Department of Financial and Professional Regulation.
14    Beginning in fiscal year 2013, the Illinois Department
15shall set forth a request for information to identify the
16benefits of a pre-payment, post-adjudication, and post-edit
17claims system with the goals of streamlining claims processing
18and provider reimbursement, reducing the number of pending or
19rejected claims, and helping to ensure a more transparent
20adjudication process through the utilization of: (i) provider
21data verification and provider screening technology; and (ii)
22clinical code editing; and (iii) pre-pay, pre- or
23post-adjudicated predictive modeling with an integrated case
24management system with link analysis. Such a request for
25information shall not be considered as a request for proposal
26or as an obligation on the part of the Illinois Department to



SB1777- 27 -LRB101 07357 KTG 56289 b

1take any action or acquire any products or services.
2    The Illinois Department shall establish policies,
3procedures, standards and criteria by rule for the acquisition,
4repair and replacement of orthotic and prosthetic devices and
5durable medical equipment. Such rules shall provide, but not be
6limited to, the following services: (1) immediate repair or
7replacement of such devices by recipients; and (2) rental,
8lease, purchase or lease-purchase of durable medical equipment
9in a cost-effective manner, taking into consideration the
10recipient's medical prognosis, the extent of the recipient's
11needs, and the requirements and costs for maintaining such
12equipment. Subject to prior approval, such rules shall enable a
13recipient to temporarily acquire and use alternative or
14substitute devices or equipment pending repairs or
15replacements of any device or equipment previously authorized
16for such recipient by the Department. Notwithstanding any
17provision of Section 5-5f to the contrary, the Department may,
18by rule, exempt certain replacement wheelchair parts from prior
19approval and, for wheelchairs, wheelchair parts, wheelchair
20accessories, and related seating and positioning items,
21determine the wholesale price by methods other than actual
22acquisition costs.
23    The Department shall require, by rule, all providers of
24durable medical equipment to be accredited by an accreditation
25organization approved by the federal Centers for Medicare and
26Medicaid Services and recognized by the Department in order to



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1bill the Department for providing durable medical equipment to
2recipients. No later than 15 months after the effective date of
3the rule adopted pursuant to this paragraph, all providers must
4meet the accreditation requirement.
5    In order to promote environmental responsibility, meet the
6needs of recipients and enrollees, and achieve significant cost
7savings, the Department, or a managed care organization under
8contract with the Department, may provide recipients or managed
9care enrollees who have a prescription or Certificate of
10Medical Necessity access to refurbished durable medical
11equipment under this Section (excluding prosthetic and
12orthotic devices as defined in the Orthotics, Prosthetics, and
13Pedorthics Practice Act and complex rehabilitation technology
14products and associated services) through the State's
15assistive technology program's reutilization program, using
16staff with the Assistive Technology Professional (ATP)
17Certification if the refurbished durable medical equipment:
18(i) is available; (ii) is less expensive, including shipping
19costs, than new durable medical equipment of the same type;
20(iii) is able to withstand at least 3 years of use; (iv) is
21cleaned, disinfected, sterilized, and safe in accordance with
22federal Food and Drug Administration regulations and guidance
23governing the reprocessing of medical devices in health care
24settings; and (v) equally meets the needs of the recipient or
25enrollee. The reutilization program shall confirm that the
26recipient or enrollee is not already in receipt of same or



SB1777- 29 -LRB101 07357 KTG 56289 b

1similar equipment from another service provider, and that the
2refurbished durable medical equipment equally meets the needs
3of the recipient or enrollee. Nothing in this paragraph shall
4be construed to limit recipient or enrollee choice to obtain
5new durable medical equipment or place any additional prior
6authorization conditions on enrollees of managed care
8    The Department shall execute, relative to the nursing home
9prescreening project, written inter-agency agreements with the
10Department of Human Services and the Department on Aging, to
11effect the following: (i) intake procedures and common
12eligibility criteria for those persons who are receiving
13non-institutional services; and (ii) the establishment and
14development of non-institutional services in areas of the State
15where they are not currently available or are undeveloped; and
16(iii) notwithstanding any other provision of law, subject to
17federal approval, on and after July 1, 2012, an increase in the
18determination of need (DON) scores from 29 to 37 for applicants
19for institutional and home and community-based long term care;
20if and only if federal approval is not granted, the Department
21may, in conjunction with other affected agencies, implement
22utilization controls or changes in benefit packages to
23effectuate a similar savings amount for this population; and
24(iv) no later than July 1, 2013, minimum level of care
25eligibility criteria for institutional and home and
26community-based long term care; and (v) no later than October



SB1777- 30 -LRB101 07357 KTG 56289 b

11, 2013, establish procedures to permit long term care
2providers access to eligibility scores for individuals with an
3admission date who are seeking or receiving services from the
4long term care provider. In order to select the minimum level
5of care eligibility criteria, the Governor shall establish a
6workgroup that includes affected agency representatives and
7stakeholders representing the institutional and home and
8community-based long term care interests. This Section shall
9not restrict the Department from implementing lower level of
10care eligibility criteria for community-based services in
11circumstances where federal approval has been granted.
12    The Illinois Department shall develop and operate, in
13cooperation with other State Departments and agencies and in
14compliance with applicable federal laws and regulations,
15appropriate and effective systems of health care evaluation and
16programs for monitoring of utilization of health care services
17and facilities, as it affects persons eligible for medical
18assistance under this Code.
19    The Illinois Department shall report annually to the
20General Assembly, no later than the second Friday in April of
211979 and each year thereafter, in regard to:
22        (a) actual statistics and trends in utilization of
23    medical services by public aid recipients;
24        (b) actual statistics and trends in the provision of
25    the various medical services by medical vendors;
26        (c) current rate structures and proposed changes in



SB1777- 31 -LRB101 07357 KTG 56289 b

1    those rate structures for the various medical vendors; and
2        (d) efforts at utilization review and control by the
3    Illinois Department.
4    The period covered by each report shall be the 3 years
5ending on the June 30 prior to the report. The report shall
6include suggested legislation for consideration by the General
7Assembly. The requirement for reporting to the General Assembly
8shall be satisfied by filing copies of the report as required
9by Section 3.1 of the General Assembly Organization Act, and
10filing such additional copies with the State Government Report
11Distribution Center for the General Assembly as is required
12under paragraph (t) of Section 7 of the State Library Act.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19    On and after July 1, 2012, the Department shall reduce any
20rate of reimbursement for services or other payments or alter
21any methodologies authorized by this Code to reduce any rate of
22reimbursement for services or other payments in accordance with
23Section 5-5e.
24    Because kidney transplantation can be an appropriate,
25cost-effective alternative to renal dialysis when medically
26necessary and notwithstanding the provisions of Section 1-11 of



SB1777- 32 -LRB101 07357 KTG 56289 b

1this Code, beginning October 1, 2014, the Department shall
2cover kidney transplantation for noncitizens with end-stage
3renal disease who are not eligible for comprehensive medical
4benefits, who meet the residency requirements of Section 5-3 of
5this Code, and who would otherwise meet the financial
6requirements of the appropriate class of eligible persons under
7Section 5-2 of this Code. To qualify for coverage of kidney
8transplantation, such person must be receiving emergency renal
9dialysis services covered by the Department. Providers under
10this Section shall be prior approved and certified by the
11Department to perform kidney transplantation and the services
12under this Section shall be limited to services associated with
13kidney transplantation.
14    Notwithstanding any other provision of this Code to the
15contrary, on or after July 1, 2015, all FDA approved forms of
16medication assisted treatment prescribed for the treatment of
17alcohol dependence or treatment of opioid dependence shall be
18covered under both fee for service and managed care medical
19assistance programs for persons who are otherwise eligible for
20medical assistance under this Article and shall not be subject
21to any (1) utilization control, other than those established
22under the American Society of Addiction Medicine patient
23placement criteria, (2) prior authorization mandate, or (3)
24lifetime restriction limit mandate.
25    On or after July 1, 2015, opioid antagonists prescribed for
26the treatment of an opioid overdose, including the medication



SB1777- 33 -LRB101 07357 KTG 56289 b

1product, administration devices, and any pharmacy fees related
2to the dispensing and administration of the opioid antagonist,
3shall be covered under the medical assistance program for
4persons who are otherwise eligible for medical assistance under
5this Article. As used in this Section, "opioid antagonist"
6means a drug that binds to opioid receptors and blocks or
7inhibits the effect of opioids acting on those receptors,
8including, but not limited to, naloxone hydrochloride or any
9other similarly acting drug approved by the U.S. Food and Drug
11    Upon federal approval, the Department shall provide
12coverage and reimbursement for all drugs that are approved for
13marketing by the federal Food and Drug Administration and that
14are recommended by the federal Public Health Service or the
15United States Centers for Disease Control and Prevention for
16pre-exposure prophylaxis and related pre-exposure prophylaxis
17services, including, but not limited to, HIV and sexually
18transmitted infection screening, treatment for sexually
19transmitted infections, medical monitoring, assorted labs, and
20counseling to reduce the likelihood of HIV infection among
21individuals who are not infected with HIV but who are at high
22risk of HIV infection.
23    A federally qualified health center, as defined in Section
241905(l)(2)(B) of the federal Social Security Act, shall be
25reimbursed by the Department in accordance with the federally
26qualified health center's encounter rate for services provided



SB1777- 34 -LRB101 07357 KTG 56289 b

1to medical assistance recipients that are performed by a dental
2hygienist, as defined under the Illinois Dental Practice Act,
3working under the general supervision of a dentist and employed
4by a federally qualified health center.
5    Notwithstanding any other provision of this Code, the
6Illinois Department shall authorize licensed dietitian
7nutritionists and certified diabetes educators to counsel
8senior diabetes patients in the senior diabetes patients' homes
9to remove the hurdle of transportation for senior diabetes
10patients to receive treatment.
11(Source: P.A. 99-78, eff. 7-20-15; 99-180, eff. 7-29-15;
1299-236, eff. 8-3-15; 99-407 (see Section 20 of P.A. 99-588 for
13the effective date of P.A. 99-407); 99-433, eff. 8-21-15;
1499-480, eff. 9-9-15; 99-588, eff. 7-20-16; 99-642, eff.
157-28-16; 99-772, eff. 1-1-17; 99-895, eff. 1-1-17; 100-201,
16eff. 8-18-17; 100-395, eff. 1-1-18; 100-449, eff. 1-1-18;
17100-538, eff. 1-1-18; 100-587, eff. 6-4-18; 100-759, eff.
181-1-19; 100-863, eff. 8-14-18; 100-974, eff. 8-19-18;
19100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19; 100-1148, eff.
21    (305 ILCS 5/6-1)  (from Ch. 23, par. 6-1)
22    Sec. 6-1. Eligibility requirements. Financial aid in
23meeting basic maintenance requirements shall be given under
24this Article to or in behalf of persons who meet the
25eligibility conditions of Sections 6-1.1 through 6-1.10,



SB1777- 35 -LRB101 07357 KTG 56289 b

1except as provided in the No Taxpayer Funding for Abortion Act.
2In addition, each unit of local government subject to this
3Article shall provide persons receiving financial aid in
4meeting basic maintenance requirements with financial aid for
5either (a) necessary treatment, care, and supplies required
6because of illness or disability, or (b) acute medical
7treatment, care, and supplies only. If a local governmental
8unit elects to provide financial aid for acute medical
9treatment, care, and supplies only, the general types of acute
10medical treatment, care, and supplies for which financial aid
11is provided shall be specified in the general assistance rules
12of the local governmental unit, which rules shall provide that
13financial aid is provided, at a minimum, for acute medical
14treatment, care, or supplies necessitated by a medical
15condition for which prior approval or authorization of medical
16treatment, care, or supplies is not required by the general
17assistance rules of the Illinois Department.
18(Source: P.A. 100-538, eff. 1-1-18.)
19    Section 910. The Problem Pregnancy Health Services and Care
20Act is amended by changing Section 4-100 as follows:
21    (410 ILCS 230/4-100)  (from Ch. 111 1/2, par. 4604-100)
22    Sec. 4-100. The Department may make grants to nonprofit
23agencies and organizations which do not use such grants to
24refer or counsel for, or perform, abortions and which



SB1777- 36 -LRB101 07357 KTG 56289 b

1coordinate and establish linkages among services that will
2further the purposes of this Act and, where appropriate, will
3provide, supplement, or improve the quality of such services.
4(Source: P.A. 100-538, eff. 1-1-18.)
5    Section 990. Application of Act; home rule powers.
6    (a) This Act applies to all State and local (including home
7rule unit) laws, ordinances, policies, procedures, practices,
8and governmental actions and their implementation, whether
9statutory or otherwise and whether adopted before or after the
10effective date of this Act.
11    (b) A home rule unit may not adopt any rule in a manner
12inconsistent with this Act. This Act is a limitation under
13subsection (i) of Section 6 of Article VII of the Illinois
14Constitution on the concurrent exercise by home rule units of
15powers and functions exercised by the State.
16    Section 999. Effective date. This Act takes effect June 1,