Illinois General Assembly - Full Text of HB2589
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Full Text of HB2589  102nd General Assembly




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1    AN ACT concerning substance use disorders.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Substance Use Disorder Act is amended by
5changing Sections 5-23 and 20-10 as follows:
6    (20 ILCS 301/5-23)
7    Sec. 5-23. Drug Overdose Prevention Program.
8    (a) Reports.
9        (1) The Department may publish annually a report on
10    drug overdose trends statewide that reviews State death
11    rates from available data to ascertain changes in the
12    causes or rates of fatal and nonfatal drug overdose. The
13    report shall also provide information on interventions
14    that would be effective in reducing the rate of fatal or
15    nonfatal drug overdose and on the current substance use
16    disorder treatment capacity within the State. The report
17    shall include an analysis of drug overdose information
18    reported to the Department of Public Health pursuant to
19    subsection (e) of Section 3-3013 of the Counties Code,
20    Section 6.14g of the Hospital Licensing Act, and
21    subsection (j) of Section 22-30 of the School Code.
22        (2) The report may include:
23            (A) Trends in drug overdose death rates.



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1            (B) Trends in emergency room utilization related
2        to drug overdose and the cost impact of emergency room
3        utilization.
4            (C) Trends in utilization of pre-hospital and
5        emergency services and the cost impact of emergency
6        services utilization.
7            (D) Suggested improvements in data collection.
8            (E) A description of other interventions effective
9        in reducing the rate of fatal or nonfatal drug
10        overdose.
11            (F) A description of efforts undertaken to educate
12        the public about unused medication and about how to
13        properly dispose of unused medication, including the
14        number of registered collection receptacles in this
15        State, mail-back programs, and drug take-back events.
16            (G) An inventory of the State's substance use
17        disorder treatment capacity, including, but not
18        limited to:
19                (i) The number and type of licensed treatment
20            programs in each geographic area of the State.
21                (ii) The availability of medication-assisted
22            treatment at each licensed program and which types
23            of medication-assisted treatment are available.
24                (iii) The number of recovery homes that accept
25            individuals using medication-assisted treatment in
26            their recovery.



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1                (iv) The number of medical professionals
2            currently authorized to prescribe buprenorphine
3            and the number of individuals who fill
4            prescriptions for that medication at retail
5            pharmacies as prescribed.
6                (v) Any partnerships between programs licensed
7            by the Department and other providers of
8            medication-assisted treatment.
9                (vi) Any challenges in providing
10            medication-assisted treatment reported by programs
11            licensed by the Department and any potential
12            solutions.
13    (b) Programs; drug overdose prevention.
14        (1) The Department may establish a program to provide
15    for the production and publication, in electronic and
16    other formats, of drug overdose prevention, recognition,
17    and response literature. The Department may develop and
18    disseminate curricula for use by professionals,
19    organizations, individuals, or committees interested in
20    the prevention of fatal and nonfatal drug overdose,
21    including, but not limited to, drug users, jail and prison
22    personnel, jail and prison inmates, drug treatment
23    professionals, emergency medical personnel, hospital
24    staff, families and associates of drug users, peace
25    officers, firefighters, public safety officers, needle
26    exchange program staff, and other persons. In addition to



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1    information regarding drug overdose prevention,
2    recognition, and response, literature produced by the
3    Department shall stress that drug use remains illegal and
4    highly dangerous and that complete abstinence from illegal
5    drug use is the healthiest choice. The literature shall
6    provide information and resources for substance use
7    disorder treatment.
8        The Department may establish or authorize programs for
9    prescribing, dispensing, or distributing opioid
10    antagonists for the treatment of drug overdose. Such
11    programs may include the prescribing of opioid antagonists
12    for the treatment of drug overdose to a person who is not
13    at risk of opioid overdose but who, in the judgment of the
14    health care professional, may be in a position to assist
15    another individual during an opioid-related drug overdose
16    and who has received basic instruction on how to
17    administer an opioid antagonist.
18        (2) The Department may provide advice to State and
19    local officials on the growing drug overdose crisis,
20    including the prevalence of drug overdose incidents,
21    programs promoting the disposal of unused prescription
22    drugs, trends in drug overdose incidents, and solutions to
23    the drug overdose crisis.
24        (3) The Department may support drug overdose
25    prevention, recognition, and response projects by
26    facilitating the acquisition of opioid antagonist



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1    medication approved for opioid overdose reversal,
2    facilitating the acquisition of opioid antagonist
3    medication approved for opioid overdose reversal,
4    providing trainings in overdose prevention best practices,
5    connecting programs to medical resources, establishing a
6    statewide standing order for the acquisition of needed
7    medication, establishing learning collaboratives between
8    localities and programs, and assisting programs in
9    navigating any regulatory requirements for establishing or
10    expanding such programs.
11        (4) In supporting best practices in drug overdose
12    prevention programming, the Department may promote the
13    following programmatic elements:
14            (A) Training individuals who currently use drugs
15        in the administration of opioid antagonists approved
16        for the reversal of an opioid overdose.
17            (B) Directly distributing opioid antagonists
18        approved for the reversal of an opioid overdose rather
19        than providing prescriptions to be filled at a
20        pharmacy.
21            (C) Conducting street and community outreach to
22        work directly with individuals who are using drugs.
23            (D) Employing community health workers or peer
24        recovery specialists who are familiar with the
25        communities served and can provide culturally
26        competent services.



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1            (E) Collaborating with other community-based
2        organizations, substance use disorder treatment
3        centers, or other health care providers engaged in
4        treating individuals who are using drugs.
5            (F) Providing linkages for individuals to obtain
6        evidence-based substance use disorder treatment.
7            (G) Engaging individuals exiting jails or prisons
8        who are at a high risk of overdose.
9            (H) Providing education and training to
10        community-based organizations who work directly with
11        individuals who are using drugs and those individuals'
12        families and communities.
13            (I) Providing education and training on drug
14        overdose prevention and response to emergency
15        personnel and law enforcement.
16            (J) Informing communities of the important role
17        emergency personnel play in responding to accidental
18        overdose.
19            (K) Producing and distributing targeted mass media
20        materials on drug overdose prevention and response,
21        the potential dangers of leaving unused prescription
22        drugs in the home, and the proper methods for
23        disposing of unused prescription drugs.
24    (c) Grants.
25        (1) The Department may award grants, in accordance
26    with this subsection, to create or support local drug



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1    overdose prevention, recognition, and response projects.
2    Local health departments, correctional institutions,
3    hospitals, universities, community-based organizations,
4    and faith-based organizations may apply to the Department
5    for a grant under this subsection at the time and in the
6    manner the Department prescribes. Eligible grant
7    activities include, but are not limited to, purchasing and
8    distributing opioid antagonists, hiring peer recovery
9    specialists or other community members to conduct
10    community outreach, and hosting public health fairs or
11    events to distribute opioid antagonists, promote harm
12    reduction activities, and provide linkages to community
13    partners.
14        (2) In awarding grants, the Department shall consider
15    the overall rate of opioid overdose, the rate of increase
16    in opioid overdose, and racial disparities in opioid
17    overdose experienced by the communities to be served by
18    grantees. The Department necessity for overdose prevention
19    projects in various settings and shall encourage all grant
20    applicants to develop interventions that will be effective
21    and viable in their local areas.
22        (3) (Blank).
23        (3.5) Any hospital licensed under the Hospital
24    Licensing Act or organized under the University of
25    Illinois Hospital Act shall be deemed to have met the
26    standards and requirements set forth in this Section to



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1    enroll in the drug overdose prevention program upon
2    completion of the enrollment process except that proof of
3    a standing order and attestation of programmatic
4    requirements shall be waived for enrollment purposes.
5    Reporting mandated by enrollment shall be necessary to
6    carry out or attain eligibility for associated resources
7    under this Section for drug overdose prevention projects
8    operated on the licensed premises of the hospital and
9    operated by the hospital or its designated agent. The
10    Department shall streamline hospital enrollment for drug
11    overdose prevention programs by accepting such deemed
12    status under this Section in order to reduce barriers to
13    hospital participation in drug overdose prevention,
14    recognition, or response projects.
15        (4) In addition to moneys appropriated by the General
16    Assembly, the Department may seek grants from private
17    foundations, the federal government, and other sources to
18    fund the grants under this Section and to fund an
19    evaluation of the programs supported by the grants.
20    (d) Health care professional prescription of opioid
22        (1) A health care professional who, acting in good
23    faith, directly or by standing order, prescribes or
24    dispenses an opioid antagonist to: (a) a patient who, in
25    the judgment of the health care professional, is capable
26    of administering the drug in an emergency, or (b) a person



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1    who is not at risk of opioid overdose but who, in the
2    judgment of the health care professional, may be in a
3    position to assist another individual during an
4    opioid-related drug overdose and who has received basic
5    instruction on how to administer an opioid antagonist
6    shall not, as a result of his or her acts or omissions, be
7    subject to: (i) any disciplinary or other adverse action
8    under the Medical Practice Act of 1987, the Physician
9    Assistant Practice Act of 1987, the Nurse Practice Act,
10    the Pharmacy Practice Act, or any other professional
11    licensing statute or (ii) any criminal liability, except
12    for willful and wanton misconduct.
13        (1.5) Notwithstanding any provision of or requirement
14    otherwise imposed by the Pharmacy Practice Act, the
15    Medical Practice Act of 1987, or any other law or rule,
16    including, but not limited to, any requirement related to
17    labeling, storage, or recordkeeping, a health care
18    professional or other person acting under the direction of
19    a health care professional may, directly or by standing
20    order, obtain, store, and dispense an opioid antagonist to
21    a patient in a facility that includes, but is not limited
22    to, a hospital, a hospital affiliate, or a federally
23    qualified health center if the patient information
24    specified in paragraph (4) of this subsection is provided
25    to the patient. A person acting in accordance with this
26    paragraph shall not, as a result of his or her acts or



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1    omissions, be subject to: (i) any disciplinary or other
2    adverse action under the Medical Practice Act of 1987, the
3    Physician Assistant Practice Act of 1987, the Nurse
4    Practice Act, the Pharmacy Practice Act, or any other
5    professional licensing statute; or (ii) any criminal
6    liability, except for willful and wanton misconduct.
7        (2) A person who is not otherwise licensed to
8    administer an opioid antagonist may in an emergency
9    administer without fee an opioid antagonist if the person
10    has received the patient information specified in
11    paragraph (4) of this subsection and believes in good
12    faith that another person is experiencing a drug overdose.
13    The person shall not, as a result of his or her acts or
14    omissions, be (i) liable for any violation of the Medical
15    Practice Act of 1987, the Physician Assistant Practice Act
16    of 1987, the Nurse Practice Act, the Pharmacy Practice
17    Act, or any other professional licensing statute, or (ii)
18    subject to any criminal prosecution or civil liability,
19    except for willful and wanton misconduct.
20        (3) A health care professional prescribing an opioid
21    antagonist to a patient shall ensure that the patient
22    receives the patient information specified in paragraph
23    (4) of this subsection. Patient information may be
24    provided by the health care professional or a
25    community-based organization, substance use disorder
26    program, or other organization with which the health care



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1    professional establishes a written agreement that includes
2    a description of how the organization will provide patient
3    information, how employees or volunteers providing
4    information will be trained, and standards for documenting
5    the provision of patient information to patients.
6    Provision of patient information shall be documented in
7    the patient's medical record or through similar means as
8    determined by agreement between the health care
9    professional and the organization. The Department, in
10    consultation with statewide organizations representing
11    physicians, pharmacists, advanced practice registered
12    nurses, physician assistants, substance use disorder
13    programs, and other interested groups, shall develop and
14    disseminate to health care professionals, community-based
15    organizations, substance use disorder programs, and other
16    organizations training materials in video, electronic, or
17    other formats to facilitate the provision of such patient
18    information.
19        (4) For the purposes of this subsection:
20        "Opioid antagonist" means a drug that binds to opioid
21    receptors and blocks or inhibits the effect of opioids
22    acting on those receptors, including, but not limited to,
23    naloxone hydrochloride or any other similarly acting drug
24    approved by the U.S. Food and Drug Administration.
25        "Health care professional" means a physician licensed
26    to practice medicine in all its branches, a licensed



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1    physician assistant with prescriptive authority, a
2    licensed advanced practice registered nurse with
3    prescriptive authority, an advanced practice registered
4    nurse or physician assistant who practices in a hospital,
5    hospital affiliate, or ambulatory surgical treatment
6    center and possesses appropriate clinical privileges in
7    accordance with the Nurse Practice Act, or a pharmacist
8    licensed to practice pharmacy under the Pharmacy Practice
9    Act.
10        "Patient" includes a person who is not at risk of
11    opioid overdose but who, in the judgment of the physician,
12    advanced practice registered nurse, or physician
13    assistant, may be in a position to assist another
14    individual during an overdose and who has received patient
15    information as required in paragraph (2) of this
16    subsection on the indications for and administration of an
17    opioid antagonist.
18        "Patient information" includes information provided to
19    the patient on drug overdose prevention and recognition;
20    how to perform rescue breathing and resuscitation; opioid
21    antagonist dosage and administration; the importance of
22    calling 911; care for the overdose victim after
23    administration of the overdose antagonist; and other
24    issues as necessary.
25    (e) Drug overdose response policy.
26        (1) Every State and local government agency that



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1    employs a law enforcement officer or fireman as those
2    terms are defined in the Line of Duty Compensation Act
3    must possess opioid antagonists and must establish a
4    policy to control the acquisition, storage,
5    transportation, and administration of such opioid
6    antagonists and to provide training in the administration
7    of opioid antagonists. A State or local government agency
8    that employs a fireman as defined in the Line of Duty
9    Compensation Act but does not respond to emergency medical
10    calls or provide medical services shall be exempt from
11    this subsection.
12        (2) Every publicly or privately owned ambulance,
13    special emergency medical services vehicle, non-transport
14    vehicle, or ambulance assist vehicle, as described in the
15    Emergency Medical Services (EMS) Systems Act, that
16    responds to requests for emergency services or transports
17    patients between hospitals in emergency situations must
18    possess opioid antagonists.
19        (3) Entities that are required under paragraphs (1)
20    and (2) to possess opioid antagonists may also apply to
21    the Department for a grant to fund the acquisition of
22    opioid antagonists and training programs on the
23    administration of opioid antagonists.
24(Source: P.A. 100-201, eff. 8-18-17; 100-513, eff. 1-1-18;
25100-759, eff. 1-1-19; 101-356, eff. 8-9-19.)



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1    (20 ILCS 301/20-10)
2    Sec. 20-10. Screening, Brief Intervention, and Referral to
3Treatment. As used in this Section, "SBIRT" means a
4comprehensive, integrated, public health approach to the
5delivery of early intervention and treatment services for
6persons who are at risk of developing substance use disorders
7or have substance use disorders including, but not limited to,
8an addiction to alcohol, opioids, tobacco, or cannabis. SBIRT
9services include all of the following:
10        (1) Screening to quickly assess the severity of
11    substance use and to identify the appropriate level of
12    treatment.
13        (2) Brief intervention focused on increasing insight
14    and awareness regarding substance use and motivation
15    toward behavioral change.
16        (3) Referral to treatment provided to those identified
17    as needing more extensive treatment with access to
18    specialty care.
19    SBIRT services may include, but are not limited to, the
20following settings and programs: primary care centers,
21hospital emergency rooms, hospital in-patient units, trauma
22centers, community behavioral health programs, and other
23community settings that provide opportunities for early
24intervention with at-risk substance users before more severe
25consequences occur.
26    (a) As used in this Section, "SBIRT" means the



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1identification of individuals, within primary care settings,
2who need substance use disorder treatment. Primary care
3providers will screen and, based on the results of the screen,
4deliver a brief intervention or make referral to a licensed
5treatment provider as appropriate. SBIRT is not a licensed
6category of service.
7    (b) The Department may develop policy or best practice
8guidelines for identification of at-risk individuals through
9SBIRT and contract or billing requirements for SBIRT.
10(Source: P.A. 100-759, eff. 1-1-19.)
11    Section 10. The Illinois Public Aid Code is amended by
12changing Section 5-5 and by adding Section 5-41 as follows:
13    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
14    Sec. 5-5. Medical services. The Illinois Department, by
15rule, shall determine the quantity and quality of and the rate
16of reimbursement for the medical assistance for which payment
17will be authorized, and the medical services to be provided,
18which may include all or part of the following: (1) inpatient
19hospital services; (2) outpatient hospital services; (3) other
20laboratory and X-ray services; (4) skilled nursing home
21services; (5) physicians' services whether furnished in the
22office, the patient's home, a hospital, a skilled nursing
23home, or elsewhere; (6) medical care, or any other type of
24remedial care furnished by licensed practitioners; (7) home



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



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1Treatment Act, for injuries sustained as a result of the
2sexual assault, including examinations and laboratory tests to
3discover evidence which may be used in criminal proceedings
4arising from the sexual assault; (16) the diagnosis and
5treatment of sickle cell anemia; and (17) any other medical
6care, and any other type of remedial care recognized under the
7laws of this State. The term "any other type of remedial care"
8shall include nursing care and nursing home service for
9persons who rely on treatment by spiritual means alone through
10prayer for healing.
11    Notwithstanding any other provision of this Section, a
12comprehensive tobacco use cessation program that includes
13purchasing prescription drugs or prescription medical devices
14approved by the Food and Drug Administration shall be covered
15under the medical assistance program under this Article for
16persons who are otherwise eligible for assistance under this
18    Notwithstanding any other provision of this Code,
19reproductive health care that is otherwise legal in Illinois
20shall be covered under the medical assistance program for
21persons who are otherwise eligible for medical assistance
22under this Article.
23    Notwithstanding any other provision of this Code, the
24Illinois Department may not require, as a condition of payment
25for any laboratory test authorized under this Article, that a
26physician's handwritten signature appear on the laboratory



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1test order form. The Illinois Department may, however, impose
2other appropriate requirements regarding laboratory test order
4    Upon receipt of federal approval of an amendment to the
5Illinois Title XIX State Plan for this purpose, the Department
6shall authorize the Chicago Public Schools (CPS) to procure a
7vendor or vendors to manufacture eyeglasses for individuals
8enrolled in a school within the CPS system. CPS shall ensure
9that its vendor or vendors are enrolled as providers in the
10medical assistance program and in any capitated Medicaid
11managed care entity (MCE) serving individuals enrolled in a
12school within the CPS system. Under any contract procured
13under this provision, the vendor or vendors must serve only
14individuals enrolled in a school within the CPS system. Claims
15for services provided by CPS's vendor or vendors to recipients
16of benefits in the medical assistance program under this Code,
17the Children's Health Insurance Program, or the Covering ALL
18KIDS Health Insurance Program shall be submitted to the
19Department or the MCE in which the individual is enrolled for
20payment and shall be reimbursed at the Department's or the
21MCE's established rates or rate methodologies for eyeglasses.
22    On and after July 1, 2012, the Department of Healthcare
23and Family Services may provide the following services to
24persons eligible for assistance under this Article who are
25participating in education, training or employment programs
26operated by the Department of Human Services as successor to



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1the Department of Public Aid:
2        (1) dental services provided by or under the
3    supervision of a dentist; and
4        (2) eyeglasses prescribed by a physician skilled in
5    the diseases of the eye, or by an optometrist, whichever
6    the person may select.
7    On and after July 1, 2018, the Department of Healthcare
8and Family Services shall provide dental services to any adult
9who is otherwise eligible for assistance under the medical
10assistance program. As used in this paragraph, "dental
11services" means diagnostic, preventative, restorative, or
12corrective procedures, including procedures and services for
13the prevention and treatment of periodontal disease and dental
14caries disease, provided by an individual who is licensed to
15practice dentistry or dental surgery or who is under the
16supervision of a dentist in the practice of his or her
18    On and after July 1, 2018, targeted dental services, as
19set forth in Exhibit D of the Consent Decree entered by the
20United States District Court for the Northern District of
21Illinois, Eastern Division, in the matter of Memisovski v.
22Maram, Case No. 92 C 1982, that are provided to adults under
23the medical assistance program shall be established at no less
24than the rates set forth in the "New Rate" column in Exhibit D
25of the Consent Decree for targeted dental services that are
26provided to persons under the age of 18 under the medical



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



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1and shall authorize payment for, screening by low-dose
2mammography for the presence of occult breast cancer for women
335 years of age or older who are eligible for medical
4assistance under this Article, as follows:
5        (A) A baseline mammogram for women 35 to 39 years of
6    age.
7        (B) An annual mammogram for women 40 years of age or
8    older.
9        (C) A mammogram at the age and intervals considered
10    medically necessary by the woman's health care provider
11    for women under 40 years of age and having a family history
12    of breast cancer, prior personal history of breast cancer,
13    positive genetic testing, or other risk factors.
14        (D) A comprehensive ultrasound screening and MRI of an
15    entire breast or breasts if a mammogram demonstrates
16    heterogeneous or dense breast tissue or when medically
17    necessary as determined by a physician licensed to
18    practice medicine in all of its branches.
19        (E) A screening MRI when medically necessary, as
20    determined by a physician licensed to practice medicine in
21    all of its branches.
22        (F) A diagnostic mammogram when medically necessary,
23    as determined by a physician licensed to practice medicine
24    in all its branches, advanced practice registered nurse,
25    or physician assistant.
26    The Department shall not impose a deductible, coinsurance,



HB2589 Enrolled- 22 -LRB102 15983 KTG 21353 b

1copayment, or any other cost-sharing requirement on the
2coverage provided under this paragraph; except that this
3sentence does not apply to coverage of diagnostic mammograms
4to the extent such coverage would disqualify a high-deductible
5health plan from eligibility for a health savings account
6pursuant to Section 223 of the Internal Revenue Code (26
7U.S.C. 223).
8    All screenings shall include a physical breast exam,
9instruction on self-examination and information regarding the
10frequency of self-examination and its value as a preventative
12     For purposes of this Section:
13    "Diagnostic mammogram" means a mammogram obtained using
14diagnostic mammography.
15    "Diagnostic mammography" means a method of screening that
16is designed to evaluate an abnormality in a breast, including
17an abnormality seen or suspected on a screening mammogram or a
18subjective or objective abnormality otherwise detected in the
20    "Low-dose mammography" means the x-ray examination of the
21breast using equipment dedicated specifically for mammography,
22including the x-ray tube, filter, compression device, and
23image receptor, with an average radiation exposure delivery of
24less than one rad per breast for 2 views of an average size
25breast. The term also includes digital mammography and
26includes breast tomosynthesis.



HB2589 Enrolled- 23 -LRB102 15983 KTG 21353 b

1    "Breast tomosynthesis" means a radiologic procedure that
2involves the acquisition of projection images over the
3stationary breast to produce cross-sectional digital
4three-dimensional images of the breast.
5    If, at any time, the Secretary of the United States
6Department of Health and Human Services, or its successor
7agency, promulgates rules or regulations to be published in
8the Federal Register or publishes a comment in the Federal
9Register or issues an opinion, guidance, or other action that
10would require the State, pursuant to any provision of the
11Patient Protection and Affordable Care Act (Public Law
12111-148), including, but not limited to, 42 U.S.C.
1318031(d)(3)(B) or any successor provision, to defray the cost
14of any coverage for breast tomosynthesis outlined in this
15paragraph, then the requirement that an insurer cover breast
16tomosynthesis is inoperative other than any such coverage
17authorized under Section 1902 of the Social Security Act, 42
18U.S.C. 1396a, and the State shall not assume any obligation
19for the cost of coverage for breast tomosynthesis set forth in
20this paragraph.
21    On and after January 1, 2016, the Department shall ensure
22that all networks of care for adult clients of the Department
23include access to at least one breast imaging Center of
24Imaging Excellence as certified by the American College of
26    On and after January 1, 2012, providers participating in a



HB2589 Enrolled- 24 -LRB102 15983 KTG 21353 b

1quality improvement program approved by the Department shall
2be reimbursed for screening and diagnostic mammography at the
3same rate as the Medicare program's rates, including the
4increased reimbursement for digital mammography.
5    The Department shall convene an expert panel including
6representatives of hospitals, free-standing mammography
7facilities, and doctors, including radiologists, to establish
8quality standards for mammography.
9    On and after January 1, 2017, providers participating in a
10breast cancer treatment quality improvement program approved
11by the Department shall be reimbursed for breast cancer
12treatment at a rate that is no lower than 95% of the Medicare
13program's rates for the data elements included in the breast
14cancer treatment quality program.
15    The Department shall convene an expert panel, including
16representatives of hospitals, free-standing breast cancer
17treatment centers, breast cancer quality organizations, and
18doctors, including breast surgeons, reconstructive breast
19surgeons, oncologists, and primary care providers to establish
20quality standards for breast cancer treatment.
21    Subject to federal approval, the Department shall
22establish a rate methodology for mammography at federally
23qualified health centers and other encounter-rate clinics.
24These clinics or centers may also collaborate with other
25hospital-based mammography facilities. By January 1, 2016, the
26Department shall report to the General Assembly on the status



HB2589 Enrolled- 25 -LRB102 15983 KTG 21353 b

1of the provision set forth in this paragraph.
2    The Department shall establish a methodology to remind
3women who are age-appropriate for screening mammography, but
4who have not received a mammogram within the previous 18
5months, of the importance and benefit of screening
6mammography. The Department shall work with experts in breast
7cancer outreach and patient navigation to optimize these
8reminders and shall establish a methodology for evaluating
9their effectiveness and modifying the methodology based on the
11    The Department shall establish a performance goal for
12primary care providers with respect to their female patients
13over age 40 receiving an annual mammogram. This performance
14goal shall be used to provide additional reimbursement in the
15form of a quality performance bonus to primary care providers
16who meet that goal.
17    The Department shall devise a means of case-managing or
18patient navigation for beneficiaries diagnosed with breast
19cancer. This program shall initially operate as a pilot
20program in areas of the State with the highest incidence of
21mortality related to breast cancer. At least one pilot program
22site shall be in the metropolitan Chicago area and at least one
23site shall be outside the metropolitan Chicago area. On or
24after July 1, 2016, the pilot program shall be expanded to
25include one site in western Illinois, one site in southern
26Illinois, one site in central Illinois, and 4 sites within



HB2589 Enrolled- 26 -LRB102 15983 KTG 21353 b

1metropolitan Chicago. An evaluation of the pilot program shall
2be carried out measuring health outcomes and cost of care for
3those served by the pilot program compared to similarly
4situated patients who are not served by the pilot program.
5    The Department shall require all networks of care to
6develop a means either internally or by contract with experts
7in navigation and community outreach to navigate cancer
8patients to comprehensive care in a timely fashion. The
9Department shall require all networks of care to include
10access for patients diagnosed with cancer to at least one
11academic commission on cancer-accredited cancer program as an
12in-network covered benefit.
13    Any medical or health care provider shall immediately
14recommend, to any pregnant woman who is being provided
15prenatal services and is suspected of having a substance use
16disorder as defined in the Substance Use Disorder Act,
17referral to a local substance use disorder treatment program
18licensed by the Department of Human Services or to a licensed
19hospital which provides substance abuse treatment services.
20The Department of Healthcare and Family Services shall assure
21coverage for the cost of treatment of the drug abuse or
22addiction for pregnant recipients in accordance with the
23Illinois Medicaid Program in conjunction with the Department
24of Human Services.
25    All medical providers providing medical assistance to
26pregnant women under this Code shall receive information from



HB2589 Enrolled- 27 -LRB102 15983 KTG 21353 b

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



HB2589 Enrolled- 28 -LRB102 15983 KTG 21353 b

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



HB2589 Enrolled- 29 -LRB102 15983 KTG 21353 b

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



HB2589 Enrolled- 30 -LRB102 15983 KTG 21353 b

1    The Illinois Department shall require health care
2providers to maintain records that document the medical care
3and services provided to recipients of Medical Assistance
4under this Article. Such records must be retained for a period
5of not less than 6 years from the date of service or as
6provided by applicable State law, whichever period is longer,
7except that if an audit is initiated within the required
8retention period then the records must be retained until the
9audit is completed and every exception is resolved. The
10Illinois Department shall require health care providers to
11make available, when authorized by the patient, in writing,
12the medical records in a timely fashion to other health care
13providers who are treating or serving persons eligible for
14Medical Assistance under this Article. All dispensers of
15medical services shall be required to maintain and retain
16business and professional records sufficient to fully and
17accurately document the nature, scope, details and receipt of
18the health care provided to persons eligible for medical
19assistance under this Code, in accordance with regulations
20promulgated by the Illinois Department. The rules and
21regulations shall require that proof of the receipt of
22prescription drugs, dentures, prosthetic devices and
23eyeglasses by eligible persons under this Section accompany
24each claim for reimbursement submitted by the dispenser of
25such medical services. No such claims for reimbursement shall
26be approved for payment by the Illinois Department without



HB2589 Enrolled- 31 -LRB102 15983 KTG 21353 b

1such proof of receipt, unless the Illinois Department shall
2have put into effect and shall be operating a system of
3post-payment audit and review which shall, on a sampling
4basis, be deemed adequate by the Illinois Department to assure
5that such drugs, dentures, prosthetic devices and eyeglasses
6for which payment is being made are actually being received by
7eligible recipients. Within 90 days after September 16, 1984
8(the effective date of Public Act 83-1439), the Illinois
9Department shall establish a current list of acquisition costs
10for all prosthetic devices and any other items recognized as
11medical equipment and supplies reimbursable under this Article
12and shall update such list on a quarterly basis, except that
13the acquisition costs of all prescription drugs shall be
14updated no less frequently than every 30 days as required by
15Section 5-5.12.
16    Notwithstanding any other law to the contrary, the
17Illinois Department shall, within 365 days after July 22, 2013
18(the effective date of Public Act 98-104), establish
19procedures to permit skilled care facilities licensed under
20the Nursing Home Care Act to submit monthly billing claims for
21reimbursement purposes. Following development of these
22procedures, the Department shall, by July 1, 2016, test the
23viability of the new system and implement any necessary
24operational or structural changes to its information
25technology platforms in order to allow for the direct
26acceptance and payment of nursing home claims.



HB2589 Enrolled- 32 -LRB102 15983 KTG 21353 b

1    Notwithstanding any other law to the contrary, the
2Illinois Department shall, within 365 days after August 15,
32014 (the effective date of Public Act 98-963), establish
4procedures to permit ID/DD facilities licensed under the ID/DD
5Community Care Act and MC/DD facilities licensed under the
6MC/DD Act to submit monthly billing claims for reimbursement
7purposes. Following development of these procedures, the
8Department shall have an additional 365 days to test the
9viability of the new system and to ensure that any necessary
10operational or structural changes to its information
11technology platforms are implemented.
12    The Illinois Department shall require all dispensers of
13medical services, other than an individual practitioner or
14group of practitioners, desiring to participate in the Medical
15Assistance program established under this Article to disclose
16all financial, beneficial, ownership, equity, surety or other
17interests in any and all firms, corporations, partnerships,
18associations, business enterprises, joint ventures, agencies,
19institutions or other legal entities providing any form of
20health care services in this State under this Article.
21    The Illinois Department may require that all dispensers of
22medical services desiring to participate in the medical
23assistance program established under this Article disclose,
24under such terms and conditions as the Illinois Department may
25by rule establish, all inquiries from clients and attorneys
26regarding medical bills paid by the Illinois Department, which



HB2589 Enrolled- 33 -LRB102 15983 KTG 21353 b

1inquiries could indicate potential existence of claims or
2liens for the Illinois Department.
3    Enrollment of a vendor shall be subject to a provisional
4period and shall be conditional for one year. During the
5period of conditional enrollment, the Department may terminate
6the vendor's eligibility to participate in, or may disenroll
7the vendor from, the medical assistance program without cause.
8Unless otherwise specified, such termination of eligibility or
9disenrollment is not subject to the Department's hearing
10process. However, a disenrolled vendor may reapply without
12    The Department has the discretion to limit the conditional
13enrollment period for vendors based upon category of risk of
14the vendor.
15    Prior to enrollment and during the conditional enrollment
16period in the medical assistance program, all vendors shall be
17subject to enhanced oversight, screening, and review based on
18the risk of fraud, waste, and abuse that is posed by the
19category of risk of the vendor. The Illinois Department shall
20establish the procedures for oversight, screening, and review,
21which may include, but need not be limited to: criminal and
22financial background checks; fingerprinting; license,
23certification, and authorization verifications; unscheduled or
24unannounced site visits; database checks; prepayment audit
25reviews; audits; payment caps; payment suspensions; and other
26screening as required by federal or State law.



HB2589 Enrolled- 34 -LRB102 15983 KTG 21353 b

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



HB2589 Enrolled- 35 -LRB102 15983 KTG 21353 b

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



HB2589 Enrolled- 36 -LRB102 15983 KTG 21353 b

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



HB2589 Enrolled- 37 -LRB102 15983 KTG 21353 b

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



HB2589 Enrolled- 38 -LRB102 15983 KTG 21353 b

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



HB2589 Enrolled- 39 -LRB102 15983 KTG 21353 b

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



HB2589 Enrolled- 40 -LRB102 15983 KTG 21353 b

1refurbished durable medical equipment equally meets the needs
2of the recipient or enrollee. Nothing in this paragraph shall
3be construed to limit recipient or enrollee choice to obtain
4new durable medical equipment or place any additional prior
5authorization conditions on enrollees of managed care
7    The Department shall execute, relative to the nursing home
8prescreening project, written inter-agency agreements with the
9Department of Human Services and the Department on Aging, to
10effect the following: (i) intake procedures and common
11eligibility criteria for those persons who are receiving
12non-institutional services; and (ii) the establishment and
13development of non-institutional services in areas of the
14State where they are not currently available or are
15undeveloped; and (iii) notwithstanding any other provision of
16law, subject to federal approval, on and after July 1, 2012, an
17increase in the determination of need (DON) scores from 29 to
1837 for applicants for institutional and home and
19community-based long term care; if and only if federal
20approval is not granted, the Department may, in conjunction
21with other affected agencies, implement utilization controls
22or changes in benefit packages to effectuate a similar savings
23amount for this population; and (iv) no later than July 1,
242013, minimum level of care eligibility criteria for
25institutional and home and community-based long term care; and
26(v) no later than October 1, 2013, establish procedures to



HB2589 Enrolled- 41 -LRB102 15983 KTG 21353 b

1permit long term care providers access to eligibility scores
2for individuals with an admission date who are seeking or
3receiving services from the long term care provider. In order
4to select the minimum level of care eligibility criteria, the
5Governor shall establish a workgroup that includes affected
6agency representatives and stakeholders representing the
7institutional and home and community-based long term care
8interests. This Section shall not restrict the Department from
9implementing lower level of care eligibility criteria for
10community-based services in circumstances where federal
11approval 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
16and programs for monitoring of utilization of health care
17services and facilities, as it affects persons eligible for
18medical assistance 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



HB2589 Enrolled- 42 -LRB102 15983 KTG 21353 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
8Assembly shall be satisfied by filing copies of the report as
9required by Section 3.1 of the General Assembly Organization
10Act, and filing such additional copies with the State
11Government Report Distribution Center for the General Assembly
12as is required under paragraph (t) of Section 7 of the State
13Library Act.
14    Rulemaking authority to implement Public Act 95-1045, if
15any, is conditioned on the rules being adopted in accordance
16with all provisions of the Illinois Administrative Procedure
17Act and all rules and procedures of the Joint Committee on
18Administrative Rules; any purported rule not so adopted, for
19whatever reason, is unauthorized.
20    On and after July 1, 2012, the Department shall reduce any
21rate of reimbursement for services or other payments or alter
22any methodologies authorized by this Code to reduce any rate
23of reimbursement for services or other payments in accordance
24with Section 5-5e.
25    Because kidney transplantation can be an appropriate,
26cost-effective alternative to renal dialysis when medically



HB2589 Enrolled- 43 -LRB102 15983 KTG 21353 b

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



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1for the treatment of an opioid overdose, including the
2medication product, administration devices, and any pharmacy
3fees or hospital fees related to the dispensing, distribution,
4and administration of the opioid antagonist, shall be covered
5under the medical assistance program for persons who are
6otherwise eligible for medical assistance under this Article.
7As used in this Section, "opioid antagonist" means a drug that
8binds to opioid receptors and blocks or inhibits the effect of
9opioids acting on those receptors, including, but not limited
10to, naloxone hydrochloride or any other similarly acting drug
11approved by the U.S. Food and Drug Administration.
12    Upon federal approval, the Department shall provide
13coverage and reimbursement for all drugs that are approved for
14marketing by the federal Food and Drug Administration and that
15are recommended by the federal Public Health Service or the
16United States Centers for Disease Control and Prevention for
17pre-exposure prophylaxis and related pre-exposure prophylaxis
18services, including, but not limited to, HIV and sexually
19transmitted infection screening, treatment for sexually
20transmitted infections, medical monitoring, assorted labs, and
21counseling to reduce the likelihood of HIV infection among
22individuals who are not infected with HIV but who are at high
23risk of HIV infection.
24    A federally qualified health center, as defined in Section
251905(l)(2)(B) of the federal Social Security Act, shall be
26reimbursed by the Department in accordance with the federally



HB2589 Enrolled- 45 -LRB102 15983 KTG 21353 b

1qualified health center's encounter rate for services provided
2to medical assistance recipients that are performed by a
3dental hygienist, as defined under the Illinois Dental
4Practice Act, working under the general supervision of a
5dentist and employed by a federally qualified health center.
6(Source: P.A. 100-201, eff. 8-18-17; 100-395, eff. 1-1-18;
7100-449, eff. 1-1-18; 100-538, eff. 1-1-18; 100-587, eff.
86-4-18; 100-759, eff. 1-1-19; 100-863, eff. 8-14-18; 100-974,
9eff. 8-19-18; 100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19;
10100-1148, eff. 12-10-18; 101-209, eff. 8-5-19; 101-580, eff.
111-1-20; revised 9-18-19.)
12    (305 ILCS 5/5-41 new)
13    Sec. 5-41. Screening, Brief Intervention, and Referral to
15    As used in this Section, "SBIRT" means a comprehensive,
16integrated, public health approach to the delivery of early
17intervention and treatment services for persons who are at
18risk of developing substance use disorders or have substance
19use disorders including, but not limited to, an addiction to
20alcohol, opioids, tobacco, or cannabis. SBIRT services include
21all of the following:
22        (1) Screening to quickly assess the severity of
23    substance use and to identify the appropriate level of
24    treatment.
25        (2) Brief intervention focused on increasing insight



HB2589 Enrolled- 46 -LRB102 15983 KTG 21353 b

1    and awareness regarding substance use and motivation
2    toward behavioral change.
3        (3) Referral to treatment provided to those identified
4    as needing more extensive treatment with access to
5    specialty care.
6    SBIRT services may include, but are not limited to, the
7following settings and programs: primary care centers,
8hospital emergency rooms, hospital in-patient units, trauma
9centers, community behavioral health programs, and other
10community settings that provide opportunities for early
11intervention with at-risk substance users before more severe
12consequences occur.
13    The Department of Healthcare and Family Services shall
14develop and seek federal approval of a SBIRT benefit for which
15qualified providers shall be reimbursed under the medical
16assistance program.
17    In conjunction with the Department of Human Services'
18Division of Substance Use Prevention and Recovery, the
19Department of Healthcare and Family Services may develop a
20methodology and reimbursement rate for SBIRT services provided
21by qualified providers in approved settings.
22    For opioid specific SBIRT services provided in a hospital
23emergency department, the Department of Healthcare and Family
24Services shall develop a bundled reimbursement methodology and
25rate for a package of opioid treatment services, which include
26initiation of medication for the treatment of opioid use



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1disorder in the emergency department setting, including
2assessment, referral to ongoing care, and arranging access to
3supportive services when necessary. This package of opioid
4related services shall be billed on a separate claim and shall
5be reimbursed outside of the Enhanced Ambulatory Patient
6Grouping system.