Illinois General Assembly - Full Text of HB1409
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Full Text of HB1409  102nd General Assembly

HB1409eng 102ND GENERAL ASSEMBLY



 


 
HB1409 EngrossedLRB102 03425 KTG 13438 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Emergency Medical Services (EMS) Systems
5Act is amended by changing Section 3.10 as follows:
 
6    (210 ILCS 50/3.10)
7    Sec. 3.10. Scope of services.
8    (a) "Advanced Life Support (ALS) Services" means an
9advanced level of pre-hospital and inter-hospital emergency
10care and non-emergency medical services that includes basic
11life support care, cardiac monitoring, cardiac defibrillation,
12electrocardiography, intravenous therapy, administration of
13medications, drugs and solutions, use of adjunctive medical
14devices, trauma care, and other authorized techniques and
15procedures, as outlined in the provisions of the National EMS
16Education Standards relating to Advanced Life Support and any
17modifications to that curriculum specified in rules adopted by
18the Department pursuant to this Act.
19    That care shall be initiated as authorized by the EMS
20Medical Director in a Department approved advanced life
21support EMS System, under the written or verbal direction of a
22physician licensed to practice medicine in all of its branches
23or under the verbal direction of an Emergency Communications

 

 

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1Registered Nurse.
2    (b) "Intermediate Life Support (ILS) Services" means an
3intermediate level of pre-hospital and inter-hospital
4emergency care and non-emergency medical services that
5includes basic life support care plus intravenous cannulation
6and fluid therapy, invasive airway management, trauma care,
7and other authorized techniques and procedures, as outlined in
8the Intermediate Life Support national curriculum of the
9United States Department of Transportation and any
10modifications to that curriculum specified in rules adopted by
11the Department pursuant to this Act.
12    That care shall be initiated as authorized by the EMS
13Medical Director in a Department approved intermediate or
14advanced life support EMS System, under the written or verbal
15direction of a physician licensed to practice medicine in all
16of its branches or under the verbal direction of an Emergency
17Communications Registered Nurse.
18    (c) "Basic Life Support (BLS) Services" means a basic
19level of pre-hospital and inter-hospital emergency care and
20non-emergency medical services that includes medical
21monitoring, clinical observation, airway management,
22cardiopulmonary resuscitation (CPR), control of shock and
23bleeding and splinting of fractures, as outlined in the
24provisions of the National EMS Education Standards relating to
25Basic Life Support and any modifications to that curriculum
26specified in rules adopted by the Department pursuant to this

 

 

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1Act.
2    That care shall be initiated, where authorized by the EMS
3Medical Director in a Department approved EMS System, under
4the written or verbal direction of a physician licensed to
5practice medicine in all of its branches or under the verbal
6direction of an Emergency Communications Registered Nurse.
7    (d) "Emergency Medical Responder Services" means a
8preliminary level of pre-hospital emergency care that includes
9cardiopulmonary resuscitation (CPR), monitoring vital signs
10and control of bleeding, as outlined in the Emergency Medical
11Responder (EMR) curriculum of the National EMS Education
12Standards and any modifications to that curriculum specified
13in rules adopted by the Department pursuant to this Act.
14    (e) "Pre-hospital care" means those medical services
15rendered to patients for analytic, resuscitative, stabilizing,
16or preventive purposes, precedent to and during transportation
17of such patients to health care facilities.
18    (f) "Inter-hospital care" means those medical services
19rendered to patients for analytic, resuscitative, stabilizing,
20or preventive purposes, during transportation of such patients
21from one hospital to another hospital.
22    (f-5) "Critical care transport" means transportation which
23includes the provision of pre-hospital or inter-hospital
24emergency care or non-emergency medical services to
25transportation of a critically injured or ill patient by a
26vehicle service provider, including the provision of medically

 

 

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1necessary supplies and services, at a level of service beyond
2the scope of the Paramedic. When medically indicated for a
3patient, as determined by a physician licensed to practice
4medicine in all of its branches, an advanced practice
5registered nurse, or a physician physician's assistant, in
6compliance with subsections (b) and (c) of Section 3.155 of
7this Act, critical care transport may be provided by:
8        (1) Department-approved critical care transport
9    providers, not owned or operated by a hospital, utilizing
10    Paramedics with additional training, nurses, or other
11    qualified health professionals; or
12        (2) Hospitals, when utilizing any vehicle service
13    provider or any hospital-owned or operated vehicle service
14    provider. Nothing in Public Act 96-1469 requires a
15    hospital to use, or to be, a Department-approved critical
16    care transport provider when transporting patients,
17    including those critically injured or ill. Nothing in this
18    Act shall restrict or prohibit a hospital from providing,
19    or arranging for, the medically appropriate transport of
20    any patient, as determined by a physician licensed to
21    practice in all of its branches, an advanced practice
22    registered nurse, or a physician physician's assistant.
23    (g) "Non-emergency medical services" means the provision
24of, and all actions necessary before and after the provision
25of, Basic Life Support (BLS) Services, Advanced Life Support
26(ALS) Services, and critical care transport to patients whose

 

 

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1conditions do not meet this Act's definition of emergency,
2before, after, or during transportation of such patients to or
3from health care facilities visited for the purpose of
4obtaining medical or health care services which are not
5emergency in nature, using a vehicle regulated by this Act and
6personnel licensed under this Act.
7    (g-5) The Department shall have the authority to
8promulgate minimum standards for critical care transport
9providers through rules adopted pursuant to this Act. All
10critical care transport providers must function within a
11Department-approved EMS System. Nothing in Department rules
12shall restrict a hospital's ability to furnish personnel,
13equipment, and medical supplies to any vehicle service
14provider, including a critical care transport provider.
15Minimum critical care transport provider standards shall
16include, but are not limited to:
17        (1) Personnel staffing and licensure.
18        (2) Education, certification, and experience.
19        (3) Medical equipment and supplies.
20        (4) Vehicular standards.
21        (5) Treatment and transport protocols.
22        (6) Quality assurance and data collection.
23    (h) The provisions of this Act shall not apply to the use
24of an ambulance or SEMSV, unless and until emergency or
25non-emergency medical services are needed during the use of
26the ambulance or SEMSV.

 

 

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1(Source: P.A. 102-623, eff. 8-27-21; revised 12-1-21.)
 
2    Section 10. The Illinois Public Aid Code is amended by
3changing Section 5-4.2 and by adding Section 5-30c as follows:
 
4    (305 ILCS 5/5-4.2)
5    Sec. 5-4.2. Ambulance services payments.
6    (a) For ambulance services provided to a recipient of aid
7under this Article on or after January 1, 1993, the Illinois
8Department shall reimburse ambulance service providers at
9rates calculated in accordance with this Section. It is the
10intent of the General Assembly to provide adequate
11reimbursement for ambulance services so as to ensure adequate
12access to services for recipients of aid under this Article
13and to provide appropriate incentives to ambulance service
14providers to provide services in an efficient and
15cost-effective manner. Thus, it is the intent of the General
16Assembly that the Illinois Department implement a
17reimbursement system for ambulance services that, to the
18extent practicable and subject to the availability of funds
19appropriated by the General Assembly for this purpose, is
20consistent with the payment principles of Medicare. To ensure
21uniformity between the payment principles of Medicare and
22Medicaid, the Illinois Department shall follow, to the extent
23necessary and practicable and subject to the availability of
24funds appropriated by the General Assembly for this purpose,

 

 

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1the statutes, laws, regulations, policies, procedures,
2principles, definitions, guidelines, and manuals used to
3determine the amounts paid to ambulance service providers
4under Title XVIII of the Social Security Act (Medicare).
5    (b) For ambulance services provided to a recipient of aid
6under this Article on or after January 1, 1996, the Illinois
7Department shall reimburse ambulance service providers based
8upon the actual distance traveled if a natural disaster,
9weather conditions, road repairs, or traffic congestion
10necessitates the use of a route other than the most direct
11route.
12    (c) For purposes of this Section, "ambulance services"
13includes medical transportation services provided by means of
14an ambulance, medi-car, service car, or taxi.
15    (c-1) For purposes of this Section, "ground ambulance
16service" means medical transportation services that are
17described as ground ambulance services by the Centers for
18Medicare and Medicaid Services and provided in a vehicle that
19is licensed as an ambulance by the Illinois Department of
20Public Health pursuant to the Emergency Medical Services (EMS)
21Systems Act.
22    (c-2) For purposes of this Section, "ground ambulance
23service provider" means a vehicle service provider as
24described in the Emergency Medical Services (EMS) Systems Act
25that operates licensed ambulances for the purpose of providing
26emergency ambulance services, or non-emergency ambulance

 

 

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1services, or both. For purposes of this Section, this includes
2both ambulance providers and ambulance suppliers as described
3by the Centers for Medicare and Medicaid Services.
4    (c-3) For purposes of this Section, "medi-car" means
5transportation services provided to a patient who is confined
6to a wheelchair and requires the use of a hydraulic or electric
7lift or ramp and wheelchair lockdown when the patient's
8condition does not require medical observation, medical
9supervision, medical equipment, the administration of
10medications, or the administration of oxygen.
11    (c-4) For purposes of this Section, "service car" means
12transportation services provided to a patient by a passenger
13vehicle where that patient does not require the specialized
14modes described in subsection (c-1) or (c-3).
15    (d) This Section does not prohibit separate billing by
16ambulance service providers for oxygen furnished while
17providing advanced life support services.
18    (e) Beginning with services rendered on or after July 1,
192008, all providers of non-emergency medi-car and service car
20transportation must certify that the driver and employee
21attendant, as applicable, have completed a safety program
22approved by the Department to protect both the patient and the
23driver, prior to transporting a patient. The provider must
24maintain this certification in its records. The provider shall
25produce such documentation upon demand by the Department or
26its representative. Failure to produce documentation of such

 

 

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1training shall result in recovery of any payments made by the
2Department for services rendered by a non-certified driver or
3employee attendant. Medi-car and service car providers must
4maintain legible documentation in their records of the driver
5and, as applicable, employee attendant that actually
6transported the patient. Providers must recertify all drivers
7and employee attendants every 3 years. If they meet the
8established training components set forth by the Department,
9providers of non-emergency medi-car and service car
10transportation that are either directly or through an
11affiliated company licensed by the Department of Public Health
12shall be approved by the Department to have in-house safety
13programs for training their own staff.
14    Notwithstanding the requirements above, any public
15transportation provider of medi-car and service car
16transportation that receives federal funding under 49 U.S.C.
175307 and 5311 need not certify its drivers and employee
18attendants under this Section, since safety training is
19already federally mandated.
20    (f) With respect to any policy or program administered by
21the Department or its agent regarding approval of
22non-emergency medical transportation by ground ambulance
23service providers, including, but not limited to, the
24Non-Emergency Transportation Services Prior Approval Program
25(NETSPAP), the Department shall establish by rule a process by
26which ground ambulance service providers of non-emergency

 

 

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1medical transportation may appeal any decision by the
2Department or its agent for which no denial was received prior
3to the time of transport that either (i) denies a request for
4approval for payment of non-emergency transportation by means
5of ground ambulance service or (ii) grants a request for
6approval of non-emergency transportation by means of ground
7ambulance service at a level of service that entitles the
8ground ambulance service provider to a lower level of
9compensation from the Department than the ground ambulance
10service provider would have received as compensation for the
11level of service requested. The rule shall be filed by
12December 15, 2012 and shall provide that, for any decision
13rendered by the Department or its agent on or after the date
14the rule takes effect, the ground ambulance service provider
15shall have 60 days from the date the decision is received to
16file an appeal. The rule established by the Department shall
17be, insofar as is practical, consistent with the Illinois
18Administrative Procedure Act. The Director's decision on an
19appeal under this Section shall be a final administrative
20decision subject to review under the Administrative Review
21Law.
22    (f-5) Beginning 90 days after July 20, 2012 (the effective
23date of Public Act 97-842), (i) no denial of a request for
24approval for payment of non-emergency transportation by means
25of ground ambulance service, and (ii) no approval of
26non-emergency transportation by means of ground ambulance

 

 

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1service at a level of service that entitles the ground
2ambulance service provider to a lower level of compensation
3from the Department than would have been received at the level
4of service submitted by the ground ambulance service provider,
5may be issued by the Department or its agent unless the
6Department has submitted the criteria for determining the
7appropriateness of the transport for first notice publication
8in the Illinois Register pursuant to Section 5-40 of the
9Illinois Administrative Procedure Act.
10    (f-6) Within 90 days after the effective date of this
11amendatory Act of the 102nd General Assembly, the Department
12shall adjust the criteria established under subsection (f-5)
13by striking any reference to prohibiting approval of ground
14ambulance services when the sole purpose of the transport is
15for the navigation of stairs or the assisting or lifting of a
16patient at a medical facility or during a medical appointment.
17It is the intent of the General Assembly to permit ground
18ambulance reimbursement for lifting, moving, or navigating
19stairs in instances when a recipient exhibits extenuating
20circumstances related to the social determinants of health
21which would make an otherwise non-eligible ground ambulance
22transport eligible for reimbursement. Such extenuating
23circumstances may include a condition which would present an
24unreasonable risk for the patient to navigate the stairs
25without the assistance of medically trained ground ambulance
26personnel. Such extenuating circumstances may be established

 

 

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1through the completion of a Physician Certification Statement
2as set forth in subsection (g).
3    (f-7) For non-emergency ground ambulance claims properly
4denied under Department policy at the time the claim is filed
5due to failure to submit a valid Medical Certification for
6Non-Emergency Ambulance on and after December 15, 2012 and
7prior to January 1, 2021, the Department shall allot
8$2,000,000 to a pool to reimburse such claims if the provider
9proves medical necessity for the service by other means.
10Providers must submit any such denied claims for which they
11seek compensation to the Department no later than December 31,
122021 along with documentation of medical necessity. No later
13than May 31, 2022, the Department shall determine for which
14claims medical necessity was established. Such claims for
15which medical necessity was established shall be paid at the
16rate in effect at the time of the service, provided the
17$2,000,000 is sufficient to pay at those rates. If the pool is
18not sufficient, claims shall be paid at a uniform percentage
19of the applicable rate such that the pool of $2,000,000 is
20exhausted. The appeal process described in subsection (f)
21shall not be applicable to the Department's determinations
22made in accordance with this subsection.
23    (g) Whenever a patient covered by a medical assistance
24program under this Code or by another medical program
25administered by the Department, including a patient covered
26under the State's Medicaid managed care program, is being

 

 

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1transported from a facility and requires non-emergency
2transportation including ground ambulance, medi-car, or
3service car transportation, a Physician Certification
4Statement as described in this Section shall be required for
5each patient. Facilities shall develop procedures for a
6licensed medical professional to provide a written and signed
7Physician Certification Statement. The Physician Certification
8Statement shall specify the level of transportation services
9needed and complete a medical certification establishing the
10criteria for approval of non-emergency ambulance
11transportation, as published by the Department of Healthcare
12and Family Services, that is met by the patient. This
13certification shall be completed prior to ordering the
14transportation service and prior to patient discharge. The
15Physician Certification Statement is not required prior to
16transport if a delay in transport can be expected to
17negatively affect the patient outcome. If the ground ambulance
18provider, medi-car provider, or service car provider is unable
19to obtain the required Physician Certification Statement
20within 10 calendar days following the date of the service, the
21ground ambulance provider, medi-car provider, or service car
22provider must document its attempt to obtain the requested
23certification and may then submit the claim for payment.
24Acceptable documentation includes a signed return receipt from
25the U.S. Postal Service, facsimile receipt, email receipt, or
26other similar service that evidences that the ground ambulance

 

 

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1provider, medi-car provider, or service car provider attempted
2to obtain the required Physician Certification Statement.
3    The medical certification specifying the level and type of
4non-emergency transportation needed shall be in the form of
5the Physician Certification Statement on a standardized form
6prescribed by the Department of Healthcare and Family
7Services. Within 75 days after July 27, 2018 (the effective
8date of Public Act 100-646), the Department of Healthcare and
9Family Services shall develop a standardized form of the
10Physician Certification Statement specifying the level and
11type of transportation services needed in consultation with
12the Department of Public Health, Medicaid managed care
13organizations, a statewide association representing ambulance
14providers, a statewide association representing hospitals, 3
15statewide associations representing nursing homes, and other
16stakeholders. The Physician Certification Statement shall
17include, but is not limited to, the criteria necessary to
18demonstrate medical necessity for the level of transport
19needed as required by (i) the Department of Healthcare and
20Family Services and (ii) the federal Centers for Medicare and
21Medicaid Services as outlined in the Centers for Medicare and
22Medicaid Services' Medicare Benefit Policy Manual, Pub.
23100-02, Chap. 10, Sec. 10.2.1, et seq. The use of the Physician
24Certification Statement shall satisfy the obligations of
25hospitals under Section 6.22 of the Hospital Licensing Act and
26nursing homes under Section 2-217 of the Nursing Home Care

 

 

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1Act. Implementation and acceptance of the Physician
2Certification Statement shall take place no later than 90 days
3after the issuance of the Physician Certification Statement by
4the Department of Healthcare and Family Services.
5    Pursuant to subsection (E) of Section 12-4.25 of this
6Code, the Department is entitled to recover overpayments paid
7to a provider or vendor, including, but not limited to, from
8the discharging physician, the discharging facility, and the
9ground ambulance service provider, in instances where a
10non-emergency ground ambulance service is rendered as the
11result of improper or false certification.
12    Beginning October 1, 2018, the Department of Healthcare
13and Family Services shall collect data from Medicaid managed
14care organizations and transportation brokers, including the
15Department's NETSPAP broker, regarding denials and appeals
16related to the missing or incomplete Physician Certification
17Statement forms and overall compliance with this subsection.
18The Department of Healthcare and Family Services shall publish
19quarterly results on its website within 15 days following the
20end of each quarter.
21    (h) On and after July 1, 2012, the Department shall reduce
22any rate of reimbursement for services or other payments or
23alter any methodologies authorized by this Code to reduce any
24rate of reimbursement for services or other payments in
25accordance with Section 5-5e.
26    (i) On and after July 1, 2018, the Department shall

 

 

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1increase the base rate of reimbursement for both base charges
2and mileage charges for ground ambulance service providers for
3medical transportation services provided by means of a ground
4ambulance to a level not lower than rates 112% of the base rate
5in effect as of July 1, 2021 June 30, 2018.
6    (k) Within 90 days after the effective date of this
7amendatory Act of the 102nd General Assembly, the Department
8shall establish a methodology for providing reimbursement for:
9(i) bariatric transports at an amount of one additional base
10rate for each additional 2 personnel necessary to safely move
11the patient; and (ii) specialty care transports to include
12transports originating or terminating at a residence and for
13intra-facility transports.
14(Source: P.A. 101-81, eff. 7-12-19; 101-649, eff. 7-7-20;
15102-364, eff. 1-1-22; 102-650, eff. 8-27-21; revised 11-8-21.)
 
16    (305 ILCS 5/5-30c new)
17    Sec. 5-30c. Medi-car and stretcher van services; rate
18increase. To ensure access to medical appointments and covered
19services and realize the objectives of the medical assistance
20program, the General Assembly must address the inadequate
21supply of non-emergency medical transportation providers
22across the State. To increase access to non-emergency
23transportation services, the Department shall increase the
24base rate for medi-car and stretcher van services to at least
25$50, and the rate of each attendant for medi-car and stretcher

 

 

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1van services to at least $50. This reimbursement rate shall
2only apply to stretcher van providers licensed by the
3Department of Public Health in accordance with Section 3.86 of
4the Emergency Medical Services (EMS) Systems Act. The
5Department shall establish a grant program for the purpose of
6building capacity among IMPACT-enrolled and BEP-certified
7providers of medi-car and stretcher van transportation
8services.
 
9    Section 99. Effective date. This Act takes effect upon
10becoming law.