Full Text of HB0115 95th General Assembly
HB0115ham001 95TH GENERAL ASSEMBLY
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Human Services Committee
Filed: 3/21/2007
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| AMENDMENT TO HOUSE BILL 115
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| AMENDMENT NO. ______. Amend House Bill 115 by replacing | 3 |
| everything after the enacting clause with the following:
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| "Section 5. The State Employees Group Insurance Act of 1971 | 5 |
| is amended by changing Section 6.11 as follows:
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| (5 ILCS 375/6.11)
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| Sec. 6.11. Required health benefits; Illinois Insurance | 8 |
| Code
requirements. The program of health
benefits shall provide | 9 |
| the post-mastectomy care benefits required to be covered
by a | 10 |
| policy of accident and health insurance under Section 356t of | 11 |
| the Illinois
Insurance Code. The program of health benefits | 12 |
| shall provide the coverage
required under Sections 356u, 356w, | 13 |
| 356x, 356z.2, 356z.4, and 356z.6 , and 356z.9 of the
Illinois | 14 |
| Insurance Code.
The program of health benefits must comply with | 15 |
| Section 155.37 of the
Illinois Insurance Code.
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| (Source: P.A. 92-440, eff. 8-17-01; 92-764, eff. 1-1-03; |
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| 93-102, eff. 1-1-04; 93-853, eff. 1-1-05.)
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| Section 10. The Department of Public Health Powers and | 3 |
| Duties Law of the
Civil Administrative Code of Illinois is | 4 |
| amended by changing Section 2310-353 as follows: | 5 |
| (20 ILCS 2310/2310-353) | 6 |
| Sec. 2310-353. Cervical Cancer Elimination Task Force. | 7 |
| (a) A standing Task Force on Cervical Cancer Elimination | 8 |
| ("Task Force") is established within the Illinois Department of | 9 |
| Public Health. | 10 |
| (b) The Task Force shall have 12 members appointed by the | 11 |
| Director of Public Health as follows: | 12 |
| (1) A representative of an organization relating to | 13 |
| women and cancer. | 14 |
| (2) A representative of an organization providing | 15 |
| health care to women. | 16 |
| (3) A health educator. | 17 |
| (4) A representative of a national organization | 18 |
| relating to cancer treatment who is an oncologist. | 19 |
| (5) A representative of the health insurance industry. | 20 |
| (6) A representative of a national organization of | 21 |
| obstetricians and gynecologists. | 22 |
| (7) A representative of a national organization of | 23 |
| family physicians. | 24 |
| (8) The State Epidemiologist. |
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| (9) A member at-large with an interest in women's | 2 |
| health. | 3 |
| (10) A social marketing expert on health issues. | 4 |
| (11) A licensed registered nurse. | 5 |
| (12) A member of the Illinois Breast and Cervical | 6 |
| Cancer Medical Advisory Committee. | 7 |
| The directors of Public Health and Healthcare and Family | 8 |
| Services
Public Aid , and the Secretary of Human Services, or | 9 |
| their designees, and the Chair and Vice-Chair of the Conference | 10 |
| of Women Legislators in Illinois, or their designees, shall be | 11 |
| ex officio members of the Task Force. The Director of Public | 12 |
| Health shall also consult with the Speaker of the House of | 13 |
| Representatives, the Minority Leader of the House of | 14 |
| Representatives, the President of the Senate, and the Minority | 15 |
| Leader of the Senate in the designation of members of the | 16 |
| Illinois General Assembly as ex-officio members. | 17 |
| Appointments to the Task Force should reflect the | 18 |
| composition of the Illinois population with regard to ethnic, | 19 |
| racial, age, and religious composition. | 20 |
| (c) The Director of Public Health shall appoint a Chair | 21 |
| from among the members of the Task Force. The Task Force shall | 22 |
| elect a Vice-Chair from its members. Initial appointments to | 23 |
| the Task Force shall be made not later than 30 days after the | 24 |
| effective date of this amendatory Act of the 93rd General | 25 |
| Assembly. A majority of the Task Force shall constitute a | 26 |
| quorum for the transaction of its business. The Task Force |
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| shall meet at least quarterly. The Task Force Chair may | 2 |
| establish sub-committees for the purpose of making special | 3 |
| studies; such sub-committees may include non-Task-Force | 4 |
| members as resource persons. | 5 |
| (d) Members of the Task Force shall be reimbursed for their | 6 |
| necessary expenses incurred in performing their duties. The | 7 |
| Department of Public Health shall provide staff and technical | 8 |
| assistance to the Task Force to the extent possible within | 9 |
| annual appropriations for its ordinary and contingent | 10 |
| expenses. | 11 |
| (e) The Task Force shall have the following duties: | 12 |
| (1) To obtain from the Department of Public Health, if | 13 |
| available, data and analyses regarding the prevalence and | 14 |
| burden of cervical cancer. The Task Force may conduct or | 15 |
| arrange for independent studies and analyses. | 16 |
| (2) To coordinate the efforts of the Task Force with | 17 |
| existing State committees and programs providing cervical | 18 |
| cancer screening, education, and case management. | 19 |
| (3) To raise public awareness on the causes and nature | 20 |
| of cervical cancer, personal risk factors, the value of | 21 |
| prevention, early detection, options for testing, | 22 |
| treatment costs, new technology, medical care | 23 |
| reimbursement, and physician education. | 24 |
| (4) To identify priority strategies, new technologies, | 25 |
| and newly introduced vaccines that are effective in | 26 |
| preventing and controlling the risk of cervical cancer and |
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| to reduce the number of women who are unscreened and | 2 |
| under-screened for cervical cancer . | 3 |
| (5) To identify and examine the limitations of existing | 4 |
| laws, regulations, programs, and services with regard to | 5 |
| coverage and awareness issues for cervical cancer, | 6 |
| including requiring insurance or other coverage for PAP | 7 |
| smears and mammograms in accordance with the most recently | 8 |
| published American Cancer Society guidelines. | 9 |
| (6) To develop a statewide comprehensive Cervical | 10 |
| Cancer Prevention Plan and strategies for implementing the | 11 |
| Plan and for promoting the Plan to the general public, | 12 |
| State and local elected officials, and various public and | 13 |
| private organizations, associations, businesses, | 14 |
| industries, and agencies. | 15 |
| (7) To receive and to consider reports and testimony | 16 |
| from individuals, local health departments, | 17 |
| community-based organizations, voluntary health | 18 |
| organizations, and other public and private organizations | 19 |
| statewide to learn more about their contributions to | 20 |
| cervical cancer diagnosis, prevention, and treatment and | 21 |
| more about their ideas for improving cervical cancer | 22 |
| prevention, diagnosis, and treatment in Illinois. | 23 |
| (8) To increase awareness about human papillomavirus | 24 |
| (HPV) and its link to cervical cancer and cervical | 25 |
| dysplasia, the availability and efficacy of the HPV vaccine | 26 |
| in the prevention of the disease, and the importance of |
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| providing it to young females 9 years of age through 26 | 2 |
| years of age.
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| (9) To assist in the development and implementation of | 4 |
| a plan to provide HPV vaccines to the maximum extent | 5 |
| possible throughout the State, as recommended by the U.S. | 6 |
| Centers for Disease Control and Prevention.
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| (f) The Task Force shall submit a report to the Governor | 8 |
| and the General Assembly by April 1, 2005 and by April 1 of | 9 |
| each year thereafter. The report shall include (i) information | 10 |
| regarding the progress being made in fulfilling the duties of | 11 |
| the Task Force and in developing the Cervical Cancer Prevention | 12 |
| Plan and (ii) recommended strategies or actions to reduce the | 13 |
| occurrence of cervical cancer and the burdens from cervical | 14 |
| cancer suffered by citizens of this State. | 15 |
| (g) The Task Force shall expire on April 1, 2009, or upon | 16 |
| submission of the Task Force's final report to the Governor and | 17 |
| the General Assembly, whichever occurs earlier.
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| (Source: P.A. 93-956, eff. 8-19-04; revised 12-15-05.) | 19 |
| Section 15. The Counties Code is amended by changing | 20 |
| Section 5-1069.3 as follows: | 21 |
| (55 ILCS 5/5-1069.3)
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| Sec. 5-1069.3. Required health benefits. If a county, | 23 |
| including a home
rule
county, is a self-insurer for purposes of | 24 |
| providing health insurance coverage
for its employees, the |
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| coverage shall include coverage for the post-mastectomy
care | 2 |
| benefits required to be covered by a policy of accident and | 3 |
| health
insurance under Section 356t and the coverage required | 4 |
| under Sections 356u,
356w, 356x ,
and 356z.6 , and 356z.9 of
the | 5 |
| Illinois Insurance Code. The requirement that health benefits | 6 |
| be covered
as provided in this Section is an
exclusive power | 7 |
| and function of the State and is a denial and limitation under
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| Article VII, Section 6, subsection (h) of the Illinois | 9 |
| Constitution. A home
rule county to which this Section applies | 10 |
| must comply with every provision of
this Section.
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| (Source: P.A. 93-853, eff. 1-1-05.)
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| Section 20. The Illinois Municipal Code is amended by | 13 |
| changing Section 10-4-2.3 as follows: | 14 |
| (65 ILCS 5/10-4-2.3)
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| Sec. 10-4-2.3. Required health benefits. If a | 16 |
| municipality, including a
home rule municipality, is a | 17 |
| self-insurer for purposes of providing health
insurance | 18 |
| coverage for its employees, the coverage shall include coverage | 19 |
| for
the post-mastectomy care benefits required to be covered by | 20 |
| a policy of
accident and health insurance under Section 356t | 21 |
| and the coverage required
under Sections 356u, 356w, 356x ,
and
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| 356z.6 , and 356z.9 of the Illinois
Insurance
Code. The | 23 |
| requirement that health
benefits be covered as provided in this | 24 |
| is an exclusive power and function of
the State and is a denial |
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| and limitation under Article VII, Section 6,
subsection (h) of | 2 |
| the Illinois Constitution. A home rule municipality to which
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| this Section applies must comply with every provision of this | 4 |
| Section.
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| (Source: P.A. 93-853, eff. 1-1-05.)
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| Section 25. The School Code is amended by changing Sections | 7 |
| 10-22.3f and 27-8.1 as follows: | 8 |
| (105 ILCS 5/10-22.3f)
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| Sec. 10-22.3f. Required health benefits. Insurance | 10 |
| protection and
benefits
for employees shall provide the | 11 |
| post-mastectomy care benefits required to be
covered by a | 12 |
| policy of accident and health insurance under Section 356t and | 13 |
| the
coverage required under Sections 356u, 356w, 356x ,
and
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| 356z.6 , 356z.9 of
the
Illinois Insurance Code.
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| (Source: P.A. 93-853, eff. 1-1-05.)
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| (105 ILCS 5/27-8.1) (from Ch. 122, par. 27-8.1)
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| Sec. 27-8.1. Health examinations and immunizations.
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| (1) In compliance with rules and regulations which the | 19 |
| Department of Public
Health shall promulgate, and except as | 20 |
| hereinafter provided, all children in
Illinois shall have a | 21 |
| health examination as follows: within one year prior to
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| entering kindergarten or the first grade of any public, | 23 |
| private, or parochial
elementary school; upon entering the |
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| fifth and ninth grades of any public,
private, or parochial | 2 |
| school; prior to entrance into any public, private, or
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| parochial nursery school; and, irrespective of grade, | 4 |
| immediately prior to or
upon entrance into any public, private, | 5 |
| or parochial school or nursery school,
each child shall present | 6 |
| proof of having been examined in accordance with this
Section | 7 |
| and the rules and regulations promulgated hereunder.
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| A tuberculosis skin test screening shall be included as a | 9 |
| required part of
each health examination included under this | 10 |
| Section if the child resides in an
area designated by the | 11 |
| Department of Public Health as having a high incidence
of | 12 |
| tuberculosis. Additional health examinations of pupils, | 13 |
| including vision examinations, may be required when deemed | 14 |
| necessary by school
authorities. Parents are encouraged to have | 15 |
| their children undergo vision examinations at the same points | 16 |
| in time required for health
examinations.
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| (1.5) In compliance with rules adopted by the Department of | 18 |
| Public Health and except as otherwise provided in this Section, | 19 |
| all children in kindergarten and the second and sixth grades of | 20 |
| any public, private, or parochial school shall have a dental | 21 |
| examination. Each of these children shall present proof of | 22 |
| having been examined by a dentist in accordance with this | 23 |
| Section and rules adopted under this Section before May 15th of | 24 |
| the school year. If a child in the second or sixth grade fails | 25 |
| to present proof by May 15th, the school may hold the child's | 26 |
| report card until one of the following occurs: (i) the child |
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| presents proof of a completed dental examination or (ii) the | 2 |
| child presents proof that a dental examination will take place | 3 |
| within 60 days after May 15th. The Department of Public Health | 4 |
| shall establish, by rule, a waiver for children who show an | 5 |
| undue burden or a lack of access to a dentist. Each public, | 6 |
| private, and parochial school must give notice of this dental | 7 |
| examination requirement to the parents and guardians of | 8 |
| students at least 60 days before May 15th of each school year.
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| (2) The Department of Public Health shall promulgate rules | 10 |
| and regulations
specifying the examinations and procedures | 11 |
| that constitute a health examination, which shall include the | 12 |
| collection of data relating to obesity ,
( including at a | 13 |
| minimum, date of birth, gender, height, weight, blood pressure, | 14 |
| and date of exam ) ,
and a dental examination and may recommend | 15 |
| by rule that certain additional examinations be performed.
The | 16 |
| rules and regulations of the Department of Public Health shall | 17 |
| specify that
a tuberculosis skin test screening shall be | 18 |
| included as a required part of each
health examination included | 19 |
| under this Section if the child resides in an area
designated | 20 |
| by the Department of Public Health as having a high incidence | 21 |
| of
tuberculosis.
The Department of Public Health shall specify | 22 |
| that a diabetes
screening as defined by rule shall be included | 23 |
| as a required part of each
health examination.
Diabetes testing | 24 |
| is not required.
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| Physicians licensed to practice medicine in all of its | 26 |
| branches, advanced
practice nurses who have a written |
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| collaborative agreement with
a collaborating physician which | 2 |
| authorizes them to perform health
examinations, or physician | 3 |
| assistants who have been delegated the
performance of health | 4 |
| examinations by their supervising physician
shall be
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| responsible for the performance of the health examinations, | 6 |
| other than dental
examinations and vision and hearing | 7 |
| screening, and shall sign all report forms
required by | 8 |
| subsection (4) of this Section that pertain to those portions | 9 |
| of
the health examination for which the physician, advanced | 10 |
| practice nurse, or
physician assistant is responsible.
If a | 11 |
| registered
nurse performs any part of a health examination, | 12 |
| then a physician licensed to
practice medicine in all of its | 13 |
| branches must review and sign all required
report forms. | 14 |
| Licensed dentists shall perform all dental examinations and
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| shall sign all report forms required by subsection (4) of this | 16 |
| Section that
pertain to the dental examinations. Physicians | 17 |
| licensed to practice medicine
in all its branches, or licensed | 18 |
| optometrists, shall perform all vision exams
required by school | 19 |
| authorities and shall sign all report forms required by
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| subsection (4) of this Section that pertain to the vision exam. | 21 |
| Vision and
hearing screening tests, which shall not be | 22 |
| considered examinations as that
term is used in this Section, | 23 |
| shall be conducted in accordance with rules and
regulations of | 24 |
| the Department of Public Health, and by individuals whom the
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| Department of Public Health has certified.
In these rules and | 26 |
| regulations, the Department of Public Health shall
require that |
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| individuals conducting vision screening tests give a child's
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| parent or guardian written notification, before the vision | 3 |
| screening is
conducted, that states, "Vision screening is not a | 4 |
| substitute for a
complete eye and vision evaluation by an eye | 5 |
| doctor. Your child is not
required to undergo this vision | 6 |
| screening if an optometrist or
ophthalmologist has completed | 7 |
| and signed a report form indicating that
an examination has | 8 |
| been administered within the previous 12 months."
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| (3) Every child shall, at or about the same time as he or | 10 |
| she receives
a health examination required by subsection (1) of | 11 |
| this Section, present
to the local school proof of having | 12 |
| received such immunizations against
preventable communicable | 13 |
| diseases as the Department of Public Health shall
require by | 14 |
| rules and regulations promulgated pursuant to this Section and | 15 |
| the
Communicable Disease Prevention Act. Beginning with the | 16 |
| 2008-2009 school year, the parent or legal guardian of a female | 17 |
| child entering the fifth grade (or such other grade as the | 18 |
| Department of Public Health designates by rule) of any public, | 19 |
| private, or parochial school for the first time must submit a | 20 |
| statement to the local school, which must be signed by a | 21 |
| physician licensed to practice medicine in all of its branches, | 22 |
| to the effect that the parent or guardian received information | 23 |
| from the physician on the connection between human | 24 |
| papillomavirus (HPV) and cervical cancer, which information | 25 |
| the physician must provide, and verifying that the child | 26 |
| received the HPV vaccine or that the parent or guardian, having |
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| received the information, elected not to have the child receive | 2 |
| the HPV vaccine and that the child did not receive the HPV | 3 |
| vaccine. The Department of Public Health may prescribe a | 4 |
| uniform statement to be used for this purpose.
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| (4) The individuals conducting the health examination or | 6 |
| dental examination shall record the
fact of having conducted | 7 |
| the examination, and such additional information as
required, | 8 |
| including for a health examination data relating to obesity ,
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| ( including at a minimum, date of birth, gender, height, weight, | 10 |
| blood pressure, and date of exam ) , on uniform forms which the | 11 |
| Department of Public Health and the State
Board of Education | 12 |
| shall prescribe for statewide use. The examiner shall
summarize | 13 |
| on the report form any condition that he or she suspects | 14 |
| indicates a
need for special services, including for a health | 15 |
| examination factors relating to obesity. The individuals | 16 |
| confirming the administration of
required immunizations shall | 17 |
| record as indicated on the form that the
immunizations were | 18 |
| administered.
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| (5) If a child does not submit proof of having had either | 20 |
| the health
examination or the immunization as required, then | 21 |
| the child shall be examined
or receive the immunization, as the | 22 |
| case may be, and present proof by October
15 of the current | 23 |
| school year, or by an earlier date of the current school year
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| established by a school district. To establish a date before | 25 |
| October 15 of the
current school year for the health | 26 |
| examination or immunization as required, a
school district must |
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| give notice of the requirements of this Section 60 days
prior | 2 |
| to the earlier established date. If for medical reasons one or | 3 |
| more of
the required immunizations must be given after October | 4 |
| 15 of the current school
year, or after an earlier established | 5 |
| date of the current school year, then
the child shall present, | 6 |
| by October 15, or by the earlier established date, a
schedule | 7 |
| for the administration of the immunizations and a statement of | 8 |
| the
medical reasons causing the delay, both the schedule and | 9 |
| the statement being
issued by the physician, advanced practice | 10 |
| nurse, physician assistant,
registered nurse, or local health | 11 |
| department that will
be responsible for administration of the | 12 |
| remaining required immunizations. If
a child does not comply by | 13 |
| October 15, or by the earlier established date of
the current | 14 |
| school year, with the requirements of this subsection, then the
| 15 |
| local school authority shall exclude that child from school | 16 |
| until such time as
the child presents proof of having had the | 17 |
| health examination as required and
presents proof of having | 18 |
| received those required immunizations which are
medically | 19 |
| possible to receive immediately. During a child's exclusion | 20 |
| from
school for noncompliance with this subsection, the child's | 21 |
| parents or legal
guardian shall be considered in violation of | 22 |
| Section 26-1 and subject to any
penalty imposed by Section | 23 |
| 26-10. This subsection (5) does not apply to dental | 24 |
| examinations.
| 25 |
| (6) Every school shall report to the State Board of | 26 |
| Education by November
15, in the manner which that agency shall |
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| require, the number of children who
have received the necessary | 2 |
| immunizations and the health examination (other than a dental | 3 |
| examination) as
required, indicating, of those who have not | 4 |
| received the immunizations and
examination as required, the | 5 |
| number of children who are exempt from health
examination and | 6 |
| immunization requirements on religious or medical grounds as
| 7 |
| provided in subsection (8). This report shall also include the | 8 |
| number of female children entering the fifth grade (or such | 9 |
| other grade as the Department of Public Health designates by | 10 |
| rule) who have received a human papillomavirus (HPV) | 11 |
| vaccination and the number of female children who have not | 12 |
| received an HPV vaccination. Every school shall report to the | 13 |
| State Board of Education by June 30, in the manner that the | 14 |
| State Board requires, the number of children who have received | 15 |
| the required dental examination, indicating, of those who have | 16 |
| not received the required dental examination, the number of | 17 |
| children who are exempt from the dental examination on | 18 |
| religious grounds as provided in subsection (8) of this Section | 19 |
| and the number of children who have received a waiver under | 20 |
| subsection (1.5) of this Section. This reported information | 21 |
| shall be provided to the
Department of Public Health by the | 22 |
| State Board of Education.
| 23 |
| (7) Upon determining that the number of pupils who are | 24 |
| required to be in
compliance with subsection (5) of this | 25 |
| Section is below 90% of the number of
pupils enrolled in the | 26 |
| school district, 10% of each State aid payment made
pursuant to |
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| Section 18-8.05 to the school district for such year shall be | 2 |
| withheld
by the regional superintendent until the number of | 3 |
| students in compliance with
subsection (5) is the applicable | 4 |
| specified percentage or higher.
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| (8) Parents or legal guardians who object to health
or | 6 |
| dental examinations or any part thereof, or to immunizations, | 7 |
| on religious grounds
shall not be required to submit their | 8 |
| children or wards to the examinations
or immunizations to which | 9 |
| they so object if such parents or legal guardians
present to | 10 |
| the appropriate local school authority a signed statement of
| 11 |
| objection, detailing the grounds for the objection. If the | 12 |
| physical condition
of the child is such that any one or more of | 13 |
| the immunizing agents should not
be administered, the examining | 14 |
| physician, advanced practice nurse, or
physician assistant | 15 |
| responsible for the performance of the
health examination shall | 16 |
| endorse that fact upon the health examination form.
Exempting a | 17 |
| child from the health or dental examination does not exempt the | 18 |
| child from
participation in the program of physical education | 19 |
| training provided in
Sections 27-5 through 27-7 of this Code.
| 20 |
| (9) For the purposes of this Section, "nursery schools" | 21 |
| means those nursery
schools operated by elementary school | 22 |
| systems or secondary level school units
or institutions of | 23 |
| higher learning.
| 24 |
| (Source: P.A. 92-703, eff. 7-19-02; 93-504, eff. 1-1-04; | 25 |
| 93-530, eff. 1-1-04; 93-946, eff. 7-1-05; 93-966, eff. 1-1-05; | 26 |
| revised 12-1-05.)
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| Section 30. The Illinois Insurance Code is amended by | 2 |
| adding Section 356z.9 as follows: | 3 |
| (215 ILCS 5/356z.9 new)
| 4 |
| Sec. 356z.9. Human papillomavirus. A group or individual | 5 |
| policy of accident and health insurance or managed care plan | 6 |
| amended, delivered, issued, or renewed after the effective date | 7 |
| of the amendatory Act of the 95th General Assembly must provide | 8 |
| coverage for a vaccine for human papillomavirus (HPV) that is | 9 |
| approved for marketing by the federal Food and Drug | 10 |
| Administration. | 11 |
| Section 35. The Health Maintenance Organization Act is | 12 |
| amended by changing Section 5-3 as follows:
| 13 |
| (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 14 |
| Sec. 5-3. Insurance Code provisions.
| 15 |
| (a) Health Maintenance Organizations
shall be subject to | 16 |
| the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | 17 |
| 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | 18 |
| 154.6,
154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, | 19 |
| 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9 364.01, | 20 |
| 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c,
401, | 21 |
| 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
| 22 |
| paragraph (c) of subsection (2) of Section 367, and Articles |
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, and XXVI of | 2 |
| the Illinois Insurance Code.
| 3 |
| (b) For purposes of the Illinois Insurance Code, except for | 4 |
| Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 5 |
| Maintenance Organizations in
the following categories are | 6 |
| deemed to be "domestic companies":
| 7 |
| (1) a corporation authorized under the
Dental Service | 8 |
| Plan Act or the Voluntary Health Services Plans Act;
| 9 |
| (2) a corporation organized under the laws of this | 10 |
| State; or
| 11 |
| (3) a corporation organized under the laws of another | 12 |
| state, 30% or more
of the enrollees of which are residents | 13 |
| of this State, except a
corporation subject to | 14 |
| substantially the same requirements in its state of
| 15 |
| organization as is a "domestic company" under Article VIII | 16 |
| 1/2 of the
Illinois Insurance Code.
| 17 |
| (c) In considering the merger, consolidation, or other | 18 |
| acquisition of
control of a Health Maintenance Organization | 19 |
| pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 20 |
| (1) the Director shall give primary consideration to | 21 |
| the continuation of
benefits to enrollees and the financial | 22 |
| conditions of the acquired Health
Maintenance Organization | 23 |
| after the merger, consolidation, or other
acquisition of | 24 |
| control takes effect;
| 25 |
| (2)(i) the criteria specified in subsection (1)(b) of | 26 |
| Section 131.8 of
the Illinois Insurance Code shall not |
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| apply and (ii) the Director, in making
his determination | 2 |
| with respect to the merger, consolidation, or other
| 3 |
| acquisition of control, need not take into account the | 4 |
| effect on
competition of the merger, consolidation, or | 5 |
| other acquisition of control;
| 6 |
| (3) the Director shall have the power to require the | 7 |
| following
information:
| 8 |
| (A) certification by an independent actuary of the | 9 |
| adequacy
of the reserves of the Health Maintenance | 10 |
| Organization sought to be acquired;
| 11 |
| (B) pro forma financial statements reflecting the | 12 |
| combined balance
sheets of the acquiring company and | 13 |
| the Health Maintenance Organization sought
to be | 14 |
| acquired as of the end of the preceding year and as of | 15 |
| a date 90 days
prior to the acquisition, as well as pro | 16 |
| forma financial statements
reflecting projected | 17 |
| combined operation for a period of 2 years;
| 18 |
| (C) a pro forma business plan detailing an | 19 |
| acquiring party's plans with
respect to the operation | 20 |
| of the Health Maintenance Organization sought to
be | 21 |
| acquired for a period of not less than 3 years; and
| 22 |
| (D) such other information as the Director shall | 23 |
| require.
| 24 |
| (d) The provisions of Article VIII 1/2 of the Illinois | 25 |
| Insurance Code
and this Section 5-3 shall apply to the sale by | 26 |
| any health maintenance
organization of greater than 10% of its
|
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| enrollee population (including without limitation the health | 2 |
| maintenance
organization's right, title, and interest in and to | 3 |
| its health care
certificates).
| 4 |
| (e) In considering any management contract or service | 5 |
| agreement subject
to Section 141.1 of the Illinois Insurance | 6 |
| Code, the Director (i) shall, in
addition to the criteria | 7 |
| specified in Section 141.2 of the Illinois
Insurance Code, take | 8 |
| into account the effect of the management contract or
service | 9 |
| agreement on the continuation of benefits to enrollees and the
| 10 |
| financial condition of the health maintenance organization to | 11 |
| be managed or
serviced, and (ii) need not take into account the | 12 |
| effect of the management
contract or service agreement on | 13 |
| competition.
| 14 |
| (f) Except for small employer groups as defined in the | 15 |
| Small Employer
Rating, Renewability and Portability Health | 16 |
| Insurance Act and except for
medicare supplement policies as | 17 |
| defined in Section 363 of the Illinois
Insurance Code, a Health | 18 |
| Maintenance Organization may by contract agree with a
group or | 19 |
| other enrollment unit to effect refunds or charge additional | 20 |
| premiums
under the following terms and conditions:
| 21 |
| (i) the amount of, and other terms and conditions with | 22 |
| respect to, the
refund or additional premium are set forth | 23 |
| in the group or enrollment unit
contract agreed in advance | 24 |
| of the period for which a refund is to be paid or
| 25 |
| additional premium is to be charged (which period shall not | 26 |
| be less than one
year); and
|
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| (ii) the amount of the refund or additional premium | 2 |
| shall not exceed 20%
of the Health Maintenance | 3 |
| Organization's profitable or unprofitable experience
with | 4 |
| respect to the group or other enrollment unit for the | 5 |
| period (and, for
purposes of a refund or additional | 6 |
| premium, the profitable or unprofitable
experience shall | 7 |
| be calculated taking into account a pro rata share of the
| 8 |
| Health Maintenance Organization's administrative and | 9 |
| marketing expenses, but
shall not include any refund to be | 10 |
| made or additional premium to be paid
pursuant to this | 11 |
| subsection (f)). The Health Maintenance Organization and | 12 |
| the
group or enrollment unit may agree that the profitable | 13 |
| or unprofitable
experience may be calculated taking into | 14 |
| account the refund period and the
immediately preceding 2 | 15 |
| plan years.
| 16 |
| The Health Maintenance Organization shall include a | 17 |
| statement in the
evidence of coverage issued to each enrollee | 18 |
| describing the possibility of a
refund or additional premium, | 19 |
| and upon request of any group or enrollment unit,
provide to | 20 |
| the group or enrollment unit a description of the method used | 21 |
| to
calculate (1) the Health Maintenance Organization's | 22 |
| profitable experience with
respect to the group or enrollment | 23 |
| unit and the resulting refund to the group
or enrollment unit | 24 |
| or (2) the Health Maintenance Organization's unprofitable
| 25 |
| experience with respect to the group or enrollment unit and the | 26 |
| resulting
additional premium to be paid by the group or |
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| enrollment unit.
| 2 |
| In no event shall the Illinois Health Maintenance | 3 |
| Organization
Guaranty Association be liable to pay any | 4 |
| contractual obligation of an
insolvent organization to pay any | 5 |
| refund authorized under this Section.
| 6 |
| (Source: P.A. 93-102, eff. 1-1-04; 93-261, eff. 1-1-04; 93-477, | 7 |
| eff. 8-8-03; 93-529, eff. 8-14-03; 93-853, eff. 1-1-05; | 8 |
| 93-1000, eff. 1-1-05; 94-906, eff. 1-1-07; 94-1076, eff. | 9 |
| 12-29-06; revised 1-5-07.)
| 10 |
| Section 40. The Voluntary Health Services Plans Act is | 11 |
| amended by changing Section 10 as follows:
| 12 |
| (215 ILCS 165/10) (from Ch. 32, par. 604)
| 13 |
| Sec. 10. Application of Insurance Code provisions. Health | 14 |
| services
plan corporations and all persons interested therein | 15 |
| or dealing therewith
shall be subject to the provisions of | 16 |
| Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | 17 |
| 149, 155.37, 354, 355.2, 356r, 356t, 356u, 356v,
356w, 356x, | 18 |
| 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
| 19 |
| 364.01, 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, | 20 |
| and 412, and paragraphs (7) and (15) of Section 367 of the | 21 |
| Illinois
Insurance Code.
| 22 |
| (Source: P.A. 93-102, eff. 1-1-04; 93-529, eff. 8-14-03; | 23 |
| 93-853, eff. 1-1-05; 93-1000, eff. 1-1-05; 94-1076, eff. | 24 |
| 12-29-06.)
|
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| Section 45. The Illinois Public Aid Code is amended by | 2 |
| changing Section 5-5 as follows: | 3 |
| (305 ILCS 5/5-5) (from Ch. 23, par. 5-5) | 4 |
| Sec. 5-5. Medical services. The Illinois Department, by | 5 |
| rule, shall
determine the quantity and quality of and the rate | 6 |
| of reimbursement for the
medical assistance for which
payment | 7 |
| will be authorized, and the medical services to be provided,
| 8 |
| which may include all or part of the following: (1) inpatient | 9 |
| hospital
services; (2) outpatient hospital services; (3) other | 10 |
| laboratory and
X-ray services; (4) skilled nursing home | 11 |
| services; (5) physicians'
services whether furnished in the | 12 |
| office, the patient's home, a
hospital, a skilled nursing home, | 13 |
| or elsewhere; (6) medical care, or any
other type of remedial | 14 |
| care furnished by licensed practitioners; (7)
home health care | 15 |
| services; (8) private duty nursing service; (9) clinic
| 16 |
| services; (10) dental services, including prevention and | 17 |
| treatment of periodontal disease and dental caries disease for | 18 |
| pregnant women; (11) physical therapy and related
services; | 19 |
| (12) prescribed drugs, dentures, and prosthetic devices; and
| 20 |
| eyeglasses prescribed by a physician skilled in the diseases of | 21 |
| the eye,
or by an optometrist, whichever the person may select; | 22 |
| (13) other
diagnostic, screening, preventive, and | 23 |
| rehabilitative services; (14)
transportation and such other | 24 |
| expenses as may be necessary; (15) medical
treatment of sexual |
|
|
|
09500HB0115ham001 |
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|
| 1 |
| assault survivors, as defined in
Section 1a of the Sexual | 2 |
| Assault Survivors Emergency Treatment Act, for
injuries | 3 |
| sustained as a result of the sexual assault, including
| 4 |
| examinations and laboratory tests to discover evidence which | 5 |
| may be used in
criminal proceedings arising from the sexual | 6 |
| assault; (16) the
diagnosis and treatment of sickle cell | 7 |
| anemia; and (17)
any other medical care, and any other type of | 8 |
| remedial care recognized
under the laws of this State, but not | 9 |
| including abortions, or induced
miscarriages or premature | 10 |
| births, unless, in the opinion of a physician,
such procedures | 11 |
| are necessary for the preservation of the life of the
woman | 12 |
| seeking such treatment, or except an induced premature birth
| 13 |
| intended to produce a live viable child and such procedure is | 14 |
| necessary
for the health of the mother or her unborn child. The | 15 |
| Illinois Department,
by rule, shall prohibit any physician from | 16 |
| providing medical assistance
to anyone eligible therefor under | 17 |
| this Code where such physician has been
found guilty of | 18 |
| performing an abortion procedure in a wilful and wanton
manner | 19 |
| upon a woman who was not pregnant at the time such abortion
| 20 |
| procedure was performed. The term "any other type of remedial | 21 |
| care" shall
include nursing care and nursing home service for | 22 |
| persons who rely on
treatment by spiritual means alone through | 23 |
| prayer for healing.
| 24 |
| Notwithstanding any other provision of this Section, a | 25 |
| comprehensive
tobacco use cessation program that includes | 26 |
| purchasing prescription drugs or
prescription medical devices |
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| approved by the Food and Drug administration shall
be covered | 2 |
| under the medical assistance
program under this Article for | 3 |
| persons who are otherwise eligible for
assistance under this | 4 |
| Article.
| 5 |
| Notwithstanding any other provision of this Code, the | 6 |
| Illinois
Department may not require, as a condition of payment | 7 |
| for any laboratory
test authorized under this Article, that a | 8 |
| physician's handwritten signature
appear on the laboratory | 9 |
| test order form. The Illinois Department may,
however, impose | 10 |
| other appropriate requirements regarding laboratory test
order | 11 |
| documentation.
| 12 |
| The Illinois Department of Healthcare and Family Services
| 13 |
| Public Aid shall provide the following services to
persons
| 14 |
| eligible for assistance under this Article who are | 15 |
| participating in
education, training or employment programs | 16 |
| operated by the Department of Human
Services as successor to | 17 |
| the Department of Public Aid:
| 18 |
| (1) dental services, which shall include but not be | 19 |
| limited to
prosthodontics; and
| 20 |
| (2) eyeglasses prescribed by a physician skilled in the | 21 |
| diseases of the
eye, or by an optometrist, whichever the | 22 |
| person may select.
| 23 |
| The Department of Healthcare and Family Services shall | 24 |
| provide a vaccine for human papillomavirus (HPV) that is | 25 |
| approved for marketing by the federal Food and Drug | 26 |
| Administration.
|
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| The Illinois Department, by rule, may distinguish and | 2 |
| classify the
medical services to be provided only in accordance | 3 |
| with the classes of
persons designated in Section 5-2.
| 4 |
| The Illinois Department shall authorize the provision of, | 5 |
| and shall
authorize payment for, screening by low-dose | 6 |
| mammography for the presence of
occult breast cancer for women | 7 |
| 35 years of age or older who are eligible
for medical | 8 |
| assistance under this Article, as follows: a baseline
mammogram | 9 |
| for women 35 to 39 years of age and an
annual mammogram for | 10 |
| women 40 years of age or older. All screenings
shall
include a | 11 |
| physical breast exam, instruction on self-examination and
| 12 |
| information regarding the frequency of self-examination and | 13 |
| its value as a
preventative tool. As used in this Section, | 14 |
| "low-dose mammography" means
the x-ray examination of the | 15 |
| breast using equipment dedicated specifically
for mammography, | 16 |
| including the x-ray tube, filter, compression device,
image | 17 |
| receptor, and cassettes, with an average radiation exposure | 18 |
| delivery
of less than one rad mid-breast, with 2 views for each | 19 |
| breast.
| 20 |
| Any medical or health care provider shall immediately | 21 |
| recommend, to
any pregnant woman who is being provided prenatal | 22 |
| services and is suspected
of drug abuse or is addicted as | 23 |
| defined in the Alcoholism and Other Drug Abuse
and Dependency | 24 |
| Act, referral to a local substance abuse treatment provider
| 25 |
| licensed by the Department of Human Services or to a licensed
| 26 |
| hospital which provides substance abuse treatment services. |
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| The Department of Healthcare and Family Services
Public Aid
| 2 |
| shall assure coverage for the cost of treatment of the drug | 3 |
| abuse or
addiction for pregnant recipients in accordance with | 4 |
| the Illinois Medicaid
Program in conjunction with the | 5 |
| Department of Human Services.
| 6 |
| All medical providers providing medical assistance to | 7 |
| pregnant women
under this Code shall receive information from | 8 |
| the Department on the
availability of services under the Drug | 9 |
| Free Families with a Future or any
comparable program providing | 10 |
| case management services for addicted women,
including | 11 |
| information on appropriate referrals for other social services
| 12 |
| that may be needed by addicted women in addition to treatment | 13 |
| for addiction.
| 14 |
| The Illinois Department, in cooperation with the | 15 |
| Departments of Human
Services (as successor to the Department | 16 |
| of Alcoholism and Substance
Abuse) and Public Health, through a | 17 |
| public awareness campaign, may
provide information concerning | 18 |
| treatment for alcoholism and drug abuse and
addiction, prenatal | 19 |
| health care, and other pertinent programs directed at
reducing | 20 |
| the number of drug-affected infants born to recipients of | 21 |
| medical
assistance.
| 22 |
| Neither the Illinois Department of Healthcare and Family | 23 |
| Services
Public Aid nor the Department of Human
Services shall | 24 |
| sanction the recipient solely on the basis of
her substance | 25 |
| abuse.
| 26 |
| The Illinois Department shall establish such regulations |
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| governing
the dispensing of health services under this Article | 2 |
| as it shall deem
appropriate. The Department
should
seek the | 3 |
| advice of formal professional advisory committees appointed by
| 4 |
| the Director of the Illinois Department for the purpose of | 5 |
| providing regular
advice on policy and administrative matters, | 6 |
| information dissemination and
educational activities for | 7 |
| medical and health care providers, and
consistency in | 8 |
| procedures to the Illinois Department.
| 9 |
| The Illinois Department may develop and contract with | 10 |
| Partnerships of
medical providers to arrange medical services | 11 |
| for persons eligible under
Section 5-2 of this Code. | 12 |
| Implementation of this Section may be by
demonstration projects | 13 |
| in certain geographic areas. The Partnership shall
be | 14 |
| represented by a sponsor organization. The Department, by rule, | 15 |
| shall
develop qualifications for sponsors of Partnerships. | 16 |
| Nothing in this
Section shall be construed to require that the | 17 |
| sponsor organization be a
medical organization.
| 18 |
| The sponsor must negotiate formal written contracts with | 19 |
| medical
providers for physician services, inpatient and | 20 |
| outpatient hospital care,
home health services, treatment for | 21 |
| alcoholism and substance abuse, and
other services determined | 22 |
| necessary by the Illinois Department by rule for
delivery by | 23 |
| Partnerships. Physician services must include prenatal and
| 24 |
| obstetrical care. The Illinois Department shall reimburse | 25 |
| medical services
delivered by Partnership providers to clients | 26 |
| in target areas according to
provisions of this Article and the |
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| Illinois Health Finance Reform Act,
except that:
| 2 |
| (1) Physicians participating in a Partnership and | 3 |
| providing certain
services, which shall be determined by | 4 |
| the Illinois Department, to persons
in areas covered by the | 5 |
| Partnership may receive an additional surcharge
for such | 6 |
| services.
| 7 |
| (2) The Department may elect to consider and negotiate | 8 |
| financial
incentives to encourage the development of | 9 |
| Partnerships and the efficient
delivery of medical care.
| 10 |
| (3) Persons receiving medical services through | 11 |
| Partnerships may receive
medical and case management | 12 |
| services above the level usually offered
through the | 13 |
| medical assistance program.
| 14 |
| Medical providers shall be required to meet certain | 15 |
| qualifications to
participate in Partnerships to ensure the | 16 |
| delivery of high quality medical
services. These | 17 |
| qualifications shall be determined by rule of the Illinois
| 18 |
| Department and may be higher than qualifications for | 19 |
| participation in the
medical assistance program. Partnership | 20 |
| sponsors may prescribe reasonable
additional qualifications | 21 |
| for participation by medical providers, only with
the prior | 22 |
| written approval of the Illinois Department.
| 23 |
| Nothing in this Section shall limit the free choice of | 24 |
| practitioners,
hospitals, and other providers of medical | 25 |
| services by clients.
In order to ensure patient freedom of | 26 |
| choice, the Illinois Department shall
immediately promulgate |
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| all rules and take all other necessary actions so that
provided | 2 |
| services may be accessed from therapeutically certified | 3 |
| optometrists
to the full extent of the Illinois Optometric | 4 |
| Practice Act of 1987 without
discriminating between service | 5 |
| providers.
| 6 |
| The Department shall apply for a waiver from the United | 7 |
| States Health
Care Financing Administration to allow for the | 8 |
| implementation of
Partnerships under this Section.
| 9 |
| The Illinois Department shall require health care | 10 |
| providers to maintain
records that document the medical care | 11 |
| and services provided to recipients
of Medical Assistance under | 12 |
| this Article. The Illinois Department shall
require health care | 13 |
| providers to make available, when authorized by the
patient, in | 14 |
| writing, the medical records in a timely fashion to other
| 15 |
| health care providers who are treating or serving persons | 16 |
| eligible for
Medical Assistance under this Article. All | 17 |
| dispensers of medical services
shall be required to maintain | 18 |
| and retain business and professional records
sufficient to | 19 |
| fully and accurately document the nature, scope, details and
| 20 |
| receipt of the health care provided to persons eligible for | 21 |
| medical
assistance under this Code, in accordance with | 22 |
| regulations promulgated by
the Illinois Department. The rules | 23 |
| and regulations shall require that proof
of the receipt of | 24 |
| prescription drugs, dentures, prosthetic devices and
| 25 |
| eyeglasses by eligible persons under this Section accompany | 26 |
| each claim
for reimbursement submitted by the dispenser of such |
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| medical services.
No such claims for reimbursement shall be | 2 |
| approved for payment by the Illinois
Department without such | 3 |
| proof of receipt, unless the Illinois Department
shall have put | 4 |
| into effect and shall be operating a system of post-payment
| 5 |
| audit and review which shall, on a sampling basis, be deemed | 6 |
| adequate by
the Illinois Department to assure that such drugs, | 7 |
| dentures, prosthetic
devices and eyeglasses for which payment | 8 |
| is being made are actually being
received by eligible | 9 |
| recipients. Within 90 days after the effective date of
this | 10 |
| amendatory Act of 1984, the Illinois Department shall establish | 11 |
| a
current list of acquisition costs for all prosthetic devices | 12 |
| and any
other items recognized as medical equipment and | 13 |
| supplies reimbursable under
this Article and shall update such | 14 |
| list on a quarterly basis, except that
the acquisition costs of | 15 |
| all prescription drugs shall be updated no
less frequently than | 16 |
| every 30 days as required by Section 5-5.12.
| 17 |
| The rules and regulations of the Illinois Department shall | 18 |
| require
that a written statement including the required opinion | 19 |
| of a physician
shall accompany any claim for reimbursement for | 20 |
| abortions, or induced
miscarriages or premature births. This | 21 |
| statement shall indicate what
procedures were used in providing | 22 |
| such medical services.
| 23 |
| The Illinois Department shall require all dispensers of | 24 |
| medical
services, other than an individual practitioner or | 25 |
| group of practitioners,
desiring to participate in the Medical | 26 |
| Assistance program
established under this Article to disclose |
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| all financial, beneficial,
ownership, equity, surety or other | 2 |
| interests in any and all firms,
corporations, partnerships, | 3 |
| associations, business enterprises, joint
ventures, agencies, | 4 |
| institutions or other legal entities providing any
form of | 5 |
| health care services in this State under this Article.
| 6 |
| The Illinois Department may require that all dispensers of | 7 |
| medical
services desiring to participate in the medical | 8 |
| assistance program
established under this Article disclose, | 9 |
| under such terms and conditions as
the Illinois Department may | 10 |
| by rule establish, all inquiries from clients
and attorneys | 11 |
| regarding medical bills paid by the Illinois Department, which
| 12 |
| inquiries could indicate potential existence of claims or liens | 13 |
| for the
Illinois Department.
| 14 |
| Enrollment of a vendor that provides non-emergency medical | 15 |
| transportation,
defined by the Department by rule,
shall be
| 16 |
| conditional for 180 days. During that time, the Department of | 17 |
| Healthcare and Family Services
Public Aid may
terminate the | 18 |
| vendor's eligibility to participate in the medical assistance
| 19 |
| program without cause. That termination of eligibility is not | 20 |
| subject to the
Department's hearing process.
| 21 |
| The Illinois Department shall establish policies, | 22 |
| procedures,
standards and criteria by rule for the acquisition, | 23 |
| repair and replacement
of orthotic and prosthetic devices and | 24 |
| durable medical equipment. Such
rules shall provide, but not be | 25 |
| limited to, the following services: (1)
immediate repair or | 26 |
| replacement of such devices by recipients without
medical |
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| authorization; and (2) rental, lease, purchase or | 2 |
| lease-purchase of
durable medical equipment in a | 3 |
| cost-effective manner, taking into
consideration the | 4 |
| recipient's medical prognosis, the extent of the
recipient's | 5 |
| needs, and the requirements and costs for maintaining such
| 6 |
| equipment. Such rules shall enable a recipient to temporarily | 7 |
| acquire and
use alternative or substitute devices or equipment | 8 |
| pending repairs or
replacements of any device or equipment | 9 |
| previously authorized for such
recipient by the Department.
| 10 |
| The Department shall execute, relative to the nursing home | 11 |
| prescreening
project, written inter-agency agreements with the | 12 |
| Department of Human
Services and the Department on Aging, to | 13 |
| effect the following: (i) intake
procedures and common | 14 |
| eligibility criteria for those persons who are receiving
| 15 |
| non-institutional services; and (ii) the establishment and | 16 |
| development of
non-institutional services in areas of the State | 17 |
| where they are not currently
available or are undeveloped.
| 18 |
| The Illinois Department shall develop and operate, in | 19 |
| cooperation
with other State Departments and agencies and in | 20 |
| compliance with
applicable federal laws and regulations, | 21 |
| appropriate and effective
systems of health care evaluation and | 22 |
| programs for monitoring of
utilization of health care services | 23 |
| and facilities, as it affects
persons eligible for medical | 24 |
| assistance under this Code.
| 25 |
| The Illinois Department shall report annually to the | 26 |
| General Assembly,
no later than the second Friday in April of |
|
|
|
09500HB0115ham001 |
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LRB095 03811 KBJ 32671 a |
|
| 1 |
| 1979 and each year
thereafter, in regard to:
| 2 |
| (a) actual statistics and trends in utilization of | 3 |
| medical services by
public aid recipients;
| 4 |
| (b) actual statistics and trends in the provision of | 5 |
| the various medical
services by medical vendors;
| 6 |
| (c) current rate structures and proposed changes in | 7 |
| those rate structures
for the various medical vendors; and
| 8 |
| (d) efforts at utilization review and control by the | 9 |
| Illinois Department.
| 10 |
| The period covered by each report shall be the 3 years | 11 |
| ending on the June
30 prior to the report. The report shall | 12 |
| include suggested legislation
for consideration by the General | 13 |
| Assembly. The filing of one copy of the
report with the | 14 |
| Speaker, one copy with the Minority Leader and one copy
with | 15 |
| the Clerk of the House of Representatives, one copy with the | 16 |
| President,
one copy with the Minority Leader and one copy with | 17 |
| the Secretary of the
Senate, one copy with the Legislative | 18 |
| Research Unit, and such additional
copies
with the State | 19 |
| Government Report Distribution Center for the General
Assembly | 20 |
| as is required under paragraph (t) of Section 7 of the State
| 21 |
| Library Act shall be deemed sufficient to comply with this | 22 |
| Section.
| 23 |
| (Source: P.A. 92-16, eff. 6-28-01; 92-651, eff. 7-11-02; | 24 |
| 92-789, eff. 8-6-02; 93-632, eff. 2-1-04; 93-841, eff. 7-30-04; | 25 |
| 93-981, eff. 8-23-04; revised 12-15-05.)".
|
|