Illinois General Assembly - Full Text of SB0769
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Full Text of SB0769  97th General Assembly


Rep. Lou Lang

Filed: 10/24/2011





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2    AMENDMENT NO. ______. Amend Senate Bill 769, AS AMENDED, by
3replacing everything after the enacting clause with the
5    "Section 5. The Illinois Public Aid Code is amended by
6changing Section 5-4.2 as follows:
7    (305 ILCS 5/5-4.2)  (from Ch. 23, par. 5-4.2)
8    Sec. 5-4.2. Ambulance services payments.
9    (a) For ambulance services provided to a recipient of aid
10under this Article on or after January 1, 1993, the Illinois
11Department shall reimburse ambulance service providers at
12rates calculated in accordance with this Section. It is the
13intent of the General Assembly to provide adequate
14reimbursement for ambulance services so as to ensure adequate
15access to services for recipients of aid under this Article and
16to provide appropriate incentives to ambulance service



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1providers to provide services in an efficient and
2cost-effective manner. Thus, it is the intent of the General
3Assembly that the Illinois Department implement a
4reimbursement system for ambulance services that, to the extent
5practicable and subject to the availability of funds
6appropriated by the General Assembly for this purpose, is
7consistent with the payment principles of Medicare. To ensure
8uniformity between the payment principles of Medicare and
9Medicaid, the Illinois Department shall follow, to the extent
10necessary and practicable and subject to the availability of
11funds appropriated by the General Assembly for this purpose,
12the statutes, laws, regulations, policies, procedures,
13principles, definitions, guidelines, and manuals used to
14determine the amounts paid to ambulance service providers under
15Title XVIII of the Social Security Act (Medicare).
16    (b) For ambulance services provided to a recipient of aid
17under this Article on or after January 1, 1996, the Illinois
18Department shall reimburse ambulance service providers based
19upon the actual distance traveled if a natural disaster,
20weather conditions, road repairs, or traffic congestion
21necessitates the use of a route other than the most direct
23    (b-1) It is the intent of the General Assembly to provide
24adequate reimbursement for the cost of fuel used during the
25provision of emergency ambulance services. Beginning with
26emergency ambulance services rendered on or after July 1, 2011,



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1the Department shall reimburse no less than 75% of the Medicare
2mileage rate for emergency ambulance services.
3    (c) For purposes of this Section, "ambulance services"
4includes medical transportation services provided by means of
5an ambulance, medi-car, service car, or taxi.
6    (c-1) For purposes of this Section, "ground ambulance
7service" means medical transportation services that are
8described as ground ambulance services by the Centers for
9Medicare and Medicaid Services and provided in a vehicle that
10is licensed as an ambulance by the Illinois Department of
11Public Health pursuant to the Emergency Medical Services (EMS)
12Systems Act.
13    (c-2) For purposes of this Section, "ground ambulance
14service provider" means a vehicle service provider as described
15in the Emergency Medical Services (EMS) Systems Act that
16operates licensed ambulances for the purpose of providing
17emergency ambulance services, or non-emergency ambulance
18services, or both. For purposes of this Section, this includes
19both ambulance providers and ambulance suppliers as described
20by the Centers for Medicare and Medicaid Services.
21    (d) This Section does not prohibit separate billing by
22ambulance service providers for oxygen furnished while
23providing advanced life support services.
24    (e) Beginning with services rendered on or after July 1,
252008, all providers of non-emergency medi-car and service car
26transportation must certify that the driver and employee



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1attendant, as applicable, have completed a safety program
2approved by the Department to protect both the patient and the
3driver, prior to transporting a patient. The provider must
4maintain this certification in its records. The provider shall
5produce such documentation upon demand by the Department or its
6representative. Failure to produce documentation of such
7training shall result in recovery of any payments made by the
8Department for services rendered by a non-certified driver or
9employee attendant. Medi-car and service car providers must
10maintain legible documentation in their records of the driver
11and, as applicable, employee attendant that actually
12transported the patient. Providers must recertify all drivers
13and employee attendants every 3 years.
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 already
19federally mandated.
20    (f) With respect to any policy or program administered by
21the Department or its agent regarding approval of non-emergency
22medical transportation by ground ambulance service providers,
23including, but not limited to, the Non-Emergency
24Transportation Services Prior Approval Program (NETSPAP), the
25Department shall establish by rule a process by which ground
26ambulance service providers of non-emergency medical



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1transportation may appeal any decision by the Department or its
2agent for which no denial was received prior to the time of
3transport that either (i) denies a request for approval for
4payment of non-emergency transportation by means of ground
5ambulance service or (ii) grants a request for approval of
6non-emergency transportation by means of ground ambulance
7service at a level of service that entitles the ground
8ambulance service provider to a lower level of compensation
9from the Department than the ground ambulance service provider
10would have received as compensation for the level of service
11requested. The rule shall be established within 12 months after
12the effective date of this amendatory Act of the 97th General
13Assembly and shall provide that, for any decision rendered by
14the Department or its agent on or after the date the rule takes
15effect, the ground ambulance service provider shall have 60
16days from the date the decision is received to file an appeal.
17The rule established by the Department shall be, insofar as is
18practical, consistent with the Illinois Administrative
19Procedure Act. The Director's decision on an appeal under this
20Section shall be a final administrative decision subject to
21review under the Administrative Review Law.
22(Source: P.A. 97-584, eff. 8-26-11.)
23    Section 99. Effective date. This Act takes effect upon
24becoming law.".