Illinois General Assembly - Full Text of SB0770
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Full Text of SB0770  97th General Assembly


Sen. John M. Sullivan

Filed: 4/8/2011





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2    AMENDMENT NO. ______. Amend Senate Bill 770 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-4.2 and 5-5 as follows:
6    (305 ILCS 5/5-4.2)  (from Ch. 23, par. 5-4.2)
7    Sec. 5-4.2. Ground ambulance Ambulance services payments.
8    (a) For purposes of this Section, the following terms have
9the following meanings:
10    "Department" means the Illinois Department of Healthcare
11and Family Services.
12    "Ground ambulance services" means medical transportation
13services that are described as ground ambulance services by the
14Centers for Medicare and Medicaid Services and provided in a
15vehicle that is licensed as an ambulance by the Illinois
16Department of Public Health pursuant to the Emergency Medical



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1Services (EMS) Systems Act.
2    "Ground ambulance services provider" means a vehicle
3service provider as described in the Emergency Medical Services
4(EMS) Systems Act that operates licensed ambulances for the
5purpose of providing emergency ambulance services, or
6non-emergency ambulance services, or both. For purposes of this
7Section, this includes both ambulance providers and ambulance
8suppliers as described by the Centers for Medicare and Medicaid
10    "Payment principles of Medicare" means: the accepted
11method propounded by the Centers for Medicare and Medicaid
12Services and used to determine the payment system for ground
13ambulance services providers and suppliers under Title XVIII of
14the Social Security Act. These principles are outlined in the
15United States Code, the Code of Federal Regulations, and the
16CMS Online Manual System, including, but not limited to, the
17Medicare Benefit Policy Manual and the Medicare Claims
18Processing Manual, and include the statues, regulations,
19policies, procedures, definitions, guidelines, and coding
20systems, including the Health Care Common Procedure Coding
21System (HCPCS) and ambulance condition coding system, as well
22as other resources which have been or will be developed and
23recognized by the Centers for Medicare and Medicaid Services.
24    "Rural county" means: any county not located in a U.S.
25Bureau of the Census Metropolitan Statistical Area (MSA); or
26any county located within a U.S. Bureau of the Census



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1Metropolitan Statistical Area but having a population of 60,000
2or less.
3    (b) It is the intent of the General Assembly to provide for
4the payment for ground ambulance services as part of the State
5Medicaid plan and to provide adequate payment for ground
6ambulance services under the State Medicaid plan so as to
7ensure adequate access to ground ambulance services for both
8recipients of aid under this Article and for the general
9population of Illinois. Unless otherwise indicated in this
10Section, the practices of the Department concerning payments
11for ground ambulance services provided to recipients of aid
12under this Article shall be consistent with the payment
13principles of Medicare.
14    (c) For ground ambulance services provided to a recipient
15of aid under this Article on or after July 1, 2011, the
16Department shall provide payment to ground ambulance services
17providers for base charges and mileage charges based upon the
18lesser of the provider's charge, as reflected on the provider's
19claim form, or the Illinois Medicaid Ambulance Fee Schedule
20payment rates calculated in accordance with this Section.
21    Effective July 1, 2011, the Illinois Medicaid Ambulance Fee
22Schedule shall be established and shall include only the ground
23ambulance services payment rates outlined in the Medicare
24Ambulance Fee Schedule as promulgated by the Centers for
25Medicare and Medicaid Services in effect as of July 1, 2011 and
26adjusted for the 4 Medicare Localities in Illinois, with an



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1adjustment of 100% of the Medicare Ambulance Fee Schedule
2payment rates, by Medicare Locality, for both base rates and
3mileage for rural counties, and an adjustment of 80% of the
4Medicare Ambulance Fee Schedule payment rates, by Medicare
5Locality, for both base rates and mileage for all other
6counties. The transition from the current payment system to the
7Illinois Medicaid Ambulance Fee Schedule shall be as follows:
8Effective for dates of service on or after July 1, 2011, for
9each individual base rate and mileage rate, the payment rate
10for ground ambulance services shall be based on the Illinois
11Medicaid Ambulance Fee Schedule amount in effect on July 1,
122011 for the designated Medicare Locality, except that any
13payment rate that was previously approved by the Department
14that exceeds this amount shall remain in force.
15    Notwithstanding the payment principles in subsection (b)
16of this Section, the Department shall develop the Illinois
17Medicaid Ambulance Fee Schedule using the ground mileage
18payment rate, as defined by the Centers for Medicare and
19Medicaid Services, and no other mileage rates which act as
20enhancements to the ground mileage rate, whether permanent or
21temporary, shall be recognized by the Department.
22    (d) Payment for mileage shall be per loaded mile with no
23loaded mileage included in the base rate. If a natural
24disaster, weather, road repairs, traffic congestion, or other
25conditions necessitate a route other than the most direct
26route, payment shall be based upon the actual distance



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1traveled. When a ground ambulance services provider provides
2transport pursuant to an emergency call as defined by the
3Centers for Medicare and Medicaid Services, no reduction in the
4mileage payment shall be made based upon the fact that a closer
5facility may have been available, so long as the ground
6ambulance services provider provided transport to the
7recipient's facility of choice or other appropriate facility
8described within the scope of the Illinois Emergency Medical
9Services (EMS) Systems Act and associated rules or the policies
10and procedures of the EMS System of which the provider is a
12    (e) The Department shall provide payment for emergency
13ground ambulance services provided to a recipient of aid under
14this Article according to the requirements provided in
15subsection (b) of this Section when those services are provided
16pursuant to a request made through a 9-1-1 or equivalent
17emergency telephone number for evaluation, treatment, and
18transport from or on behalf of an individual with a condition
19of such a nature that a prudent layperson would have reasonably
20expected that a delay in seeking immediate medical attention
21would have been hazardous to life or health. This standard is
22deemed to be met if there is an emergency medical condition
23manifesting itself by acute symptoms of sufficient severity,
24including but not limited to severe pain, such that a prudent
25layperson who possesses an average knowledge of medicine and
26health can reasonably expect that the absence of immediate



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1medical attention could result in placing the health of the
2individual or, with respect to a pregnant woman, the health of
3the woman or her unborn child, in serious jeopardy, cause
4serious impairment to bodily functions, or cause serious
5dysfunction of any bodily organ or part.
6    (f) For ground ambulance services provided to a recipient
7enrolled in a Medicaid managed care plan by a ground ambulance
8services provider that is not a contracted provider to the
9Medicaid managed care plan in question, the amount of the
10payment for ground ambulance services by the Medicaid managed
11care plan shall be the lesser of the provider's charge, as
12reflected on the provider's claim form, or the Illinois
13Medicaid Ambulance Fee Schedule payment rates calculated in
14accordance with this Section.
15    (g) Nothing in this Section prohibits the Department from
16setting payment rates for out-of-State ground ambulance
17services providers by administrative rule.
18    (g-5) Nothing in this Section prohibits the Department from
19setting payment rates for State ground ambulance services
20providers by administrative rule pending the availability of
21appropriations dedicated to rate increases provided under
22subsections (c) and (h) of this Section.
23    (h) Effective for dates of service on or after July 1,
242011, payments for stretcher van services provided by ground
25ambulance services providers shall be as follows:
26        (1) For each individual base rate, the amount of the



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1    payment shall be the lesser of the provider's charge, as
2    reflected on the provider's claim form, or 80% of the
3    Illinois Medicaid Ambulance Fee Schedule payment rate for
4    the basic life support non-emergency base rate.
5        (2) For each loaded mile, the amount of the payment
6    shall be the lesser of the provider's charge, as reflected
7    on the provider's claim form, or 80% of the Illinois
8    Medicaid Ambulance Fee Schedule payment rate for mileage.
9    (i) All payments under subsections (c) and (h) of this
10Section are subject to the availability of appropriations for
11those purposes.
12    For ambulance services provided to a recipient of aid under
13this Article on or after January 1, 1993, the Illinois
14Department shall reimburse ambulance service providers at
15rates calculated in accordance with this Section. It is the
16intent of the General Assembly to provide adequate
17reimbursement for ambulance services so as to ensure adequate
18access to services for recipients of aid under this Article and
19to provide appropriate incentives to ambulance service
20providers to provide services in an efficient and
21cost-effective manner. Thus, it is the intent of the General
22Assembly that the Illinois Department implement a
23reimbursement system for ambulance services that, to the extent
24practicable and subject to the availability of funds
25appropriated by the General Assembly for this purpose, is
26consistent with the payment principles of Medicare. To ensure



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1uniformity between the payment principles of Medicare and
2Medicaid, the Illinois Department shall follow, to the extent
3necessary and practicable and subject to the availability of
4funds appropriated by the General Assembly for this purpose,
5the statutes, laws, regulations, policies, procedures,
6principles, definitions, guidelines, and manuals used to
7determine the amounts paid to ambulance service providers under
8Title XVIII of the Social Security Act (Medicare).
9    For ambulance services provided to a recipient of aid under
10this Article on or after January 1, 1996, the Illinois
11Department shall reimburse ambulance service providers based
12upon the actual distance traveled if a natural disaster,
13weather conditions, road repairs, or traffic congestion
14necessitates the use of a route other than the most direct
16    For purposes of this Section, "ambulance services"
17includes medical transportation services provided by means of
18an ambulance, medi-car, service car, or taxi.
19    This Section does not prohibit separate billing by
20ambulance service providers for oxygen furnished while
21providing advanced life support services.
22    (j) Beginning with services rendered on or after July 1,
232008, all providers of non-emergency medi-car and service car
24transportation must certify that the driver and employee
25attendant, as applicable, have completed a safety program
26approved by the Department to protect both the patient and the



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1driver, prior to transporting a patient. The provider must
2maintain this certification in its records. The provider shall
3produce such documentation upon demand by the Department or its
4representative. Failure to produce documentation of such
5training shall result in recovery of any payments made by the
6Department for services rendered by a non-certified driver or
7employee attendant. Medi-car and service car providers must
8maintain legible documentation in their records of the driver
9and, as applicable, employee attendant that actually
10transported the patient. Providers must recertify all drivers
11and employee attendants every 3 years.
12    Notwithstanding the requirements above, any public
13transportation provider of medi-car and service car
14transportation that receives federal funding under 49 U.S.C.
155307 and 5311 need not certify its drivers and employee
16attendants under this Section, since safety training is already
17federally mandated.
18(Source: P.A. 95-501, eff. 8-28-07.)
19    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
20    Sec. 5-5. Medical services. The Illinois Department, by
21rule, shall determine the quantity and quality of and the rate
22of reimbursement for the medical assistance for which payment
23will be authorized, and the medical services to be provided,
24which may include all or part of the following: (1) inpatient
25hospital services; (2) outpatient hospital services; (3) other



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1laboratory and X-ray services; (4) skilled nursing home
2services; (5) physicians' services whether furnished in the
3office, the patient's home, a hospital, a skilled nursing home,
4or elsewhere; (6) medical care, or any other type of remedial
5care furnished by licensed practitioners; (7) home health care
6services; (8) private duty nursing service; (9) clinic
7services; (10) dental services, including prevention and
8treatment of periodontal disease and dental caries disease for
9pregnant women, provided by an individual licensed to practice
10dentistry or dental surgery; for purposes of this item (10),
11"dental services" means diagnostic, preventive, or corrective
12procedures provided by or under the supervision of a dentist in
13the practice of his or her profession; (11) physical therapy
14and related services; (12) prescribed drugs, dentures, and
15prosthetic devices; and eyeglasses prescribed by a physician
16skilled in the diseases of the eye, or by an optometrist,
17whichever the person may select; (13) other diagnostic,
18screening, preventive, and rehabilitative services; (14)
19transportation and such other expenses as may be necessary,
20provided that payment for ground ambulance services shall be as
21provided in Section 5-4.2; (15) medical treatment of sexual
22assault survivors, as defined in Section 1a of the Sexual
23Assault Survivors Emergency Treatment Act, for injuries
24sustained as a result of the sexual assault, including
25examinations and laboratory tests to discover evidence which
26may be used in criminal proceedings arising from the sexual



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1assault; (16) the diagnosis and treatment of sickle cell
2anemia; and (17) any other medical care, and any other type of
3remedial care recognized under the laws of this State, but not
4including abortions, or induced miscarriages or premature
5births, unless, in the opinion of a physician, such procedures
6are necessary for the preservation of the life of the woman
7seeking such treatment, or except an induced premature birth
8intended to produce a live viable child and such procedure is
9necessary for the health of the mother or her unborn child. The
10Illinois Department, by rule, shall prohibit any physician from
11providing medical assistance to anyone eligible therefor under
12this Code where such physician has been found guilty of
13performing an abortion procedure in a wilful and wanton manner
14upon a woman who was not pregnant at the time such abortion
15procedure was performed. The term "any other type of remedial
16care" shall include nursing care and nursing home service for
17persons who rely on treatment by spiritual means alone through
18prayer for healing.
19    Notwithstanding any other provision of this Section, a
20comprehensive tobacco use cessation program that includes
21purchasing prescription drugs or prescription medical devices
22approved by the Food and Drug Administration shall be covered
23under the medical assistance program under this Article for
24persons who are otherwise eligible for assistance under this
26    Notwithstanding any other provision of this Code, the



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1Illinois Department may not require, as a condition of payment
2for any laboratory test authorized under this Article, that a
3physician's handwritten signature appear on the laboratory
4test order form. The Illinois Department may, however, impose
5other appropriate requirements regarding laboratory test order
7    The Department of Healthcare and Family Services shall
8provide the following services to persons eligible for
9assistance under this Article who are participating in
10education, training or employment programs operated by the
11Department of Human Services as successor to the Department of
12Public Aid:
13        (1) dental services provided by or under the
14    supervision of a dentist; and
15        (2) eyeglasses prescribed by a physician skilled in the
16    diseases of the eye, or by an optometrist, whichever the
17    person may select.
18    Notwithstanding any other provision of this Code and
19subject to federal approval, the Department may adopt rules to
20allow a dentist who is volunteering his or her service at no
21cost to render dental services through an enrolled
22not-for-profit health clinic without the dentist personally
23enrolling as a participating provider in the medical assistance
24program. A not-for-profit health clinic shall include a public
25health clinic or Federally Qualified Health Center or other
26enrolled provider, as determined by the Department, through



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1which dental services covered under this Section are performed.
2The Department shall establish a process for payment of claims
3for reimbursement for covered dental services rendered under
4this provision.
5    The Illinois Department, by rule, may distinguish and
6classify the medical services to be provided only in accordance
7with the classes of persons designated in Section 5-2.
8    The Department of Healthcare and Family Services must
9provide coverage and reimbursement for amino acid-based
10elemental formulas, regardless of delivery method, for the
11diagnosis and treatment of (i) eosinophilic disorders and (ii)
12short bowel syndrome when the prescribing physician has issued
13a written order stating that the amino acid-based elemental
14formula is medically necessary.
15    The Illinois Department shall authorize the provision of,
16and shall authorize payment for, screening by low-dose
17mammography for the presence of occult breast cancer for women
1835 years of age or older who are eligible for medical
19assistance under this Article, as follows:
20        (A) A baseline mammogram for women 35 to 39 years of
21    age.
22        (B) An annual mammogram for women 40 years of age or
23    older.
24        (C) A mammogram at the age and intervals considered
25    medically necessary by the woman's health care provider for
26    women under 40 years of age and having a family history of



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1    breast cancer, prior personal history of breast cancer,
2    positive genetic testing, or other risk factors.
3        (D) A comprehensive ultrasound screening of an entire
4    breast or breasts if a mammogram demonstrates
5    heterogeneous or dense breast tissue, when medically
6    necessary as determined by a physician licensed to practice
7    medicine in all of its branches.
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
11tool. For purposes of this Section, "low-dose mammography"
12means the x-ray examination of the breast using equipment
13dedicated specifically for mammography, including the x-ray
14tube, filter, compression device, and image receptor, with an
15average radiation exposure delivery of less than one rad per
16breast for 2 views of an average size breast. The term also
17includes digital mammography.
18    On and after July 1, 2008, screening and diagnostic
19mammography shall be reimbursed at the same rate as the
20Medicare program's rates, including the increased
21reimbursement for digital mammography.
22    The Department shall convene an expert panel including
23representatives of hospitals, free-standing mammography
24facilities, and doctors, including radiologists, to establish
25quality standards. Based on these quality standards, the
26Department shall provide for bonus payments to mammography



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1facilities meeting the standards for screening and diagnosis.
2The bonus payments shall be at least 15% higher than the
3Medicare rates for mammography.
4    Subject to federal approval, the Department shall
5establish a rate methodology for mammography at federally
6qualified health centers and other encounter-rate clinics.
7These clinics or centers may also collaborate with other
8hospital-based mammography facilities.
9    The Department shall establish a methodology to remind
10women who are age-appropriate for screening mammography, but
11who have not received a mammogram within the previous 18
12months, of the importance and benefit of screening mammography.
13    The Department shall establish a performance goal for
14primary care providers with respect to their female patients
15over age 40 receiving an annual mammogram. This performance
16goal shall be used to provide additional reimbursement in the
17form of a quality performance bonus to primary care providers
18who meet that goal.
19    The Department shall devise a means of case-managing or
20patient navigation for beneficiaries diagnosed with breast
21cancer. This program shall initially operate as a pilot program
22in areas of the State with the highest incidence of mortality
23related to breast cancer. At least one pilot program site shall
24be in the metropolitan Chicago area and at least one site shall
25be outside the metropolitan Chicago area. An evaluation of the
26pilot program shall be carried out measuring health outcomes



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1and cost of care for those served by the pilot program compared
2to similarly situated patients who are not served by the pilot
4    Any medical or health care provider shall immediately
5recommend, to any pregnant woman who is being provided prenatal
6services and is suspected of drug abuse or is addicted as
7defined in the Alcoholism and Other Drug Abuse and Dependency
8Act, referral to a local substance abuse treatment provider
9licensed by the Department of Human Services or to a licensed
10hospital which provides substance abuse treatment services.
11The Department of Healthcare and Family Services shall assure
12coverage for the cost of treatment of the drug abuse or
13addiction for pregnant recipients in accordance with the
14Illinois Medicaid Program in conjunction with the Department of
15Human Services.
16    All medical providers providing medical assistance to
17pregnant women under this Code shall receive information from
18the Department on the availability of services under the Drug
19Free Families with a Future or any comparable program providing
20case management services for addicted women, including
21information on appropriate referrals for other social services
22that may be needed by addicted women in addition to treatment
23for addiction.
24    The Illinois Department, in cooperation with the
25Departments of Human Services (as successor to the Department
26of Alcoholism and Substance Abuse) and Public Health, through a



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1public awareness campaign, may provide information concerning
2treatment for alcoholism and drug abuse and addiction, prenatal
3health care, and other pertinent programs directed at reducing
4the number of drug-affected infants born to recipients of
5medical assistance.
6    Neither the Department of Healthcare and Family Services
7nor the Department of Human Services shall sanction the
8recipient solely on the basis of her substance abuse.
9    The Illinois Department shall establish such regulations
10governing the dispensing of health services under this Article
11as it shall deem appropriate. The Department should seek the
12advice of formal professional advisory committees appointed by
13the Director of the Illinois Department for the purpose of
14providing regular advice on policy and administrative matters,
15information dissemination and educational activities for
16medical and health care providers, and consistency in
17procedures to the Illinois Department.
18    Notwithstanding any other provision of law, a health care
19provider under the medical assistance program may elect, in
20lieu of receiving direct payment for services provided under
21that program, to participate in the State Employees Deferred
22Compensation Plan adopted under Article 24 of the Illinois
23Pension Code. A health care provider who elects to participate
24in the plan does not have a cause of action against the State
25for any damages allegedly suffered by the provider as a result
26of any delay by the State in crediting the amount of any



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



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



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1implementation of Partnerships under this Section.
2    The Illinois Department shall require health care
3providers to maintain records that document the medical care
4and services provided to recipients of Medical Assistance under
5this Article. The Illinois Department shall require health care
6providers to make available, when authorized by the patient, in
7writing, the medical records in a timely fashion to other
8health care providers who are treating or serving persons
9eligible for Medical Assistance under this Article. All
10dispensers of medical services shall be required to maintain
11and retain business and professional records sufficient to
12fully and accurately document the nature, scope, details and
13receipt of the health care provided to persons eligible for
14medical assistance under this Code, in accordance with
15regulations promulgated by the Illinois Department. The rules
16and regulations shall require that proof of the receipt of
17prescription drugs, dentures, prosthetic devices and
18eyeglasses by eligible persons under this Section accompany
19each claim for reimbursement submitted by the dispenser of such
20medical services. No such claims for reimbursement shall be
21approved for payment by the Illinois Department without such
22proof of receipt, unless the Illinois Department shall have put
23into effect and shall be operating a system of post-payment
24audit and review which shall, on a sampling basis, be deemed
25adequate by the Illinois Department to assure that such drugs,
26dentures, prosthetic devices and eyeglasses for which payment



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1is being made are actually being received by eligible
2recipients. Within 90 days after the effective date of this
3amendatory Act of 1984, the Illinois Department shall establish
4a current list of acquisition costs for all prosthetic devices
5and any other items recognized as medical equipment and
6supplies reimbursable under this Article and shall update such
7list on a quarterly basis, except that the acquisition costs of
8all prescription drugs shall be updated no less frequently than
9every 30 days as required by Section 5-5.12.
10    The rules and regulations of the Illinois Department shall
11require that a written statement including the required opinion
12of a physician shall accompany any claim for reimbursement for
13abortions, or induced miscarriages or premature births. This
14statement shall indicate what procedures were used in providing
15such medical services.
16    The Illinois Department shall require all dispensers of
17medical services, other than an individual practitioner or
18group of practitioners, desiring to participate in the Medical
19Assistance program established under this Article to disclose
20all financial, beneficial, ownership, equity, surety or other
21interests in any and all firms, corporations, partnerships,
22associations, business enterprises, joint ventures, agencies,
23institutions or other legal entities providing any form of
24health care services in this State under this Article.
25    The Illinois Department may require that all dispensers of
26medical services desiring to participate in the medical



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1assistance program established under this Article disclose,
2under such terms and conditions as the Illinois Department may
3by rule establish, all inquiries from clients and attorneys
4regarding medical bills paid by the Illinois Department, which
5inquiries could indicate potential existence of claims or liens
6for the Illinois Department.
7    Enrollment of a vendor that provides non-emergency medical
8transportation, defined by the Department by rule, shall be
9conditional for 180 days. During that time, the Department of
10Healthcare and Family Services may terminate the vendor's
11eligibility to participate in the medical assistance program
12without cause. That termination of eligibility is not subject
13to the Department's hearing process.
14    The Illinois Department shall establish policies,
15procedures, standards and criteria by rule for the acquisition,
16repair and replacement of orthotic and prosthetic devices and
17durable medical equipment. Such rules shall provide, but not be
18limited to, the following services: (1) immediate repair or
19replacement of such devices by recipients without medical
20authorization; and (2) rental, lease, purchase or
21lease-purchase of durable medical equipment in a
22cost-effective manner, taking into consideration the
23recipient's medical prognosis, the extent of the recipient's
24needs, and the requirements and costs for maintaining such
25equipment. Such rules shall enable a recipient to temporarily
26acquire and use alternative or substitute devices or equipment



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1pending repairs or replacements of any device or equipment
2previously authorized for such recipient by the Department.
3    The Department shall execute, relative to the nursing home
4prescreening project, written inter-agency agreements with the
5Department of Human Services and the Department on Aging, to
6effect the following: (i) intake procedures and common
7eligibility criteria for those persons who are receiving
8non-institutional services; and (ii) the establishment and
9development of non-institutional services in areas of the State
10where they are not currently available or are undeveloped.
11    The Illinois Department shall develop and operate, in
12cooperation with other State Departments and agencies and in
13compliance with applicable federal laws and regulations,
14appropriate and effective systems of health care evaluation and
15programs for monitoring of utilization of health care services
16and facilities, as it affects persons eligible for medical
17assistance under this Code.
18    The Illinois Department shall report annually to the
19General Assembly, no later than the second Friday in April of
201979 and each year thereafter, in regard to:
21        (a) actual statistics and trends in utilization of
22    medical services by public aid recipients;
23        (b) actual statistics and trends in the provision of
24    the various medical services by medical vendors;
25        (c) current rate structures and proposed changes in
26    those rate structures for the various medical vendors; and



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1        (d) efforts at utilization review and control by the
2    Illinois Department.
3    The period covered by each report shall be the 3 years
4ending on the June 30 prior to the report. The report shall
5include suggested legislation for consideration by the General
6Assembly. The filing of one copy of the report with the
7Speaker, one copy with the Minority Leader and one copy with
8the Clerk of the House of Representatives, one copy with the
9President, one copy with the Minority Leader and one copy with
10the Secretary of the Senate, one copy with the Legislative
11Research Unit, and such additional copies with the State
12Government Report Distribution Center for the General Assembly
13as is required under paragraph (t) of Section 7 of the State
14Library Act shall be deemed sufficient to comply with this
16    Rulemaking authority to implement Public Act 95-1045, if
17any, is conditioned on the rules being adopted in accordance
18with all provisions of the Illinois Administrative Procedure
19Act and all rules and procedures of the Joint Committee on
20Administrative Rules; any purported rule not so adopted, for
21whatever reason, is unauthorized.
22(Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07;
2395-1045, eff. 3-27-09; 96-156, eff. 1-1-10; 96-806, eff.
247-1-10; 96-926, eff. 1-1-11; 96-1000, eff. 7-2-10.)
25    Section 99. Effective date. This Act takes effect July 1,



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