Illinois General Assembly - Full Text of SB2429
Illinois General Assembly

Previous General Assemblies

Full Text of SB2429  100th General Assembly




State of Illinois
2017 and 2018


Introduced 1/30/2018, by Sen. Omar Aquino


305 ILCS 5/5-5  from Ch. 23, par. 5-5
305 ILCS 5/5-30

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall provide dental services to an adult who is otherwise eligible for assistance under the medical assistance program. Provides that targeted dental services, as set forth in a specified exhibit in a federal consent decree, that are provided to adults under the medical assistance program shall be reimbursed at the rates set forth in a specified column in the exhibit for targeted dental services that are provided to persons under the age of 18 under the medical assistance program. Requires the Department to actively monitor the contractual relationship between Managed Care Organizations (MCOs) and a dental administrator contracted by an MCO to provide dental services. Contains provisions concerning the Department's adoption of appropriate data and measures; the inclusion of certain dental performance measures in the Department's Health Plan Comparison Tool and Illinois Medicaid Plan Report Card; and the collection of information about the types of contracted, broad-based care coordination occurring between a MCO and any dental administrator. Prohibits a health plan from attempting to limit the right of medical assistance recipients to obtain dental services from a qualified Medicaid provider. Prohibits the Department from adopting a rule or entering into a contract that prohibits a licensed dentist or dental hygienist from receiving reimbursement under the medical assistance program for a dental encounter. Effective immediately.

LRB100 16511 KTG 31643 b






SB2429LRB100 16511 KTG 31643 b

1    AN ACT concerning public aid.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-5 and 5-30 as follows:
6    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
7    Sec. 5-5. Medical services. The Illinois Department, by
8rule, shall determine the quantity and quality of and the rate
9of reimbursement for the medical assistance for which payment
10will be authorized, and the medical services to be provided,
11which may include all or part of the following: (1) inpatient
12hospital services; (2) outpatient hospital services; (3) other
13laboratory and X-ray services; (4) skilled nursing home
14services; (5) physicians' services whether furnished in the
15office, the patient's home, a hospital, a skilled nursing home,
16or elsewhere; (6) medical care, or any other type of remedial
17care furnished by licensed practitioners; (7) home health care
18services; (8) private duty nursing service; (9) clinic
19services; (10) dental services, including prevention and
20treatment of periodontal disease and dental caries disease for
21pregnant women, provided by an individual licensed to practice
22dentistry or dental surgery; for purposes of this item (10),
23"dental services" means diagnostic, preventive, or corrective



SB2429- 2 -LRB100 16511 KTG 31643 b

1procedures provided by or under the supervision of a dentist in
2the practice of his or her profession; (11) physical therapy
3and related services; (12) prescribed drugs, dentures, and
4prosthetic devices; and eyeglasses prescribed by a physician
5skilled in the diseases of the eye, or by an optometrist,
6whichever the person may select; (13) other diagnostic,
7screening, preventive, and rehabilitative services, including
8to ensure that the individual's need for intervention or
9treatment of mental disorders or substance use disorders or
10co-occurring mental health and substance use disorders is
11determined using a uniform screening, assessment, and
12evaluation process inclusive of criteria, for children and
13adults; for purposes of this item (13), a uniform screening,
14assessment, and evaluation process refers to a process that
15includes an appropriate evaluation and, as warranted, a
16referral; "uniform" does not mean the use of a singular
17instrument, tool, or process that all must utilize; (14)
18transportation and such other expenses as may be necessary;
19(15) medical treatment of sexual assault survivors, as defined
20in Section 1a of the Sexual Assault Survivors Emergency
21Treatment Act, for injuries sustained as a result of the sexual
22assault, including examinations and laboratory tests to
23discover evidence which may be used in criminal proceedings
24arising from the sexual assault; (16) the diagnosis and
25treatment of sickle cell anemia; and (17) any other medical
26care, and any other type of remedial care recognized under the



SB2429- 3 -LRB100 16511 KTG 31643 b

1laws of this State. The term "any other type of remedial care"
2shall include nursing care and nursing home service for persons
3who rely on treatment by spiritual means alone through prayer
4for healing.
5    Notwithstanding any other provision of this Section, a
6comprehensive tobacco use cessation program that includes
7purchasing prescription drugs or prescription medical devices
8approved by the Food and Drug Administration shall be covered
9under the medical assistance program under this Article for
10persons who are otherwise eligible for assistance under this
12    Notwithstanding any other provision of this Code,
13reproductive health care that is otherwise legal in Illinois
14shall be covered under the medical assistance program for
15persons who are otherwise eligible for medical assistance under
16this Article.
17    Notwithstanding any other provision of this Code, the
18Illinois Department may not require, as a condition of payment
19for any laboratory test authorized under this Article, that a
20physician's handwritten signature appear on the laboratory
21test order form. The Illinois Department may, however, impose
22other appropriate requirements regarding laboratory test order
24    Upon receipt of federal approval of an amendment to the
25Illinois Title XIX State Plan for this purpose, the Department
26shall authorize the Chicago Public Schools (CPS) to procure a



SB2429- 4 -LRB100 16511 KTG 31643 b

1vendor or vendors to manufacture eyeglasses for individuals
2enrolled in a school within the CPS system. CPS shall ensure
3that its vendor or vendors are enrolled as providers in the
4medical assistance program and in any capitated Medicaid
5managed care entity (MCE) serving individuals enrolled in a
6school within the CPS system. Under any contract procured under
7this provision, the vendor or vendors must serve only
8individuals enrolled in a school within the CPS system. Claims
9for services provided by CPS's vendor or vendors to recipients
10of benefits in the medical assistance program under this Code,
11the Children's Health Insurance Program, or the Covering ALL
12KIDS Health Insurance Program shall be submitted to the
13Department or the MCE in which the individual is enrolled for
14payment and shall be reimbursed at the Department's or the
15MCE's established rates or rate methodologies for eyeglasses.
16    On and after July 1, 2012, the Department of Healthcare and
17Family Services may provide the following services to persons
18eligible for assistance under this Article who are
19participating in education, training or employment programs
20operated by the Department of Human Services as successor to
21the Department of Public Aid:
22        (1) dental services provided by or under the
23    supervision of a dentist; and
24        (2) eyeglasses prescribed by a physician skilled in the
25    diseases of the eye, or by an optometrist, whichever the
26    person may select.



SB2429- 5 -LRB100 16511 KTG 31643 b

1    On and after July 1, 2018, the Department of Healthcare and
2Family Services shall provide dental services to any adult who
3is otherwise eligible for assistance under the medical
4assistance program. As used in this paragraph, "dental
5services" means diagnostic, preventative, restorative, or
6corrective procedures, including procedures and services for
7the prevention and treatment of periodontal disease and dental
8caries disease, provided by an individual who is licensed to
9practice dentistry or dental surgery or who is under the
10supervision of a dentist in the practice of his or her
12    On and after July 1, 2018, targeted dental services, as set
13forth in Exhibit D of the Consent Decree entered by the United
14States District Court for the Northern District of Illinois,
15Eastern Division, in the matter of Memisovski v. Maram, Case
16No. 92 C 1982, that are provided to adults under the medical
17assistance program shall be reimbursed at the rates set forth
18in the "New Rate" column in Exhibit D of the Consent Decree for
19targeted dental services that are provided to persons under the
20age of 18 under the medical assistance program.
21    Notwithstanding any other provision of this Code and
22subject to federal approval, the Department may adopt rules to
23allow a dentist who is volunteering his or her service at no
24cost to render dental services through an enrolled
25not-for-profit health clinic without the dentist personally
26enrolling as a participating provider in the medical assistance



SB2429- 6 -LRB100 16511 KTG 31643 b

1program. A not-for-profit health clinic shall include a public
2health clinic or Federally Qualified Health Center or other
3enrolled provider, as determined by the Department, through
4which dental services covered under this Section are performed.
5The Department shall establish a process for payment of claims
6for reimbursement for covered dental services rendered under
7this provision.
8    The Illinois Department, by rule, may distinguish and
9classify the medical services to be provided only in accordance
10with the classes of persons designated in Section 5-2.
11    The Department of Healthcare and Family Services must
12provide coverage and reimbursement for amino acid-based
13elemental formulas, regardless of delivery method, for the
14diagnosis and treatment of (i) eosinophilic disorders and (ii)
15short bowel syndrome when the prescribing physician has issued
16a written order stating that the amino acid-based elemental
17formula is medically necessary.
18    The Illinois Department shall authorize the provision of,
19and shall authorize payment for, screening by low-dose
20mammography for the presence of occult breast cancer for women
2135 years of age or older who are eligible for medical
22assistance under this Article, as follows:
23        (A) A baseline mammogram for women 35 to 39 years of
24    age.
25        (B) An annual mammogram for women 40 years of age or
26    older.



SB2429- 7 -LRB100 16511 KTG 31643 b

1        (C) A mammogram at the age and intervals considered
2    medically necessary by the woman's health care provider for
3    women under 40 years of age and having a family history of
4    breast cancer, prior personal history of breast cancer,
5    positive genetic testing, or other risk factors.
6        (D) A comprehensive ultrasound screening and MRI of an
7    entire breast or breasts if a mammogram demonstrates
8    heterogeneous or dense breast tissue, when medically
9    necessary as determined by a physician licensed to practice
10    medicine in all of its branches.
11        (E) A screening MRI when medically necessary, as
12    determined by a physician licensed to practice medicine in
13    all of its branches.
14    All screenings shall include a physical breast exam,
15instruction on self-examination and information regarding the
16frequency of self-examination and its value as a preventative
17tool. For purposes of this Section, "low-dose mammography"
18means the x-ray examination of the breast using equipment
19dedicated specifically for mammography, including the x-ray
20tube, filter, compression device, and image receptor, with an
21average radiation exposure delivery of less than one rad per
22breast for 2 views of an average size breast. The term also
23includes digital mammography and includes breast
24tomosynthesis. As used in this Section, the term "breast
25tomosynthesis" means a radiologic procedure that involves the
26acquisition of projection images over the stationary breast to



SB2429- 8 -LRB100 16511 KTG 31643 b

1produce cross-sectional digital three-dimensional images of
2the breast. If, at any time, the Secretary of the United States
3Department of Health and Human Services, or its successor
4agency, promulgates rules or regulations to be published in the
5Federal Register or publishes a comment in the Federal Register
6or issues an opinion, guidance, or other action that would
7require the State, pursuant to any provision of the Patient
8Protection and Affordable Care Act (Public Law 111-148),
9including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
10successor provision, to defray the cost of any coverage for
11breast tomosynthesis outlined in this paragraph, then the
12requirement that an insurer cover breast tomosynthesis is
13inoperative other than any such coverage authorized under
14Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and
15the State shall not assume any obligation for the cost of
16coverage for breast tomosynthesis set forth in this paragraph.
17    On and after January 1, 2016, the Department shall ensure
18that all networks of care for adult clients of the Department
19include access to at least one breast imaging Center of Imaging
20Excellence as certified by the American College of Radiology.
21    On and after January 1, 2012, providers participating in a
22quality improvement program approved by the Department shall be
23reimbursed for screening and diagnostic mammography at the same
24rate as the Medicare program's rates, including the increased
25reimbursement for digital mammography.
26    The Department shall convene an expert panel including



SB2429- 9 -LRB100 16511 KTG 31643 b

1representatives of hospitals, free-standing mammography
2facilities, and doctors, including radiologists, to establish
3quality standards for mammography.
4    On and after January 1, 2017, providers participating in a
5breast cancer treatment quality improvement program approved
6by the Department shall be reimbursed for breast cancer
7treatment at a rate that is no lower than 95% of the Medicare
8program's rates for the data elements included in the breast
9cancer treatment quality program.
10    The Department shall convene an expert panel, including
11representatives of hospitals, free standing breast cancer
12treatment centers, breast cancer quality organizations, and
13doctors, including breast surgeons, reconstructive breast
14surgeons, oncologists, and primary care providers to establish
15quality standards for breast cancer treatment.
16    Subject to federal approval, the Department shall
17establish a rate methodology for mammography at federally
18qualified health centers and other encounter-rate clinics.
19These clinics or centers may also collaborate with other
20hospital-based mammography facilities. By January 1, 2016, the
21Department shall report to the General Assembly on the status
22of the provision set forth in this paragraph.
23    The Department shall establish a methodology to remind
24women who are age-appropriate for screening mammography, but
25who have not received a mammogram within the previous 18
26months, of the importance and benefit of screening mammography.



SB2429- 10 -LRB100 16511 KTG 31643 b

1The Department shall work with experts in breast cancer
2outreach and patient navigation to optimize these reminders and
3shall establish a methodology for evaluating their
4effectiveness and modifying the methodology based on the
6    The Department shall establish a performance goal for
7primary care providers with respect to their female patients
8over age 40 receiving an annual mammogram. This performance
9goal shall be used to provide additional reimbursement in the
10form of a quality performance bonus to primary care providers
11who meet that goal.
12    The Department shall devise a means of case-managing or
13patient navigation for beneficiaries diagnosed with breast
14cancer. This program shall initially operate as a pilot program
15in areas of the State with the highest incidence of mortality
16related to breast cancer. At least one pilot program site shall
17be in the metropolitan Chicago area and at least one site shall
18be outside the metropolitan Chicago area. On or after July 1,
192016, the pilot program shall be expanded to include one site
20in western Illinois, one site in southern Illinois, one site in
21central Illinois, and 4 sites within metropolitan Chicago. An
22evaluation of the pilot program shall be carried out measuring
23health outcomes and cost of care for those served by the pilot
24program compared to similarly situated patients who are not
25served by the pilot program.
26    The Department shall require all networks of care to



SB2429- 11 -LRB100 16511 KTG 31643 b

1develop a means either internally or by contract with experts
2in navigation and community outreach to navigate cancer
3patients to comprehensive care in a timely fashion. The
4Department shall require all networks of care to include access
5for patients diagnosed with cancer to at least one academic
6commission on cancer-accredited cancer program as an
7in-network covered benefit.
8    Any medical or health care provider shall immediately
9recommend, to any pregnant woman who is being provided prenatal
10services and is suspected of drug abuse or is addicted as
11defined in the Alcoholism and Other Drug Abuse and Dependency
12Act, referral to a local substance abuse treatment provider
13licensed by the Department of Human Services or to a licensed
14hospital which provides substance abuse treatment services.
15The Department of Healthcare and Family Services shall assure
16coverage for the cost of treatment of the drug abuse or
17addiction for pregnant recipients in accordance with the
18Illinois Medicaid Program in conjunction with the Department of
19Human Services.
20    All medical providers providing medical assistance to
21pregnant women under this Code shall receive information from
22the Department on the availability of services under the Drug
23Free Families with a Future or any comparable program providing
24case management services for addicted women, including
25information on appropriate referrals for other social services
26that may be needed by addicted women in addition to treatment



SB2429- 12 -LRB100 16511 KTG 31643 b

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



SB2429- 13 -LRB100 16511 KTG 31643 b

1represented by a sponsor organization. The Department, by rule,
2shall develop qualifications for sponsors of Partnerships.
3Nothing in this Section shall be construed to require that the
4sponsor organization be a medical organization.
5    The sponsor must negotiate formal written contracts with
6medical providers for physician services, inpatient and
7outpatient hospital care, home health services, treatment for
8alcoholism and substance abuse, and other services determined
9necessary by the Illinois Department by rule for delivery by
10Partnerships. Physician services must include prenatal and
11obstetrical care. The Illinois Department shall reimburse
12medical services delivered by Partnership providers to clients
13in target areas according to provisions of this Article and the
14Illinois Health Finance Reform Act, except that:
15        (1) Physicians participating in a Partnership and
16    providing certain services, which shall be determined by
17    the Illinois Department, to persons in areas covered by the
18    Partnership may receive an additional surcharge for such
19    services.
20        (2) The Department may elect to consider and negotiate
21    financial incentives to encourage the development of
22    Partnerships and the efficient delivery of medical care.
23        (3) Persons receiving medical services through
24    Partnerships may receive medical and case management
25    services above the level usually offered through the
26    medical assistance program.



SB2429- 14 -LRB100 16511 KTG 31643 b

1    Medical providers shall be required to meet certain
2qualifications to participate in Partnerships to ensure the
3delivery of high quality medical services. These
4qualifications shall be determined by rule of the Illinois
5Department and may be higher than qualifications for
6participation in the medical assistance program. Partnership
7sponsors may prescribe reasonable additional qualifications
8for participation by medical providers, only with the prior
9written approval of the Illinois Department.
10    Nothing in this Section shall limit the free choice of
11practitioners, hospitals, and other providers of medical
12services by clients. In order to ensure patient freedom of
13choice, the Illinois Department shall immediately promulgate
14all rules and take all other necessary actions so that provided
15services may be accessed from therapeutically certified
16optometrists to the full extent of the Illinois Optometric
17Practice Act of 1987 without discriminating between service
19    The Department shall apply for a waiver from the United
20States Health Care Financing Administration to allow for the
21implementation of Partnerships under this Section.
22    The Illinois Department shall require health care
23providers to maintain records that document the medical care
24and services provided to recipients of Medical Assistance under
25this Article. Such records must be retained for a period of not
26less than 6 years from the date of service or as provided by



SB2429- 15 -LRB100 16511 KTG 31643 b

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



SB2429- 16 -LRB100 16511 KTG 31643 b

1recipients. Within 90 days after September 16, 1984 (the
2effective date of Public Act 83-1439), the Illinois Department
3shall establish a current list of acquisition costs for all
4prosthetic devices and any other items recognized as medical
5equipment and supplies reimbursable under this Article and
6shall update such list on a quarterly basis, except that the
7acquisition costs of all prescription drugs shall be updated no
8less frequently than every 30 days as required by Section
10    Notwithstanding any other law to the contrary, the Illinois
11Department shall, within 365 days after July 22, 2013 (the
12effective date of Public Act 98-104), establish procedures to
13permit skilled care facilities licensed under the Nursing Home
14Care Act to submit monthly billing claims for reimbursement
15purposes. Following development of these procedures, the
16Department shall, by July 1, 2016, test the viability of the
17new system and implement any necessary operational or
18structural changes to its information technology platforms in
19order to allow for the direct acceptance and payment of nursing
20home claims.
21    Notwithstanding any other law to the contrary, the Illinois
22Department shall, within 365 days after August 15, 2014 (the
23effective date of Public Act 98-963), establish procedures to
24permit ID/DD facilities licensed under the ID/DD Community Care
25Act and MC/DD facilities licensed under the MC/DD Act to submit
26monthly billing claims for reimbursement purposes. Following



SB2429- 17 -LRB100 16511 KTG 31643 b

1development of these procedures, the Department shall have an
2additional 365 days to test the viability of the new system and
3to ensure that any necessary operational or structural changes
4to its information technology platforms are implemented.
5    The Illinois Department shall require all dispensers of
6medical services, other than an individual practitioner or
7group of practitioners, desiring to participate in the Medical
8Assistance program established under this Article to disclose
9all financial, beneficial, ownership, equity, surety or other
10interests in any and all firms, corporations, partnerships,
11associations, business enterprises, joint ventures, agencies,
12institutions or other legal entities providing any form of
13health care services in this State under this Article.
14    The Illinois Department may require that all dispensers of
15medical services desiring to participate in the medical
16assistance program established under this Article disclose,
17under such terms and conditions as the Illinois Department may
18by rule establish, all inquiries from clients and attorneys
19regarding medical bills paid by the Illinois Department, which
20inquiries could indicate potential existence of claims or liens
21for the Illinois Department.
22    Enrollment of a vendor shall be subject to a provisional
23period and shall be conditional for one year. During the period
24of conditional enrollment, the Department may terminate the
25vendor's eligibility to participate in, or may disenroll the
26vendor from, the medical assistance program without cause.



SB2429- 18 -LRB100 16511 KTG 31643 b

1Unless otherwise specified, such termination of eligibility or
2disenrollment is not subject to the Department's hearing
3process. However, a disenrolled vendor may reapply without
5    The Department has the discretion to limit the conditional
6enrollment period for vendors based upon category of risk of
7the vendor.
8    Prior to enrollment and during the conditional enrollment
9period in the medical assistance program, all vendors shall be
10subject to enhanced oversight, screening, and review based on
11the risk of fraud, waste, and abuse that is posed by the
12category of risk of the vendor. The Illinois Department shall
13establish the procedures for oversight, screening, and review,
14which may include, but need not be limited to: criminal and
15financial background checks; fingerprinting; license,
16certification, and authorization verifications; unscheduled or
17unannounced site visits; database checks; prepayment audit
18reviews; audits; payment caps; payment suspensions; and other
19screening as required by federal or State law.
20    The Department shall define or specify the following: (i)
21by provider notice, the "category of risk of the vendor" for
22each type of vendor, which shall take into account the level of
23screening applicable to a particular category of vendor under
24federal law and regulations; (ii) by rule or provider notice,
25the maximum length of the conditional enrollment period for
26each category of risk of the vendor; and (iii) by rule, the



SB2429- 19 -LRB100 16511 KTG 31643 b

1hearing rights, if any, afforded to a vendor in each category
2of risk of the vendor that is terminated or disenrolled during
3the conditional enrollment period.
4    To be eligible for payment consideration, a vendor's
5payment claim or bill, either as an initial claim or as a
6resubmitted claim following prior rejection, must be received
7by the Illinois Department, or its fiscal intermediary, no
8later than 180 days after the latest date on the claim on which
9medical goods or services were provided, with the following
11        (1) In the case of a provider whose enrollment is in
12    process by the Illinois Department, the 180-day period
13    shall not begin until the date on the written notice from
14    the Illinois Department that the provider enrollment is
15    complete.
16        (2) In the case of errors attributable to the Illinois
17    Department or any of its claims processing intermediaries
18    which result in an inability to receive, process, or
19    adjudicate a claim, the 180-day period shall not begin
20    until the provider has been notified of the error.
21        (3) In the case of a provider for whom the Illinois
22    Department initiates the monthly billing process.
23        (4) In the case of a provider operated by a unit of
24    local government with a population exceeding 3,000,000
25    when local government funds finance federal participation
26    for claims payments.



SB2429- 20 -LRB100 16511 KTG 31643 b

1    For claims for services rendered during a period for which
2a recipient received retroactive eligibility, claims must be
3filed within 180 days after the Department determines the
4applicant is eligible. For claims for which the Illinois
5Department is not the primary payer, claims must be submitted
6to the Illinois Department within 180 days after the final
7adjudication by the primary payer.
8    In the case of long term care facilities, within 45
9calendar days of receipt by the facility of required
10prescreening information, new admissions with associated
11admission documents shall be submitted through the Medical
12Electronic Data Interchange (MEDI) or the Recipient
13Eligibility Verification (REV) System or shall be submitted
14directly to the Department of Human Services using required
15admission forms. Effective September 1, 2014, admission
16documents, including all prescreening information, must be
17submitted through MEDI or REV. Confirmation numbers assigned to
18an accepted transaction shall be retained by a facility to
19verify timely submittal. Once an admission transaction has been
20completed, all resubmitted claims following prior rejection
21are subject to receipt no later than 180 days after the
22admission transaction has been completed.
23    Claims that are not submitted and received in compliance
24with the foregoing requirements shall not be eligible for
25payment under the medical assistance program, and the State
26shall have no liability for payment of those claims.



SB2429- 21 -LRB100 16511 KTG 31643 b

1    To the extent consistent with applicable information and
2privacy, security, and disclosure laws, State and federal
3agencies and departments shall provide the Illinois Department
4access to confidential and other information and data necessary
5to perform eligibility and payment verifications and other
6Illinois Department functions. This includes, but is not
7limited to: information pertaining to licensure;
8certification; earnings; immigration status; citizenship; wage
9reporting; unearned and earned income; pension income;
10employment; supplemental security income; social security
11numbers; National Provider Identifier (NPI) numbers; the
12National Practitioner Data Bank (NPDB); program and agency
13exclusions; taxpayer identification numbers; tax delinquency;
14corporate information; and death records.
15    The Illinois Department shall enter into agreements with
16State agencies and departments, and is authorized to enter into
17agreements with federal agencies and departments, under which
18such agencies and departments shall share data necessary for
19medical assistance program integrity functions and oversight.
20The Illinois Department shall develop, in cooperation with
21other State departments and agencies, and in compliance with
22applicable federal laws and regulations, appropriate and
23effective methods to share such data. At a minimum, and to the
24extent necessary to provide data sharing, the Illinois
25Department shall enter into agreements with State agencies and
26departments, and is authorized to enter into agreements with



SB2429- 22 -LRB100 16511 KTG 31643 b

1federal agencies and departments, including but not limited to:
2the Secretary of State; the Department of Revenue; the
3Department of Public Health; the Department of Human Services;
4and the Department of Financial and Professional Regulation.
5    Beginning in fiscal year 2013, the Illinois Department
6shall set forth a request for information to identify the
7benefits of a pre-payment, post-adjudication, and post-edit
8claims system with the goals of streamlining claims processing
9and provider reimbursement, reducing the number of pending or
10rejected claims, and helping to ensure a more transparent
11adjudication process through the utilization of: (i) provider
12data verification and provider screening technology; and (ii)
13clinical code editing; and (iii) pre-pay, pre- or
14post-adjudicated predictive modeling with an integrated case
15management system with link analysis. Such a request for
16information shall not be considered as a request for proposal
17or as an obligation on the part of the Illinois Department to
18take any action or acquire any products or services.
19    The Illinois Department shall establish policies,
20procedures, standards and criteria by rule for the acquisition,
21repair and replacement of orthotic and prosthetic devices and
22durable medical equipment. Such rules shall provide, but not be
23limited to, the following services: (1) immediate repair or
24replacement of such devices by recipients; and (2) rental,
25lease, purchase or lease-purchase of durable medical equipment
26in a cost-effective manner, taking into consideration the



SB2429- 23 -LRB100 16511 KTG 31643 b

1recipient's medical prognosis, the extent of the recipient's
2needs, and the requirements and costs for maintaining such
3equipment. Subject to prior approval, such rules shall enable a
4recipient to temporarily acquire and use alternative or
5substitute devices or equipment pending repairs or
6replacements of any device or equipment previously authorized
7for such recipient by the Department. Notwithstanding any
8provision of Section 5-5f to the contrary, the Department may,
9by rule, exempt certain replacement wheelchair parts from prior
10approval and, for wheelchairs, wheelchair parts, wheelchair
11accessories, and related seating and positioning items,
12determine the wholesale price by methods other than actual
13acquisition costs.
14    The Department shall require, by rule, all providers of
15durable medical equipment to be accredited by an accreditation
16organization approved by the federal Centers for Medicare and
17Medicaid Services and recognized by the Department in order to
18bill the Department for providing durable medical equipment to
19recipients. No later than 15 months after the effective date of
20the rule adopted pursuant to this paragraph, all providers must
21meet the accreditation requirement.
22    The Department shall execute, relative to the nursing home
23prescreening project, written inter-agency agreements with the
24Department of Human Services and the Department on Aging, to
25effect the following: (i) intake procedures and common
26eligibility criteria for those persons who are receiving



SB2429- 24 -LRB100 16511 KTG 31643 b

1non-institutional services; and (ii) the establishment and
2development of non-institutional services in areas of the State
3where they are not currently available or are undeveloped; and
4(iii) notwithstanding any other provision of law, subject to
5federal approval, on and after July 1, 2012, an increase in the
6determination of need (DON) scores from 29 to 37 for applicants
7for institutional and home and community-based long term care;
8if and only if federal approval is not granted, the Department
9may, in conjunction with other affected agencies, implement
10utilization controls or changes in benefit packages to
11effectuate a similar savings amount for this population; and
12(iv) no later than July 1, 2013, minimum level of care
13eligibility criteria for institutional and home and
14community-based long term care; and (v) no later than October
151, 2013, establish procedures to permit long term care
16providers access to eligibility scores for individuals with an
17admission date who are seeking or receiving services from the
18long term care provider. In order to select the minimum level
19of care eligibility criteria, the Governor shall establish a
20workgroup that includes affected agency representatives and
21stakeholders representing the institutional and home and
22community-based long term care interests. This Section shall
23not restrict the Department from implementing lower level of
24care eligibility criteria for community-based services in
25circumstances where federal approval has been granted.
26    The Illinois Department shall develop and operate, in



SB2429- 25 -LRB100 16511 KTG 31643 b

1cooperation with other State Departments and agencies and in
2compliance with applicable federal laws and regulations,
3appropriate and effective systems of health care evaluation and
4programs for monitoring of utilization of health care services
5and facilities, as it affects persons eligible for medical
6assistance under this Code.
7    The Illinois Department shall report annually to the
8General Assembly, no later than the second Friday in April of
91979 and each year thereafter, in regard to:
10        (a) actual statistics and trends in utilization of
11    medical services by public aid recipients;
12        (b) actual statistics and trends in the provision of
13    the various medical services by medical vendors;
14        (c) current rate structures and proposed changes in
15    those rate structures for the various medical vendors; and
16        (d) efforts at utilization review and control by the
17    Illinois Department.
18    The period covered by each report shall be the 3 years
19ending on the June 30 prior to the report. The report shall
20include suggested legislation for consideration by the General
21Assembly. The filing of one copy of the report with the
22Speaker, one copy with the Minority Leader and one copy with
23the Clerk of the House of Representatives, one copy with the
24President, one copy with the Minority Leader and one copy with
25the Secretary of the Senate, one copy with the Legislative
26Research Unit, and such additional copies with the State



SB2429- 26 -LRB100 16511 KTG 31643 b

1Government Report Distribution Center for the General Assembly
2as is required under paragraph (t) of Section 7 of the State
3Library Act shall be deemed sufficient to comply with this
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11    On and after July 1, 2012, the Department shall reduce any
12rate of reimbursement for services or other payments or alter
13any methodologies authorized by this Code to reduce any rate of
14reimbursement for services or other payments in accordance with
15Section 5-5e.
16    Because kidney transplantation can be an appropriate, cost
17effective alternative to renal dialysis when medically
18necessary and notwithstanding the provisions of Section 1-11 of
19this Code, beginning October 1, 2014, the Department shall
20cover kidney transplantation for noncitizens with end-stage
21renal disease who are not eligible for comprehensive medical
22benefits, who meet the residency requirements of Section 5-3 of
23this Code, and who would otherwise meet the financial
24requirements of the appropriate class of eligible persons under
25Section 5-2 of this Code. To qualify for coverage of kidney
26transplantation, such person must be receiving emergency renal



SB2429- 27 -LRB100 16511 KTG 31643 b

1dialysis services covered by the Department. Providers under
2this Section shall be prior approved and certified by the
3Department to perform kidney transplantation and the services
4under this Section shall be limited to services associated with
5kidney transplantation.
6    Notwithstanding any other provision of this Code to the
7contrary, on or after July 1, 2015, all FDA approved forms of
8medication assisted treatment prescribed for the treatment of
9alcohol dependence or treatment of opioid dependence shall be
10covered under both fee for service and managed care medical
11assistance programs for persons who are otherwise eligible for
12medical assistance under this Article and shall not be subject
13to any (1) utilization control, other than those established
14under the American Society of Addiction Medicine patient
15placement criteria, (2) prior authorization mandate, or (3)
16lifetime restriction limit mandate.
17    On or after July 1, 2015, opioid antagonists prescribed for
18the treatment of an opioid overdose, including the medication
19product, administration devices, and any pharmacy fees related
20to the dispensing and administration of the opioid antagonist,
21shall be covered under the medical assistance program for
22persons who are otherwise eligible for medical assistance under
23this Article. As used in this Section, "opioid antagonist"
24means a drug that binds to opioid receptors and blocks or
25inhibits the effect of opioids acting on those receptors,
26including, but not limited to, naloxone hydrochloride or any



SB2429- 28 -LRB100 16511 KTG 31643 b

1other similarly acting drug approved by the U.S. Food and Drug
3    Upon federal approval, the Department shall provide
4coverage and reimbursement for all drugs that are approved for
5marketing by the federal Food and Drug Administration and that
6are recommended by the federal Public Health Service or the
7United States Centers for Disease Control and Prevention for
8pre-exposure prophylaxis and related pre-exposure prophylaxis
9services, including, but not limited to, HIV and sexually
10transmitted infection screening, treatment for sexually
11transmitted infections, medical monitoring, assorted labs, and
12counseling to reduce the likelihood of HIV infection among
13individuals who are not infected with HIV but who are at high
14risk of HIV infection.
15(Source: P.A. 99-78, eff. 7-20-15; 99-180, eff. 7-29-15;
1699-236, eff. 8-3-15; 99-407 (see Section 20 of P.A. 99-588 for
17the effective date of P.A. 99-407); 99-433, eff. 8-21-15;
1899-480, eff. 9-9-15; 99-588, eff. 7-20-16; 99-642, eff.
197-28-16; 99-772, eff. 1-1-17; 99-895, eff. 1-1-17; 100-201,
20eff. 8-18-17; 100-395, eff. 1-1-18; 100-449, eff. 1-1-18;
21100-538, eff. 1-1-18; revised 10-26-17.)
22    (305 ILCS 5/5-30)
23    Sec. 5-30. Care coordination.
24    (a) At least 50% of recipients eligible for comprehensive
25medical benefits in all medical assistance programs or other



SB2429- 29 -LRB100 16511 KTG 31643 b

1health benefit programs administered by the Department,
2including the Children's Health Insurance Program Act and the
3Covering ALL KIDS Health Insurance Act, shall be enrolled in a
4care coordination program by no later than January 1, 2015. For
5purposes of this Section, "coordinated care" or "care
6coordination" means delivery systems where recipients will
7receive their care from providers who participate under
8contract in integrated delivery systems that are responsible
9for providing or arranging the majority of care, including
10primary care physician services, referrals from primary care
11physicians, diagnostic and treatment services, behavioral
12health services, in-patient and outpatient hospital services,
13dental services, and rehabilitation and long-term care
14services. The Department shall designate or contract for such
15integrated delivery systems (i) to ensure enrollees have a
16choice of systems and of primary care providers within such
17systems; (ii) to ensure that enrollees receive quality care in
18a culturally and linguistically appropriate manner; and (iii)
19to ensure that coordinated care programs meet the diverse needs
20of enrollees with developmental, mental health, physical, and
21age-related disabilities.
22    (b) Payment for such coordinated care shall be based on
23arrangements where the State pays for performance related to
24health care outcomes, the use of evidence-based practices, the
25use of primary care delivered through comprehensive medical
26homes, the use of electronic medical records, and the



SB2429- 30 -LRB100 16511 KTG 31643 b

1appropriate exchange of health information electronically made
2either on a capitated basis in which a fixed monthly premium
3per recipient is paid and full financial risk is assumed for
4the delivery of services, or through other risk-based payment
6    (c) To qualify for compliance with this Section, the 50%
7goal shall be achieved by enrolling medical assistance
8enrollees from each medical assistance enrollment category,
9including parents, children, seniors, and people with
10disabilities to the extent that current State Medicaid payment
11laws would not limit federal matching funds for recipients in
12care coordination programs. In addition, services must be more
13comprehensively defined and more risk shall be assumed than in
14the Department's primary care case management program as of
15January 25, 2011 (the effective date of Public Act 96-1501).
16    (d) The Department shall report to the General Assembly in
17a separate part of its annual medical assistance program
18report, beginning April, 2012 until April, 2016, on the
19progress and implementation of the care coordination program
20initiatives established by the provisions of Public Act
2196-1501. The Department shall include in its April 2011 report
22a full analysis of federal laws or regulations regarding upper
23payment limitations to providers and the necessary revisions or
24adjustments in rate methodologies and payments to providers
25under this Code that would be necessary to implement
26coordinated care with full financial risk by a party other than



SB2429- 31 -LRB100 16511 KTG 31643 b

1the Department.
2    (e) Integrated Care Program for individuals with chronic
3mental health conditions.
4        (1) The Integrated Care Program shall encompass
5    services administered to recipients of medical assistance
6    under this Article to prevent exacerbations and
7    complications using cost-effective, evidence-based
8    practice guidelines and mental health management
9    strategies.
10        (2) The Department may utilize and expand upon existing
11    contractual arrangements with integrated care plans under
12    the Integrated Care Program for providing the coordinated
13    care provisions of this Section.
14        (3) Payment for such coordinated care shall be based on
15    arrangements where the State pays for performance related
16    to mental health outcomes on a capitated basis in which a
17    fixed monthly premium per recipient is paid and full
18    financial risk is assumed for the delivery of services, or
19    through other risk-based payment arrangements such as
20    provider-based care coordination.
21        (4) The Department shall examine whether chronic
22    mental health management programs and services for
23    recipients with specific chronic mental health conditions
24    do any or all of the following:
25            (A) Improve the patient's overall mental health in
26        a more expeditious and cost-effective manner.



SB2429- 32 -LRB100 16511 KTG 31643 b

1            (B) Lower costs in other aspects of the medical
2        assistance program, such as hospital admissions,
3        emergency room visits, or more frequent and
4        inappropriate psychotropic drug use.
5        (5) The Department shall work with the facilities and
6    any integrated care plan participating in the program to
7    identify and correct barriers to the successful
8    implementation of this subsection (e) prior to and during
9    the implementation to best facilitate the goals and
10    objectives of this subsection (e).
11    (f) A hospital that is located in a county of the State in
12which the Department mandates some or all of the beneficiaries
13of the Medical Assistance Program residing in the county to
14enroll in a Care Coordination Program, as set forth in Section
155-30 of this Code, shall not be eligible for any non-claims
16based payments not mandated by Article V-A of this Code for
17which it would otherwise be qualified to receive, unless the
18hospital is a Coordinated Care Participating Hospital no later
19than 60 days after June 14, 2012 (the effective date of Public
20Act 97-689) or 60 days after the first mandatory enrollment of
21a beneficiary in a Coordinated Care program. For purposes of
22this subsection, "Coordinated Care Participating Hospital"
23means a hospital that meets one of the following criteria:
24        (1) The hospital has entered into a contract to provide
25    hospital services with one or more MCOs to enrollees of the
26    care coordination program.



SB2429- 33 -LRB100 16511 KTG 31643 b

1        (2) The hospital has not been offered a contract by a
2    care coordination plan that the Department has determined
3    to be a good faith offer and that pays at least as much as
4    the Department would pay, on a fee-for-service basis, not
5    including disproportionate share hospital adjustment
6    payments or any other supplemental adjustment or add-on
7    payment to the base fee-for-service rate, except to the
8    extent such adjustments or add-on payments are
9    incorporated into the development of the applicable MCO
10    capitated rates.
11    As used in this subsection (f), "MCO" means any entity
12which contracts with the Department to provide services where
13payment for medical services is made on a capitated basis.
14    (g) No later than August 1, 2013, the Department shall
15issue a purchase of care solicitation for Accountable Care
16Entities (ACE) to serve any children and parents or caretaker
17relatives of children eligible for medical assistance under
18this Article. An ACE may be a single corporate structure or a
19network of providers organized through contractual
20relationships with a single corporate entity. The solicitation
21shall require that:
22        (1) An ACE operating in Cook County be capable of
23    serving at least 40,000 eligible individuals in that
24    county; an ACE operating in Lake, Kane, DuPage, or Will
25    Counties be capable of serving at least 20,000 eligible
26    individuals in those counties and an ACE operating in other



SB2429- 34 -LRB100 16511 KTG 31643 b

1    regions of the State be capable of serving at least 10,000
2    eligible individuals in the region in which it operates.
3    During initial periods of mandatory enrollment, the
4    Department shall require its enrollment services
5    contractor to use a default assignment algorithm that
6    ensures if possible an ACE reaches the minimum enrollment
7    levels set forth in this paragraph.
8        (2) An ACE must include at a minimum the following
9    types of providers: primary care, specialty care,
10    hospitals, and behavioral healthcare.
11        (3) An ACE shall have a governance structure that
12    includes the major components of the health care delivery
13    system, including one representative from each of the
14    groups listed in paragraph (2).
15        (4) An ACE must be an integrated delivery system,
16    including a network able to provide the full range of
17    services needed by Medicaid beneficiaries and system
18    capacity to securely pass clinical information across
19    participating entities and to aggregate and analyze that
20    data in order to coordinate care.
21        (5) An ACE must be capable of providing both care
22    coordination and complex case management, as necessary, to
23    beneficiaries. To be responsive to the solicitation, a
24    potential ACE must outline its care coordination and
25    complex case management model and plan to reduce the cost
26    of care.



SB2429- 35 -LRB100 16511 KTG 31643 b

1        (6) In the first 18 months of operation, unless the ACE
2    selects a shorter period, an ACE shall be paid care
3    coordination fees on a per member per month basis that are
4    projected to be cost neutral to the State during the term
5    of their payment and, subject to federal approval, be
6    eligible to share in additional savings generated by their
7    care coordination.
8        (7) In months 19 through 36 of operation, unless the
9    ACE selects a shorter period, an ACE shall be paid on a
10    pre-paid capitation basis for all medical assistance
11    covered services, under contract terms similar to Managed
12    Care Organizations (MCO), with the Department sharing the
13    risk through either stop-loss insurance for extremely high
14    cost individuals or corridors of shared risk based on the
15    overall cost of the total enrollment in the ACE. The ACE
16    shall be responsible for claims processing, encounter data
17    submission, utilization control, and quality assurance.
18        (8) In the fourth and subsequent years of operation, an
19    ACE shall convert to a Managed Care Community Network
20    (MCCN), as defined in this Article, or Health Maintenance
21    Organization pursuant to the Illinois Insurance Code,
22    accepting full-risk capitation payments.
23    The Department shall allow potential ACE entities 5 months
24from the date of the posting of the solicitation to submit
25proposals. After the solicitation is released, in addition to
26the MCO rate development data available on the Department's



SB2429- 36 -LRB100 16511 KTG 31643 b

1website, subject to federal and State confidentiality and
2privacy laws and regulations, the Department shall provide 2
3years of de-identified summary service data on the targeted
4population, split between children and adults, showing the
5historical type and volume of services received and the cost of
6those services to those potential bidders that sign a data use
7agreement. The Department may add up to 2 non-state government
8employees with expertise in creating integrated delivery
9systems to its review team for the purchase of care
10solicitation described in this subsection. Any such
11individuals must sign a no-conflict disclosure and
12confidentiality agreement and agree to act in accordance with
13all applicable State laws.
14    During the first 2 years of an ACE's operation, the
15Department shall provide claims data to the ACE on its
16enrollees on a periodic basis no less frequently than monthly.
17    Nothing in this subsection shall be construed to limit the
18Department's mandate to enroll 50% of its beneficiaries into
19care coordination systems by January 1, 2015, using all
20available care coordination delivery systems, including Care
21Coordination Entities (CCE), MCCNs, or MCOs, nor be construed
22to affect the current CCEs, MCCNs, and MCOs selected to serve
23seniors and persons with disabilities prior to that date.
24    Nothing in this subsection precludes the Department from
25considering future proposals for new ACEs or expansion of
26existing ACEs at the discretion of the Department.



SB2429- 37 -LRB100 16511 KTG 31643 b

1    (h) Department contracts with MCOs and other entities
2reimbursed by risk based capitation shall have a minimum
3medical loss ratio of 85%, shall require the entity to
4establish an appeals and grievances process for consumers and
5providers, and shall require the entity to provide a quality
6assurance and utilization review program. Entities contracted
7with the Department to coordinate healthcare regardless of risk
8shall be measured utilizing the same quality metrics. The
9quality metrics may be population specific. Any contracted
10entity serving at least 5,000 seniors or people with
11disabilities or 15,000 individuals in other populations
12covered by the Medical Assistance Program that has been
13receiving full-risk capitation for a year shall be accredited
14by a national accreditation organization authorized by the
15Department within 2 years after the date it is eligible to
16become accredited. The requirements of this subsection shall
17apply to contracts with MCOs entered into or renewed or
18extended after June 1, 2013.
19    (h-5) The Department shall monitor and enforce compliance
20by MCOs with agreements they have entered into with providers
21on issues that include, but are not limited to, timeliness of
22payment, payment rates, and processes for obtaining prior
23approval. The Department may impose sanctions on MCOs for
24violating provisions of those agreements that include, but are
25not limited to, financial penalties, suspension of enrollment
26of new enrollees, and termination of the MCO's contract with



SB2429- 38 -LRB100 16511 KTG 31643 b

1the Department. As used in this subsection (h-5), "MCO" has the
2meaning ascribed to that term in Section 5-30.1 of this Code.
3    (i) Unless otherwise required by federal law, Medicaid
4Managed Care Entities and their respective business associates
5shall not disclose, directly or indirectly, including by
6sending a bill or explanation of benefits, information
7concerning the sensitive health services received by enrollees
8of the Medicaid Managed Care Entity to any person other than
9covered entities and business associates, which may receive,
10use, and further disclose such information solely for the
11purposes permitted under applicable federal and State laws and
12regulations if such use and further disclosure satisfies all
13applicable requirements of such laws and regulations. The
14Medicaid Managed Care Entity or its respective business
15associates may disclose information concerning the sensitive
16health services if the enrollee who received the sensitive
17health services requests the information from the Medicaid
18Managed Care Entity or its respective business associates and
19authorized the sending of a bill or explanation of benefits.
20Communications including, but not limited to, statements of
21care received or appointment reminders either directly or
22indirectly to the enrollee from the health care provider,
23health care professional, and care coordinators, remain
24permissible. Medicaid Managed Care Entities or their
25respective business associates may communicate directly with
26their enrollees regarding care coordination activities for



SB2429- 39 -LRB100 16511 KTG 31643 b

1those enrollees.
2    For the purposes of this subsection, the term "Medicaid
3Managed Care Entity" includes Care Coordination Entities,
4Accountable Care Entities, Managed Care Organizations, and
5Managed Care Community Networks.
6    For purposes of this subsection, the term "sensitive health
7services" means mental health services, substance abuse
8treatment services, reproductive health services, family
9planning services, services for sexually transmitted
10infections and sexually transmitted diseases, and services for
11sexual assault or domestic abuse. Services include prevention,
12screening, consultation, examination, treatment, or follow-up.
13    For purposes of this subsection, "business associate",
14"covered entity", "disclosure", and "use" have the meanings
15ascribed to those terms in 45 CFR 160.103.
16    Nothing in this subsection shall be construed to relieve a
17Medicaid Managed Care Entity or the Department of any duty to
18report incidents of sexually transmitted infections to the
19Department of Public Health or to the local board of health in
20accordance with regulations adopted under a statute or
21ordinance or to report incidents of sexually transmitted
22infections as necessary to comply with the requirements under
23Section 5 of the Abused and Neglected Child Reporting Act or as
24otherwise required by State or federal law.
25    The Department shall create policy in order to implement
26the requirements in this subsection.



SB2429- 40 -LRB100 16511 KTG 31643 b

1    (j) Managed Care Entities (MCEs), including MCOs and all
2other care coordination organizations, shall develop and
3maintain a written language access policy that sets forth the
4standards, guidelines, and operational plan to ensure language
5appropriate services and that is consistent with the standard
6of meaningful access for populations with limited English
7proficiency. The language access policy shall describe how the
8MCEs will provide all of the following required services:
9        (1) Translation (the written replacement of text from
10    one language into another) of all vital documents and forms
11    as identified by the Department.
12        (2) Qualified interpreter services (the oral
13    communication of a message from one language into another
14    by a qualified interpreter).
15        (3) Staff training on the language access policy,
16    including how to identify language needs, access and
17    provide language assistance services, work with
18    interpreters, request translations, and track the use of
19    language assistance services.
20        (4) Data tracking that identifies the language need.
21        (5) Notification to participants on the availability
22    of language access services and on how to access such
23    services.
24    (k) The Department shall actively monitor the contractual
25relationship between Managed Care Organizations (MCOs) and any
26dental administrator contracted by an MCO to provide dental



SB2429- 41 -LRB100 16511 KTG 31643 b

1services. The Department shall adopt appropriate dental
2Healthcare Effectiveness Data and Information Set measures or
3other dental quality performance measures as part of its
4monitoring and shall include additional specific dental
5performance measurers in its Health Plan Comparison Tool and
6Illinois Medicaid Plan Report Card that is available on the
7Department's website for enrolled individuals.
8    The Department shall collect from each MCO specific
9information about the types of contracted, broad-based care
10coordination occurring between the MCO and any dental
11administrator, including, but not limited to, pregnant women
12and diabetic patients in need of oral care.
13    (l) No health plan or its subcontractors by contract,
14written policy, or procedure shall contain any clause
15attempting to limit the right of medical assistance recipients
16under any medical assistance program administered by the
17Department to obtain dental services from any qualified
18Medicaid provider who undertakes to provide those services.
19    (m) Notwithstanding any other law to the contrary, the
20Department shall not adopt any rule or enter into any contract
21that prohibits an individual licensed to practice dentistry or
22dental hygiene under the Illinois Dental Practice Act from
23receiving reimbursement under the medical assistance program
24for a dental encounter.
25(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14;
2699-106, eff. 1-1-16; 99-181, eff. 7-29-15; 99-566, eff. 1-1-17;



SB2429- 42 -LRB100 16511 KTG 31643 b

199-642, eff. 7-28-16.)
2    Section 99. Effective date. This Act takes effect upon
3becoming law.