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

HB1409ham002 102ND GENERAL ASSEMBLY

Rep. Mary E. Flowers

Filed: 4/1/2022

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 1409

2    AMENDMENT NO. ______. Amend House Bill 1409 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Emergency Medical Services (EMS) Systems
5Act is amended by changing Section 3.10 as follows:
 
6    (210 ILCS 50/3.10)
7    Sec. 3.10. Scope of services.
8    (a) "Advanced Life Support (ALS) Services" means an
9advanced level of pre-hospital and inter-hospital emergency
10care and non-emergency medical services that includes basic
11life support care, cardiac monitoring, cardiac defibrillation,
12electrocardiography, intravenous therapy, administration of
13medications, drugs and solutions, use of adjunctive medical
14devices, trauma care, and other authorized techniques and
15procedures, as outlined in the provisions of the National EMS
16Education Standards relating to Advanced Life Support and any

 

 

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

 

 

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

 

 

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

 

 

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1    practice in all of its branches, an advanced practice
2    registered nurse, or a physician physician's assistant.
3    (g) "Non-emergency medical services" means the provision
4of, and all actions necessary before and after the provision
5of, Basic Life Support (BLS) Services, Advanced Life Support
6(ALS) Services, and critical care transport to patients whose
7conditions do not meet this Act's definition of emergency,
8before, after, or during transportation of such patients to or
9from health care facilities visited for the purpose of
10obtaining medical or health care services which are not
11emergency in nature, using a vehicle regulated by this Act and
12personnel licensed under this Act.
13    (g-5) The Department shall have the authority to
14promulgate minimum standards for critical care transport
15providers through rules adopted pursuant to this Act. All
16critical care transport providers must function within a
17Department-approved EMS System. Nothing in Department rules
18shall restrict a hospital's ability to furnish personnel,
19equipment, and medical supplies to any vehicle service
20provider, including a critical care transport provider.
21Minimum critical care transport provider standards shall
22include, but are not limited to:
23        (1) Personnel staffing and licensure.
24        (2) Education, certification, and experience.
25        (3) Medical equipment and supplies.
26        (4) Vehicular standards.

 

 

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1        (5) Treatment and transport protocols.
2        (6) Quality assurance and data collection.
3    (h) The provisions of this Act shall not apply to the use
4of an ambulance or SEMSV, unless and until emergency or
5non-emergency medical services are needed during the use of
6the ambulance or SEMSV.
7(Source: P.A. 102-623, eff. 8-27-21; revised 12-1-21.)
 
8    Section 10. The Illinois Public Aid Code is amended by
9changing Section 5-4.2 and by adding Section 5-30c as follows:
 
10    (305 ILCS 5/5-4.2)
11    Sec. 5-4.2. Ambulance services payments.
12    (a) For ambulance services provided to a recipient of aid
13under this 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
19and to 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
24extent practicable and subject to the availability of funds

 

 

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

 

 

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1Systems Act.
2    (c-2) For purposes of this Section, "ground ambulance
3service provider" means a vehicle service provider as
4described in the Emergency Medical Services (EMS) Systems Act
5that operates licensed ambulances for the purpose of providing
6emergency ambulance services, or non-emergency ambulance
7services, or both. For purposes of this Section, this includes
8both ambulance providers and ambulance suppliers as described
9by the Centers for Medicare and Medicaid Services.
10    (c-3) For purposes of this Section, "medi-car" means
11transportation services provided to a patient who is confined
12to a wheelchair and requires the use of a hydraulic or electric
13lift or ramp and wheelchair lockdown when the patient's
14condition does not require medical observation, medical
15supervision, medical equipment, the administration of
16medications, or the administration of oxygen.
17    (c-4) For purposes of this Section, "service car" means
18transportation services provided to a patient by a passenger
19vehicle where that patient does not require the specialized
20modes described in subsection (c-1) or (c-3).
21    (d) This Section does not prohibit separate billing by
22ambulance service providers for oxygen furnished while
23providing advanced life support services.
24    (e) Beginning with services rendered on or after July 1,
252008, all providers of non-emergency medi-car and service car
26transportation must certify that the driver and employee

 

 

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1attendant, as applicable, have completed a safety program
2approved by the Department to protect both the patient and the
3driver, prior to transporting a patient. The provider must
4maintain this certification in its records. The provider shall
5produce such documentation upon demand by the Department or
6its representative. Failure to produce documentation of such
7training shall result in recovery of any payments made by the
8Department for services rendered by a non-certified driver or
9employee attendant. Medi-car and service car providers must
10maintain legible documentation in their records of the driver
11and, as applicable, employee attendant that actually
12transported the patient. Providers must recertify all drivers
13and employee attendants every 3 years. If they meet the
14established training components set forth by the Department,
15providers of non-emergency medi-car and service car
16transportation that are either directly or through an
17affiliated company licensed by the Department of Public Health
18shall be approved by the Department to have in-house safety
19programs for training their own staff.
20    Notwithstanding the requirements above, any public
21transportation provider of medi-car and service car
22transportation that receives federal funding under 49 U.S.C.
235307 and 5311 need not certify its drivers and employee
24attendants under this Section, since safety training is
25already federally mandated.
26    (f) With respect to any policy or program administered by

 

 

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1the Department or its agent regarding approval of
2non-emergency medical transportation by ground ambulance
3service providers, including, but not limited to, the
4Non-Emergency Transportation Services Prior Approval Program
5(NETSPAP), the Department shall establish by rule a process by
6which ground ambulance service providers of non-emergency
7medical transportation may appeal any decision by the
8Department or its agent for which no denial was received prior
9to the time of transport that either (i) denies a request for
10approval for payment of non-emergency transportation by means
11of ground ambulance service or (ii) grants a request for
12approval of non-emergency transportation by means of ground
13ambulance service at a level of service that entitles the
14ground ambulance service provider to a lower level of
15compensation from the Department than the ground ambulance
16service provider would have received as compensation for the
17level of service requested. The rule shall be filed by
18December 15, 2012 and shall provide that, for any decision
19rendered by the Department or its agent on or after the date
20the rule takes effect, the ground ambulance service provider
21shall have 60 days from the date the decision is received to
22file an appeal. The rule established by the Department shall
23be, insofar as is practical, consistent with the Illinois
24Administrative Procedure Act. The Director's decision on an
25appeal under this Section shall be a final administrative
26decision subject to review under the Administrative Review

 

 

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1Law.
2    (f-5) Beginning 90 days after July 20, 2012 (the effective
3date of Public Act 97-842), (i) no denial of a request for
4approval for payment of non-emergency transportation by means
5of ground ambulance service, and (ii) no approval of
6non-emergency transportation by means of ground ambulance
7service at a level of service that entitles the ground
8ambulance service provider to a lower level of compensation
9from the Department than would have been received at the level
10of service submitted by the ground ambulance service provider,
11may be issued by the Department or its agent unless the
12Department has submitted the criteria for determining the
13appropriateness of the transport for first notice publication
14in the Illinois Register pursuant to Section 5-40 of the
15Illinois Administrative Procedure Act.
16    (f-6) Within 90 days after the effective date of this
17amendatory Act of the 102nd General Assembly, the Department
18shall adjust the criteria established under subsection (f-5)
19by striking any reference to prohibiting approval of ground
20ambulance services when the sole purpose of the transport is
21for the navigation of stairs or the assisting or lifting of a
22patient at a medical facility or during a medical appointment.
23It is the intent of the General Assembly to permit ground
24ambulance reimbursement for lifting, moving, or navigating
25stairs in instances when a recipient exhibits extenuating
26circumstances related to the social determinants of health

 

 

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1which would make an otherwise non-eligible ground ambulance
2transport eligible for reimbursement. Such extenuating
3circumstances may include a condition which would present an
4unreasonable risk for the patient to navigate the stairs
5without the assistance of medically trained ground ambulance
6personnel. Such extenuating circumstances may be established
7through the completion of a Physician Certification Statement
8as set forth in subsection (g).
9    (f-7) For non-emergency ground ambulance claims properly
10denied under Department policy at the time the claim is filed
11due to failure to submit a valid Medical Certification for
12Non-Emergency Ambulance on and after December 15, 2012 and
13prior to January 1, 2021, the Department shall allot
14$2,000,000 to a pool to reimburse such claims if the provider
15proves medical necessity for the service by other means.
16Providers must submit any such denied claims for which they
17seek compensation to the Department no later than December 31,
182021 along with documentation of medical necessity. No later
19than May 31, 2022, the Department shall determine for which
20claims medical necessity was established. Such claims for
21which medical necessity was established shall be paid at the
22rate in effect at the time of the service, provided the
23$2,000,000 is sufficient to pay at those rates. If the pool is
24not sufficient, claims shall be paid at a uniform percentage
25of the applicable rate such that the pool of $2,000,000 is
26exhausted. The appeal process described in subsection (f)

 

 

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1shall not be applicable to the Department's determinations
2made in accordance with this subsection.
3    (g) Whenever a patient covered by a medical assistance
4program under this Code or by another medical program
5administered by the Department, including a patient covered
6under the State's Medicaid managed care program, is being
7transported from a facility and requires non-emergency
8transportation including ground ambulance, medi-car, or
9service car transportation, a Physician Certification
10Statement as described in this Section shall be required for
11each patient. Facilities shall develop procedures for a
12licensed medical professional to provide a written and signed
13Physician Certification Statement. The Physician Certification
14Statement shall specify the level of transportation services
15needed and complete a medical certification establishing the
16criteria for approval of non-emergency ambulance
17transportation, as published by the Department of Healthcare
18and Family Services, that is met by the patient. This
19certification shall be completed prior to ordering the
20transportation service and prior to patient discharge. The
21Physician Certification Statement is not required prior to
22transport if a delay in transport can be expected to
23negatively affect the patient outcome. If the ground ambulance
24provider, medi-car provider, or service car provider is unable
25to obtain the required Physician Certification Statement
26within 10 calendar days following the date of the service, the

 

 

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1ground ambulance provider, medi-car provider, or service car
2provider must document its attempt to obtain the requested
3certification and may then submit the claim for payment.
4Acceptable documentation includes a signed return receipt from
5the U.S. Postal Service, facsimile receipt, email receipt, or
6other similar service that evidences that the ground ambulance
7provider, medi-car provider, or service car provider attempted
8to obtain the required Physician Certification Statement.
9    The medical certification specifying the level and type of
10non-emergency transportation needed shall be in the form of
11the Physician Certification Statement on a standardized form
12prescribed by the Department of Healthcare and Family
13Services. Within 75 days after July 27, 2018 (the effective
14date of Public Act 100-646), the Department of Healthcare and
15Family Services shall develop a standardized form of the
16Physician Certification Statement specifying the level and
17type of transportation services needed in consultation with
18the Department of Public Health, Medicaid managed care
19organizations, a statewide association representing ambulance
20providers, a statewide association representing hospitals, 3
21statewide associations representing nursing homes, and other
22stakeholders. The Physician Certification Statement shall
23include, but is not limited to, the criteria necessary to
24demonstrate medical necessity for the level of transport
25needed as required by (i) the Department of Healthcare and
26Family Services and (ii) the federal Centers for Medicare and

 

 

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1Medicaid Services as outlined in the Centers for Medicare and
2Medicaid Services' Medicare Benefit Policy Manual, Pub.
3100-02, Chap. 10, Sec. 10.2.1, et seq. The use of the Physician
4Certification Statement shall satisfy the obligations of
5hospitals under Section 6.22 of the Hospital Licensing Act and
6nursing homes under Section 2-217 of the Nursing Home Care
7Act. Implementation and acceptance of the Physician
8Certification Statement shall take place no later than 90 days
9after the issuance of the Physician Certification Statement by
10the Department of Healthcare and Family Services.
11    Pursuant to subsection (E) of Section 12-4.25 of this
12Code, the Department is entitled to recover overpayments paid
13to a provider or vendor, including, but not limited to, from
14the discharging physician, the discharging facility, and the
15ground ambulance service provider, in instances where a
16non-emergency ground ambulance service is rendered as the
17result of improper or false certification.
18    Beginning October 1, 2018, the Department of Healthcare
19and Family Services shall collect data from Medicaid managed
20care organizations and transportation brokers, including the
21Department's NETSPAP broker, regarding denials and appeals
22related to the missing or incomplete Physician Certification
23Statement forms and overall compliance with this subsection.
24The Department of Healthcare and Family Services shall publish
25quarterly results on its website within 15 days following the
26end of each quarter.

 

 

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1    (h) On and after July 1, 2012, the Department shall reduce
2any rate of reimbursement for services or other payments or
3alter any methodologies authorized by this Code to reduce any
4rate of reimbursement for services or other payments in
5accordance with Section 5-5e.
6    (i) On and after July 1, 2018, the Department shall
7increase the base rate of reimbursement for both base charges
8and mileage charges for ground ambulance service providers for
9medical transportation services provided by means of a ground
10ambulance to a level not lower than rates 112% of the base rate
11in effect as of July 1, 2021 June 30, 2018.
12    (k) Within 90 days after the effective date of this
13amendatory Act of the 102nd General Assembly, the Department
14shall establish a methodology for providing reimbursement for:
15(i) bariatric transports at an amount of one additional base
16rate for each additional 2 personnel necessary to safely move
17the patient; and (ii) specialty care transports to include
18transports originating or terminating at a residence and for
19intra-facility transports.
20(Source: P.A. 101-81, eff. 7-12-19; 101-649, eff. 7-7-20;
21102-364, eff. 1-1-22; 102-650, eff. 8-27-21; revised 11-8-21.)
 
22    (305 ILCS 5/5-30c new)
23    Sec. 5-30c. Medi-car and stretcher van services; rate
24increase. To ensure access to medical appointments and covered
25services and realize the objectives of the medical assistance

 

 

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1program, the General Assembly must address the inadequate
2supply of non-emergency medical transportation providers
3across the State. To increase access to non-emergency
4transportation services, the Department shall increase the
5base rate for medi-car and stretcher van services to at least
6$50, and the rate of each attendant for medi-car and stretcher
7van services to at least $50. This reimbursement rate shall
8only apply to stretcher van providers licensed by the
9Department of Public Health in accordance with Section 3.86 of
10the Emergency Medical Services (EMS) Systems Act. The
11Department shall establish a grant program for the purpose of
12building capacity among IMPACT-enrolled and BEP-certified
13providers of medi-car and stretcher van transportation
14services.
 
15    Section 99. Effective date. This Act takes effect upon
16becoming law.".