Illinois General Assembly - Full Text of HB2286
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Full Text of HB2286  101st General Assembly




State of Illinois
2019 and 2020


Introduced , by Rep. Thomas Morrison


See Index

    Creates the No Taxpayer Funding for Abortion Act. Provides that neither the State nor any of its subdivisions may authorize the use of, appropriate, or expend funds to pay for an abortion or to cover any part of the costs of a health plan that includes coverage of abortion or to provide or refer for an abortion, unless a woman who suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death if an abortion is not performed. Amends the State Employees Group Insurance Act of 1971 and the Illinois Public Aid Code. Excludes from the programs of health benefits and services authorized under those Acts coverage for elective abortions as provided in the No Taxpayer Funding for Abortion Act. Prohibits a physician who has been found guilty of performing an abortion procedure in a willful and wanton manner upon a woman who was not pregnant when the abortion procedure was performed from participating in the State's Medical Assistance Program. Provides that the Department of Healthcare and Family Services shall require a written statement, including the required opinion of a physician, to accompany a claim for reimbursement for abortions or induced miscarriages or premature births. Makes other changes. Amends the Problem Pregnancy Health Services and Care Act. Permits the Department of Human Services to make grants to nonprofit agencies and organizations that do not use those grants to refer or counsel for, or perform, abortions. Contains provisions regarding applicability and preempts home rule. Effective June 1, 2019.

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HB2286LRB101 09222 KTG 54316 b

1    AN ACT concerning abortion.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Short title. This Act may be cited as the No
5Taxpayer Funding for Abortion Act.
6    Section 5. Public policy. It is the public policy of this
7State that the General Assembly of the State of Illinois does
8solemnly declare and find in reaffirmation of the longstanding
9policy of this State that the unborn child is a human being
10from the time of conception and has a right to life and, to the
11extent consistent with the United States Constitution,
12Illinois law should be interpreted to recognize that right to
13life and to protect unborn life.
14    The General Assembly further declares and finds that, while
15the people of Illinois hold a variety of positions on the issue
16of abortion, they generally oppose the use of tax dollars to
17pay for elective abortions and support the federal Hyde
18Amendment, named after the late Henry J. Hyde, whose memory is
19revered and service celebrated as a Congressman from the great
20State of Illinois. This Act honors the strong beliefs of the
21people of Illinois by prohibiting the taxpayer funding of
22abortion in this State.



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1    Section 10. Use of funds to pay for abortions prohibited;
2exceptions. Notwithstanding any other provision of law,
3neither the State nor any of its subdivisions may authorize the
4use of, appropriate, or expend any funds to pay for any
5abortion or to cover any part of the costs of any health plan
6that includes coverage of abortion or to provide or refer for
7any abortion, except in the case where a woman suffers from a
8physical disorder, physical injury, or physical illness that
9would, as certified by a physician, place the woman in danger
10of death unless an abortion is performed, including a
11life-endangering physical condition caused by or arising from
12the pregnancy itself, or in such other circumstances as
13required by federal law.
14    Section 900. The State Employees Group Insurance Act of
151971 is amended by changing Sections 6 and 6.1 as follows:
16    (5 ILCS 375/6)  (from Ch. 127, par. 526)
17    Sec. 6. Program of health benefits.
18    (a) The program of health benefits shall provide for
19protection against the financial costs of health care expenses
20incurred in and out of hospital including basic
21hospital-surgical-medical coverages. The program may include,
22but shall not be limited to, such supplemental coverages as
23out-patient diagnostic X-ray and laboratory expenses,
24prescription drugs, dental services, hearing evaluations,



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1hearing aids, the dispensing and fitting of hearing aids, and
2similar group benefits as are now or may become available,
3except as provided in the No Taxpayer Funding for Abortion Act.
4The program may also include coverage for those who rely on
5treatment by prayer or spiritual means alone for healing in
6accordance with the tenets and practice of a recognized
7religious denomination.
8    The program of health benefits shall be designed by the
9Director (1) to provide a reasonable relationship between the
10benefits to be included and the expected distribution of
11expenses of each such type to be incurred by the covered
12members and dependents, (2) to specify, as covered benefits and
13as optional benefits, the medical services of practitioners in
14all categories licensed under the Medical Practice Act of 1987,
15(3) to include reasonable controls, which may include
16deductible and co-insurance provisions, applicable to some or
17all of the benefits, or a coordination of benefits provision,
18to prevent or minimize unnecessary utilization of the various
19hospital, surgical and medical expenses to be provided and to
20provide reasonable assurance of stability of the program, and
21(4) to provide benefits to the extent possible to members
22throughout the State, wherever located, on an equitable basis.
23Notwithstanding any other provision of this Section or Act, for
24all members or dependents who are eligible for benefits under
25Social Security or the Railroad Retirement system or who had
26sufficient Medicare-covered government employment, the



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1Department shall reduce benefits which would otherwise be paid
2by Medicare, by the amount of benefits for which the member or
3dependents are eligible under Medicare, except that such
4reduction in benefits shall apply only to those members or
5dependents who (1) first become eligible for such medicare
6coverage on or after the effective date of this amendatory Act
7of 1992; or (2) are Medicare-eligible members or dependents of
8a local government unit which began participation in the
9program on or after July 1, 1992; or (3) remain eligible for
10but no longer receive Medicare coverage which they had been
11receiving on or after the effective date of this amendatory Act
12of 1992.
13    Notwithstanding any other provisions of this Act, where a
14covered member or dependents are eligible for benefits under
15the federal Medicare health insurance program (Title XVIII of
16the Social Security Act as added by Public Law 89-97, 89th
17Congress), benefits paid under the State of Illinois program or
18plan will be reduced by the amount of benefits paid by
19Medicare. For members or dependents who are eligible for
20benefits under Social Security or the Railroad Retirement
21system or who had sufficient Medicare-covered government
22employment, benefits shall be reduced by the amount for which
23the member or dependent is eligible under Medicare, except that
24such reduction in benefits shall apply only to those members or
25dependents who (1) first become eligible for such Medicare
26coverage on or after the effective date of this amendatory Act



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1of 1992; or (2) are Medicare-eligible members or dependents of
2a local government unit which began participation in the
3program on or after July 1, 1992; or (3) remain eligible for,
4but no longer receive Medicare coverage which they had been
5receiving on or after the effective date of this amendatory Act
6of 1992. Premiums may be adjusted, where applicable, to an
7amount deemed by the Director to be reasonably consistent with
8any reduction of benefits.
9    (b) A member, not otherwise covered by this Act, who has
10retired as a participating member under Article 2 of the
11Illinois Pension Code but is ineligible for the retirement
12annuity under Section 2-119 of the Illinois Pension Code, shall
13pay the premiums for coverage, not exceeding the amount paid by
14the State for the non-contributory coverage for other members,
15under the group health benefits program under this Act. The
16Director shall determine the premiums to be paid by a member
17under this subsection (b).
18(Source: P.A. 100-538, eff. 1-1-18.)
19    (5 ILCS 375/6.1)  (from Ch. 127, par. 526.1)
20    Sec. 6.1. The program of health benefits may offer as an
21alternative, available on an optional basis, coverage through
22health maintenance organizations. That part of the premium for
23such coverage which is in excess of the amount which would
24otherwise be paid by the State for the program of health
25benefits shall be paid by the member who elects such



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1alternative coverage and shall be collected as provided for
2premiums for other optional coverages, except as provided in
3the No Taxpayer Funding for Abortion Act.
4(Source: P.A. 100-538, eff. 1-1-18.)
5    Section 905. The Illinois Public Aid Code is amended by
6changing Sections 5-5, 5-8, 5-9, and 6-1 as follows:
7    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
8    Sec. 5-5. Medical services. The Illinois Department, by
9rule, shall determine the quantity and quality of and the rate
10of reimbursement for the medical assistance for which payment
11will be authorized, and the medical services to be provided,
12which may include all or part of the following: (1) inpatient
13hospital services; (2) outpatient hospital services; (3) other
14laboratory and X-ray services; (4) skilled nursing home
15services; (5) physicians' services whether furnished in the
16office, the patient's home, a hospital, a skilled nursing home,
17or elsewhere; (6) medical care, or any other type of remedial
18care furnished by licensed practitioners; (7) home health care
19services; (8) private duty nursing service; (9) clinic
20services; (10) dental services, including prevention and
21treatment of periodontal disease and dental caries disease for
22pregnant women, provided by an individual licensed to practice
23dentistry or dental surgery; for purposes of this item (10),
24"dental services" means diagnostic, preventive, or corrective



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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



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1laws of this State, except as provided in the No Taxpayer
2Funding for Abortion Act. The Illinois Department, by rule,
3shall prohibit any physician from providing medical assistance
4to anyone eligible therefor under this Code where such
5physician has been found guilty of performing an abortion
6procedure in a willful and wanton manner upon a woman who was
7not pregnant at the time such abortion procedure was performed.
8The term "any other type of remedial care" shall include
9nursing care and nursing home service for persons who rely on
10treatment by spiritual means alone through prayer for healing.
11    Notwithstanding any other provision of this Section, a
12comprehensive tobacco use cessation program that includes
13purchasing prescription drugs or prescription medical devices
14approved by the Food and Drug Administration shall be covered
15under the medical assistance program under this Article for
16persons who are otherwise eligible for assistance under this
18    Notwithstanding any other provision of this Code,
19reproductive health care that is otherwise legal in Illinois
20shall be covered under the medical assistance program for
21persons who are otherwise eligible for medical assistance under
22this Article, except as provided in the No Taxpayer Funding for
23Abortion Act.
24    Notwithstanding any other provision of this Code, the
25Illinois Department may not require, as a condition of payment
26for any laboratory test authorized under this Article, that a



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1physician's handwritten signature appear on the laboratory
2test order form. The Illinois Department may, however, impose
3other appropriate requirements regarding laboratory test order
5    Upon receipt of federal approval of an amendment to the
6Illinois Title XIX State Plan for this purpose, the Department
7shall authorize the Chicago Public Schools (CPS) to procure a
8vendor or vendors to manufacture eyeglasses for individuals
9enrolled in a school within the CPS system. CPS shall ensure
10that its vendor or vendors are enrolled as providers in the
11medical assistance program and in any capitated Medicaid
12managed care entity (MCE) serving individuals enrolled in a
13school within the CPS system. Under any contract procured under
14this provision, the vendor or vendors must serve only
15individuals enrolled in a school within the CPS system. Claims
16for services provided by CPS's vendor or vendors to recipients
17of benefits in the medical assistance program under this Code,
18the Children's Health Insurance Program, or the Covering ALL
19KIDS Health Insurance Program shall be submitted to the
20Department or the MCE in which the individual is enrolled for
21payment and shall be reimbursed at the Department's or the
22MCE's established rates or rate methodologies for eyeglasses.
23    On and after July 1, 2012, the Department of Healthcare and
24Family Services may provide the following services to persons
25eligible for assistance under this Article who are
26participating in education, training or employment programs



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1operated by the Department of Human Services as successor to
2the Department of Public Aid:
3        (1) dental services provided by or under the
4    supervision of a dentist; and
5        (2) eyeglasses prescribed by a physician skilled in the
6    diseases of the eye, or by an optometrist, whichever the
7    person may select.
8    On and after July 1, 2018, the Department of Healthcare and
9Family Services shall provide dental services to any adult who
10is otherwise eligible for assistance under the medical
11assistance program. As used in this paragraph, "dental
12services" means diagnostic, preventative, restorative, or
13corrective procedures, including procedures and services for
14the prevention and treatment of periodontal disease and dental
15caries disease, provided by an individual who is licensed to
16practice dentistry or dental surgery or who is under the
17supervision of a dentist in the practice of his or her
19    On and after July 1, 2018, targeted dental services, as set
20forth in Exhibit D of the Consent Decree entered by the United
21States District Court for the Northern District of Illinois,
22Eastern Division, in the matter of Memisovski v. Maram, Case
23No. 92 C 1982, that are provided to adults under the medical
24assistance program shall be established at no less than the
25rates set forth in the "New Rate" column in Exhibit D of the
26Consent Decree for targeted dental services that are provided



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1to persons under the age of 18 under the medical assistance
3    Notwithstanding any other provision of this Code and
4subject to federal approval, the Department may adopt rules to
5allow a dentist who is volunteering his or her service at no
6cost to render dental services through an enrolled
7not-for-profit health clinic without the dentist personally
8enrolling as a participating provider in the medical assistance
9program. A not-for-profit health clinic shall include a public
10health clinic or Federally Qualified Health Center or other
11enrolled provider, as determined by the Department, through
12which dental services covered under this Section are performed.
13The Department shall establish a process for payment of claims
14for reimbursement for covered dental services rendered under
15this provision.
16    The Illinois Department, by rule, may distinguish and
17classify the medical services to be provided only in accordance
18with the classes of persons designated in Section 5-2.
19    The Department of Healthcare and Family Services must
20provide coverage and reimbursement for amino acid-based
21elemental formulas, regardless of delivery method, for the
22diagnosis and treatment of (i) eosinophilic disorders and (ii)
23short bowel syndrome when the prescribing physician has issued
24a written order stating that the amino acid-based elemental
25formula is medically necessary.
26    The Illinois Department shall authorize the provision of,



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1and shall authorize payment for, screening by low-dose
2mammography for the presence of occult breast cancer for women
335 years of age or older who are eligible for medical
4assistance under this Article, as follows:
5        (A) A baseline mammogram for women 35 to 39 years of
6    age.
7        (B) An annual mammogram for women 40 years of age or
8    older.
9        (C) A mammogram at the age and intervals considered
10    medically necessary by the woman's health care provider for
11    women under 40 years of age and having a family history of
12    breast cancer, prior personal history of breast cancer,
13    positive genetic testing, or other risk factors.
14        (D) A comprehensive ultrasound screening and MRI of an
15    entire breast or breasts if a mammogram demonstrates
16    heterogeneous or dense breast tissue, when medically
17    necessary as determined by a physician licensed to practice
18    medicine in all of its branches.
19        (E) A screening MRI when medically necessary, as
20    determined by a physician licensed to practice medicine in
21    all of its branches.
22    All screenings shall include a physical breast exam,
23instruction on self-examination and information regarding the
24frequency of self-examination and its value as a preventative
25tool. For purposes of this Section, "low-dose mammography"
26means the x-ray examination of the breast using equipment



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1dedicated specifically for mammography, including the x-ray
2tube, filter, compression device, and image receptor, with an
3average radiation exposure delivery of less than one rad per
4breast for 2 views of an average size breast. The term also
5includes digital mammography and includes breast
6tomosynthesis. As used in this Section, the term "breast
7tomosynthesis" means a radiologic procedure that involves the
8acquisition of projection images over the stationary breast to
9produce cross-sectional digital three-dimensional images of
10the breast. If, at any time, the Secretary of the United States
11Department of Health and Human Services, or its successor
12agency, promulgates rules or regulations to be published in the
13Federal Register or publishes a comment in the Federal Register
14or issues an opinion, guidance, or other action that would
15require the State, pursuant to any provision of the Patient
16Protection and Affordable Care Act (Public Law 111-148),
17including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
18successor provision, to defray the cost of any coverage for
19breast tomosynthesis outlined in this paragraph, then the
20requirement that an insurer cover breast tomosynthesis is
21inoperative other than any such coverage authorized under
22Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and
23the State shall not assume any obligation for the cost of
24coverage for breast tomosynthesis set forth in this paragraph.
25    On and after January 1, 2016, the Department shall ensure
26that all networks of care for adult clients of the Department



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1include access to at least one breast imaging Center of Imaging
2Excellence as certified by the American College of Radiology.
3    On and after January 1, 2012, providers participating in a
4quality improvement program approved by the Department shall be
5reimbursed for screening and diagnostic mammography at the same
6rate as the Medicare program's rates, including the increased
7reimbursement for digital mammography.
8    The Department shall convene an expert panel including
9representatives of hospitals, free-standing mammography
10facilities, and doctors, including radiologists, to establish
11quality standards for mammography.
12    On and after January 1, 2017, providers participating in a
13breast cancer treatment quality improvement program approved
14by the Department shall be reimbursed for breast cancer
15treatment at a rate that is no lower than 95% of the Medicare
16program's rates for the data elements included in the breast
17cancer treatment quality program.
18    The Department shall convene an expert panel, including
19representatives of hospitals, free-standing breast cancer
20treatment centers, breast cancer quality organizations, and
21doctors, including breast surgeons, reconstructive breast
22surgeons, oncologists, and primary care providers to establish
23quality standards for breast cancer treatment.
24    Subject to federal approval, the Department shall
25establish a rate methodology for mammography at federally
26qualified health centers and other encounter-rate clinics.



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1These clinics or centers may also collaborate with other
2hospital-based mammography facilities. By January 1, 2016, the
3Department shall report to the General Assembly on the status
4of the provision set forth in this paragraph.
5    The Department shall establish a methodology to remind
6women who are age-appropriate for screening mammography, but
7who have not received a mammogram within the previous 18
8months, of the importance and benefit of screening mammography.
9The Department shall work with experts in breast cancer
10outreach and patient navigation to optimize these reminders and
11shall establish a methodology for evaluating their
12effectiveness and modifying the methodology based on the
14    The Department shall establish a performance goal for
15primary care providers with respect to their female patients
16over age 40 receiving an annual mammogram. This performance
17goal shall be used to provide additional reimbursement in the
18form of a quality performance bonus to primary care providers
19who meet that goal.
20    The Department shall devise a means of case-managing or
21patient navigation for beneficiaries diagnosed with breast
22cancer. This program shall initially operate as a pilot program
23in areas of the State with the highest incidence of mortality
24related to breast cancer. At least one pilot program site shall
25be in the metropolitan Chicago area and at least one site shall
26be outside the metropolitan Chicago area. On or after July 1,



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12016, the pilot program shall be expanded to include one site
2in western Illinois, one site in southern Illinois, one site in
3central Illinois, and 4 sites within metropolitan Chicago. An
4evaluation of the pilot program shall be carried out measuring
5health outcomes and cost of care for those served by the pilot
6program compared to similarly situated patients who are not
7served by the pilot program.
8    The Department shall require all networks of care to
9develop a means either internally or by contract with experts
10in navigation and community outreach to navigate cancer
11patients to comprehensive care in a timely fashion. The
12Department shall require all networks of care to include access
13for patients diagnosed with cancer to at least one academic
14commission on cancer-accredited cancer program as an
15in-network covered benefit.
16    Any medical or health care provider shall immediately
17recommend, to any pregnant woman who is being provided prenatal
18services and is suspected of having a substance use disorder as
19defined in the Substance Use Disorder Act, referral to a local
20substance use disorder treatment program licensed by the
21Department of Human Services or to a licensed hospital which
22provides substance abuse treatment services. The Department of
23Healthcare and Family Services shall assure coverage for the
24cost of treatment of the drug abuse or addiction for pregnant
25recipients in accordance with the Illinois Medicaid Program in
26conjunction with the Department of Human Services.



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



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1procedures to the Illinois Department.
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. Such records must be retained for a period of not
6less than 6 years from the date of service or as provided by
7applicable State law, whichever period is longer, except that
8if an audit is initiated within the required retention period
9then the records must be retained until the audit is completed
10and every exception is resolved. The Illinois Department shall
11require health care providers to make available, when
12authorized by the patient, in writing, the medical records in a
13timely fashion to other health care providers who are treating
14or serving persons eligible for Medical Assistance under this
15Article. All dispensers of medical services shall be required
16to maintain and retain business and professional records
17sufficient to fully and accurately document the nature, scope,
18details and receipt of the health care provided to persons
19eligible for medical assistance under this Code, in accordance
20with regulations promulgated by the Illinois Department. The
21rules and regulations shall require that proof of the receipt
22of prescription drugs, dentures, prosthetic devices and
23eyeglasses by eligible persons under this Section accompany
24each claim for reimbursement submitted by the dispenser of such
25medical services. No such claims for reimbursement shall be
26approved for payment by the Illinois Department without such



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1proof of receipt, unless the Illinois Department shall have put
2into effect and shall be operating a system of post-payment
3audit and review which shall, on a sampling basis, be deemed
4adequate by the Illinois Department to assure that such drugs,
5dentures, prosthetic devices and eyeglasses for which payment
6is being made are actually being received by eligible
7recipients. Within 90 days after September 16, 1984 (the
8effective date of Public Act 83-1439), the Illinois Department
9shall establish a current list of acquisition costs for all
10prosthetic devices and any other items recognized as medical
11equipment and supplies reimbursable under this Article and
12shall update such list on a quarterly basis, except that the
13acquisition costs of all prescription drugs shall be updated no
14less frequently than every 30 days as required by Section
16    The rules and regulations of the Illinois Department shall
17require that a written statement including the required opinion
18of a physician shall accompany any claim for reimbursement for
19abortions or induced miscarriages or premature births. This
20statement shall indicate what procedures were used in providing
21such medical services.
22    Notwithstanding any other law to the contrary, the Illinois
23Department shall, within 365 days after July 22, 2013 (the
24effective date of Public Act 98-104), establish procedures to
25permit skilled care facilities licensed under the Nursing Home
26Care Act to submit monthly billing claims for reimbursement



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1purposes. Following development of these procedures, the
2Department shall, by July 1, 2016, test the viability of the
3new system and implement any necessary operational or
4structural changes to its information technology platforms in
5order to allow for the direct acceptance and payment of nursing
6home claims.
7    Notwithstanding any other law to the contrary, the Illinois
8Department shall, within 365 days after August 15, 2014 (the
9effective date of Public Act 98-963), establish procedures to
10permit ID/DD facilities licensed under the ID/DD Community Care
11Act and MC/DD facilities licensed under the MC/DD Act to submit
12monthly billing claims for reimbursement purposes. Following
13development of these procedures, the Department shall have an
14additional 365 days to test the viability of the new system and
15to ensure that any necessary operational or structural changes
16to its information technology platforms are implemented.
17    The Illinois Department shall require all dispensers of
18medical services, other than an individual practitioner or
19group of practitioners, desiring to participate in the Medical
20Assistance program established under this Article to disclose
21all financial, beneficial, ownership, equity, surety or other
22interests in any and all firms, corporations, partnerships,
23associations, business enterprises, joint ventures, agencies,
24institutions or other legal entities providing any form of
25health care services in this State under this Article.
26    The Illinois Department may require that all dispensers of



HB2286- 23 -LRB101 09222 KTG 54316 b

1medical services desiring to participate in the medical
2assistance program established under this Article disclose,
3under such terms and conditions as the Illinois Department may
4by rule establish, all inquiries from clients and attorneys
5regarding medical bills paid by the Illinois Department, which
6inquiries could indicate potential existence of claims or liens
7for the Illinois Department.
8    Enrollment of a vendor shall be subject to a provisional
9period and shall be conditional for one year. During the period
10of conditional enrollment, the Department may terminate the
11vendor's eligibility to participate in, or may disenroll the
12vendor from, the medical assistance program without cause.
13Unless otherwise specified, such termination of eligibility or
14disenrollment is not subject to the Department's hearing
15process. However, a disenrolled vendor may reapply without
17    The Department has the discretion to limit the conditional
18enrollment period for vendors based upon category of risk of
19the vendor.
20    Prior to enrollment and during the conditional enrollment
21period in the medical assistance program, all vendors shall be
22subject to enhanced oversight, screening, and review based on
23the risk of fraud, waste, and abuse that is posed by the
24category of risk of the vendor. The Illinois Department shall
25establish the procedures for oversight, screening, and review,
26which may include, but need not be limited to: criminal and



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1financial background checks; fingerprinting; license,
2certification, and authorization verifications; unscheduled or
3unannounced site visits; database checks; prepayment audit
4reviews; audits; payment caps; payment suspensions; and other
5screening as required by federal or State law.
6    The Department shall define or specify the following: (i)
7by provider notice, the "category of risk of the vendor" for
8each type of vendor, which shall take into account the level of
9screening applicable to a particular category of vendor under
10federal law and regulations; (ii) by rule or provider notice,
11the maximum length of the conditional enrollment period for
12each category of risk of the vendor; and (iii) by rule, the
13hearing rights, if any, afforded to a vendor in each category
14of risk of the vendor that is terminated or disenrolled during
15the conditional enrollment period.
16    To be eligible for payment consideration, a vendor's
17payment claim or bill, either as an initial claim or as a
18resubmitted claim following prior rejection, must be received
19by the Illinois Department, or its fiscal intermediary, no
20later than 180 days after the latest date on the claim on which
21medical goods or services were provided, with the following
23        (1) In the case of a provider whose enrollment is in
24    process by the Illinois Department, the 180-day period
25    shall not begin until the date on the written notice from
26    the Illinois Department that the provider enrollment is



HB2286- 25 -LRB101 09222 KTG 54316 b

1    complete.
2        (2) In the case of errors attributable to the Illinois
3    Department or any of its claims processing intermediaries
4    which result in an inability to receive, process, or
5    adjudicate a claim, the 180-day period shall not begin
6    until the provider has been notified of the error.
7        (3) In the case of a provider for whom the Illinois
8    Department initiates the monthly billing process.
9        (4) In the case of a provider operated by a unit of
10    local government with a population exceeding 3,000,000
11    when local government funds finance federal participation
12    for claims payments.
13    For claims for services rendered during a period for which
14a recipient received retroactive eligibility, claims must be
15filed within 180 days after the Department determines the
16applicant is eligible. For claims for which the Illinois
17Department is not the primary payer, claims must be submitted
18to the Illinois Department within 180 days after the final
19adjudication by the primary payer.
20    In the case of long term care facilities, within 45
21calendar days of receipt by the facility of required
22prescreening information, new admissions with associated
23admission documents shall be submitted through the Medical
24Electronic Data Interchange (MEDI) or the Recipient
25Eligibility Verification (REV) System or shall be submitted
26directly to the Department of Human Services using required



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1admission forms. Effective September 1, 2014, admission
2documents, including all prescreening information, must be
3submitted through MEDI or REV. Confirmation numbers assigned to
4an accepted transaction shall be retained by a facility to
5verify timely submittal. Once an admission transaction has been
6completed, all resubmitted claims following prior rejection
7are subject to receipt no later than 180 days after the
8admission transaction has been completed.
9    Claims that are not submitted and received in compliance
10with the foregoing requirements shall not be eligible for
11payment under the medical assistance program, and the State
12shall have no liability for payment of those claims.
13    To the extent consistent with applicable information and
14privacy, security, and disclosure laws, State and federal
15agencies and departments shall provide the Illinois Department
16access to confidential and other information and data necessary
17to perform eligibility and payment verifications and other
18Illinois Department functions. This includes, but is not
19limited to: information pertaining to licensure;
20certification; earnings; immigration status; citizenship; wage
21reporting; unearned and earned income; pension income;
22employment; supplemental security income; social security
23numbers; National Provider Identifier (NPI) numbers; the
24National Practitioner Data Bank (NPDB); program and agency
25exclusions; taxpayer identification numbers; tax delinquency;
26corporate information; and death records.



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1    The Illinois Department shall enter into agreements with
2State agencies and departments, and is authorized to enter into
3agreements with federal agencies and departments, under which
4such agencies and departments shall share data necessary for
5medical assistance program integrity functions and oversight.
6The Illinois Department shall develop, in cooperation with
7other State departments and agencies, and in compliance with
8applicable federal laws and regulations, appropriate and
9effective methods to share such data. At a minimum, and to the
10extent necessary to provide data sharing, the Illinois
11Department shall enter into agreements with State agencies and
12departments, and is authorized to enter into agreements with
13federal agencies and departments, including but not limited to:
14the Secretary of State; the Department of Revenue; the
15Department of Public Health; the Department of Human Services;
16and the Department of Financial and Professional Regulation.
17    Beginning in fiscal year 2013, the Illinois Department
18shall set forth a request for information to identify the
19benefits of a pre-payment, post-adjudication, and post-edit
20claims system with the goals of streamlining claims processing
21and provider reimbursement, reducing the number of pending or
22rejected claims, and helping to ensure a more transparent
23adjudication process through the utilization of: (i) provider
24data verification and provider screening technology; and (ii)
25clinical code editing; and (iii) pre-pay, pre- or
26post-adjudicated predictive modeling with an integrated case



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1management system with link analysis. Such a request for
2information shall not be considered as a request for proposal
3or as an obligation on the part of the Illinois Department to
4take any action or acquire any products or services.
5    The Illinois Department shall establish policies,
6procedures, standards and criteria by rule for the acquisition,
7repair and replacement of orthotic and prosthetic devices and
8durable medical equipment. Such rules shall provide, but not be
9limited to, the following services: (1) immediate repair or
10replacement of such devices by recipients; and (2) rental,
11lease, purchase or lease-purchase of durable medical equipment
12in a cost-effective manner, taking into consideration the
13recipient's medical prognosis, the extent of the recipient's
14needs, and the requirements and costs for maintaining such
15equipment. Subject to prior approval, such rules shall enable a
16recipient to temporarily acquire and use alternative or
17substitute devices or equipment pending repairs or
18replacements of any device or equipment previously authorized
19for such recipient by the Department. Notwithstanding any
20provision of Section 5-5f to the contrary, the Department may,
21by rule, exempt certain replacement wheelchair parts from prior
22approval and, for wheelchairs, wheelchair parts, wheelchair
23accessories, and related seating and positioning items,
24determine the wholesale price by methods other than actual
25acquisition costs.
26    The Department shall require, by rule, all providers of



HB2286- 29 -LRB101 09222 KTG 54316 b

1durable medical equipment to be accredited by an accreditation
2organization approved by the federal Centers for Medicare and
3Medicaid Services and recognized by the Department in order to
4bill the Department for providing durable medical equipment to
5recipients. No later than 15 months after the effective date of
6the rule adopted pursuant to this paragraph, all providers must
7meet the accreditation requirement.
8    In order to promote environmental responsibility, meet the
9needs of recipients and enrollees, and achieve significant cost
10savings, the Department, or a managed care organization under
11contract with the Department, may provide recipients or managed
12care enrollees who have a prescription or Certificate of
13Medical Necessity access to refurbished durable medical
14equipment under this Section (excluding prosthetic and
15orthotic devices as defined in the Orthotics, Prosthetics, and
16Pedorthics Practice Act and complex rehabilitation technology
17products and associated services) through the State's
18assistive technology program's reutilization program, using
19staff with the Assistive Technology Professional (ATP)
20Certification if the refurbished durable medical equipment:
21(i) is available; (ii) is less expensive, including shipping
22costs, than new durable medical equipment of the same type;
23(iii) is able to withstand at least 3 years of use; (iv) is
24cleaned, disinfected, sterilized, and safe in accordance with
25federal Food and Drug Administration regulations and guidance
26governing the reprocessing of medical devices in health care



HB2286- 30 -LRB101 09222 KTG 54316 b

1settings; and (v) equally meets the needs of the recipient or
2enrollee. The reutilization program shall confirm that the
3recipient or enrollee is not already in receipt of same or
4similar equipment from another service provider, and that the
5refurbished durable medical equipment equally meets the needs
6of the recipient or enrollee. Nothing in this paragraph shall
7be construed to limit recipient or enrollee choice to obtain
8new durable medical equipment or place any additional prior
9authorization conditions on enrollees of managed care
11    The Department shall execute, relative to the nursing home
12prescreening project, written inter-agency agreements with the
13Department of Human Services and the Department on Aging, to
14effect the following: (i) intake procedures and common
15eligibility criteria for those persons who are receiving
16non-institutional services; and (ii) the establishment and
17development of non-institutional services in areas of the State
18where they are not currently available or are undeveloped; and
19(iii) notwithstanding any other provision of law, subject to
20federal approval, on and after July 1, 2012, an increase in the
21determination of need (DON) scores from 29 to 37 for applicants
22for institutional and home and community-based long term care;
23if and only if federal approval is not granted, the Department
24may, in conjunction with other affected agencies, implement
25utilization controls or changes in benefit packages to
26effectuate a similar savings amount for this population; and



HB2286- 31 -LRB101 09222 KTG 54316 b

1(iv) no later than July 1, 2013, minimum level of care
2eligibility criteria for institutional and home and
3community-based long term care; and (v) no later than October
41, 2013, establish procedures to permit long term care
5providers access to eligibility scores for individuals with an
6admission date who are seeking or receiving services from the
7long term care provider. In order to select the minimum level
8of care eligibility criteria, the Governor shall establish a
9workgroup that includes affected agency representatives and
10stakeholders representing the institutional and home and
11community-based long term care interests. This Section shall
12not restrict the Department from implementing lower level of
13care eligibility criteria for community-based services in
14circumstances where federal approval has been granted.
15    The Illinois Department shall develop and operate, in
16cooperation with other State Departments and agencies and in
17compliance with applicable federal laws and regulations,
18appropriate and effective systems of health care evaluation and
19programs for monitoring of utilization of health care services
20and facilities, as it affects persons eligible for medical
21assistance under this Code.
22    The Illinois Department shall report annually to the
23General Assembly, no later than the second Friday in April of
241979 and each year thereafter, in regard to:
25        (a) actual statistics and trends in utilization of
26    medical services by public aid recipients;



HB2286- 32 -LRB101 09222 KTG 54316 b

1        (b) actual statistics and trends in the provision of
2    the various medical services by medical vendors;
3        (c) current rate structures and proposed changes in
4    those rate structures for the various medical vendors; and
5        (d) efforts at utilization review and control by the
6    Illinois Department.
7    The period covered by each report shall be the 3 years
8ending on the June 30 prior to the report. The report shall
9include suggested legislation for consideration by the General
10Assembly. The requirement for reporting to the General Assembly
11shall be satisfied by filing copies of the report as required
12by Section 3.1 of the General Assembly Organization Act, and
13filing such additional copies with the State Government Report
14Distribution Center for the General Assembly as is required
15under paragraph (t) of Section 7 of the State Library Act.
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    On and after July 1, 2012, the Department shall reduce any
23rate of reimbursement for services or other payments or alter
24any methodologies authorized by this Code to reduce any rate of
25reimbursement for services or other payments in accordance with
26Section 5-5e.



HB2286- 33 -LRB101 09222 KTG 54316 b

1    Because kidney transplantation can be an appropriate,
2cost-effective alternative to renal dialysis when medically
3necessary and notwithstanding the provisions of Section 1-11 of
4this Code, beginning October 1, 2014, the Department shall
5cover kidney transplantation for noncitizens with end-stage
6renal disease who are not eligible for comprehensive medical
7benefits, who meet the residency requirements of Section 5-3 of
8this Code, and who would otherwise meet the financial
9requirements of the appropriate class of eligible persons under
10Section 5-2 of this Code. To qualify for coverage of kidney
11transplantation, such person must be receiving emergency renal
12dialysis services covered by the Department. Providers under
13this Section shall be prior approved and certified by the
14Department to perform kidney transplantation and the services
15under this Section shall be limited to services associated with
16kidney transplantation.
17    Notwithstanding any other provision of this Code to the
18contrary, on or after July 1, 2015, all FDA approved forms of
19medication assisted treatment prescribed for the treatment of
20alcohol dependence or treatment of opioid dependence shall be
21covered under both fee for service and managed care medical
22assistance programs for persons who are otherwise eligible for
23medical assistance under this Article and shall not be subject
24to any (1) utilization control, other than those established
25under the American Society of Addiction Medicine patient
26placement criteria, (2) prior authorization mandate, or (3)



HB2286- 34 -LRB101 09222 KTG 54316 b

1lifetime restriction limit mandate.
2    On or after July 1, 2015, opioid antagonists prescribed for
3the treatment of an opioid overdose, including the medication
4product, administration devices, and any pharmacy fees related
5to the dispensing and administration of the opioid antagonist,
6shall be covered under the medical assistance program for
7persons who are otherwise eligible for medical assistance under
8this Article. As used in this Section, "opioid antagonist"
9means a drug that binds to opioid receptors and blocks or
10inhibits the effect of opioids acting on those receptors,
11including, but not limited to, naloxone hydrochloride or any
12other similarly acting drug approved by the U.S. Food and Drug
14    Upon federal approval, the Department shall provide
15coverage and reimbursement for all drugs that are approved for
16marketing by the federal Food and Drug Administration and that
17are recommended by the federal Public Health Service or the
18United States Centers for Disease Control and Prevention for
19pre-exposure prophylaxis and related pre-exposure prophylaxis
20services, including, but not limited to, HIV and sexually
21transmitted infection screening, treatment for sexually
22transmitted infections, medical monitoring, assorted labs, and
23counseling to reduce the likelihood of HIV infection among
24individuals who are not infected with HIV but who are at high
25risk of HIV infection.
26    A federally qualified health center, as defined in Section



HB2286- 35 -LRB101 09222 KTG 54316 b

11905(l)(2)(B) of the federal Social Security Act, shall be
2reimbursed by the Department in accordance with the federally
3qualified health center's encounter rate for services provided
4to medical assistance recipients that are performed by a dental
5hygienist, as defined under the Illinois Dental Practice Act,
6working under the general supervision of a dentist and employed
7by a federally qualified health center.
8    Notwithstanding any other provision of this Code, the
9Illinois Department shall authorize licensed dietitian
10nutritionists and certified diabetes educators to counsel
11senior diabetes patients in the senior diabetes patients' homes
12to remove the hurdle of transportation for senior diabetes
13patients to receive treatment.
14(Source: P.A. 99-78, eff. 7-20-15; 99-180, eff. 7-29-15;
1599-236, eff. 8-3-15; 99-407 (see Section 20 of P.A. 99-588 for
16the effective date of P.A. 99-407); 99-433, eff. 8-21-15;
1799-480, eff. 9-9-15; 99-588, eff. 7-20-16; 99-642, eff.
187-28-16; 99-772, eff. 1-1-17; 99-895, eff. 1-1-17; 100-201,
19eff. 8-18-17; 100-395, eff. 1-1-18; 100-449, eff. 1-1-18;
20100-538, eff. 1-1-18; 100-587, eff. 6-4-18; 100-759, eff.
211-1-19; 100-863, eff. 8-14-18; 100-974, eff. 8-19-18;
22100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19; 100-1148, eff.
24    (305 ILCS 5/5-8)  (from Ch. 23, par. 5-8)
25    Sec. 5-8. Practitioners. In supplying medical assistance,



HB2286- 36 -LRB101 09222 KTG 54316 b

1the Illinois Department may provide for the legally authorized
2services of (i) persons licensed under the Medical Practice Act
3of 1987, as amended, except as hereafter in this Section
4stated, whether under a general or limited license, (ii)
5persons licensed under the Nurse Practice Act as advanced
6practice registered nurses, regardless of whether or not the
7persons have written collaborative agreements, (iii) persons
8licensed or registered under other laws of this State to
9provide dental, medical, pharmaceutical, optometric,
10podiatric, or nursing services, or other remedial care
11recognized under State law, (iv) persons licensed under other
12laws of this State as a clinical social worker, and (v) persons
13licensed under other laws of this State as physician
14assistants. The Department shall adopt rules, no later than 90
15days after January 1, 2017 (the effective date of Public Act
1699-621), for the legally authorized services of persons
17licensed under other laws of this State as a clinical social
18worker. The Department may not provide for legally authorized
19services of any physician who has been convicted of having
20performed an abortion procedure in a willful and wanton manner
21on a woman who was not pregnant at the time such abortion
22procedure was performed. The utilization of the services of
23persons engaged in the treatment or care of the sick, which
24persons are not required to be licensed or registered under the
25laws of this State, is not prohibited by this Section.
26(Source: P.A. 99-173, eff. 7-29-15; 99-621, eff. 1-1-17;



HB2286- 37 -LRB101 09222 KTG 54316 b

1100-453, eff. 8-25-17; 100-513, eff. 1-1-18; 100-538, eff.
21-1-18; 100-863, eff. 8-14-18.)
3    (305 ILCS 5/5-9)  (from Ch. 23, par. 5-9)
4    Sec. 5-9. Choice of medical dispensers. Applicants and
5recipients shall be entitled to free choice of those qualified
6practitioners, hospitals, nursing homes, and other dispensers
7of medical services meeting the requirements and complying with
8the rules and regulations of the Illinois Department. However,
9the Director of Healthcare and Family Services may, after
10providing reasonable notice and opportunity for hearing, deny,
11suspend or terminate any otherwise qualified person, firm,
12corporation, association, agency, institution, or other legal
13entity, from participation as a vendor of goods or services
14under the medical assistance program authorized by this Article
15if the Director finds such vendor of medical services in
16violation of this Act or the policy or rules and regulations
17issued pursuant to this Act. Any physician who has been
18convicted of performing an abortion procedure in a willful and
19wanton manner upon a woman who was not pregnant at the time
20such abortion procedure was performed shall be automatically
21removed from the list of physicians qualified to participate as
22a vendor of medical services under the medical assistance
23program authorized by this Article.
24(Source: P.A. 100-538, eff. 1-1-18.)



HB2286- 38 -LRB101 09222 KTG 54316 b

1    (305 ILCS 5/6-1)  (from Ch. 23, par. 6-1)
2    Sec. 6-1. Eligibility requirements. Financial aid in
3meeting basic maintenance requirements shall be given under
4this Article to or in behalf of persons who meet the
5eligibility conditions of Sections 6-1.1 through 6-1.10,
6except as provided in the No Taxpayer Funding for Abortion Act.
7In addition, each unit of local government subject to this
8Article shall provide persons receiving financial aid in
9meeting basic maintenance requirements with financial aid for
10either (a) necessary treatment, care, and supplies required
11because of illness or disability, or (b) acute medical
12treatment, care, and supplies only. If a local governmental
13unit elects to provide financial aid for acute medical
14treatment, care, and supplies only, the general types of acute
15medical treatment, care, and supplies for which financial aid
16is provided shall be specified in the general assistance rules
17of the local governmental unit, which rules shall provide that
18financial aid is provided, at a minimum, for acute medical
19treatment, care, or supplies necessitated by a medical
20condition for which prior approval or authorization of medical
21treatment, care, or supplies is not required by the general
22assistance rules of the Illinois Department.
23(Source: P.A. 100-538, eff. 1-1-18.)
24    Section 910. The Problem Pregnancy Health Services and Care
25Act is amended by changing Section 4-100 as follows:



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1    (410 ILCS 230/4-100)  (from Ch. 111 1/2, par. 4604-100)
2    Sec. 4-100. The Department may make grants to nonprofit
3agencies and organizations which do not use such grants to
4refer or counsel for, or perform, abortions and which
5coordinate and establish linkages among services that will
6further the purposes of this Act and, where appropriate, will
7provide, supplement, or improve the quality of such services.
8(Source: P.A. 100-538, eff. 1-1-18.)
9    Section 990. Application of Act; home rule powers.
10    (a) This Act applies to all State and local (including home
11rule unit) laws, ordinances, policies, procedures, practices,
12and governmental actions and their implementation, whether
13statutory or otherwise and whether adopted before or after the
14effective date of this Act.
15    (b) A home rule unit may not adopt any rule in a manner
16inconsistent with this Act. This Act is a limitation under
17subsection (i) of Section 6 of Article VII of the Illinois
18Constitution on the concurrent exercise by home rule units of
19powers and functions exercised by the State.
20    Section 999. Effective date. This Act takes effect upon
21becoming law.



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2 Statutes amended in order of appearance
3    New Act
4    5 ILCS 375/6from Ch. 127, par. 526
5    5 ILCS 375/6.1from Ch. 127, par. 526.1
6    305 ILCS 5/5-5from Ch. 23, par. 5-5
7    305 ILCS 5/5-8from Ch. 23, par. 5-8
8    305 ILCS 5/5-9from Ch. 23, par. 5-9
9    305 ILCS 5/6-1from Ch. 23, par. 6-1
10    410 ILCS 230/4-100from Ch. 111 1/2, par. 4604-100