State of Illinois
91st General Assembly
Legislation

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[ Engrossed ][ Enrolled ][ Governor's Message ]
[ House Amendment 006 ]

91_HB0709

 
                                               LRB9100307SMdv

 1        AN ACT to amend the Illinois Public Aid Code by  changing
 2    Sections 5-5 and 6-1.
 3        WHEREAS,  There  has been entered in the Circuit Court of
 4    Cook County, in the case of Doe v. Wright,  case  no.  91  CH
 5    1958,  an  order (i) finding that Sections 5-5 and 6-1 of the
 6    Illinois Public Aid Code violate the  Illinois  Constitution,
 7    (ii)  enjoining  the  Department of Public Aid from enforcing
 8    those Sections insofar as  they  deny  reimbursement  for  an
 9    abortion  necessary  to protect a woman's health although not
10    necessary to  preserve  her  life,  and  (iii)  ordering  the
11    Department  to  provide  reimbursement  through  the  State's
12    medical   assistance  programs  for  abortions  necessary  to
13    protect a woman's health; and

14        WHEREAS, The General Assembly desires to  re-express  its
15    intent that State moneys not be used to provide reimbursement
16    for  abortions  unless necessary to preserve the woman's life
17    and that the Department of Public Aid  enforce  Sections  5-5
18    and  6-1  of  the  Illinois  Public  Aid  Code  in all cases;
19    therefore

20        Be it enacted by the People of  the  State  of  Illinois,
21    represented in the General Assembly:

22        Section  5.  The  Illinois  Public Aid Code is amended by
23    changing Sections 5-5 and 6-1 as follows:

24        (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
25        Sec. 5-5.  Medical services. The Illinois Department,  by
26    rule,  shall  determine  the  quantity and quality of and the
27    rate of reimbursement for the medical  assistance  for  which
28    payment  will  be  authorized, and the medical services to be
29    provided, which may include all or part of the following: (1)
30    inpatient  hospital   services;   (2)   outpatient   hospital
31    services;  (3)  other  laboratory  and  X-ray  services;  (4)
 
                            -2-                LRB9100307SMdv
 1    skilled  nursing  home  services;  (5)  physicians'  services
 2    whether  furnished  in  the  office,  the  patient's  home, a
 3    hospital, a skilled nursing home, or elsewhere;  (6)  medical
 4    care,  or  any  other  type  of  remedial  care  furnished by
 5    licensed practitioners; (7) home health  care  services;  (8)
 6    private  duty  nursing  service;  (9)  clinic  services; (10)
 7    dental services; (11) physical therapy and related  services;
 8    (12)  prescribed drugs, dentures, and prosthetic devices; and
 9    eyeglasses prescribed by a physician skilled in the  diseases
10    of  the  eye,  or by an optometrist, whichever the person may
11    select; (13) other  diagnostic,  screening,  preventive,  and
12    rehabilitative  services;  (14) transportation and such other
13    expenses as may  be  necessary;  (15)  medical  treatment  of
14    sexual  assault  survivors,  as  defined in Section 1a of the
15    Sexual  Assault  Survivors  Emergency  Treatment   Act,   for
16    injuries  sustained  as  a  result  of  the  sexual  assault,
17    including  examinations  and  laboratory  tests  to  discover
18    evidence  which  may  be used in criminal proceedings arising
19    from the sexual assault; (16) the diagnosis and treatment  of
20    sickle  cell anemia; and (17) any other medical care, and any
21    other type of remedial care recognized under the laws of this
22    State, but not including abortions, or  induced  miscarriages
23    or  premature  births, unless, in the opinion of a physician,
24    such procedures are necessary for  the  preservation  of  the
25    life  of  the  woman  seeking  such  treatment,  or except an
26    induced premature birth intended to  produce  a  live  viable
27    child  and  such procedure is necessary for the health of the
28    mother or her unborn child; State funds may also be  used  to
29    pay  for abortions to terminate a pregnancy resulting from an
30    act of criminal sexual assault, as defined in  Section  12-13
31    of  the  Criminal Code of 1961, an act of aggravated criminal
32    sexual assault, as defined in Section 12-14 of  the  Criminal
33    Code  of 1961, or an act of sexual relations within families,
34    as defined in Section 11-11 of the Criminal Code of 1961, but
 
                            -3-                LRB9100307SMdv
 1    only to  the  extent  that  payment  for  such  abortions  is
 2    required by federal law as determined by a court of competent
 3    jurisdiction;  provided  further that payment for an abortion
 4    to terminate a pregnancy resulting from an  act  of  criminal
 5    sexual assault, aggravated criminal sexual assault, or sexual
 6    relations  within  families  is reported to a law enforcement
 7    agency before the abortion is  performed  but  not  including
 8    abortions,  or  induced  miscarriages  or  premature  births,
 9    unless,  in  the  opinion of a physician, such procedures are
10    necessary for the preservation  of  the  life  of  the  woman
11    seeking  such treatment, or except an induced premature birth
12    intended to produce a live viable child and such procedure is
13    necessary for the health of the mother or her  unborn  child.
14    The   Illinois   Department,  by  rule,  shall  prohibit  any
15    physician  from  providing  medical  assistance   to   anyone
16    eligible  therefor  under  this Code where such physician has
17    been found guilty of performing an abortion  procedure  in  a
18    wilful and wanton manner upon a woman who was not pregnant at
19    the time such abortion procedure was performed. The term "any
20    other  type  of remedial care" shall include nursing care and
21    nursing home service for persons who  rely  on  treatment  by
22    spiritual means alone through prayer for healing.
23        The  Illinois  Department of Public Aid shall provide the
24    following services to persons eligible for  assistance  under
25    this  Article who are participating in education, training or
26    employment programs  operated  by  the  Department  of  Human
27    Services as successor to the Department of Public Aid:
28             (1)  dental services, which shall include but not be
29        limited to prosthodontics; and
30             (2)  eyeglasses prescribed by a physician skilled in
31        the  diseases of the eye, or by an optometrist, whichever
32        the person may select.
33        The Illinois Department, by  rule,  may  distinguish  and
34    classify   the  medical  services  to  be  provided  only  in
 
                            -4-                LRB9100307SMdv
 1    accordance with the classes of persons designated in  Section
 2    5-2.
 3        The Illinois Department shall authorize the provision of,
 4    and  shall  authorize  payment  for,  screening  by  low-dose
 5    mammography  for  the  presence  of  occult breast cancer for
 6    women 35 years of age or older who are eligible  for  medical
 7    assistance  under  this  Article,  as  follows:   a  baseline
 8    mammogram  for  women  35  to  39  years of age and an annual
 9    mammogram for women 40 years of age or older.  All screenings
10    shall  include  a  physical  breast  exam,   instruction   on
11    self-examination  and  information regarding the frequency of
12    self-examination and its value as a  preventative  tool.   As
13    used  in this Section, "low-dose mammography" means the x-ray
14    examination  of  the   breast   using   equipment   dedicated
15    specifically  for  mammography,  including  the  x-ray  tube,
16    filter,  compression  device,  image receptor, and cassettes,
17    with an average radiation exposure delivery of less than  one
18    rad mid-breast, with 2 views for each breast.
19        Any  medical  or  health  care provider shall immediately
20    recommend, to  any  pregnant  woman  who  is  being  provided
21    prenatal  services  and  is  suspected  of  drug  abuse or is
22    addicted as defined in the Alcoholism and  Other  Drug  Abuse
23    and  Dependency  Act,  referral  to  a  local substance abuse
24    treatment  provider  licensed  by  the  Department  of  Human
25    Services or to a licensed hospital which  provides  substance
26    abuse treatment services.  The Department of Public Aid shall
27    assure  coverage  for the cost of treatment of the drug abuse
28    or addiction for pregnant recipients in accordance  with  the
29    Illinois  Medicaid Program in conjunction with the Department
30    of Human Services.
31        All medical providers  providing  medical  assistance  to
32    pregnant women under this Code shall receive information from
33    the Department on the availability of services under the Drug
34    Free  Families  with  a  Future  or  any  comparable  program
 
                            -5-                LRB9100307SMdv
 1    providing   case  management  services  for  addicted  women,
 2    including information  on  appropriate  referrals  for  other
 3    social  services  that  may  be  needed  by addicted women in
 4    addition to treatment for addiction.
 5        The  Illinois  Department,  in   cooperation   with   the
 6    Departments of Human Services (as successor to the Department
 7    of Alcoholism and Substance Abuse) and Public Health, through
 8    a   public   awareness   campaign,  may  provide  information
 9    concerning  treatment  for  alcoholism  and  drug  abuse  and
10    addiction, prenatal health care, and other pertinent programs
11    directed at reducing the number of drug-affected infants born
12    to recipients of medical assistance.
13        Neither the Illinois Department of  Public  Aid  nor  the
14    Department  of  Human  Services  shall sanction the recipient
15    solely on the basis of her substance abuse.
16        The Illinois Department shall establish such  regulations
17    governing  the  dispensing  of  health  services  under  this
18    Article  as  it shall deem appropriate.  In formulating these
19    regulations the Illinois Department shall  consult  with  and
20    give substantial weight to the recommendations offered by the
21    Citizens  Assembly/Council  on  Public  Aid.  The  Department
22    should  seek  the  advice  of  formal  professional  advisory
23    committees   appointed   by  the  Director  of  the  Illinois
24    Department for the purpose of  providing  regular  advice  on
25    policy  and administrative matters, information dissemination
26    and  educational  activities  for  medical  and  health  care
27    providers, and consistency  in  procedures  to  the  Illinois
28    Department.
29        The  Illinois  Department  may  develop and contract with
30    Partnerships of medical providers to arrange medical services
31    for  persons  eligible  under  Section  5-2  of  this   Code.
32    Implementation  of  this  Section  may  be  by  demonstration
33    projects  in certain geographic areas.  The Partnership shall
34    be represented by a sponsor organization.  The Department, by
 
                            -6-                LRB9100307SMdv
 1    rule,  shall   develop   qualifications   for   sponsors   of
 2    Partnerships.   Nothing in this Section shall be construed to
 3    require  that  the  sponsor   organization   be   a   medical
 4    organization.
 5        The  sponsor must negotiate formal written contracts with
 6    medical  providers  for  physician  services,  inpatient  and
 7    outpatient hospital care, home health services, treatment for
 8    alcoholism and substance abuse, and other services determined
 9    necessary by the Illinois Department by rule for delivery  by
10    Partnerships.   Physician  services must include prenatal and
11    obstetrical care.  The Illinois  Department  shall  reimburse
12    medical   services  delivered  by  Partnership  providers  to
13    clients in target  areas  according  to  provisions  of  this
14    Article  and  the  Illinois Health Finance Reform Act, except
15    that:
16             (1)  Physicians participating in a  Partnership  and
17        providing  certain services, which shall be determined by
18        the Illinois Department, to persons in areas  covered  by
19        the  Partnership  may receive an additional surcharge for
20        such services.
21             (2)  The  Department  may  elect  to  consider   and
22        negotiate   financial   incentives   to   encourage   the
23        development of Partnerships and the efficient delivery of
24        medical care.
25             (3)  Persons   receiving  medical  services  through
26        Partnerships may  receive  medical  and  case  management
27        services  above  the  level  usually  offered through the
28        medical assistance program.
29        Medical providers  shall  be  required  to  meet  certain
30    qualifications  to  participate in Partnerships to ensure the
31    delivery   of   high   quality   medical   services.    These
32    qualifications shall be determined by rule  of  the  Illinois
33    Department   and   may  be  higher  than  qualifications  for
34    participation in the medical assistance program.  Partnership
 
                            -7-                LRB9100307SMdv
 1    sponsors may prescribe reasonable  additional  qualifications
 2    for  participation  by medical providers, only with the prior
 3    written approval of the Illinois Department.
 4        Nothing in this Section shall limit the  free  choice  of
 5    practitioners,  hospitals,  and  other  providers  of medical
 6    services by clients.
 7        The Department shall apply for a waiver from  the  United
 8    States  Health Care Financing Administration to allow for the
 9    implementation of Partnerships under this Section.
10        The  Illinois  Department  shall  require   health   care
11    providers  to maintain records that document the medical care
12    and services provided to  recipients  of  Medical  Assistance
13    under  this  Article.   The Illinois Department shall require
14    health care providers to make available, when  authorized  by
15    the  patient,  in  writing,  the  medical records in a timely
16    fashion to other health care providers who  are  treating  or
17    serving  persons  eligible  for Medical Assistance under this
18    Article.   All  dispensers  of  medical  services  shall   be
19    required  to  maintain  and  retain business and professional
20    records sufficient  to  fully  and  accurately  document  the
21    nature,  scope,  details  and  receipt  of  the  health  care
22    provided  to  persons  eligible  for medical assistance under
23    this Code, in accordance with regulations promulgated by  the
24    Illinois  Department. The rules and regulations shall require
25    that proof of the receipt of  prescription  drugs,  dentures,
26    prosthetic  devices  and eyeglasses by eligible persons under
27    this Section accompany each claim for reimbursement submitted
28    by the dispenser of such medical services. No such claims for
29    reimbursement shall be approved for payment by  the  Illinois
30    Department without such proof of receipt, unless the Illinois
31    Department  shall have put into effect and shall be operating
32    a system of post-payment audit and review which shall,  on  a
33    sampling basis, be deemed adequate by the Illinois Department
34    to  assure  that such drugs, dentures, prosthetic devices and
 
                            -8-                LRB9100307SMdv
 1    eyeglasses for which payment is being made are actually being
 2    received by eligible recipients. Within  90  days  after  the
 3    effective  date  of this amendatory Act of 1984, the Illinois
 4    Department shall establish  a  current  list  of  acquisition
 5    costs   for  all  prosthetic  devices  and  any  other  items
 6    recognized as medical  equipment  and  supplies  reimbursable
 7    under  this Article and shall update such list on a quarterly
 8    basis, except that the acquisition costs of all  prescription
 9    drugs  shall be updated no less frequently than every 30 days
10    as required by Section 5-5.12.
11        The rules and  regulations  of  the  Illinois  Department
12    shall require that a written statement including the required
13    opinion   of  a  physician  shall  accompany  any  claim  for
14    reimbursement  for  abortions,  or  induced  miscarriages  or
15    premature  births.   This  statement  shall   indicate   what
16    procedures were used in providing such medical services.
17        The Illinois Department shall require that all dispensers
18    of medical services, other than an individual practitioner or
19    group  of  practitioners,  desiring  to  participate  in  the
20    Medical  Assistance program established under this Article to
21    disclose all financial, beneficial, ownership, equity, surety
22    or other  interests  in  any  and  all  firms,  corporations,
23    partnerships,   associations,   business  enterprises,  joint
24    ventures, agencies,  institutions  or  other  legal  entities
25    providing  any  form  of  health  care services in this State
26    under this Article.
27        The Illinois Department may require that  all  dispensers
28    of  medical  services  desiring to participate in the medical
29    assistance program established under this  Article  disclose,
30    under  such  terms  and conditions as the Illinois Department
31    may  by  rule  establish,  all  inquiries  from  clients  and
32    attorneys  regarding  medical  bills  paid  by  the  Illinois
33    Department,  which   inquiries   could   indicate   potential
34    existence of claims or liens for the Illinois Department.
 
                            -9-                LRB9100307SMdv
 1        The   Illinois   Department   shall  establish  policies,
 2    procedures,  standards  and  criteria   by   rule   for   the
 3    acquisition,   repair   and   replacement   of  orthotic  and
 4    prosthetic devices and durable medical equipment.  Such rules
 5    shall provide, but not be limited to, the following services:
 6    (1) immediate  repair  or  replacement  of  such  devices  by
 7    recipients  without  medical  authorization;  and (2) rental,
 8    lease,  purchase  or  lease-purchase   of   durable   medical
 9    equipment   in   a   cost-effective   manner,   taking   into
10    consideration  the  recipient's medical prognosis, the extent
11    of the recipient's needs, and the requirements and costs  for
12    maintaining  such  equipment.   Such  rules  shall  enable  a
13    recipient  to  temporarily  acquire  and  use  alternative or
14    substitute  devices   or   equipment   pending   repairs   or
15    replacements of any device or equipment previously authorized
16    for  such recipient by the Department. Rules under clause (2)
17    above shall not provide for  purchase  or  lease-purchase  of
18    durable medical equipment or supplies used for the purpose of
19    oxygen delivery and respiratory care.
20        The  Department  shall  execute,  relative to the nursing
21    home prescreening project,  written  inter-agency  agreements
22    with  the  Department of Human Services and the Department on
23    Aging, to effect the following:  (i)  intake  procedures  and
24    common   eligibility  criteria  for  those  persons  who  are
25    receiving   non-institutional   services;   and   (ii)    the
26    establishment  and  development of non-institutional services
27    in areas of the State where they are not currently  available
28    or are undeveloped.
29        The  Illinois  Department  shall  develop and operate, in
30    cooperation with other State Departments and agencies and  in
31    compliance  with  applicable  federal  laws  and regulations,
32    appropriate and effective systems of health  care  evaluation
33    and  programs  for  monitoring  of utilization of health care
34    services and facilities, as it affects persons  eligible  for
 
                            -10-               LRB9100307SMdv
 1    medical  assistance  under this Code. The Illinois Department
 2    shall report regularly the results of the operation  of  such
 3    systems  and  programs  to  the  Citizens Assembly/Council on
 4    Public Aid to enable the Committee to ensure,  from  time  to
 5    time, that these programs are effective and meaningful.
 6        The  Illinois  Department  shall  report  annually to the
 7    General Assembly, no later than the second Friday in April of
 8    1979 and each year thereafter, in regard to:
 9             (a)  actual statistics and trends in utilization  of
10        medical services by public aid recipients;
11             (b)  actual  statistics  and trends in the provision
12        of the various medical services by medical vendors;
13             (c)  current rate structures and proposed changes in
14        those rate structures for the  various  medical  vendors;
15        and
16             (d)  efforts  at  utilization  review and control by
17        the Illinois Department.
18        The period covered by each report shall be  the  3  years
19    ending  on the June 30 prior to the report.  The report shall
20    include  suggested  legislation  for  consideration  by   the
21    General  Assembly.  The filing of one copy of the report with
22    the Speaker, one copy with the Minority Leader and  one  copy
23    with the Clerk of the House of Representatives, one copy with
24    the President, one copy with the Minority Leader and one copy
25    with   the  Secretary  of  the  Senate,  one  copy  with  the
26    Legislative Research Unit, such additional  copies  with  the
27    State  Government  Report Distribution Center for the General
28    Assembly as is required under paragraph (t) of Section  7  of
29    the  State  Library  Act  and  one  copy  with  the  Citizens
30    Assembly/Council  on  Public  Aid  or  its successor shall be
31    deemed sufficient to comply with this Section.
32    (Source:  P.A.  89-21,  eff.  7-1-95;  89-507,  eff.  7-1-97;
33    89-517, eff. 1-1-97; 90-7, eff. 6-10-97; 90-14, eff. 7-1-97.)
 
                            -11-               LRB9100307SMdv
 1        (305 ILCS 5/6-1) (from Ch. 23, par. 6-1)
 2        Sec. 6-1.  Eligibility  requirements.  Financial  aid  in
 3    meeting  basic  maintenance requirements shall be given under
 4    this Article  to  or  in  behalf  of  persons  who  meet  the
 5    eligibility  conditions  of Sections 6-1.1 through 6-1.10. In
 6    addition, each unit  of  local  government  subject  to  this
 7    Article  shall  provide  persons  receiving  financial aid in
 8    meeting basic maintenance requirements with financial aid for
 9    either (a) necessary treatment, care, and  supplies  required
10    because  of  illness  or  disability,  or  (b)  acute medical
11    treatment, care, and supplies only. If a  local  governmental
12    unit  elects  to  provide  financial  aid  for  acute medical
13    treatment, care, and supplies  only,  the  general  types  of
14    acute   medical  treatment,  care,  and  supplies  for  which
15    financial aid is provided shall be specified in  the  general
16    assistance  rules of the local governmental unit, which rules
17    shall provide that financial aid is provided, at  a  minimum,
18    for  acute  medical treatment, care, or supplies necessitated
19    by  a  medical  condition  for  which   prior   approval   or
20    authorization  of medical treatment, care, or supplies is not
21    required by the general  assistance  rules  of  the  Illinois
22    Department.  Nothing  in  this  Article shall be construed to
23    permit the granting of financial aid  where  the  purpose  of
24    such  aid  is  to  obtain an abortion, induced miscarriage or
25    induced  premature  birth  unless,  in  the  opinion   of   a
26    physician, such procedures are necessary for the preservation
27    of the life of the woman seeking such treatment, or except an
28    induced  premature  birth  intended  to produce a live viable
29    child and such procedure is necessary for the health  of  the
30    mother  or  her unborn child; State funds may also be used to
31    pay for abortions to terminate a pregnancy resulting from  an
32    act  of  criminal sexual assault, as defined in Section 12-13
33    of the Criminal Code of 1961, an act of  aggravated  criminal
34    sexual  assault,  as defined in Section 12-14 of the Criminal
 
                            -12-               LRB9100307SMdv
 1    Code of 1961,  or an act of sexual relations within families,
 2    as defined in Section 11-11 of the Criminal Code of 1961, but
 3    only to  the  extent  that  payment  for  such  abortions  is
 4    required by federal law as determined by a court of competent
 5    jurisdiction;  provided  further that payment for an abortion
 6    to terminate a pregnancy resulting from an  act  of  criminal
 7    sexual assault, aggravated criminal sexual assault, or sexual
 8    relations  within  families  is reported to a law enforcement
 9    agency before the abortion  is  performed.  Nothing  in  this
10    Article   shall  be  construed  to  permit  the  granting  of
11    financial aid where the purpose of such aid is to  obtain  an
12    abortion,  induced  miscarriage  or  induced  premature birth
13    unless, in the opinion of a physician,  such  procedures  are
14    necessary  for  the  preservation  of  the  life of the woman
15    seeking such treatment, or except an induced premature  birth
16    intended to produce a live viable child and such procedure is
17    necessary for the health of the mother or her unborn child.
18        Until  August  1, 1969, children who require care outside
19    their  own  homes,  where  no  other  sources  of  funds   or
20    insufficient  funds  are  available  to provide the necessary
21    care, are included among persons eligible for aid under  this
22    Article.  After July 31, 1969, the Department of Children and
23    Family  Services  shall  have the responsibility of providing
24    child welfare services  to  such  children,  as  provided  in
25    Section  5 of "An Act creating the Department of Children and
26    Family  Services,  codifying  its  powers  and  duties,   and
27    repealing  certain  Acts and Sections herein named", approved
28    June 4, 1963, as amended.
29        In cities, villages and incorporated towns of  more  than
30    500,000  population,  the Illinois Department may establish a
31    separate program under this Article.  The 2 programs shall be
32    differentiated, but  the  placement  of  persons  under  both
33    programs  shall  be  based upon their ability or inability to
34    engage  in  employment  in  accordance  with  the  rules  and
 
                            -13-               LRB9100307SMdv
 1    regulations  promulgated  by  the  Illinois  Department.   In
 2    establishing rules and regulations for determining whether  a
 3    person   is  able  to  engage  in  employment,  the  Illinois
 4    Department may establish rules different than those  set  out
 5    under  Section  11-20.  In determining need and the amount of
 6    aid under Sections 6-1.2 and 6-2  for  the  2  programs,  the
 7    Illinois Department may establish different standards for the
 8    2  programs  based  upon  the specific needs of the different
 9    populations to be served by the  2  programs.   The  Illinois
10    Department   may   enter  into  contracts  with  entities  to
11    establish work or training related projects under the program
12    established for persons determined to be able  to  engage  in
13    employment.
14    (Source: P.A. 89-646, eff. 1-1-97.)

15        Section  90.   Severability.   If  any  provision,  word,
16    phrase  or  clause  of  this  amendatory  Act  of 1999 or its
17    application to any person or circumstance  is  held  invalid,
18    the   invalidity  does  not  affect  the  provisions,  words,
19    phrases, clauses or application of  this  amendatory  Act  of
20    1999 which can be given effect without the invalid provision,
21    word,  phrase,  clause,  or  application, and to this end the
22    provisions, words, phrases, and clauses  of  this  amendatory
23    Act of 1999 are declared to be severable.

24        Section  99.  Effective date.  This Act takes effect upon
25    becoming law.

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