State of Illinois
92nd General Assembly

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[ Engrossed ][ House Amendment 001 ]



 1        AN ACT in relation to public aid.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section  5.   The  Illinois Public Aid Code is amended by
 5    changing Sections 5-5, 5-8, and 12-13 as follows:

 6        (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
 7        Sec. 5-5.  Medical services. The Illinois Department,  by
 8    rule,  shall  determine  the  quantity and quality of and the
 9    rate of reimbursement for the medical  assistance  for  which
10    payment  will  be  authorized, and the medical services to be
11    provided, which may include all or part of the following: (1)
12    inpatient  hospital   services;   (2)   outpatient   hospital
13    services;  (3)  other  laboratory  and  X-ray  services;  (4)
14    skilled  nursing  home  services;  (5)  physicians'  services
15    whether  furnished  in  the  office,  the  patient's  home, a
16    hospital, a skilled nursing home, or elsewhere;  (6)  medical
17    care,  or  any  other  type  of  remedial  care  furnished by
18    licensed practitioners; (6.5) behavioral health  services  as
19    defined  in  subsection  (m) of Section 5-16.3; (6.10) mental
20    health services as  defined  in  subsection  (m)  of  Section
21    5-16.3;  (7)  home  health  care  services;  (8) private duty
22    nursing service; (9) clinic services; (10)  dental  services;
23    (11)  physical  therapy and related services; (12) prescribed
24    drugs,  dentures,  and  prosthetic  devices;  and  eyeglasses
25    prescribed by a physician skilled in the diseases of the eye,
26    or by an optometrist, whichever the person may  select;  (13)
27    other  diagnostic,  screening, preventive, and rehabilitative
28    services; (14) transportation and such other expenses as  may
29    be  necessary;  (15)  medical  treatment  of  sexual  assault
30    survivors,  as  defined  in  Section 1a of the Sexual Assault
31    Survivors Emergency Treatment Act, for injuries sustained  as
                            -2-                LRB9207228DJmg
 1    a  result  of  the sexual assault, including examinations and
 2    laboratory tests to discover evidence which may  be  used  in
 3    criminal  proceedings  arising  from the sexual assault; (16)
 4    the diagnosis and treatment of sickle cell anemia;  and  (17)
 5    any  other  medical care, and any other type of remedial care
 6    recognized under the laws of this State,  but  not  including
 7    abortions,  or  induced  miscarriages  or  premature  births,
 8    unless,  in  the  opinion of a physician, such procedures are
 9    necessary for the preservation  of  the  life  of  the  woman
10    seeking  such treatment, or except an induced premature birth
11    intended to produce a live viable child and such procedure is
12    necessary for the health of the mother or her  unborn  child.
13    The   Illinois   Department,  by  rule,  shall  prohibit  any
14    physician  from  providing  medical  assistance   to   anyone
15    eligible  therefor  under  this Code where such physician has
16    been found guilty of performing an abortion  procedure  in  a
17    wilful and wanton manner upon a woman who was not pregnant at
18    the time such abortion procedure was performed. The term "any
19    other  type  of remedial care" shall include nursing care and
20    nursing home service for persons who  rely  on  treatment  by
21    spiritual means alone through prayer for healing.
22        Notwithstanding  any  other  provision of this Section, a
23    comprehensive tobacco use  cessation  program  that  includes
24    purchasing prescription drugs or prescription medical devices
25    approved by the Food and Drug administration shall be covered
26    under  the  medical assistance program under this Article for
27    persons who are otherwise eligible for assistance under  this
28    Article.
29        Notwithstanding  any  other  provision  of this Code, the
30    Illinois Department  may  not  require,  as  a  condition  of
31    payment   for  any  laboratory  test  authorized  under  this
32    Article, that a physician's handwritten signature  appear  on
33    the laboratory test order form.  The Illinois Department may,
34    however,  impose  other  appropriate  requirements  regarding
                            -3-                LRB9207228DJmg
 1    laboratory test order documentation.
 2        The  Illinois  Department of Public Aid shall provide the
 3    following services to persons eligible for  assistance  under
 4    this  Article who are participating in education, training or
 5    employment programs  operated  by  the  Department  of  Human
 6    Services as successor to the Department of Public Aid:
 7             (1)  dental services, which shall include but not be
 8        limited to prosthodontics; and
 9             (2)  eyeglasses prescribed by a physician skilled in
10        the  diseases of the eye, or by an optometrist, whichever
11        the person may select.
12        The Illinois Department, by  rule,  may  distinguish  and
13    classify   the  medical  services  to  be  provided  only  in
14    accordance with the classes of persons designated in  Section
15    5-2.
16        The Illinois Department shall authorize the provision of,
17    and  shall  authorize  payment  for,  screening  by  low-dose
18    mammography  for  the  presence  of  occult breast cancer for
19    women 35 years of age or older who are eligible  for  medical
20    assistance  under  this  Article,  as  follows:   a  baseline
21    mammogram  for  women  35  to  39  years of age and an annual
22    mammogram for women 40 years of age or older.  All screenings
23    shall  include  a  physical  breast  exam,   instruction   on
24    self-examination  and  information regarding the frequency of
25    self-examination and its value as a  preventative  tool.   As
26    used  in this Section, "low-dose mammography" means the x-ray
27    examination  of  the   breast   using   equipment   dedicated
28    specifically  for  mammography,  including  the  x-ray  tube,
29    filter,  compression  device,  image receptor, and cassettes,
30    with an average radiation exposure delivery of less than  one
31    rad mid-breast, with 2 views for each breast.
32        Any  medical  or  health  care provider shall immediately
33    recommend, to  any  pregnant  woman  who  is  being  provided
34    prenatal  services  and  is  suspected  of  drug  abuse or is
                            -4-                LRB9207228DJmg
 1    addicted as defined in the Alcoholism and  Other  Drug  Abuse
 2    and  Dependency  Act,  referral  to  a  local substance abuse
 3    treatment  provider  licensed  by  the  Department  of  Human
 4    Services or to a licensed hospital which  provides  substance
 5    abuse treatment services.  The Department of Public Aid shall
 6    assure  coverage  for the cost of treatment of the drug abuse
 7    or addiction for pregnant recipients in accordance  with  the
 8    Illinois  Medicaid Program in conjunction with the Department
 9    of Human Services.
10        All medical providers  providing  medical  assistance  to
11    pregnant women under this Code shall receive information from
12    the Department on the availability of services under the Drug
13    Free  Families  with  a  Future  or  any  comparable  program
14    providing   case  management  services  for  addicted  women,
15    including information  on  appropriate  referrals  for  other
16    social  services  that  may  be  needed  by addicted women in
17    addition to treatment for addiction.
18        The  Illinois  Department,  in   cooperation   with   the
19    Departments of Human Services (as successor to the Department
20    of Alcoholism and Substance Abuse) and Public Health, through
21    a   public   awareness   campaign,  may  provide  information
22    concerning  treatment  for  alcoholism  and  drug  abuse  and
23    addiction, prenatal health care, and other pertinent programs
24    directed at reducing the number of drug-affected infants born
25    to recipients of medical assistance.
26        Neither the Illinois Department of  Public  Aid  nor  the
27    Department  of  Human  Services  shall sanction the recipient
28    solely on the basis of her substance abuse.
29        The Illinois Department shall establish such  regulations
30    governing  the  dispensing  of  health  services  under  this
31    Article  as  it shall deem appropriate.  In formulating these
32    regulations the Illinois Department shall  consult  with  and
33    give substantial weight to the recommendations offered by the
34    Citizens  Assembly/Council  on  Public  Aid.  The  Department
                            -5-                LRB9207228DJmg
 1    should  seek  the  advice  of  formal  professional  advisory
 2    committees   appointed   by  the  Director  of  the  Illinois
 3    Department for the purpose of  providing  regular  advice  on
 4    policy  and administrative matters, information dissemination
 5    and  educational  activities  for  medical  and  health  care
 6    providers, and consistency  in  procedures  to  the  Illinois
 7    Department.
 8        The  Illinois  Department  may  develop and contract with
 9    Partnerships of medical providers to arrange medical services
10    for  persons  eligible  under  Section  5-2  of  this   Code.
11    Implementation  of  this  Section  may  be  by  demonstration
12    projects  in certain geographic areas.  The Partnership shall
13    be represented by a sponsor organization.  The Department, by
14    rule,  shall   develop   qualifications   for   sponsors   of
15    Partnerships.   Nothing in this Section shall be construed to
16    require  that  the  sponsor   organization   be   a   medical
17    organization.
18        The  sponsor must negotiate formal written contracts with
19    medical  providers  for  physician  services,  inpatient  and
20    outpatient hospital care, home health services, treatment for
21    alcoholism and substance abuse, and other services determined
22    necessary by the Illinois Department by rule for delivery  by
23    Partnerships.   Physician  services must include prenatal and
24    obstetrical care.  The Illinois  Department  shall  reimburse
25    medical   services  delivered  by  Partnership  providers  to
26    clients in target  areas  according  to  provisions  of  this
27    Article  and  the  Illinois Health Finance Reform Act, except
28    that:
29             (1)  Physicians participating in a  Partnership  and
30        providing  certain services, which shall be determined by
31        the Illinois Department, to persons in areas  covered  by
32        the  Partnership  may receive an additional surcharge for
33        such services.
34             (2)  The  Department  may  elect  to  consider   and
                            -6-                LRB9207228DJmg
 1        negotiate   financial   incentives   to   encourage   the
 2        development of Partnerships and the efficient delivery of
 3        medical care.
 4             (3)  Persons   receiving  medical  services  through
 5        Partnerships may  receive  medical  and  case  management
 6        services  above  the  level  usually  offered through the
 7        medical assistance program.
 8        Medical providers  shall  be  required  to  meet  certain
 9    qualifications  to  participate in Partnerships to ensure the
10    delivery   of   high   quality   medical   services.    These
11    qualifications shall be determined by rule  of  the  Illinois
12    Department   and   may  be  higher  than  qualifications  for
13    participation in the medical assistance program.  Partnership
14    sponsors may prescribe reasonable  additional  qualifications
15    for  participation  by medical providers, only with the prior
16    written approval of the Illinois Department.
17        Nothing in this Section shall limit the  free  choice  of
18    practitioners,  hospitals,  and  other  providers  of medical
19    services by clients. In order to ensure  patient  freedom  of
20    choice,  the Illinois Department shall immediately promulgate
21    all rules and  take  all  other  necessary  actions  so  that
22    provided   services  may  be  accessed  from  therapeutically
23    certified optometrists to the full  extent  of  the  Illinois
24    Optometric   Practice  Act  of  1987  without  discriminating
25    between service providers.
26        The Department shall apply for a waiver from  the  United
27    States  Health Care Financing Administration to allow for the
28    implementation of Partnerships under this Section.
29        The  Illinois  Department  shall  require   health   care
30    providers  to maintain records that document the medical care
31    and services provided to  recipients  of  Medical  Assistance
32    under  this  Article.   The Illinois Department shall require
33    health care providers to make available, when  authorized  by
34    the  patient,  in  writing,  the  medical records in a timely
                            -7-                LRB9207228DJmg
 1    fashion to other health care providers who  are  treating  or
 2    serving  persons  eligible  for Medical Assistance under this
 3    Article.   All  dispensers  of  medical  services  shall   be
 4    required  to  maintain  and  retain business and professional
 5    records sufficient  to  fully  and  accurately  document  the
 6    nature,  scope,  details  and  receipt  of  the  health  care
 7    provided  to  persons  eligible  for medical assistance under
 8    this Code, in accordance with regulations promulgated by  the
 9    Illinois  Department. The rules and regulations shall require
10    that proof of the receipt of  prescription  drugs,  dentures,
11    prosthetic  devices  and eyeglasses by eligible persons under
12    this Section accompany each claim for reimbursement submitted
13    by the dispenser of such medical services. No such claims for
14    reimbursement shall be approved for payment by  the  Illinois
15    Department without such proof of receipt, unless the Illinois
16    Department  shall have put into effect and shall be operating
17    a system of post-payment audit and review which shall,  on  a
18    sampling basis, be deemed adequate by the Illinois Department
19    to  assure  that such drugs, dentures, prosthetic devices and
20    eyeglasses for which payment is being made are actually being
21    received by eligible recipients. Within  90  days  after  the
22    effective  date  of this amendatory Act of 1984, the Illinois
23    Department shall establish  a  current  list  of  acquisition
24    costs   for  all  prosthetic  devices  and  any  other  items
25    recognized as medical  equipment  and  supplies  reimbursable
26    under  this Article and shall update such list on a quarterly
27    basis, except that the acquisition costs of all  prescription
28    drugs  shall be updated no less frequently than every 30 days
29    as required by Section 5-5.12.
30        The rules and  regulations  of  the  Illinois  Department
31    shall require that a written statement including the required
32    opinion   of  a  physician  shall  accompany  any  claim  for
33    reimbursement  for  abortions,  or  induced  miscarriages  or
34    premature  births.   This  statement  shall   indicate   what
                            -8-                LRB9207228DJmg
 1    procedures were used in providing such medical services.
 2        The Illinois Department shall require that all dispensers
 3    of medical services, other than an individual practitioner or
 4    group  of  practitioners,  desiring  to  participate  in  the
 5    Medical  Assistance program established under this Article to
 6    disclose all financial, beneficial, ownership, equity, surety
 7    or other  interests  in  any  and  all  firms,  corporations,
 8    partnerships,   associations,   business  enterprises,  joint
 9    ventures, agencies,  institutions  or  other  legal  entities
10    providing  any  form  of  health  care services in this State
11    under this Article.
12        The Illinois Department may require that  all  dispensers
13    of  medical  services  desiring to participate in the medical
14    assistance program established under this  Article  disclose,
15    under  such  terms  and conditions as the Illinois Department
16    may  by  rule  establish,  all  inquiries  from  clients  and
17    attorneys  regarding  medical  bills  paid  by  the  Illinois
18    Department,  which   inquiries   could   indicate   potential
19    existence of claims or liens for the Illinois Department.
20        The   Illinois   Department   shall  establish  policies,
21    procedures,  standards  and  criteria   by   rule   for   the
22    acquisition,   repair   and   replacement   of  orthotic  and
23    prosthetic devices and durable medical equipment.  Such rules
24    shall provide, but not be limited to, the following services:
25    (1) immediate  repair  or  replacement  of  such  devices  by
26    recipients  without  medical  authorization;  and (2) rental,
27    lease,  purchase  or  lease-purchase   of   durable   medical
28    equipment   in   a   cost-effective   manner,   taking   into
29    consideration  the  recipient's medical prognosis, the extent
30    of the recipient's needs, and the requirements and costs  for
31    maintaining  such  equipment.   Such  rules  shall  enable  a
32    recipient  to  temporarily  acquire  and  use  alternative or
33    substitute  devices   or   equipment   pending   repairs   or
34    replacements of any device or equipment previously authorized
                            -9-                LRB9207228DJmg
 1    for  such recipient by the Department. Rules under clause (2)
 2    above shall not provide for  purchase  or  lease-purchase  of
 3    durable medical equipment or supplies used for the purpose of
 4    oxygen delivery and respiratory care.
 5        The  Department  shall  execute,  relative to the nursing
 6    home prescreening project,  written  inter-agency  agreements
 7    with  the  Department of Human Services and the Department on
 8    Aging, to effect the following:  (i)  intake  procedures  and
 9    common   eligibility  criteria  for  those  persons  who  are
10    receiving   non-institutional   services;   and   (ii)    the
11    establishment  and  development of non-institutional services
12    in areas of the State where they are not currently  available
13    or are undeveloped.
14        The  Illinois  Department  shall  develop and operate, in
15    cooperation with other State Departments and agencies and  in
16    compliance  with  applicable  federal  laws  and regulations,
17    appropriate and effective systems of health  care  evaluation
18    and  programs  for  monitoring  of utilization of health care
19    services and facilities, as it affects persons  eligible  for
20    medical  assistance  under this Code. The Illinois Department
21    shall report regularly the results of the operation  of  such
22    systems  and  programs  to  the  Citizens Assembly/Council on
23    Public Aid to enable the Committee to ensure,  from  time  to
24    time, that these programs are effective and meaningful.
25        The  Illinois  Department  shall  report  annually to the
26    General Assembly, no later than the second Friday in April of
27    1979 and each year thereafter, in regard to:
28             (a)  actual statistics and trends in utilization  of
29        medical services by public aid recipients;
30             (b)  actual  statistics  and trends in the provision
31        of the various medical services by medical vendors;
32             (c)  current rate structures and proposed changes in
33        those rate structures for the  various  medical  vendors;
34        and
                            -10-               LRB9207228DJmg
 1             (d)  efforts  at  utilization  review and control by
 2        the Illinois Department.
 3        The period covered by each report shall be  the  3  years
 4    ending  on the June 30 prior to the report.  The report shall
 5    include  suggested  legislation  for  consideration  by   the
 6    General  Assembly.  The filing of one copy of the report with
 7    the Speaker, one copy with the Minority Leader and  one  copy
 8    with the Clerk of the House of Representatives, one copy with
 9    the President, one copy with the Minority Leader and one copy
10    with   the  Secretary  of  the  Senate,  one  copy  with  the
11    Legislative Research Unit, such additional  copies  with  the
12    State  Government  Report Distribution Center for the General
13    Assembly as is required under paragraph (t) of Section  7  of
14    the  State  Library  Act  and  one  copy  with  the  Citizens
15    Assembly/Council  on  Public  Aid  or  its successor shall be
16    deemed sufficient to comply with this Section.
17    (Source: P.A. 90-7, eff. 6-10-97; 90-14, eff. 7-1-97; 91-344,
18    eff. 1-1-00; 91-462,  eff.  8-6-99;  91-666,  eff.  12-22-99;
19    revised 1-6-00.)

20        (305 ILCS 5/5-8) (from Ch. 23, par. 5-8)
21        Sec. 5-8. Practitioners. In supplying medical assistance,
22    the   Illinois   Department   may  provide  for  the  legally
23    authorized services of (i) persons licensed under the Medical
24    Practice Act of 1987, as amended, except as hereafter in this
25    Section stated, whether under a general or  limited  license,
26    (ii)  and  of persons licensed or registered under other laws
27    of this State to  provide  dental,  medical,  pharmaceutical,
28    optometric, podiatric, or nursing services, or other remedial
29    care  recognized  under State law, and (iii) persons licensed
30    under other laws of this State as  a  clinical  psychologist,
31    clinical  social  worker, or clinical professional counselor.
32    In authorizing reimbursement for behavioral  health  services
33    and  mental  health  services,  the  Illinois  Department may
                            -11-               LRB9207228DJmg
 1    provide  for  the  legally  authorized  services  of  persons
 2    licensed  under  the  Medical  Practice  Act  of  1987.   The
 3    Department may not provide for legally authorized services of
 4    any  physician  who has been convicted of having performed an
 5    abortion procedure in a wilful and wanton manner on  a  woman
 6    who  was not pregnant at the time such abortion procedure was
 7    performed.   The  utilization  of  the  services  of  persons
 8    engaged in the treatment or care of the sick,  which  persons
 9    are  not required to be licensed or registered under the laws
10    of this State, is not prohibited by this Section.
11    (Source: P.A. 85-1209.)

12        (305 ILCS 5/12-13) (from Ch. 23, par. 12-13)
13        Sec. 12-13. Rules and regulations.  The Department  shall
14    make all rules and regulations and take such action as may be
15    necessary  or  desirable  for  carrying out the provisions of
16    this Code, to the end that its  spirit  and  purpose  may  be
17    achieved and the public aid programs administered efficiently
18    throughout  the  State.  However,  the  rules and regulations
19    shall not provide that payment for  services  rendered  to  a
20    specific recipient by (i) a person licensed under the Medical
21    Practice  Act  of  1987,  whether  under a general or limited
22    license, (ii) or a person licensed or registered under  other
23    laws   of  this  State  to  provide  dental,  optometric,  or
24    pediatric care, or (iii) a  licensed  clinical  psychologist,
25    licensed   clinical   social  worker,  or  licensed  clinical
26    professional counselor may be authorized only  when  services
27    are  recommended  for  that recipient by a person licensed to
28    practice medicine in all its branches.
29        Whenever a  rule  of  the  Department  requires  that  an
30    applicant  or  recipient  verify information submitted to the
31    Department, the rule, in order to make the public fully aware
32    of what  information  is  required  for  verification,  shall
33    specify  the  acceptable  means of verification or shall list
                            -12-               LRB9207228DJmg
 1    examples of acceptable means of verification.
 2        The provisions of the Illinois  Administrative  Procedure
 3    Act are hereby expressly adopted and incorporated herein, and
 4    shall apply to all administrative rules and procedures of the
 5    Illinois  Department under this Act, except that Section 5-35
 6    of the Illinois  Administrative  Procedure  Act  relating  to
 7    procedures  for rule-making does not apply to the adoption of
 8    any rule required by federal law in connection with which the
 9    Illinois Department is precluded by law from  exercising  any
10    discretion,   and  the  requirements  of  the  Administrative
11    Procedure  Act  with  respect  to  contested  cases  are  not
12    applicable  to  (1)   hearings   involving   eligibility   of
13    applicants  or recipients of public aid, (2) support hearings
14    involving responsible relatives, or  (3)  personnel  hearings
15    involving matters arising under Section 12-18.1.
16    (Source: P.A. 88-45.)

17        Section  99.  Effective date.  This Act takes effect upon
18    becoming law.

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