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| Public Act 097-0842 | ||||
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AN ACT concerning public aid.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Public Aid Code is amended by | ||||
changing Section 5-4.2 as follows:
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(305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
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Sec. 5-4.2. Ambulance services payments. | ||||
(a) For
ambulance
services provided to a recipient of aid | ||||
under this Article on or after
January 1, 1993, the Illinois | ||||
Department shall reimburse ambulance service
providers at | ||||
rates calculated in accordance with this Section. It is the | ||||
intent
of the General Assembly to provide adequate | ||||
reimbursement for ambulance
services so as to ensure adequate | ||||
access to services for recipients of aid
under this Article and | ||||
to provide appropriate incentives to ambulance service
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providers to provide services in an efficient and | ||||
cost-effective manner. Thus,
it is the intent of the General | ||||
Assembly that the Illinois Department implement
a | ||||
reimbursement system for ambulance services that, to the extent | ||||
practicable
and subject to the availability of funds | ||||
appropriated by the General Assembly
for this purpose, is | ||||
consistent with the payment principles of Medicare. To
ensure | ||||
uniformity between the payment principles of Medicare and | ||||
Medicaid, the
Illinois Department shall follow, to the extent | ||
necessary and practicable and
subject to the availability of | ||
funds appropriated by the General Assembly for
this purpose, | ||
the statutes, laws, regulations, policies, procedures,
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principles, definitions, guidelines, and manuals used to | ||
determine the amounts
paid to ambulance service providers under | ||
Title XVIII of the Social Security
Act (Medicare).
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(b) For ambulance services provided to a recipient of aid | ||
under this Article
on or after January 1, 1996, the Illinois | ||
Department shall reimburse ambulance
service providers based | ||
upon the actual distance traveled if a natural
disaster, | ||
weather conditions, road repairs, or traffic congestion | ||
necessitates
the use of a
route other than the most direct | ||
route.
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(c) For purposes of this Section, "ambulance services" | ||
includes medical
transportation services provided by means of | ||
an ambulance, medi-car, service
car, or
taxi.
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(c-1) For purposes of this Section, "ground ambulance | ||
service" means medical transportation services that are | ||
described as ground ambulance services by the Centers for | ||
Medicare and Medicaid Services and provided in a vehicle that | ||
is licensed as an ambulance by the Illinois Department of | ||
Public Health pursuant to the Emergency Medical Services (EMS) | ||
Systems Act. | ||
(c-2) For purposes of this Section, "ground ambulance | ||
service provider" means a vehicle service provider as described | ||
in the Emergency Medical Services (EMS) Systems Act that | ||
operates licensed ambulances for the purpose of providing | ||
emergency ambulance services, or non-emergency ambulance | ||
services, or both. For purposes of this Section, this includes | ||
both ambulance providers and ambulance suppliers as described | ||
by the Centers for Medicare and Medicaid Services. | ||
(d) This Section does not prohibit separate billing by | ||
ambulance service
providers for oxygen furnished while | ||
providing advanced life support
services.
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(e) Beginning with services rendered on or after July 1, | ||
2008, all providers of non-emergency medi-car and service car | ||
transportation must certify that the driver and employee | ||
attendant, as applicable, have completed a safety program | ||
approved by the Department to protect both the patient and the | ||
driver, prior to transporting a patient.
The provider must | ||
maintain this certification in its records. The provider shall | ||
produce such documentation upon demand by the Department or its | ||
representative. Failure to produce documentation of such | ||
training shall result in recovery of any payments made by the | ||
Department for services rendered by a non-certified driver or | ||
employee attendant. Medi-car and service car providers must | ||
maintain legible documentation in their records of the driver | ||
and, as applicable, employee attendant that actually | ||
transported the patient. Providers must recertify all drivers | ||
and employee attendants every 3 years.
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Notwithstanding the requirements above, any public | ||
transportation provider of medi-car and service car | ||
transportation that receives federal funding under 49 U.S.C. | ||
5307 and 5311 need not certify its drivers and employee | ||
attendants under this Section, since safety training is already | ||
federally mandated.
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(f) With respect to any policy or program administered by | ||
the Department or its agent regarding approval of non-emergency | ||
medical transportation by ground ambulance service providers, | ||
including, but not limited to, the Non-Emergency | ||
Transportation Services Prior Approval Program (NETSPAP), the | ||
Department shall establish by rule a process by which ground | ||
ambulance service providers of non-emergency medical | ||
transportation may appeal any decision by the Department or its | ||
agent for which no denial was received prior to the time of | ||
transport that either (i) denies a request for approval for | ||
payment of non-emergency transportation by means of ground | ||
ambulance service or (ii) grants a request for approval of | ||
non-emergency transportation by means of ground ambulance | ||
service at a level of service that entitles the ground | ||
ambulance service provider to a lower level of compensation | ||
from the Department than the ground ambulance service provider | ||
would have received as compensation for the level of service | ||
requested. The rule shall be established within 12 months after | ||
the effective date of this amendatory Act of the 97th General | ||
Assembly and shall provide that, for any decision rendered by | ||
the Department or its agent on or after the date the rule takes | ||
effect, the ground ambulance service provider shall have 60 | ||
days from the date the decision is received to file an appeal. | ||
The rule established by the Department shall be, insofar as is | ||
practical, consistent with the Illinois Administrative | ||
Procedure Act. The Director's decision on an appeal under this | ||
Section shall be a final administrative decision subject to | ||
review under the Administrative Review Law. | ||
(g) Beginning 90 days after the effective date of this | ||
amendatory Act of the 97th General Assembly, (i) no denial of a | ||
request for approval for payment of non-emergency | ||
transportation by means of ground ambulance service, and (ii) | ||
no approval of non-emergency transportation by means of ground | ||
ambulance service at a level of service that entitles the | ||
ground ambulance service provider to a lower level of | ||
compensation from the Department than would have been received | ||
at the level of service submitted by the ground ambulance | ||
service provider, may be issued by the Department or its agent | ||
unless the Department has submitted the criteria for | ||
determining the appropriateness of the transport for first | ||
notice publication in the Illinois Register pursuant to Section | ||
5-40 of the Illinois Administrative Procedure Act. | ||
(Source: P.A. 97-584, eff. 8-26-11.)
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Section 99. Effective date. This Act takes effect upon | ||
becoming law.
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