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| Public Act 097-1061 | ||||
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AN ACT concerning health.
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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 Alcoholism and Other Drug Abuse and | ||||
Dependency Act is amended by changing Section 1-10 as follows:
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(20 ILCS 301/1-10)
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Sec. 1-10. Definitions. As used in this Act, unless the | ||||
context clearly
indicates otherwise, the following words and | ||||
terms have the following meanings:
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"Act" means the Alcoholism and Other Drug Abuse and | ||||
Dependency Act.
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"Addict" means a person who exhibits the disease known as | ||||
"addiction".
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"Addiction" means a disease process characterized by the | ||||
continued use of a
specific psycho-active substance despite | ||||
physical, psychological or social
harm. The term also describes | ||||
the advanced stages of chemical dependency.
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"Administrator" means a person responsible for | ||||
administration of a program.
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"Alcoholic" means a person who exhibits the disease known | ||||
as "alcoholism".
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"Alcoholism" means a chronic and progressive disease or | ||||
illness
characterized by preoccupation with and loss of control | ||||
over the consumption of
alcohol, and the use of alcohol despite | ||
adverse consequences. Typically,
combinations of the following | ||
tendencies are also present: periodic or chronic
intoxication; | ||
physical disability; impaired emotional, occupational or | ||
social
adjustment; tendency toward relapse; a detrimental | ||
effect on the individual,
his family and society; psychological | ||
dependence; and physical dependence.
Alcoholism is also known | ||
as addiction to alcohol. Alcoholism is described and
further | ||
categorized in clinical detail in the DSM and the ICD.
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"Array of services" means assistance to individuals, | ||
families and communities
in response to alcohol or other drug | ||
abuse or dependency. The array of
services includes, but is not | ||
limited to: prevention assistance for communities
and schools; | ||
case finding, assessment and intervention to help individuals | ||
stop
abusing alcohol or other drugs; a uniform screening, | ||
assessment, and evaluation process including criteria for | ||
substance use disorders and mental disorders or co-occurring | ||
substance use and mental health disorders; case management; | ||
detoxification to aid
individuals in physically withdrawing | ||
from alcohol or other drugs; short-term
and long-term treatment | ||
and support services to help individuals and family
members | ||
begin the process of recovery; prescription and dispensing of | ||
the drug
methadone or other medications as an adjunct to | ||
treatment; relapse prevention
services; education and | ||
counseling for children or other co-dependents of
alcoholics or | ||
other drug abusers or addicts. For purposes of this Section, a | ||
uniform screening, assessment, and evaluation process refers | ||
to a process that includes an appropriate evaluation and, as | ||
warranted, a referral. "Uniform" does not mean the use of a | ||
singular instrument, tool, or process that all must utilize.
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"Case management" means those services which will assist | ||
individuals in
gaining access to needed social, educational, | ||
medical, treatment and other
services.
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"Children of alcoholics or drug addicts or abusers of | ||
alcohol and other
drugs" means the minor or adult children of | ||
individuals who have abused or been
dependent upon alcohol or | ||
other drugs. These children may or may not become
dependent | ||
upon alcohol or other drugs themselves; however, they are | ||
physically,
psychologically, and behaviorally at high risk of | ||
developing the illness.
Children of alcoholics and other drug | ||
abusers experience emotional and other
problems, and benefit | ||
from prevention and treatment services provided by funded
and | ||
non-funded agencies licensed by the Department.
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"Co-dependents" means individuals who are involved in the | ||
lives of and are
affected by people who are dependent upon | ||
alcohol and other drugs.
Co-dependents compulsively engage in | ||
behaviors that cause them to suffer
adverse physical, | ||
emotional, familial, social, behavioral, vocational, and
legal | ||
consequences as they attempt to cope with the alcohol or drug | ||
dependent
person. People who become co-dependents include | ||
spouses, parents, siblings,
and friends of alcohol or drug | ||
dependent people. Co-dependents benefit from
prevention and | ||
treatment services provided by agencies licensed by the
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Department.
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"Controlled substance" means any substance or immediate | ||
precursor which is
enumerated in the schedules of Article II of | ||
the Illinois Controlled Substances
Act or the Cannabis Control | ||
Act.
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"Crime of violence" means any of the following crimes: | ||
murder, voluntary
manslaughter, criminal sexual assault, | ||
aggravated criminal sexual assault,
predatory criminal sexual | ||
assault of a child,
armed robbery, robbery, arson, kidnapping, | ||
aggravated battery, aggravated
arson, or any
other felony which | ||
involves the use or threat of physical force or violence
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against another individual.
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"Department" means the Illinois Department of Human | ||
Services as successor to
the former Department of Alcoholism | ||
and Substance Abuse.
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"Designated program" means a program designated by the | ||
Department to provide
services described in subsection (c) or | ||
(d) of Section 15-10 of this Act.
A
designated program's | ||
primary function is screening, assessing, referring and
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tracking clients identified by the criminal justice system, and | ||
the program
agrees to apply statewide the standards, uniform | ||
criteria and procedures
established by the Department pursuant | ||
to such designation.
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"Detoxification" means the process of allowing an | ||
individual to safely
withdraw from a drug in a controlled | ||
environment.
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"DSM" means the most current edition of the Diagnostic and | ||
Statistical
Manual of Mental Disorders.
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"D.U.I." means driving under the influence of alcohol or | ||
other substances
which may cause impairment of driving ability.
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"Facility" means the building or premises which are used | ||
for the provision
of licensable program services, including | ||
support services, as set forth by
rule.
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"ICD" means the most current edition of the International | ||
Classification of
Diseases.
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"Incapacitated" means that a person is unconscious or | ||
otherwise exhibits, by
overt behavior or by extreme physical | ||
debilitation, an inability to care for
his own needs or to | ||
recognize the obvious danger of his situation or to make
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rational decisions with respect to his need for treatment.
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"Intermediary person" means a person with expertise | ||
relative to addiction,
alcoholism, and the abuse of alcohol or | ||
other drugs who may be called on to
assist the police in | ||
carrying out enforcement or other activities with respect
to | ||
persons who abuse or are dependent on alcohol or other drugs.
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"Intervention" means readily accessible activities which | ||
assist individuals
and their partners or family members in | ||
coping with the immediate problems of
alcohol and other drug | ||
abuse or dependency, and in reducing their alcohol and
other | ||
drug use. Intervention can facilitate emotional and social | ||
stability, and
involves referring people for further treatment | ||
as needed.
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"Intoxicated person" means a person whose mental or | ||
physical functioning is
substantially impaired as a result of | ||
the current effects of alcohol or other
drugs within the body.
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"Local advisory council" means an alcohol and substance | ||
abuse body
established in a county, township or community area, | ||
which represents public
and private entities having an interest | ||
in the prevention and treatment of
alcoholism or other drug | ||
abuse.
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"Off-site services" means licensable program services or | ||
activities which are
conducted at a location separate from the | ||
primary service location of the
provider, and which services | ||
are operated by a program or entity licensed under
this Act.
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"Person" means any individual, firm, group, association, | ||
partnership,
corporation, trust, government or governmental | ||
subdivision or agency.
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"Prevention" means an interactive process of individuals, | ||
families, schools,
religious organizations, communities and | ||
regional, state and national
organizations to reduce | ||
alcoholism, prevent the use of illegal drugs and the
abuse of | ||
legal drugs by persons of all ages, prevent the use of alcohol | ||
by
minors, build the capacities of individuals and systems, and | ||
promote healthy
environments, lifestyles and behaviors.
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"Program" means a licensable or fundable activity or | ||
service, or a
coordinated range of such activities or services, | ||
as the Department may
establish by rule.
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"Recovery" means the long-term, often life-long, process | ||
in which an addicted
person changes the way in which he makes | ||
decisions and establishes personal and
life priorities. The | ||
evolution of this decision-making and priority-setting
process | ||
is generally manifested by an obvious improvement in the | ||
individual's
life and lifestyle and by his overcoming the abuse | ||
of or
dependence on alcohol or other drugs. Recovery is also | ||
generally manifested by
prolonged periods of abstinence from | ||
addictive chemicals which are not
medically supervised. | ||
Recovery is the goal of treatment.
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"Rehabilitation" means a process whereby those clinical | ||
services necessary
and appropriate for improving an | ||
individual's life and lifestyle and for
overcoming his or her | ||
abuse of or dependency upon alcohol or other drugs, or
both, | ||
are delivered in an appropriate setting and manner as defined | ||
in rules
established by the Department.
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"Relapse" means a process which is manifested by a | ||
progressive pattern of
behavior that reactivates the symptoms | ||
of a disease or creates debilitating
conditions in an | ||
individual who has experienced remission from addiction or
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alcoholism.
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"Secretary" means the Secretary of Human Services or his or | ||
her designee.
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"Substance abuse" or "abuse" means a pattern of use of | ||
alcohol or other drugs
with the potential of leading to | ||
immediate functional problems or to alcoholism
or other drug | ||
dependency, or to the use of alcohol and/or other drugs solely
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for purposes of intoxication. The term also means the use of | ||
illegal drugs by
persons of any age, and the use of alcohol by | ||
persons under the age of 21.
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"Treatment" means the broad range of emergency, | ||
outpatient, intermediate
and residential services and care | ||
(including assessment, diagnosis, medical,
psychiatric, | ||
psychological and social services, care and counseling, and
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aftercare) which may be extended to individuals who abuse or | ||
are dependent
on alcohol or other drugs or families of those | ||
persons.
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(Source: P.A. 89-202, eff. 7-21-95; 89-428, eff. 12-13-95; | ||
89-462, eff.
5-29-96; 89-507, eff. 7-1-97; 90-14, eff. 7-1-97; | ||
90-135, eff. 7-22-97.)
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Section 8. The Illinois Public Aid Code is amended by | ||
changing Section 5-5 as follows: | ||
(305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
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Sec. 5-5. Medical services. The Illinois Department, by | ||
rule, shall
determine the quantity and quality of and the rate | ||
of reimbursement for the
medical assistance for which
payment | ||
will be authorized, and the medical services to be provided,
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which may include all or part of the following: (1) inpatient | ||
hospital
services; (2) outpatient hospital services; (3) other | ||
laboratory and
X-ray services; (4) skilled nursing home | ||
services; (5) physicians'
services whether furnished in the | ||
office, the patient's home, a
hospital, a skilled nursing home, | ||
or elsewhere; (6) medical care, or any
other type of remedial | ||
care furnished by licensed practitioners; (7)
home health care | ||
services; (8) private duty nursing service; (9) clinic
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services; (10) dental services, including prevention and | ||
treatment of periodontal disease and dental caries disease for | ||
pregnant women, provided by an individual licensed to practice | ||
dentistry or dental surgery; for purposes of this item (10), | ||
"dental services" means diagnostic, preventive, or corrective | ||
procedures provided by or under the supervision of a dentist in | ||
the practice of his or her profession; (11) physical therapy | ||
and related
services; (12) prescribed drugs, dentures, and | ||
prosthetic devices; and
eyeglasses prescribed by a physician | ||
skilled in the diseases of the eye,
or by an optometrist, | ||
whichever the person may select; (13) other
diagnostic, | ||
screening, preventive, and rehabilitative services, including | ||
to ensure that the individual's need for intervention or | ||
treatment of mental disorders or substance use disorders or | ||
co-occurring mental health and substance use disorders is | ||
determined using a uniform screening, assessment, and | ||
evaluation process inclusive of criteria, for children and | ||
adults; for purposes of this item (13), a uniform screening, | ||
assessment, and evaluation process refers to a process that | ||
includes an appropriate evaluation and, as warranted, a | ||
referral; "uniform" does not mean the use of a singular | ||
instrument, tool, or process that all must utilize; (14)
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transportation and such other expenses as may be necessary; | ||
(15) medical
treatment of sexual assault survivors, as defined | ||
in
Section 1a of the Sexual Assault Survivors Emergency | ||
Treatment Act, for
injuries sustained as a result of the sexual | ||
assault, including
examinations and laboratory tests to | ||
discover evidence which may be used in
criminal proceedings | ||
arising from the sexual assault; (16) the
diagnosis and | ||
treatment of sickle cell anemia; and (17)
any other medical | ||
care, and any other type of remedial care recognized
under the | ||
laws of this State, but not including abortions, or induced
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miscarriages or premature births, unless, in the opinion of a | ||
physician,
such procedures are necessary for the preservation | ||
of the life of the
woman seeking such treatment, or except an | ||
induced premature birth
intended to produce a live viable child | ||
and such procedure is necessary
for the health of the mother or | ||
her unborn child. The Illinois Department,
by rule, shall | ||
prohibit any physician from providing medical assistance
to | ||
anyone eligible therefor under this Code where such physician | ||
has been
found guilty of performing an abortion procedure in a | ||
wilful and wanton
manner upon a woman who was not pregnant at | ||
the time such abortion
procedure was performed. The term "any | ||
other type of remedial care" shall
include nursing care and | ||
nursing home service for persons who rely on
treatment by | ||
spiritual means alone through prayer for healing.
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Notwithstanding any other provision of this Section, a | ||
comprehensive
tobacco use cessation program that includes | ||
purchasing prescription drugs or
prescription medical devices | ||
approved by the Food and Drug Administration shall
be covered | ||
under the medical assistance
program under this Article for | ||
persons who are otherwise eligible for
assistance under this | ||
Article.
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Notwithstanding any other provision of this Code, the | ||
Illinois
Department may not require, as a condition of payment | ||
for any laboratory
test authorized under this Article, that a | ||
physician's handwritten signature
appear on the laboratory | ||
test order form. The Illinois Department may,
however, impose | ||
other appropriate requirements regarding laboratory test
order | ||
documentation.
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The Department of Healthcare and Family Services shall | ||
provide the following services to
persons
eligible for | ||
assistance under this Article who are participating in
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education, training or employment programs operated by the | ||
Department of Human
Services as successor to the Department of | ||
Public Aid:
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(1) dental services provided by or under the | ||
supervision of a dentist; and
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(2) eyeglasses prescribed by a physician skilled in the | ||
diseases of the
eye, or by an optometrist, whichever the | ||
person may select.
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Notwithstanding any other provision of this Code and | ||
subject to federal approval, the Department may adopt rules to | ||
allow a dentist who is volunteering his or her service at no | ||
cost to render dental services through an enrolled | ||
not-for-profit health clinic without the dentist personally | ||
enrolling as a participating provider in the medical assistance | ||
program. A not-for-profit health clinic shall include a public | ||
health clinic or Federally Qualified Health Center or other | ||
enrolled provider, as determined by the Department, through | ||
which dental services covered under this Section are performed. | ||
The Department shall establish a process for payment of claims | ||
for reimbursement for covered dental services rendered under | ||
this provision. | ||
The Illinois Department, by rule, may distinguish and | ||
classify the
medical services to be provided only in accordance | ||
with the classes of
persons designated in Section 5-2.
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The Department of Healthcare and Family Services must | ||
provide coverage and reimbursement for amino acid-based | ||
elemental formulas, regardless of delivery method, for the | ||
diagnosis and treatment of (i) eosinophilic disorders and (ii) | ||
short bowel syndrome when the prescribing physician has issued | ||
a written order stating that the amino acid-based elemental | ||
formula is medically necessary.
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The Illinois Department shall authorize the provision of, | ||
and shall
authorize payment for, screening by low-dose | ||
mammography for the presence of
occult breast cancer for women | ||
35 years of age or older who are eligible
for medical | ||
assistance under this Article, as follows: | ||
(A) A baseline
mammogram for women 35 to 39 years of | ||
age.
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(B) An annual mammogram for women 40 years of age or | ||
older. | ||
(C) A mammogram at the age and intervals considered | ||
medically necessary by the woman's health care provider for | ||
women under 40 years of age and having a family history of | ||
breast cancer, prior personal history of breast cancer, | ||
positive genetic testing, or other risk factors. | ||
(D) A comprehensive ultrasound screening of an entire | ||
breast or breasts if a mammogram demonstrates | ||
heterogeneous or dense breast tissue, when medically | ||
necessary as determined by a physician licensed to practice | ||
medicine in all of its branches. | ||
All screenings
shall
include a physical breast exam, | ||
instruction on self-examination and
information regarding the | ||
frequency of self-examination and its value as a
preventative | ||
tool. For purposes of this Section, "low-dose mammography" | ||
means
the x-ray examination of the breast using equipment | ||
dedicated specifically
for mammography, including the x-ray | ||
tube, filter, compression device,
and image receptor, with an | ||
average radiation exposure delivery
of less than one rad per | ||
breast for 2 views of an average size breast.
The term also | ||
includes digital mammography.
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On and after January 1, 2012, providers participating in a | ||
quality improvement program approved by the Department shall be | ||
reimbursed for screening and diagnostic mammography at the same | ||
rate as the Medicare program's rates, including the increased | ||
reimbursement for digital mammography. | ||
The Department shall convene an expert panel including | ||
representatives of hospitals, free-standing mammography | ||
facilities, and doctors, including radiologists, to establish | ||
quality standards. | ||
Subject to federal approval, the Department shall | ||
establish a rate methodology for mammography at federally | ||
qualified health centers and other encounter-rate clinics. | ||
These clinics or centers may also collaborate with other | ||
hospital-based mammography facilities. | ||
The Department shall establish a methodology to remind | ||
women who are age-appropriate for screening mammography, but | ||
who have not received a mammogram within the previous 18 | ||
months, of the importance and benefit of screening mammography. | ||
The Department shall establish a performance goal for | ||
primary care providers with respect to their female patients | ||
over age 40 receiving an annual mammogram. This performance | ||
goal shall be used to provide additional reimbursement in the | ||
form of a quality performance bonus to primary care providers | ||
who meet that goal. | ||
The Department shall devise a means of case-managing or | ||
patient navigation for beneficiaries diagnosed with breast | ||
cancer. This program shall initially operate as a pilot program | ||
in areas of the State with the highest incidence of mortality | ||
related to breast cancer. At least one pilot program site shall | ||
be in the metropolitan Chicago area and at least one site shall | ||
be outside the metropolitan Chicago area. An evaluation of the | ||
pilot program shall be carried out measuring health outcomes | ||
and cost of care for those served by the pilot program compared | ||
to similarly situated patients who are not served by the pilot | ||
program. | ||
Any medical or health care provider shall immediately | ||
recommend, to
any pregnant woman who is being provided prenatal | ||
services and is suspected
of drug abuse or is addicted as | ||
defined in the Alcoholism and Other Drug Abuse
and Dependency | ||
Act, referral to a local substance abuse treatment provider
| ||
licensed by the Department of Human Services or to a licensed
| ||
hospital which provides substance abuse treatment services. | ||
The Department of Healthcare and Family Services
shall assure | ||
coverage for the cost of treatment of the drug abuse or
| ||
addiction for pregnant recipients in accordance with the | ||
Illinois Medicaid
Program in conjunction with the Department of | ||
Human Services.
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All medical providers providing medical assistance to | ||
pregnant women
under this Code shall receive information from | ||
the Department on the
availability of services under the Drug | ||
Free Families with a Future or any
comparable program providing | ||
case management services for addicted women,
including | ||
information on appropriate referrals for other social services
| ||
that may be needed by addicted women in addition to treatment | ||
for addiction.
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The Illinois Department, in cooperation with the | ||
Departments of Human
Services (as successor to the Department | ||
of Alcoholism and Substance
Abuse) and Public Health, through a | ||
public awareness campaign, may
provide information concerning | ||
treatment for alcoholism and drug abuse and
addiction, prenatal | ||
health care, and other pertinent programs directed at
reducing | ||
the number of drug-affected infants born to recipients of | ||
medical
assistance.
| ||
Neither the Department of Healthcare and Family Services | ||
nor the Department of Human
Services shall sanction the | ||
recipient solely on the basis of
her substance abuse.
| ||
The Illinois Department shall establish such regulations | ||
governing
the dispensing of health services under this Article | ||
as it shall deem
appropriate. The Department
should
seek the | ||
advice of formal professional advisory committees appointed by
| ||
the Director of the Illinois Department for the purpose of | ||
providing regular
advice on policy and administrative matters, | ||
information dissemination and
educational activities for | ||
medical and health care providers, and
consistency in | ||
procedures to the Illinois Department.
| ||
Notwithstanding any other provision of law, a health care | ||
provider under the medical assistance program may elect, in | ||
lieu of receiving direct payment for services provided under | ||
that program, to participate in the State Employees Deferred | ||
Compensation Plan adopted under Article 24 of the Illinois | ||
Pension Code. A health care provider who elects to participate | ||
in the plan does not have a cause of action against the State | ||
for any damages allegedly suffered by the provider as a result | ||
of any delay by the State in crediting the amount of any | ||
contribution to the provider's plan account. | ||
The Illinois Department may develop and contract with | ||
Partnerships of
medical providers to arrange medical services | ||
for persons eligible under
Section 5-2 of this Code. | ||
Implementation of this Section may be by
demonstration projects | ||
in certain geographic areas. The Partnership shall
be | ||
represented by a sponsor organization. The Department, by rule, | ||
shall
develop qualifications for sponsors of Partnerships. | ||
Nothing in this
Section shall be construed to require that the | ||
sponsor organization be a
medical organization.
| ||
The sponsor must negotiate formal written contracts with | ||
medical
providers for physician services, inpatient and | ||
outpatient hospital care,
home health services, treatment for | ||
alcoholism and substance abuse, and
other services determined | ||
necessary by the Illinois Department by rule for
delivery by | ||
Partnerships. Physician services must include prenatal and
| ||
obstetrical care. The Illinois Department shall reimburse | ||
medical services
delivered by Partnership providers to clients | ||
in target areas according to
provisions of this Article and the | ||
Illinois Health Finance Reform Act,
except that:
| ||
(1) Physicians participating in a Partnership and | ||
providing certain
services, which shall be determined by | ||
the Illinois Department, to persons
in areas covered by the | ||
Partnership may receive an additional surcharge
for such | ||
services.
| ||
(2) The Department may elect to consider and negotiate | ||
financial
incentives to encourage the development of | ||
Partnerships and the efficient
delivery of medical care.
| ||
(3) Persons receiving medical services through | ||
Partnerships may receive
medical and case management | ||
services above the level usually offered
through the | ||
medical assistance program.
| ||
Medical providers shall be required to meet certain | ||
qualifications to
participate in Partnerships to ensure the | ||
delivery of high quality medical
services. These | ||
qualifications shall be determined by rule of the Illinois
| ||
Department and may be higher than qualifications for | ||
participation in the
medical assistance program. Partnership | ||
sponsors may prescribe reasonable
additional qualifications | ||
for participation by medical providers, only with
the prior | ||
written approval of the Illinois Department.
| ||
Nothing in this Section shall limit the free choice of | ||
practitioners,
hospitals, and other providers of medical | ||
services by clients.
In order to ensure patient freedom of | ||
choice, the Illinois Department shall
immediately promulgate | ||
all rules and take all other necessary actions so that
provided | ||
services may be accessed from therapeutically certified | ||
optometrists
to the full extent of the Illinois Optometric | ||
Practice Act of 1987 without
discriminating between service | ||
providers.
| ||
The Department shall apply for a waiver from the United | ||
States Health
Care Financing Administration to allow for the | ||
implementation of
Partnerships under this Section.
| ||
The Illinois Department shall require health care | ||
providers to maintain
records that document the medical care | ||
and services provided to recipients
of Medical Assistance under | ||
this Article. Such records must be retained for a period of not | ||
less than 6 years from the date of service or as provided by | ||
applicable State law, whichever period is longer, except that | ||
if an audit is initiated within the required retention period | ||
then the records must be retained until the audit is completed | ||
and every exception is resolved. The Illinois Department shall
| ||
require health care providers to make available, when | ||
authorized by the
patient, in writing, the medical records in a | ||
timely fashion to other
health care providers who are treating | ||
or serving persons eligible for
Medical Assistance under this | ||
Article. All dispensers of medical services
shall be required | ||
to maintain and retain business and professional records
| ||
sufficient to fully and accurately document the nature, scope, | ||
details and
receipt of the health care provided to persons | ||
eligible for medical
assistance under this Code, in accordance | ||
with regulations promulgated by
the Illinois Department. The | ||
rules and regulations shall require that proof
of the receipt | ||
of prescription drugs, dentures, prosthetic devices and
| ||
eyeglasses by eligible persons under this Section accompany | ||
each claim
for reimbursement submitted by the dispenser of such | ||
medical services.
No such claims for reimbursement shall be | ||
approved for payment by the Illinois
Department without such | ||
proof of receipt, unless the Illinois Department
shall have put | ||
into effect and shall be operating a system of post-payment
| ||
audit and review which shall, on a sampling basis, be deemed | ||
adequate by
the Illinois Department to assure that such drugs, | ||
dentures, prosthetic
devices and eyeglasses for which payment | ||
is being made are actually being
received by eligible | ||
recipients. Within 90 days after the effective date of
this | ||
amendatory Act of 1984, the Illinois Department shall establish | ||
a
current list of acquisition costs for all prosthetic devices | ||
and any
other items recognized as medical equipment and | ||
supplies reimbursable under
this Article and shall update such | ||
list on a quarterly basis, except that
the acquisition costs of | ||
all prescription drugs shall be updated no
less frequently than | ||
every 30 days as required by Section 5-5.12.
| ||
The rules and regulations of the Illinois Department shall | ||
require
that a written statement including the required opinion | ||
of a physician
shall accompany any claim for reimbursement for | ||
abortions, or induced
miscarriages or premature births. This | ||
statement shall indicate what
procedures were used in providing | ||
such medical services.
| ||
The Illinois Department shall require all dispensers of | ||
medical
services, other than an individual practitioner or | ||
group of practitioners,
desiring to participate in the Medical | ||
Assistance program
established under this Article to disclose | ||
all financial, beneficial,
ownership, equity, surety or other | ||
interests in any and all firms,
corporations, partnerships, | ||
associations, business enterprises, joint
ventures, agencies, | ||
institutions or other legal entities providing any
form of | ||
health care services in this State under this Article.
| ||
The Illinois Department may require that all dispensers of | ||
medical
services desiring to participate in the medical | ||
assistance program
established under this Article disclose, | ||
under such terms and conditions as
the Illinois Department may | ||
by rule establish, all inquiries from clients
and attorneys | ||
regarding medical bills paid by the Illinois Department, which
| ||
inquiries could indicate potential existence of claims or liens | ||
for the
Illinois Department.
| ||
Enrollment of a vendor that provides non-emergency medical | ||
transportation,
defined by the Department by rule,
shall be
| ||
conditional for 180 days. During that time, the Department of | ||
Healthcare and Family Services may
terminate the vendor's | ||
eligibility to participate in the medical assistance
program | ||
without cause. That termination of eligibility is not subject | ||
to the
Department's hearing process.
| ||
The Illinois Department shall establish policies, | ||
procedures,
standards and criteria by rule for the acquisition, | ||
repair and replacement
of orthotic and prosthetic devices and | ||
durable medical equipment. Such
rules shall provide, but not be | ||
limited to, the following services: (1)
immediate repair or | ||
replacement of such devices by recipients without
medical | ||
authorization; and (2) rental, lease, purchase or | ||
lease-purchase of
durable medical equipment in a | ||
cost-effective manner, taking into
consideration the | ||
recipient's medical prognosis, the extent of the
recipient's | ||
needs, and the requirements and costs for maintaining such
| ||
equipment. Such rules shall enable a recipient to temporarily | ||
acquire and
use alternative or substitute devices or equipment | ||
pending repairs or
replacements of any device or equipment | ||
previously authorized for such
recipient by the Department.
| ||
The Department shall execute, relative to the nursing home | ||
prescreening
project, written inter-agency agreements with the | ||
Department of Human
Services and the Department on Aging, to | ||
effect the following: (i) intake
procedures and common | ||
eligibility criteria for those persons who are receiving
| ||
non-institutional services; and (ii) the establishment and | ||
development of
non-institutional services in areas of the State | ||
where they are not currently
available or are undeveloped.
| ||
The Illinois Department shall develop and operate, in | ||
cooperation
with other State Departments and agencies and in | ||
compliance with
applicable federal laws and regulations, | ||
appropriate and effective
systems of health care evaluation and | ||
programs for monitoring of
utilization of health care services | ||
and facilities, as it affects
persons eligible for medical | ||
assistance under this Code.
| ||
The Illinois Department shall report annually to the | ||
General Assembly,
no later than the second Friday in April of | ||
1979 and each year
thereafter, in regard to:
| ||
(a) actual statistics and trends in utilization of | ||
medical services by
public aid recipients;
| ||
(b) actual statistics and trends in the provision of | ||
the various medical
services by medical vendors;
| ||
(c) current rate structures and proposed changes in | ||
those rate structures
for the various medical vendors; and
| ||
(d) efforts at utilization review and control by the | ||
Illinois Department.
| ||
The period covered by each report shall be the 3 years | ||
ending on the June
30 prior to the report. The report shall | ||
include suggested legislation
for consideration by the General | ||
Assembly. The filing of one copy of the
report with the | ||
Speaker, one copy with the Minority Leader and one copy
with | ||
the Clerk of the House of Representatives, one copy with the | ||
President,
one copy with the Minority Leader and one copy with | ||
the Secretary of the
Senate, one copy with the Legislative | ||
Research Unit, and such additional
copies
with the State | ||
Government Report Distribution Center for the General
Assembly | ||
as is required under paragraph (t) of Section 7 of the State
| ||
Library Act shall be deemed sufficient to comply with this | ||
Section.
| ||
Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 96-156, eff. 1-1-10; 96-806, eff. 7-1-10; 96-926, | ||
eff. 1-1-11; 96-1000, eff. 7-2-10; 97-48, eff. 6-28-11; 97-638, | ||
eff. 1-1-12.) | ||
Section 10. The Community Services Act is amended by | ||
changing Section 2 as follows:
| ||
(405 ILCS 30/2) (from Ch. 91 1/2, par. 902)
| ||
Sec. 2. Community Services System. Services should be | ||
planned,
developed, delivered and evaluated as part of a | ||
comprehensive and
coordinated system. The Department of Human | ||
Services
shall encourage the establishment of services in each | ||
area of the State
which cover the services categories described | ||
below. What specific
services are provided under each service | ||
category shall be based on local
needs; special attention shall | ||
be given to unserved and underserved
populations, including | ||
children and youth, racial and ethnic minorities,
and the | ||
elderly. The service categories shall include:
| ||
(a) Prevention: services designed primarily to reduce the | ||
incidence
and ameliorate the severity of developmental | ||
disabilities, mental illness and
alcohol and drug dependence;
| ||
(b) Client Assessment and Diagnosis: services designed to | ||
identify
persons with developmental disabilities, mental | ||
illness and alcohol and
drug dependency; to determine the | ||
extent of the disability and the level of
functioning; to | ||
ensure that the individual's need for treatment of mental | ||
disorders or substance use disorders or co-occurring substance | ||
use and mental health disorders is determined using a uniform | ||
screening, assessment, and evaluation process inclusive of | ||
criteria; for purposes of this subsection (b), a uniform | ||
screening, assessment, and evaluation process refers to a | ||
process that includes an appropriate evaluation and, as | ||
warranted, a referral; "uniform" does not mean the use of a | ||
singular instrument, tool, or process that all must utilize; | ||
information obtained through client evaluation can be used in
| ||
individual treatment and habilitation plans; to assure | ||
appropriate
placement and to assist in program evaluation;
| ||
(c) Case Coordination: services to provide information and | ||
assistance to
disabled persons to insure that they obtain | ||
needed services provided by the
private and public sectors; | ||
case coordination services should be available
to individuals | ||
whose functioning level or history of institutional
recidivism | ||
or long-term care indicate that such assistance is required for
| ||
successful community living;
| ||
(d) Crisis and Emergency: services to assist individuals | ||
and
their families through crisis periods, to stabilize | ||
individuals under stress
and to prevent unnecessary | ||
institutionalization;
| ||
(e) Treatment, Habilitation and Support: services designed | ||
to help
individuals develop skills which promote independence | ||
and improved levels
of social and vocational functioning and | ||
personal growth; and to provide
non-treatment support services | ||
which are necessary for successful
community living;
| ||
(f) Community Residential Alternatives to Institutional | ||
Settings:
services to provide living arrangements for persons | ||
unable to live
independently; the level of supervision, | ||
services provided and length of
stay at community residential | ||
alternatives will vary by the type of program
and the needs and | ||
functioning level of the residents; other services may be
| ||
provided in a community residential alternative which promote | ||
the
acquisition of independent living skills and integration | ||
with the community.
| ||
(Source: P.A. 89-507, eff. 7-1-97.)
| ||
Section 99. Effective date. This Act takes effect upon | ||
becoming law.
| ||