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| [ House Amendment 006 ] |
91_HB0709enr HB0709 Enrolled 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 HB0709 Enrolled -2- LRB9100307SMdv 1 services; (3) other laboratory and X-ray services; (4) 2 skilled nursing home services; (5) physicians' services 3 whether furnished in the office, the patient's home, a 4 hospital, a skilled nursing home, or elsewhere; (6) medical 5 care, or any other type of remedial care furnished by 6 licensed practitioners; (7) home health care services; (8) 7 private duty nursing service; (9) clinic services; (10) 8 dental services; (11) physical therapy and related services; 9 (12) prescribed drugs, dentures, and prosthetic devices; and 10 eyeglasses prescribed by a physician skilled in the diseases 11 of the eye, or by an optometrist, whichever the person may 12 select; (13) other diagnostic, screening, preventive, and 13 rehabilitative services; (14) transportation and such other 14 expenses as may be necessary; (15) medical treatment of 15 sexual assault survivors, as defined in Section 1a of the 16 Sexual Assault Survivors Emergency Treatment Act, for 17 injuries sustained as a result of the sexual assault, 18 including examinations and laboratory tests to discover 19 evidence which may be used in criminal proceedings arising 20 from the sexual assault; (16) the diagnosis and treatment of 21 sickle cell anemia; and (17) any other medical care, and any 22 other type of remedial care recognized under the laws of this 23 State, but not including abortions, or induced miscarriages 24 or premature births, unless, in the opinion of a physician, 25 such procedures are necessary for the preservation of the 26 life of the woman seeking such treatment, or except an 27 induced premature birth intended to produce a live viable 28 child and such procedure is necessary for the health of the 29 mother or her unborn child; State funds may also be used to 30 pay for abortions to terminate a pregnancy resulting from an 31 act of criminal sexual assault, as defined in Section 12-13 32 of the Criminal Code of 1961, an act of aggravated criminal 33 sexual assault, as defined in Section 12-14 of the Criminal 34 Code of 1961, or an act of sexual relations within families, HB0709 Enrolled -3- LRB9100307SMdv 1 as defined in Section 11-11 of the Criminal Code of 1961, but 2 only to the extent that payment for such abortions is 3 required by federal law as determined by a court of competent 4 jurisdictionbut not including abortions, or induced5miscarriages or premature births, unless, in the opinion of a6physician, such procedures are necessary for the preservation7of the life of the woman seeking such treatment, or except an8induced premature birth intended to produce a live viable9child and such procedure is necessary for the health of the10mother or her unborn child. The Illinois Department, by rule, 11 shall prohibit any physician from providing medical 12 assistance to anyone eligible therefor under this Code where 13 such physician has been found guilty of performing an 14 abortion procedure in a wilful and wanton manner upon a woman 15 who was not pregnant at the time such abortion procedure was 16 performed. The term "any other type of remedial care" shall 17 include nursing care and nursing home service for persons who 18 rely on treatment by spiritual means alone through prayer for 19 healing. 20 Notwithstanding any other provision of this Code, the 21 Illinois Department may not require, as a condition of 22 payment for any laboratory test authorized under this 23 Article, that a physician's handwritten signature appear on 24 the laboratory test order form. The Illinois Department may, 25 however, impose other appropriate requirements regarding 26 laboratory test order documentation. 27 The Illinois Department of Public Aid shall provide the 28 following services to persons eligible for assistance under 29 this Article who are participating in education, training or 30 employment programs operated by the Department of Human 31 Services as successor to the Department of Public Aid: 32 (1) dental services, which shall include but not be 33 limited to prosthodontics; and 34 (2) eyeglasses prescribed by a physician skilled in HB0709 Enrolled -4- LRB9100307SMdv 1 the diseases of the eye, or by an optometrist, whichever 2 the person may select. 3 The Illinois Department, by rule, may distinguish and 4 classify the medical services to be provided only in 5 accordance with the classes of persons designated in Section 6 5-2. 7 The Illinois Department shall authorize the provision of, 8 and shall authorize payment for, screening by low-dose 9 mammography for the presence of occult breast cancer for 10 women 35 years of age or older who are eligible for medical 11 assistance under this Article, as follows: a baseline 12 mammogram for women 35 to 39 years of age and an annual 13 mammogram for women 40 years of age or older. All screenings 14 shall include a physical breast exam, instruction on 15 self-examination and information regarding the frequency of 16 self-examination and its value as a preventative tool. As 17 used in this Section, "low-dose mammography" means the x-ray 18 examination of the breast using equipment dedicated 19 specifically for mammography, including the x-ray tube, 20 filter, compression device, image receptor, and cassettes, 21 with an average radiation exposure delivery of less than one 22 rad mid-breast, with 2 views for each breast. 23 Any medical or health care provider shall immediately 24 recommend, to any pregnant woman who is being provided 25 prenatal services and is suspected of drug abuse or is 26 addicted as defined in the Alcoholism and Other Drug Abuse 27 and Dependency Act, referral to a local substance abuse 28 treatment provider licensed by the Department of Human 29 Services or to a licensed hospital which provides substance 30 abuse treatment services. The Department of Public Aid shall 31 assure coverage for the cost of treatment of the drug abuse 32 or addiction for pregnant recipients in accordance with the 33 Illinois Medicaid Program in conjunction with the Department 34 of Human Services. HB0709 Enrolled -5- LRB9100307SMdv 1 All medical providers providing medical assistance to 2 pregnant women under this Code shall receive information from 3 the Department on the availability of services under the Drug 4 Free Families with a Future or any comparable program 5 providing case management services for addicted women, 6 including information on appropriate referrals for other 7 social services that may be needed by addicted women in 8 addition to treatment for addiction. 9 The Illinois Department, in cooperation with the 10 Departments of Human Services (as successor to the Department 11 of Alcoholism and Substance Abuse) and Public Health, through 12 a public awareness campaign, may provide information 13 concerning treatment for alcoholism and drug abuse and 14 addiction, prenatal health care, and other pertinent programs 15 directed at reducing the number of drug-affected infants born 16 to recipients of medical assistance. 17 Neither the Illinois Department of Public Aid nor the 18 Department of Human Services shall sanction the recipient 19 solely on the basis of her substance abuse. 20 The Illinois Department shall establish such regulations 21 governing the dispensing of health services under this 22 Article as it shall deem appropriate. In formulating these 23 regulations the Illinois Department shall consult with and 24 give substantial weight to the recommendations offered by the 25 Citizens Assembly/Council on Public Aid. The Department 26 should seek the advice of formal professional advisory 27 committees appointed by the Director of the Illinois 28 Department for the purpose of providing regular advice on 29 policy and administrative matters, information dissemination 30 and educational activities for medical and health care 31 providers, and consistency in procedures to the Illinois 32 Department. 33 The Illinois Department may develop and contract with 34 Partnerships of medical providers to arrange medical services HB0709 Enrolled -6- LRB9100307SMdv 1 for persons eligible under Section 5-2 of this Code. 2 Implementation of this Section may be by demonstration 3 projects in certain geographic areas. The Partnership shall 4 be represented by a sponsor organization. The Department, by 5 rule, shall develop qualifications for sponsors of 6 Partnerships. Nothing in this Section shall be construed to 7 require that the sponsor organization be a medical 8 organization. 9 The sponsor must negotiate formal written contracts with 10 medical providers for physician services, inpatient and 11 outpatient hospital care, home health services, treatment for 12 alcoholism and substance abuse, and other services determined 13 necessary by the Illinois Department by rule for delivery by 14 Partnerships. Physician services must include prenatal and 15 obstetrical care. The Illinois Department shall reimburse 16 medical services delivered by Partnership providers to 17 clients in target areas according to provisions of this 18 Article and the Illinois Health Finance Reform Act, except 19 that: 20 (1) Physicians participating in a Partnership and 21 providing certain services, which shall be determined by 22 the Illinois Department, to persons in areas covered by 23 the Partnership may receive an additional surcharge for 24 such services. 25 (2) The Department may elect to consider and 26 negotiate financial incentives to encourage the 27 development of Partnerships and the efficient delivery of 28 medical care. 29 (3) Persons receiving medical services through 30 Partnerships may receive medical and case management 31 services above the level usually offered through the 32 medical assistance program. 33 Medical providers shall be required to meet certain 34 qualifications to participate in Partnerships to ensure the HB0709 Enrolled -7- LRB9100307SMdv 1 delivery of high quality medical services. These 2 qualifications shall be determined by rule of the Illinois 3 Department and may be higher than qualifications for 4 participation in the medical assistance program. Partnership 5 sponsors may prescribe reasonable additional qualifications 6 for participation by medical providers, only with the prior 7 written approval of the Illinois Department. 8 Nothing in this Section shall limit the free choice of 9 practitioners, hospitals, and other providers of medical 10 services by clients. In order to ensure patient freedom of 11 choice, the Illinois Department shall immediately promulgate 12 all rules and take all other necessary actions so that 13 provided services may be accessed from therapeutically 14 certified optometrists to the full extent of the Illinois 15 Optometric Practice Act of 1987 without discriminating 16 between service providers. 17 The Department shall apply for a waiver from the United 18 States Health Care Financing Administration to allow for the 19 implementation of Partnerships under this Section. 20 The Illinois Department shall require health care 21 providers to maintain records that document the medical care 22 and services provided to recipients of Medical Assistance 23 under this Article. The Illinois Department shall require 24 health care providers to make available, when authorized by 25 the patient, in writing, the medical records in a timely 26 fashion to other health care providers who are treating or 27 serving persons eligible for Medical Assistance under this 28 Article. All dispensers of medical services shall be 29 required to maintain and retain business and professional 30 records sufficient to fully and accurately document the 31 nature, scope, details and receipt of the health care 32 provided to persons eligible for medical assistance under 33 this Code, in accordance with regulations promulgated by the 34 Illinois Department. The rules and regulations shall require HB0709 Enrolled -8- LRB9100307SMdv 1 that proof of the receipt of prescription drugs, dentures, 2 prosthetic devices and eyeglasses by eligible persons under 3 this Section accompany each claim for reimbursement submitted 4 by the dispenser of such medical services. No such claims for 5 reimbursement shall be approved for payment by the Illinois 6 Department without such proof of receipt, unless the Illinois 7 Department shall have put into effect and shall be operating 8 a system of post-payment audit and review which shall, on a 9 sampling basis, be deemed adequate by the Illinois Department 10 to assure that such drugs, dentures, prosthetic devices and 11 eyeglasses for which payment is being made are actually being 12 received by eligible recipients. Within 90 days after the 13 effective date of this amendatory Act of 1984, the Illinois 14 Department shall establish a current list of acquisition 15 costs for all prosthetic devices and any other items 16 recognized as medical equipment and supplies reimbursable 17 under this Article and shall update such list on a quarterly 18 basis, except that the acquisition costs of all prescription 19 drugs shall be updated no less frequently than every 30 days 20 as required by Section 5-5.12. 21 The rules and regulations of the Illinois Department 22 shall require that a written statement including the required 23 opinion of a physician shall accompany any claim for 24 reimbursement for abortions, or induced miscarriages or 25 premature births. This statement shall indicate what 26 procedures were used in providing such medical services. 27 The Illinois Department shall require that all dispensers 28 of medical services, other than an individual practitioner or 29 group of practitioners, desiring to participate in the 30 Medical Assistance program established under this Article to 31 disclose all financial, beneficial, ownership, equity, surety 32 or other interests in any and all firms, corporations, 33 partnerships, associations, business enterprises, joint 34 ventures, agencies, institutions or other legal entities HB0709 Enrolled -9- LRB9100307SMdv 1 providing any form of health care services in this State 2 under this Article. 3 The Illinois Department may require that all dispensers 4 of medical services desiring to participate in the medical 5 assistance program established under this Article disclose, 6 under such terms and conditions as the Illinois Department 7 may by rule establish, all inquiries from clients and 8 attorneys regarding medical bills paid by the Illinois 9 Department, which inquiries could indicate potential 10 existence of claims or liens for the Illinois Department. 11 The Illinois Department shall establish policies, 12 procedures, standards and criteria by rule for the 13 acquisition, repair and replacement of orthotic and 14 prosthetic devices and durable medical equipment. Such rules 15 shall provide, but not be limited to, the following services: 16 (1) immediate repair or replacement of such devices by 17 recipients without medical authorization; and (2) rental, 18 lease, purchase or lease-purchase of durable medical 19 equipment in a cost-effective manner, taking into 20 consideration the recipient's medical prognosis, the extent 21 of the recipient's needs, and the requirements and costs for 22 maintaining such equipment. Such rules shall enable a 23 recipient to temporarily acquire and use alternative or 24 substitute devices or equipment pending repairs or 25 replacements of any device or equipment previously authorized 26 for such recipient by the Department. Rules under clause (2) 27 above shall not provide for purchase or lease-purchase of 28 durable medical equipment or supplies used for the purpose of 29 oxygen delivery and respiratory care. 30 The Department shall execute, relative to the nursing 31 home prescreening project, written inter-agency agreements 32 with the Department of Human Services and the Department on 33 Aging, to effect the following: (i) intake procedures and 34 common eligibility criteria for those persons who are HB0709 Enrolled -10- LRB9100307SMdv 1 receiving non-institutional services; and (ii) the 2 establishment and development of non-institutional services 3 in areas of the State where they are not currently available 4 or are undeveloped. 5 The Illinois Department shall develop and operate, in 6 cooperation with other State Departments and agencies and in 7 compliance with applicable federal laws and regulations, 8 appropriate and effective systems of health care evaluation 9 and programs for monitoring of utilization of health care 10 services and facilities, as it affects persons eligible for 11 medical assistance under this Code. The Illinois Department 12 shall report regularly the results of the operation of such 13 systems and programs to the Citizens Assembly/Council on 14 Public Aid to enable the Committee to ensure, from time to 15 time, that these programs are effective and meaningful. 16 The Illinois Department shall report annually to the 17 General Assembly, no later than the second Friday in April of 18 1979 and each year thereafter, in regard to: 19 (a) actual statistics and trends in utilization of 20 medical services by public aid recipients; 21 (b) actual statistics and trends in the provision 22 of the various medical services by medical vendors; 23 (c) current rate structures and proposed changes in 24 those rate structures for the various medical vendors; 25 and 26 (d) efforts at utilization review and control by 27 the Illinois Department. 28 The period covered by each report shall be the 3 years 29 ending on the June 30 prior to the report. The report shall 30 include suggested legislation for consideration by the 31 General Assembly. The filing of one copy of the report with 32 the Speaker, one copy with the Minority Leader and one copy 33 with the Clerk of the House of Representatives, one copy with 34 the President, one copy with the Minority Leader and one copy HB0709 Enrolled -11- LRB9100307SMdv 1 with the Secretary of the Senate, one copy with the 2 Legislative Research Unit, such additional copies with the 3 State Government Report Distribution Center for the General 4 Assembly as is required under paragraph (t) of Section 7 of 5 the State Library Act and one copy with the Citizens 6 Assembly/Council on Public Aid or its successor shall be 7 deemed sufficient to comply with this Section. 8 (Source: P.A. 90-7, eff. 6-10-97; 90-14, eff. 7-1-97; 91-344, 9 eff. 1-1-00; 91-462, eff. 8-6-99; revised 10-15-99.) 10 (305 ILCS 5/6-1) (from Ch. 23, par. 6-1) 11 Sec. 6-1. Eligibility requirements. Financial aid in 12 meeting basic maintenance requirements shall be given under 13 this Article to or in behalf of persons who meet the 14 eligibility conditions of Sections 6-1.1 through 6-1.10. In 15 addition, each unit of local government subject to this 16 Article shall provide persons receiving financial aid in 17 meeting basic maintenance requirements with financial aid for 18 either (a) necessary treatment, care, and supplies required 19 because of illness or disability, or (b) acute medical 20 treatment, care, and supplies only. If a local governmental 21 unit elects to provide financial aid for acute medical 22 treatment, care, and supplies only, the general types of 23 acute medical treatment, care, and supplies for which 24 financial aid is provided shall be specified in the general 25 assistance rules of the local governmental unit, which rules 26 shall provide that financial aid is provided, at a minimum, 27 for acute medical treatment, care, or supplies necessitated 28 by a medical condition for which prior approval or 29 authorization of medical treatment, care, or supplies is not 30 required by the general assistance rules of the Illinois 31 Department. Nothing in this Article shall be construed to 32 permit the granting of financial aid where the purpose of 33 such aid is to obtain an abortion, induced miscarriage or HB0709 Enrolled -12- LRB9100307SMdv 1 induced premature birth unless, in the opinion of a 2 physician, such procedures are necessary for the preservation 3 of the life of the woman seeking such treatment, or except an 4 induced premature birth intended to produce a live viable 5 child and such procedure is necessary for the health of the 6 mother or her unborn child; State funds may also be used to 7 pay for abortions to terminate a pregnancy resulting from an 8 act of criminal sexual assault, as defined in Section 12-13 9 of the Criminal Code of 1961, an act of aggravated criminal 10 sexual assault, as defined in Section 12-14 of the Criminal 11 Code of 1961, or an act of sexual relations within families, 12 as defined in Section 11-11 of the Criminal Code of 1961, but 13 only to the extent that payment for such abortions is 14 required by federal law as determined by a court of competent 15 jurisdiction.Nothing in this Article shall be construed to16permit the granting of financial aid where the purpose of17such aid is to obtain an abortion, induced miscarriage or18induced premature birth unless, in the opinion of a19physician, such procedures are necessary for the preservation20of the life of the woman seeking such treatment, or except an21induced premature birth intended to produce a live viable22child and such procedure is necessary for the health of the23mother or her unborn child.24 Until August 1, 1969, children who require care outside 25 their own homes, where no other sources of funds or 26 insufficient funds are available to provide the necessary 27 care, are included among persons eligible for aid under this 28 Article. After July 31, 1969, the Department of Children and 29 Family Services shall have the responsibility of providing 30 child welfare services to such children, as provided in 31 Section 5 of "An Act creating the Department of Children and 32 Family Services, codifying its powers and duties, and 33 repealing certain Acts and Sections herein named", approved 34 June 4, 1963, as amended. HB0709 Enrolled -13- LRB9100307SMdv 1 In cities, villages and incorporated towns of more than 2 500,000 population, the Illinois Department may establish a 3 separate program under this Article. The 2 programs shall be 4 differentiated, but the placement of persons under both 5 programs shall be based upon their ability or inability to 6 engage in employment in accordance with the rules and 7 regulations promulgated by the Illinois Department. In 8 establishing rules and regulations for determining whether a 9 person is able to engage in employment, the Illinois 10 Department may establish rules different than those set out 11 under Section 11-20. In determining need and the amount of 12 aid under Sections 6-1.2 and 6-2 for the 2 programs, the 13 Illinois Department may establish different standards for the 14 2 programs based upon the specific needs of the different 15 populations to be served by the 2 programs. The Illinois 16 Department may enter into contracts with entities to 17 establish work or training related projects under the program 18 established for persons determined to be able to engage in 19 employment. 20 (Source: P.A. 89-646, eff. 1-1-97.) 21 Section 90. Severability. If any provision, word, 22 phrase or clause of this amendatory Act of the 91st General 23 Assembly or its application to any person or circumstance is 24 held invalid, the invalidity does not affect the provisions, 25 words, phrases, clauses or application of this amendatory Act 26 of the 91st General Assembly which can be given effect 27 without the invalid provision, word, phrase, clause, or 28 application, and to this end the provisions, words, phrases, 29 and clauses of this amendatory Act of the 91st General 30 Assembly are declared to be severable. 31 Section 99. Effective date. This Act takes effect July 32 1, 2000.